Caution is imperative when high doses of intravenous immune globulin (IVIg) treatment are given to obese patients and to patients with risk factors for thrombosis, say researchers who reported on two cases of thrombotic complications.

One patient, with idiopathic thrombo-cytopenic purpura, received 1 g/kg of IVIg per day as a five-hour infusion daily for two days. During the second infusion, she experienced expressive aphasia, right facial droop, and right hemiparesis. The infusion was stopped, and she was given platelets for a presumed intra-cranial hemorrhage. Magnetic resonance imaging showed acute nonhemorrhagic infarcts in the brain, but a transthoracic echocardiogram and carotid ultrasonog-raphy showed nothing significant. On day six, the patient felt pain in her left lower leg, which ultrasound examination revealed to be thrombosis. Enoxaparin sodium (Lovenox® Injection, Aventis) therapy was initiated, and her speech and the hemiparesis improved over the next few days.

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A new vaccine, which is expected to be able to eliminate six of the 20 injections that babies receive before age two years, has received federal approval. Pediarix™ (GlaxoSmithKline) combines protection, into one injection, against five serious diseases—diphtheria, tetanus, whooping cough (pertussis), hepatitis B, and polio.

The vaccine is to be given in a three-dose series to infants at two, four, and six months of age.
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Until now, children needed nine shots to protect them; with the new vaccine, they need only three. This approval represents a major breakthrough and should greatly reduce anxiety for both children and their parents.

Older patients who are treated with topical beta blockers for glaucoma, a major cause of blindness, may be at a higher risk of airways obstruction—even if they have no history of respiratory disease, say researchers from the Institute of Ophthalmology, Royal Brompton Hospital, and Moorfields Eye Hospital, all in London. Analyzing data from 11,739 patients, they found enough of a heightened risk to recommend that frail elderly patients not be given beta-blocker therapy for glaucoma.

Although topical beta blockers are the most widely prescribed drugs for glaucoma in the United Kingdom, they have been known to exacerbate broncho-spasm in patients with asthma and chronic obstructive pulmonary disease and they affect respiratory function in elderly patients with no previous history of airways obstruction. In this study, the attributed risk of new development of respiratory disease was 1,000 patients per year in the United Kingdom, or one case every 11 years for a general practitioner.
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Patients with pre-existing airways obstruction might be even more sensitive to beta blockers, the researchers suggest. If airways obstruction develops, they advise discontinuing the drug immediately and notifying the patient’s ophthalmologist. A refilled prescription that includes topical beta blockers and drugs for asthma should automatically signal an alarm, they warn. The study authors even suggested that many frail elderly patients for whom loss of eyesight was not an immediate threat might fare better with no treatment rather than face a risk of airways obstruction.

Sanofi-Synthelabo and Bristol-Myers Squibb have announced the launch of the REACH (deduction of Atherothrom-bosis for Continued Health) Award Program, which aims to recognize promising work in improving the management of this disease. canadian cialis online

Just as many women are throwing out their hormone replacement prescriptions, an ongoing study has shown a link between prior use of hormone replacement therapy (HRT) and a reduced risk of Alzheimer’s disease. However, the data suggest that the benefits can take 10 years to appear, say researchers for the Cache County Study.

In this long-term trial, 1,889 women and 1,357 men were first assessed between 1995 and 1997. Between the initial interview and follow-up, 88 women (4.7%) and 35 men (2.6%) were found to have Alzheimer’s disease. Among those over 80 years of age, the risk for women was double that for men; however, in women who reported earlier use of HRT, the risk was 41% lower. Alzheimer’s disease developed in 26 of 1,066 women who had received HRT compared with 58 of 800 women who had never used HRT. The risk varied with the duration of therapy, and this sex-specific increased risk disappeared with more than 10 years of treatment.
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If the theory about the10-year lag time is correct, one of the study coauthors stated that “it explains a very large and seemingly conflicted literature” on the relationship between HRT and Alzheimer’s disease. The study findings corroborate other recent research suggesting that HRT may help prevent Alzheimer’s disease.

Children and adolescents with attention deficit hyperactivity disorder (ADHD) have smaller brains than children without the disorder—but medication treatment is not the reason, say researchers from the National Institute of Mental Health (NIMH). Moreover, although the brains of ADHD children were smaller, they developed in the same way as those of patients without ADHD. This suggests that whatever caused the disorder probably occurred before the medication was given; in fact, the researchers add, the medication may actually help to mature the brain.

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Antihypertensive treatment with nitrendipine, a dihydropyridine calcium channel blocker, reduced the incidence of dementia by 55%, according to new data from the Systolic Hypertension in Europe Study.

After earlier findings from the study showed that the incidence of dementia was halved, from 7.7 cases to 3.8 per 1,000 patients, the researchers extended their study into an open-label, active-treatment, follow-up trial. At the same time, they also continued the Vascular Dementia Project to review their original estimates of the drug’s benefit.
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The data are based on 5,849 patient-years of follow-up in the former placebo group and on 6,359 patient-years in the active treatment group. The overall incidence of dementia was 5.2 cases per 1,000 patient-years, 43 in the control group, and 21 in the active treatment group. The incidence of both Alzheimer’s disease and mixed or vascular dementia was reduced.

The findings, say the researchers, imply that treating 1,000 patients for five years might prevent 20 cases of dementia. These results, as well as those from other overviews, suggest that calcium channel blockers offer better protection against stroke than diuretics and beta blockers do.