PDSA E-News: January 25, 2016




High-Dose Dexamethasone May Be Preferred First-Line Treatment Compared to Conventional Steroids in Adult Primary ITP

By Carol Hoxie

Dexamethasone vialResearchers at Shandong University in Jinan, China compared safety and efficacy of high-dose dexamethasone (HD-DXM) and conventional prednisone (PDN) in newly diagnosed adults with primary ITP. Prednisone is the standard initial treatment for adult primary ITP patients, but only a small number of patients achieve long-lasting remission. The study included 195 patients. Researchers randomly assigned patients to four days of dexamethasone (n= 95; 40 mg/day) or four weeks of prednisone (n = 97; 1 mg/kg per day). Patients assigned HD-DXM who didn’t respond had an option to receive an additional 4-day treatment.

Initial response and sustained response were primary study endpoints. Dexamethasone was associated with higher rates of overall initial response (82.1% vs. 67.4%) and complete response (50.5% vs. 26.8%) compared to prednisone (PDN). Time to response was shorter in the HD-DXM group. Sustained response was achieved by 40.0% of patients in the HD-DXM group and 41.4% in the PDN group. An initial complete response was a positive indicator of sustained response. Presence of anti-platelet autoantibodies was a negative indicator of sustained response for both treatments. Both treatment regimens were well tolerated. The researchers concluded that high-dose dexamethasone could be a preferred corticosteroid strategy for first-line management of adult primary ITP.

Wei Y, Ji X, Wang Y., et al. “High-dose dexamethasone versus prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial.” Blood. 2015; doi:10.1182/blood-2015-07-659656.


Successful Treatment of ITP Secondary to Cytomegalovirus Infection: A Case Report

By Carol Hoxie

DoctorITP that is secondary to an underlying condition is a diagnosis of exclusion. Proper diagnosis is essential to establish for proper treatment. Secondary thrombocytopenia caused by cytomegalovirus (CMV) is common but case reports of diagnosis in patients who are immunocompetent adults is rare. This report was the case study of a 37-year-old female who presented at the ER with a history of petechiae, heavy menses, shortness of breath, and a platelet count of 1,000. The usual first-line treatment with steroids and IVIg did not improve the platelet count. An infectious laboratory workup detected CMV infection. The woman was treated with antiviral agents and a platelet growth drug. Treatment caused her platelet count to increase and the viral load to decrease.

CMV is a known cause of illness and death in immunocompromised patients, but in immunocompetent patients the virus usually manifests as a mononucleosis-like syndrome. Symptoms of CMV usually include malaise (fatigue and sense of not feeling well), myalgia (muscle pain), headache, sore throat, and fever. Associated clinical syndromes could include encephalitis, pneumonitis, hepatitis, colitis, and uveitis. Treatment of the primary infection is imperative because the standard ITP therapies regain their efficacy after the CMV infection is resolved. Some doctors believe treatment with steroids should be avoided in patients with CMV-induced thrombocytopenia. The immunosuppressive treatment with steroids may cause primary CMV infections to worsen and could trigger further decrease in platelet count.

The researchers said their case report adds to the existing body of research and will increase awareness of this type of thrombocytopenia. Additional research is needed to establish treatment guidelines for patients with CMV-induced thrombocytopenia.

Flores-Chang B, Arias-Morales C, Wadskier F, et al. “Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus Infection: A Case Report.” Front Med (Lausanne). 2015; 2: 79.




New Touchless Device Makes Detection of Heart Problems Possible Earlier

By Alexandra Kruse. Photo courtesy of UWaterloo/Fred Hunsberger.

Reseach A new and exciting method for monitoring vital signs has been designed at the University of Waterloo in Canada. The new technology called Coded Hemodynamic Imaging is the first of its kind to detect blood flow at a multitude of locations on the body -- without even touching the skin. This type of device will drastically improve disease observation, treatment, and preventative care in cardiovascular and hematological diseases, as well as alleviate the discomfort of blood flow monitoring in patients with chronically sensitive skin or infectious diseases.

Another innovative aspect of Coded Hemodynamic Imaging is that it allows for observation at a variety of arterial and venous locations; traditional methods are only able to examine one location at a time. A constant examination at numerous distinct points of the blood stream illustrates a more comprehensive image of the cardiovascular system as a whole. Professor Alexander Wong, Canada Research Chair in Medical Imaging Systems and Engineering Faculty Member at the University of Waterloo, explains that the technology can even “scan multiple patients individually at once and from a distance,” which has impressive implications for “mass emergency scenarios or long-term care homes.”

Smyth, P. “New Touchless Device Makes Earlier Detection of Heart Problems Possible.” University of Waterloo, Ontario. ScienceDaily, 7 January 2016.




Positive Emotions and Your Health: Benefits of Developing a Brighter Outlook

By Alexandra Kruse

Positive Here’s another reason to be happy -- researchers recently discovered a link between a positive attitude and improved health outcomes, which contributes to “lower blood pressure, reduced risk for heart disease, healthier weight, better blood sugar levels, and longer life.” Positive feelings and emotions activate the reward pathways in the brain, such as the ventral striatum, which has been associated with lower levels of stress hormone production. On the other hand, negative feelings activate the amygdala in the brain, which activates emotions like fear and anxiety. Research has shown that people who unconsciously activate their amygdala frequently tend to be at greater risk for serious health issues.

In fact, NIH researchers are finding that emotional wellness can be improved by cultivating certain habits which rewire the brain, such as meditation, psychotherapy, self-reflection, yoga, and self-affirmation. All of these activities have been found to promote consistent stimulation of the reward pathway, which in turn leads to positive responses in the brain and a continual positive outlook on life, thus increasing health outcomes.

One experiment that reinforced this hypothesis observed that reflection on what matters most to someone before they receive health advice is linked to positive health behaviors and outcomes. In the study, adults were told the benefits of a healthy lifestyle and were encouraged to increase their physical activity. Half of these adults were told to think about what is most important to them before receiving this advice; this group was significantly more physically active during the study. Researchers found that “when people are asked to think about things that they find meaningful, a brain region that recognizes personally relevant information becomes activated… [which] changes how people respond to health advice.” Ultimately, incorporating these activities and a positive outlook into your daily routine could prove beneficial to both your health and overall wellbeing.

Wein, Harrison, PhD. “Positive Emotions and Your Health: Developing a Brighter Outlook.”. NIH News in Health. National Institutes of Health, Washington, DC, August 2015.



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