Category: Health

Reduced Risk of Death With Low INR

The higher a patient’s International Normalized Ratio (INR) value, the higher the risk of death, according to a study by researchers from the Hospital of Kungalv in Sweden. The INR is a measurement used in patients who are receiving oral anticoagulation therapy. The degree of anticoagulation is calculated from the prothrombin time (which measures the efficacy of the therapy) and is expressed as the INR.

The investigators analyzed 1.25 million INR measurements and the records of 42,451 patients receiving anticoagula-tion therapy at 46 clinics. Of those patients, 3,533 died. The mortality rate was lowest among patients with an INR of 2.2 to 2.3—regardless of the indication for anticoagulation treatment. However, 1,069 patients died within seven weeks after an INR of 3.0 or higher.
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The researchers estimated risk to be such that at least 500 deaths were associated with, but not necessarily caused by, a high INR. Not enough autopsies were performed to accurately determine the number of deaths that were caused by bleeding.

The researchers expected that bleeding would be the only cause of death that increased with increasing INR, but their analysis suggests that other causes predominated. A high INR has been reported to suggest a final stage of disease; malnutrition, diarrhea, and other factors probably influence the INR.

Tablets for Hepatitis B

Hepatitis B

The Food and Drug Administration (FDA) has approved adefovir dipivoxil tablets (Hepsera™, Gilead Sciences) for patients with chronic hepatitis B, a serious infection that can cause cirrhosis, liver cancer, liver failure, and death. HepseraTM slows the progression of the infection by interfering with viral replication and causing deoxyribonucleic acid (DNA) chain termination after its incorporation into viral DNA.

The FDA’s approval is based on two randomized, double-blind, placebo-controlled studies. At week 48, 53% of patients in one study and 64% in the other study showed significant improvement in liver inflammation caused by the hepatitis B virus (HBV), compared with 25% and 35% of patients receiving placebo. Patients taking HepseraTM also showed statistically significant improvement in the degree of liver fibrosis. HepseraTM has also been shown to be effective in treating patients with clinical evidence of HBV that is resistant to lamivudine, an antiviral agent.
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The major adverse events included severe, acute exacerbation of hepatitis B after the drug regimen was discontinued; this result has also been seen with other hepatitis treatments.

Patients who stop taking HepseraTM should be monitored for hepatic function at regular intervals over a period of time. Kidney toxicity was reported in patients who were at risk for or who had underlying kidney dysfunction. The FDA has noted a theoretical concern that resistance to HIV might emerge in patients who have chronic hepatitis B with unrecognized or untreated HIV infection.

Healing Pressure Ulcers with Nerve Growth Factor

Pressure ulcers seem to heal faster with a daily topical solution of nerve growth factor, according to a study conducted at a teaching nursing home in Fontecchio, Italy. Nerve growth factor has been shown to stimulate the production of vascular endothelial growth factor.

Researchers randomly assigned 36 patients, who had had skin ulcers for an average of 13 days, to either regular treatment (e.g., being turned in bed, using pressure-relieving mattresses, or receiving daily local care), or regular treatment along with a solution of murine nerve growth factor. At the baseline examination, three patients in each group had stage 2 ulcers; nine in the treatment group and 13 in the control group had stage 3 ulcers; five in the treatment group and one in the control group had stage 4 ulcers; and one in each group had stage 5 ulcers.

After six weeks of treatment, the mean area of ulcers in the treatment group was reduced by 738 mm2, to 274 mm2. In contrast, the ulcer areas were reduced by 485 mm2, to 526 mm2 in the control group. Epithelial tissue growing from the margin toward the center of the ulcer was already visible in all patients in the treatment group within two weeks after treatment began. Within four weeks, the total area was reduced by nearly 50% in all ulcers in the treatment group. Two patients in the treatment group were completely healed within three weeks, and eight were completely healed within six weeks.
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By comparison, only one patient in the control group healed completely within three weeks. In addition, pressure ulcers improved by three or more stages in five patients in the treatment group but in none of the patients in the control group. Eight patients in the control group showed no improvement at all.

None of the patients in the treatment group experienced systemic or local side effects during treatment with either nerve growth factor or conventional therapy.

Natural Tampon for Vaginal Infections

Rostam, Ltd., has won approval to market the Ela tampon that releases a natural supplement to help ward off vaginal infections. The tampon absorbs menstrual fluid but also releases lactic and citric acids into the vagina. Some research suggests that maintaining higher acidity levels during menstruation might help prevent common vaginal infections. The acids are contained in a natural fiber strip woven into the tampon.

The FDA categorized the tampon as a medical device, not a new drug. Rostam simply had to demonstrate that the product was as safe and as effective as other tampons but did not have to show that it could treat a specific health problem. The key ingredient is a natural supplement, a category that isn’t tightly regulated. canada drugs pharmacy

Rostam plans to position the tampon as a “wellness product,” because FDA rules bar the company from making specific health claims without additional studies.

Inferior Care for Hepatitis C Patients

Hepatitis C Patients

A study by the Department of Veterans Affairs has found laboratory monitoring and duration of therapy to be “sub-optimal” for patients with hepatitis C infection. An “excessive duration” of therapy led to increased costs and exposed patients to “unnecessary” potential toxicity, the researchers say.
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The researchers emphasized that excessive treatment exposes patients to unnecessary potential toxicity. These findings underscore the need for practitioners to adhere to the recommended guidelines for discontinuing therapy.

Can We Get Too Much Sleep

A study from 2002 found that more than seven hours of sleep each night was associated with a shorter life span. When the subjects slept longer than seven hours a night, the risk of dying in that period rose. For people who slept for an average of eight hours each night, the chance of death rose by 12%. canadian antibiotics

Other researchers have found that life expectancy declines as the amount of sleep falls below seven hours but does not drop as steeply as with eight hours or more. Some think that people who sleep longer might have illnesses that cause fatigue and earlier death.

Rofecoxib: Quick Relief for Migraine

Quick Relief

For fast migraine relief without gastrointestinal symptoms, rofecoxib (Vioxx®, Merck), a long-acting selective cyclo-oxygenase-2 inhibitor, might be an answer. Researchers who conducted a parallel-group, multicenter study found the drug to be effective in just 30 minutes.

The researchers compared two doses of rofecoxib (25 and 50 mg) with placebo in 538 patients. Both doses were statistically superior to placebo in the acute treatment of a migraine attack as well as in relieving pain, photophobia, phono-phobia, nausea, and functional disability and in reducing the use of rescue medications. canadian discount pharmacy

The drug was well tolerated, and most clinical adverse events were mild to moderate in both treatment groups.