Folic acid 'increases memory'
By Nic Fleming, Medical Correspondent
Last Updated: 2:18AM GMT 19 Jan 2007
Folic acid supplements can significantly improve the memory and brain power of older people, according to a study to be published today.
Researchers found that men and post-menopausal women aged between 50 and 70 who took daily doses had the mental abilities of those almost five years their junior.
The supplements also helped maintain speed of information processing, reactions involving movement and overall brain power. These abilities decline with age, and their loss has been linked to a higher risk of dementia.
Folate, the natural form of synthetic folic acid, is found in broccoli, Brussels sprouts, peas, chickpeas, yeast extract, brown rice and fruit including oranges and bananas.
The research, published in the Lancet medical journal, was led by Dr Jane Durga, from the University of Wageningen in the Netherlands.
Dr Durga said: "Folic acid improves performance in tests that measure information processing speed and memory - domains known to decline with age.
"Trials similar to our own should now be repeated to provide greater insight into the clinical relevance of folic acid to people with mild cognitive impairment and dementia."
Folic acid supplements were also found to reduce levels of homocysteine, a blood chemical linked both to heart disease and dementia.
Age Concern has warned that increased consumption could have the side effect of masking deficiencies in the vitamin B12 - found in meat, eggs and dairy products - which could actually cause neurological damage.
"Further research is needed to reach a definitive answer on the benefits, or not, of folic acid," said the charity's director-general Gordon Lishman.
Tuesday, January 6, 2009
Diabetes dulls the brain claim scientists
1/6/09 12:19 PM
Diabetes dulls the brain claim scientists - Telegraph
http://www.telegraph.co.uk/health/healthnews/4126051/Diabetes-dulls-the-brain-claim-scientists.html
Diabetes dulls the brain claim scientists
People with diabetes suffer a mental slowdown early in the disease, according to a new study.
By Richard Alleyne, Science Correspondent
Last Updated: 3:57PM GMT 05 Jan 2009
Researchers found that healthy adults performed significantly better in planning, paying attention and speed of thought
than those suffering from diabetes.
But the differences were not significant in terms of memory, verbal fluency or reaction time.
As Britain's diabetic population continues to rise sharply, the findings mean that millions of people could be in danger of
mental slow down.
The team from the University of Alberta in Canada tracked 41 people with type 2 diabetes - also known as adult-onset
diabetes - and 424 without to make the finding.
The study, published in the journal Neuropsychology, found that the mental deterioration was no better in younger adults
with diabetes than in an older group, suggesting that the damage is done early in the disease and remains stable
thereafter.
Professor Roger Dixon, the report's co-author, said that people with serious cases of type 2 diabetes should be screened
for these cognitive effects to make sure they get the right medication and advice on diet or mental training.
"There could be some ways to compensate for these declines, at least early and with proper management," he said.
Obesity is one of the principal causes of type 2 diabetes, and has contributed to a rapid rise in the numbers of people with
the condition.
About a quarter of English adults are obese, and one official forecast suggests nine out of ten adults will be overweight or
obese by 2050.
Diabetes is linked to heart disease, stroke, amputations, kidney failure and blindness, and about one in 10 deaths is linked
to the disease. This is forecast to rise to one in eight next year.
Diabetes dulls the brain claim scientists - Telegraph
http://www.telegraph.co.uk/health/healthnews/4126051/Diabetes-dulls-the-brain-claim-scientists.html
Diabetes dulls the brain claim scientists
People with diabetes suffer a mental slowdown early in the disease, according to a new study.
By Richard Alleyne, Science Correspondent
Last Updated: 3:57PM GMT 05 Jan 2009
Researchers found that healthy adults performed significantly better in planning, paying attention and speed of thought
than those suffering from diabetes.
But the differences were not significant in terms of memory, verbal fluency or reaction time.
As Britain's diabetic population continues to rise sharply, the findings mean that millions of people could be in danger of
mental slow down.
The team from the University of Alberta in Canada tracked 41 people with type 2 diabetes - also known as adult-onset
diabetes - and 424 without to make the finding.
The study, published in the journal Neuropsychology, found that the mental deterioration was no better in younger adults
with diabetes than in an older group, suggesting that the damage is done early in the disease and remains stable
thereafter.
Professor Roger Dixon, the report's co-author, said that people with serious cases of type 2 diabetes should be screened
for these cognitive effects to make sure they get the right medication and advice on diet or mental training.
"There could be some ways to compensate for these declines, at least early and with proper management," he said.
Obesity is one of the principal causes of type 2 diabetes, and has contributed to a rapid rise in the numbers of people with
the condition.
About a quarter of English adults are obese, and one official forecast suggests nine out of ten adults will be overweight or
obese by 2050.
Diabetes is linked to heart disease, stroke, amputations, kidney failure and blindness, and about one in 10 deaths is linked
to the disease. This is forecast to rise to one in eight next year.
Thursday, December 18, 2008
Bringing Stem Cells to War: Meet the Blood Pharmers
12/18/08 8:42 PM
Loading “Popular Mechanics”
Page 1 of 2
http://www.popularmechanics.com/science/health_medicine/4296060.html?nav=hpPrint&do=print
Bringing Stem Cells to War: Meet the Blood Pharmers
New research from DARPA could open the door to on-demand blood-cell manufacturing on battlefields and in hospitals. All
medics need is a machine that uses a nanofiber that mimics bone marrow to turn a handful of stem cells into gallons of
blood. Who needs blood donations when you have blood pharming?
By Michael Milstein
Published on: December 16, 2008
Fresher blood is better than stale: It carries more oxygen and, when transfused into patients, speeds recovery.
Military medics are all too familiar with this problem in the field, where donated blood may take two or more weeks to
reach soldiers who need it immediately. But medical researchers—also known as blood pharmers—are working on
manufacturing the red stuff on the spot.
With a machine the size of a few refrigerators, the Defense Department's advanced research arm, the Defense Advanced
Research Projects Agency (DARPA) envisions liter upon liter of fresh blood churning out, destined for the veins of injured soldiers. It
doesn't get any fresher than that. And if it works for the military, it should also work for domestic hospitals that are paying
increasingly pricey bills for blood that's in short supply, says DARPA project scientist Jon Mogford, who was awarded nearly $2
million to Cleveland-based Arteriocyte for blood-pharming research.
The company's key ingredient is umbilical-cord stem cells, the Houdini of human cells, that can transform into whatever other cells
the body might need to repair or replace injured ones. Arteriocyte researchers were trying to grow big batches of stem cells when
they realized that the growing conditions they used—such as temperature and levels of oxygen and carbon dioxide —caused the
stem cells to turn into an early stage of red blood cell. At first they were frustrated because they wanted stem cells. Then they
realized that they may have unintentionally found a clever way to produce new blood.
Blood is in extremely short supply, and not only on the battlefield. Americans today do not donate blood as often as they used to and
many are ineligible to donate because of the risk of hepatitis and other diseases tied to ubiquitous tattoos and piercings. The
shortage has driven the cost of blood up and hospitals are having a hard time getting the kind that they need when they need it.
Even when they do, it may be several days old. On battlefields, the blood may be even older: "It often takes seven to 14 days to get
from my arm to a staging center," said Arteriocyte CEO Donald Brown.
The trick isn't producing red blood cells—the company has that figured out—it is producing them in enough volume to do patients
some good. The cells can be finicky: they need just the right environment to grow. For that, Arteriocyte is relying on a technique
developed at Johns Hopkins University that uses nanofibers to mimic the three-dimensional structure of bone marrow, which
12/18/08 8:42 PM
Loading “Popular Mechanics”
Page 2 of 2
http://www.popularmechanics.com/science/health_medicine/4296060.html?nav=hpPrint&do=print
manufactures blood in the body. Parent stem cells readily multiply in the matrix. "You're trying to replicate what goes on in human
bone marrow," Brown says.
The DARPA award gives Arteriocyte three years to scale up to a self-contained system that could turn out 100 units of universal
blood (which could be transfused into people with any blood type) a week for eight weeks. The system can measure no more than
47 cu ft and must stand up to the rigors of frontline military deployment. DARPA then wants to submit the system to the FDA for
approval. In the end, if the system works, soldiers and civilian patients could have all the blood they need available on tap.
Loading “Popular Mechanics”
Page 1 of 2
http://www.popularmechanics.com/science/health_medicine/4296060.html?nav=hpPrint&do=print
Bringing Stem Cells to War: Meet the Blood Pharmers
New research from DARPA could open the door to on-demand blood-cell manufacturing on battlefields and in hospitals. All
medics need is a machine that uses a nanofiber that mimics bone marrow to turn a handful of stem cells into gallons of
blood. Who needs blood donations when you have blood pharming?
By Michael Milstein
Published on: December 16, 2008
Fresher blood is better than stale: It carries more oxygen and, when transfused into patients, speeds recovery.
Military medics are all too familiar with this problem in the field, where donated blood may take two or more weeks to
reach soldiers who need it immediately. But medical researchers—also known as blood pharmers—are working on
manufacturing the red stuff on the spot.
With a machine the size of a few refrigerators, the Defense Department's advanced research arm, the Defense Advanced
Research Projects Agency (DARPA) envisions liter upon liter of fresh blood churning out, destined for the veins of injured soldiers. It
doesn't get any fresher than that. And if it works for the military, it should also work for domestic hospitals that are paying
increasingly pricey bills for blood that's in short supply, says DARPA project scientist Jon Mogford, who was awarded nearly $2
million to Cleveland-based Arteriocyte for blood-pharming research.
The company's key ingredient is umbilical-cord stem cells, the Houdini of human cells, that can transform into whatever other cells
the body might need to repair or replace injured ones. Arteriocyte researchers were trying to grow big batches of stem cells when
they realized that the growing conditions they used—such as temperature and levels of oxygen and carbon dioxide —caused the
stem cells to turn into an early stage of red blood cell. At first they were frustrated because they wanted stem cells. Then they
realized that they may have unintentionally found a clever way to produce new blood.
Blood is in extremely short supply, and not only on the battlefield. Americans today do not donate blood as often as they used to and
many are ineligible to donate because of the risk of hepatitis and other diseases tied to ubiquitous tattoos and piercings. The
shortage has driven the cost of blood up and hospitals are having a hard time getting the kind that they need when they need it.
Even when they do, it may be several days old. On battlefields, the blood may be even older: "It often takes seven to 14 days to get
from my arm to a staging center," said Arteriocyte CEO Donald Brown.
The trick isn't producing red blood cells—the company has that figured out—it is producing them in enough volume to do patients
some good. The cells can be finicky: they need just the right environment to grow. For that, Arteriocyte is relying on a technique
developed at Johns Hopkins University that uses nanofibers to mimic the three-dimensional structure of bone marrow, which
12/18/08 8:42 PM
Loading “Popular Mechanics”
Page 2 of 2
http://www.popularmechanics.com/science/health_medicine/4296060.html?nav=hpPrint&do=print
manufactures blood in the body. Parent stem cells readily multiply in the matrix. "You're trying to replicate what goes on in human
bone marrow," Brown says.
The DARPA award gives Arteriocyte three years to scale up to a self-contained system that could turn out 100 units of universal
blood (which could be transfused into people with any blood type) a week for eight weeks. The system can measure no more than
47 cu ft and must stand up to the rigors of frontline military deployment. DARPA then wants to submit the system to the FDA for
approval. In the end, if the system works, soldiers and civilian patients could have all the blood they need available on tap.
Wednesday, December 17, 2008
ZYVOX INDICATIONS
http://www.zyvox.com/index.asp?hcp=true
ZYVOX INDICATIONS
ZYVOX® (linezolid) is indicated in the treatment of the following infections caused by susceptible strains of the designated microorganisms:
Nosocomial pneumonia caused by Staphylococcus aureus(methicillin-susceptible and -resistant strains) or Streptococcus pneumoniae(including multidrug-resistant strains [MDRSP]). MDRSP refers to isolates resistant to 2 or more of the following antibiotics: penicillin, second-generation cephalosporins, macrolides, tetracycline, and trimethoprim/sulfamethoxazole.
Complicated skin and skin structure infections, including diabetic foot infections, without concomitant osteomyelitis, caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains), Streptococcus pyogenes, or Streptococcus agalactiae. ZYVOX has not been studied in the treatment of decubitus ulcers.
IMPORTANT SAFETY CONSIDERATIONS
ZYVOX formulations are contraindicated for use in patients who have known hypersensitivity to linezolid or any of the other product components.
ZYVOX should not be used in patients taking any medicinal product which inhibits monoamine oxidases A or B (e.g. phenelzine, isocarboxazid) or within 2 weeks of taking any such medicinal product.
Unless patients are monitored for potential increases in blood pressure, ZYVOX should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis and/or patients taking any of the following types of medications: directly and indirectly acting sympathomimetic agents (e.g. pseudoephedrine), vasopressive agents (e.g. epinephrine, norepinephrine), and dopaminergic agents (e.g. dopamine, dobutamine).
Unless patients are carefully observed for signs and/or symptoms of serotonin syndrome, ZYVOX should not be administered to patients with carcinoid syndrome and/or patients taking any of the following medications: serotonin re-uptake inhibitors, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine, or buspirone.
Myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia) has been reported in patients receiving ZYVOX. In cases where the outcome is known, when ZYVOX was discontinued, the affected hematologic parameters have risen toward pretreatment levels. Complete blood counts should be monitored weekly in patients who receive ZYVOX, particularly in those who receive ZYVOX for longer than 2 weeks, those with preexisting myelosuppression, those receiving concomitant drugs that produce bone marrow suppression, or those with a chronic infection who have received previous or concomitant antibiotic therapy. Discontinuation of therapy with ZYVOX should be considered in patients who develop or have worsening myelosuppression.
ZYVOX is not approved and should not be used for the treatment of patients with catheter-related bloodstream infections or catheter-site infections.
In an open-label investigational study in seriously ill patients with intravascular catheter-related infections, an imbalance in mortality was seen in patients treated with ZYVOX compared with vancomycin/dicloxacillin/oxacillin. While causality has not been established, mortality was higher in patients treated with ZYVOX who were infected with Gram-negative organisms alone, with both Gram-positive and Gram-negative organisms, or who had no infection when they entered the study. Patients with Gram-positive infections had no difference in mortality.
ZYVOX has no clinical activity against Gram-negative pathogens and is not indicated for the treatment of Gram-negative infections. It is critical that specific Gram-negative therapy be initiated immediately if a concomitant Gram-negative pathogen is documented or suspected.
Lactic acidosis has been reported with the use of ZYVOX. In reported cases, patients experienced repeated episodes of nausea and vomiting. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving ZYVOX should receive immediate medical evaluation.
Spontaneous reports of serotonin syndrome associated with the coadministration of ZYVOX and serotonergic agents, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs), have been reported. Where administration of ZYVOX and concomitant serotonergic agents is clinically appropriate, patients should be closely observed for signs and symptoms of serotonin syndrome such as cognitive dysfunction, hyperpyrexia, hyperreflexia, and incoordination. If signs or symptoms occur, physicians should consider discontinuation of either one or both agents.
Peripheral and optic neuropathy have been reported in patients treated with ZYVOX, primarily those patients treated for longer than the maximum recommended duration of 28 days. In cases of optic neuropathy that progressed to loss of vision, patients were treated for extended periods beyond the maximum recommended duration. Visual blurring has been reported in some patients treated with ZYVOX for less than 28 days.
If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, blurred vision, or visual field defect, prompt ophthalmic evaluation is recommended. Visual function should be monitored in all patients taking ZYVOX for extended periods (3 months) and in all patients reporting new visual symptoms regardless of length of therapy with ZYVOX. If peripheral or optic neuropathy occurs, the continued use of ZYVOX in these patients should be weighed against the potential risks.
Convulsions have been reported in patients when treated with ZYVOX. In some of these cases, a history of seizures or risk factors for seizures was reported.
The most commonly reported adverse events in adults across clinical trials were nausea, headache, and diarrhea.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of ZYVOX and other antibacterial drugs, ZYVOX should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Clostridium difficile –associated diarrhea (CDAD) has been reported with the use of nearly all antibacterial agents, including ZYVOX, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C difficile . C difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur more than 2 months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C difficile , and surgical evaluation should be instituted as clinically indicated.
ZYVOX INDICATIONS
ZYVOX® (linezolid) is indicated in the treatment of the following infections caused by susceptible strains of the designated microorganisms:
Nosocomial pneumonia caused by Staphylococcus aureus(methicillin-susceptible and -resistant strains) or Streptococcus pneumoniae(including multidrug-resistant strains [MDRSP]). MDRSP refers to isolates resistant to 2 or more of the following antibiotics: penicillin, second-generation cephalosporins, macrolides, tetracycline, and trimethoprim/sulfamethoxazole.
Complicated skin and skin structure infections, including diabetic foot infections, without concomitant osteomyelitis, caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains), Streptococcus pyogenes, or Streptococcus agalactiae. ZYVOX has not been studied in the treatment of decubitus ulcers.
IMPORTANT SAFETY CONSIDERATIONS
ZYVOX formulations are contraindicated for use in patients who have known hypersensitivity to linezolid or any of the other product components.
ZYVOX should not be used in patients taking any medicinal product which inhibits monoamine oxidases A or B (e.g. phenelzine, isocarboxazid) or within 2 weeks of taking any such medicinal product.
Unless patients are monitored for potential increases in blood pressure, ZYVOX should not be administered to patients with uncontrolled hypertension, pheochromocytoma, thyrotoxicosis and/or patients taking any of the following types of medications: directly and indirectly acting sympathomimetic agents (e.g. pseudoephedrine), vasopressive agents (e.g. epinephrine, norepinephrine), and dopaminergic agents (e.g. dopamine, dobutamine).
Unless patients are carefully observed for signs and/or symptoms of serotonin syndrome, ZYVOX should not be administered to patients with carcinoid syndrome and/or patients taking any of the following medications: serotonin re-uptake inhibitors, tricyclic antidepressants, serotonin 5-HT1 receptor agonists (triptans), meperidine, or buspirone.
Myelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia) has been reported in patients receiving ZYVOX. In cases where the outcome is known, when ZYVOX was discontinued, the affected hematologic parameters have risen toward pretreatment levels. Complete blood counts should be monitored weekly in patients who receive ZYVOX, particularly in those who receive ZYVOX for longer than 2 weeks, those with preexisting myelosuppression, those receiving concomitant drugs that produce bone marrow suppression, or those with a chronic infection who have received previous or concomitant antibiotic therapy. Discontinuation of therapy with ZYVOX should be considered in patients who develop or have worsening myelosuppression.
ZYVOX is not approved and should not be used for the treatment of patients with catheter-related bloodstream infections or catheter-site infections.
In an open-label investigational study in seriously ill patients with intravascular catheter-related infections, an imbalance in mortality was seen in patients treated with ZYVOX compared with vancomycin/dicloxacillin/oxacillin. While causality has not been established, mortality was higher in patients treated with ZYVOX who were infected with Gram-negative organisms alone, with both Gram-positive and Gram-negative organisms, or who had no infection when they entered the study. Patients with Gram-positive infections had no difference in mortality.
ZYVOX has no clinical activity against Gram-negative pathogens and is not indicated for the treatment of Gram-negative infections. It is critical that specific Gram-negative therapy be initiated immediately if a concomitant Gram-negative pathogen is documented or suspected.
Lactic acidosis has been reported with the use of ZYVOX. In reported cases, patients experienced repeated episodes of nausea and vomiting. Patients who develop recurrent nausea or vomiting, unexplained acidosis, or a low bicarbonate level while receiving ZYVOX should receive immediate medical evaluation.
Spontaneous reports of serotonin syndrome associated with the coadministration of ZYVOX and serotonergic agents, including antidepressants such as selective serotonin reuptake inhibitors (SSRIs), have been reported. Where administration of ZYVOX and concomitant serotonergic agents is clinically appropriate, patients should be closely observed for signs and symptoms of serotonin syndrome such as cognitive dysfunction, hyperpyrexia, hyperreflexia, and incoordination. If signs or symptoms occur, physicians should consider discontinuation of either one or both agents.
Peripheral and optic neuropathy have been reported in patients treated with ZYVOX, primarily those patients treated for longer than the maximum recommended duration of 28 days. In cases of optic neuropathy that progressed to loss of vision, patients were treated for extended periods beyond the maximum recommended duration. Visual blurring has been reported in some patients treated with ZYVOX for less than 28 days.
If patients experience symptoms of visual impairment, such as changes in visual acuity, changes in color vision, blurred vision, or visual field defect, prompt ophthalmic evaluation is recommended. Visual function should be monitored in all patients taking ZYVOX for extended periods (3 months) and in all patients reporting new visual symptoms regardless of length of therapy with ZYVOX. If peripheral or optic neuropathy occurs, the continued use of ZYVOX in these patients should be weighed against the potential risks.
Convulsions have been reported in patients when treated with ZYVOX. In some of these cases, a history of seizures or risk factors for seizures was reported.
The most commonly reported adverse events in adults across clinical trials were nausea, headache, and diarrhea.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of ZYVOX and other antibacterial drugs, ZYVOX should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Clostridium difficile –associated diarrhea (CDAD) has been reported with the use of nearly all antibacterial agents, including ZYVOX, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C difficile . C difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur more than 2 months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C difficile , and surgical evaluation should be instituted as clinically indicated.
North American breakthrough for dialysis patients
http://www.physorg.com/printnews.php?newsid=147001312
North American breakthrough for dialysis patients
Suffering from end-stage renal disease (ESRD), a growing number of patients at the Centre hospitalier de l'Université de Montréal (CHUM), have become the beneficiaries of a North American breakthrough: high efficacy hemodiafiltration (HDF).
An extracorporeal blood purification technique, HDF is indicated for ESRD patients. Since the HDF unit was introduced in CHUM's Nephrology section, preliminary results show a clear advantage of high efficacy HDF over conventional hemodialysis in several areas, including the following:
-- Improved removal of uremic toxins;
-- Decreased number of hospitalization days;
-- A better tolerance for patients;
-- Minimizes the state of chronic inflammation that too often may lead to complications over a long course of dialysis;
-- Diminished need for certain medications.
-- Increased biocompatibility across the blood-dialysis system interface.
"Conventional hemodialysis continues to save lives, but we now have the technology to improve the lot of dialysis patients," says Dr. Rénee Lévesque, nephologist and lead physician in the HDF program at CHUM, and a professor with the medical faculty of the Université de Montréal. "At CHUM, we're proud to soon be accepting a cohort of forty patients undergoing HDF." Dr. Lévesque added that the CHUM Nephrology section is putting much efforts behind the new process, and hopes that one day soon all dialysis patients will be treated in this fashion.
Recent retrospective clinical data indicate that HDF reduces the mortality rates of dialysis patients and randomized studies are under way to provide clear proof of increased survival rates for patients. Among these, the CONTRAST study compares hemodialysis with online hemodiafiltration HDF in overall performance relative to cardiovascular morbidity and mortality. The study seeks to recruit seven hundred test subjects and follow them over a three-year period. CHUM is the only medical centre in North America to take part in this study, currently the largest in terms of the size of the randomized cohort.
Hemodiafiltration : the best of both worlds
HDF combines the elements of two processes, conventional hemodialysis (HD) and hemofiltration (HF). Renal replacement therapy for ESRD is based on two processes: diffusion and convection.
Conventional HD is diffusive; blood is circulated in an artificial kidney machine on one side of a semi-permeable membrane, while a special dialysis fluid is circulated on the other side. Small molecules of metabolic waste seep out into a dialysis solution flowing in the opposite direction on the other side of the membrane, mimicking the kidneys and washing wastes and toxins out of the bloodstream. One major toxin is urea. HD is the most widely used renal replacement function technology for ESRD.
Hemofiltration (HF) or ultrafiltration is exclusively convective, forcing blood through a filter under high pressure. The principle consists of applying a hydrostatic pressure gradient (high pressure on one side, low pressure on the other) across the membrane or filter. This results in an ultrafiltrate (water and electrolytes) on the other side. The quantity of ultrafiltrate lost in this process must be compensated by a matching infusion of replacement fluid. HF is used primarily in continuous mode and in acute care or intensive care.
In HDF, the diffusive component of HD is combined with the convective component of HF. As is the case in HF, the excessive loss of liquid must be compensated by the reinfusion of a sterile and apyrogenic (not producing fever) fluid. Recent developments have led to the "on-line" production of large volumes of ultrapure liquid of high quality. This has led to higher quality physicochemical and microbiological properties in these solutions, in comparison with HD.
Some statistics on the treatment of end-stage renal disease:
-- At the end of 2003, there were 29,551 Canadians undergoing renal substitution treatment and that number is expected to double over the next ten years;
-- Among that number, 61 % were in dialysis. Of these patients, 81 % were in hemodialysis and 19 % followed a regiment of peritoneal dialysis, e.g. from the abdomen.
Source: Université de Montréal Hospital Centre
North American breakthrough for dialysis patients
Suffering from end-stage renal disease (ESRD), a growing number of patients at the Centre hospitalier de l'Université de Montréal (CHUM), have become the beneficiaries of a North American breakthrough: high efficacy hemodiafiltration (HDF).
An extracorporeal blood purification technique, HDF is indicated for ESRD patients. Since the HDF unit was introduced in CHUM's Nephrology section, preliminary results show a clear advantage of high efficacy HDF over conventional hemodialysis in several areas, including the following:
-- Improved removal of uremic toxins;
-- Decreased number of hospitalization days;
-- A better tolerance for patients;
-- Minimizes the state of chronic inflammation that too often may lead to complications over a long course of dialysis;
-- Diminished need for certain medications.
-- Increased biocompatibility across the blood-dialysis system interface.
"Conventional hemodialysis continues to save lives, but we now have the technology to improve the lot of dialysis patients," says Dr. Rénee Lévesque, nephologist and lead physician in the HDF program at CHUM, and a professor with the medical faculty of the Université de Montréal. "At CHUM, we're proud to soon be accepting a cohort of forty patients undergoing HDF." Dr. Lévesque added that the CHUM Nephrology section is putting much efforts behind the new process, and hopes that one day soon all dialysis patients will be treated in this fashion.
Recent retrospective clinical data indicate that HDF reduces the mortality rates of dialysis patients and randomized studies are under way to provide clear proof of increased survival rates for patients. Among these, the CONTRAST study compares hemodialysis with online hemodiafiltration HDF in overall performance relative to cardiovascular morbidity and mortality. The study seeks to recruit seven hundred test subjects and follow them over a three-year period. CHUM is the only medical centre in North America to take part in this study, currently the largest in terms of the size of the randomized cohort.
Hemodiafiltration : the best of both worlds
HDF combines the elements of two processes, conventional hemodialysis (HD) and hemofiltration (HF). Renal replacement therapy for ESRD is based on two processes: diffusion and convection.
Conventional HD is diffusive; blood is circulated in an artificial kidney machine on one side of a semi-permeable membrane, while a special dialysis fluid is circulated on the other side. Small molecules of metabolic waste seep out into a dialysis solution flowing in the opposite direction on the other side of the membrane, mimicking the kidneys and washing wastes and toxins out of the bloodstream. One major toxin is urea. HD is the most widely used renal replacement function technology for ESRD.
Hemofiltration (HF) or ultrafiltration is exclusively convective, forcing blood through a filter under high pressure. The principle consists of applying a hydrostatic pressure gradient (high pressure on one side, low pressure on the other) across the membrane or filter. This results in an ultrafiltrate (water and electrolytes) on the other side. The quantity of ultrafiltrate lost in this process must be compensated by a matching infusion of replacement fluid. HF is used primarily in continuous mode and in acute care or intensive care.
In HDF, the diffusive component of HD is combined with the convective component of HF. As is the case in HF, the excessive loss of liquid must be compensated by the reinfusion of a sterile and apyrogenic (not producing fever) fluid. Recent developments have led to the "on-line" production of large volumes of ultrapure liquid of high quality. This has led to higher quality physicochemical and microbiological properties in these solutions, in comparison with HD.
Some statistics on the treatment of end-stage renal disease:
-- At the end of 2003, there were 29,551 Canadians undergoing renal substitution treatment and that number is expected to double over the next ten years;
-- Among that number, 61 % were in dialysis. Of these patients, 81 % were in hemodialysis and 19 % followed a regiment of peritoneal dialysis, e.g. from the abdomen.
Source: Université de Montréal Hospital Centre
Wednesday, December 10, 2008
Diabetes causes more amputations than landmines
December 8, 2008
The condition now accounts for 70 per cent of all lower limb amputations
Dr Thomas Stuttaford
Mohandas Gandhi was known as Mahatma, or “great soul”, because he combined patriotism with moral teaching, reform and a horror of violence, consumerism and class, caste or racial discrimination.
Gandhi would have welcomed the support given to the World Diabetes Foundation (WDF) and the World Health Organisation (WHO) by Handicap International. That is the French charitable organisation that has been awarded a Nobel prize for its work with people left crippled and handicapped in Vietnam, Cambodia and other countries by landmines.
Exploding hidden landmines remain a considerable danger, but one that has been overtaken by diabetes as a reason for the amputation of younger people's legs around the world. Diabetes now accounts for 70 per cent of all lower limb amputations. Hence the decision of Handicap International, while continuing to work in Vietnam, Cambodia and other former war zones, to add to its agenda the WDF campaign to reduce the incidence and improve the treatment of diabetes in developing countries.
The loss of a lower limb in a working man usually heralds the loss of the family's livelihood so that poverty becomes inevitable. Locally made artificial lower limbs are satisfactory for walking but rarely adequate for hard manual work.
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The WDF's expertise helps in the formation of partnerships to deal with diabetes in the developing world. It unites the various people and organisations interested in raising the awareness of the lifestyle changes needed to prevent diabetes and the need for prompt diagnosis and treatment. Earlier treatment of diabetic foot complications would prevent 85 per cent of amputations.
Currently 40,000 legs are amputated in India each year. Last week doctors, health workers and journalists gathered in Bangalore and Madras. In Bangalore they visited the vascular surgical unit at the Bhagwan Jain hospital. The unit, led by Dr Kalkunte Suresh, is financed by the WDF, the WHO, Handicap International and several local philanthropists. It runs a footcare division that organises local clinics that screen people in surrounding villages for diabetes and the first signs of nerve damage that could desensitise their feet so that they become vulnerable to minor injury.
The clinics also raise public awareness of the lifestyle changes needed to reduce the incidence of diabetes and its complications. Dr Suresh, the director of the scheme and of the hospital's vascular surgical unit, said that diabetic foot complications were increasing and that someone with diabetes in India was 25 times more likely to have a leg amputated than someone without it.
Dr Suresh added that doctors trained in the developed world associate foot complications including gangrene and amputation with elderly or obese, under-exercised patients. This is not so in India. There, the most common cause for a crisis leading to gangrene and amputation was more likely to be precipitated by diabetic nerve damage than deteriorating arterial blood flow.
The Indian patients who need amputation are often aged only around 35 to 45, a time in the manual worker's life when he has maximal domestic responsibilities and is probably providing for several generations. Most of Dr Suresh's patients who had leg amputations were not overweight but lean, tough and muscular agricultural workers.
Gandhi, delegates were reminded, taught that India lives in its villages, and in order to bring about change it was necessary to change the way that village people think.
Dr Suresh and his team, when spreading the message about diabetic prevention and treatment, rely on well -respected local people - popular village postmen or bus drivers are ideal - to educate their fellow villagers about the signs and symptoms of early diabetes, the need for foot care, and the importance of wearing shoes in and out of the house (more feet are injured indoors than in the fields).
All these aspects of diabetes can be taught in the villages by troupes of enthusiastic street performers acting out short plays and singing traditional folk songs, modified to spell out the methods of prevention and treatment of diabetes.
While India watched and mourned the atrocities in Mumbai, the delegates moved to Madras. There they visited the projects the WDF has established with the Pabolu Ogirala and Sriram Charitable Trust. It aims to combat eye problems in diabetic patients, who are twice as likely to develop them as non-diabetic people. Fifty per cent of all diabetic people develop some degree of diabetic eye disease.
www.worlddiabetesfoundation.org
The condition now accounts for 70 per cent of all lower limb amputations
Dr Thomas Stuttaford
Mohandas Gandhi was known as Mahatma, or “great soul”, because he combined patriotism with moral teaching, reform and a horror of violence, consumerism and class, caste or racial discrimination.
Gandhi would have welcomed the support given to the World Diabetes Foundation (WDF) and the World Health Organisation (WHO) by Handicap International. That is the French charitable organisation that has been awarded a Nobel prize for its work with people left crippled and handicapped in Vietnam, Cambodia and other countries by landmines.
Exploding hidden landmines remain a considerable danger, but one that has been overtaken by diabetes as a reason for the amputation of younger people's legs around the world. Diabetes now accounts for 70 per cent of all lower limb amputations. Hence the decision of Handicap International, while continuing to work in Vietnam, Cambodia and other former war zones, to add to its agenda the WDF campaign to reduce the incidence and improve the treatment of diabetes in developing countries.
The loss of a lower limb in a working man usually heralds the loss of the family's livelihood so that poverty becomes inevitable. Locally made artificial lower limbs are satisfactory for walking but rarely adequate for hard manual work.
RELATED LINKS
Temporary castration for prostate cancer sufferers
Back pain causing a lack of sleep
Are injectable self-tans safe?
The WDF's expertise helps in the formation of partnerships to deal with diabetes in the developing world. It unites the various people and organisations interested in raising the awareness of the lifestyle changes needed to prevent diabetes and the need for prompt diagnosis and treatment. Earlier treatment of diabetic foot complications would prevent 85 per cent of amputations.
Currently 40,000 legs are amputated in India each year. Last week doctors, health workers and journalists gathered in Bangalore and Madras. In Bangalore they visited the vascular surgical unit at the Bhagwan Jain hospital. The unit, led by Dr Kalkunte Suresh, is financed by the WDF, the WHO, Handicap International and several local philanthropists. It runs a footcare division that organises local clinics that screen people in surrounding villages for diabetes and the first signs of nerve damage that could desensitise their feet so that they become vulnerable to minor injury.
The clinics also raise public awareness of the lifestyle changes needed to reduce the incidence of diabetes and its complications. Dr Suresh, the director of the scheme and of the hospital's vascular surgical unit, said that diabetic foot complications were increasing and that someone with diabetes in India was 25 times more likely to have a leg amputated than someone without it.
Dr Suresh added that doctors trained in the developed world associate foot complications including gangrene and amputation with elderly or obese, under-exercised patients. This is not so in India. There, the most common cause for a crisis leading to gangrene and amputation was more likely to be precipitated by diabetic nerve damage than deteriorating arterial blood flow.
The Indian patients who need amputation are often aged only around 35 to 45, a time in the manual worker's life when he has maximal domestic responsibilities and is probably providing for several generations. Most of Dr Suresh's patients who had leg amputations were not overweight but lean, tough and muscular agricultural workers.
Gandhi, delegates were reminded, taught that India lives in its villages, and in order to bring about change it was necessary to change the way that village people think.
Dr Suresh and his team, when spreading the message about diabetic prevention and treatment, rely on well -respected local people - popular village postmen or bus drivers are ideal - to educate their fellow villagers about the signs and symptoms of early diabetes, the need for foot care, and the importance of wearing shoes in and out of the house (more feet are injured indoors than in the fields).
All these aspects of diabetes can be taught in the villages by troupes of enthusiastic street performers acting out short plays and singing traditional folk songs, modified to spell out the methods of prevention and treatment of diabetes.
While India watched and mourned the atrocities in Mumbai, the delegates moved to Madras. There they visited the projects the WDF has established with the Pabolu Ogirala and Sriram Charitable Trust. It aims to combat eye problems in diabetic patients, who are twice as likely to develop them as non-diabetic people. Fifty per cent of all diabetic people develop some degree of diabetic eye disease.
www.worlddiabetesfoundation.org
Salt 'as bad as cigarettes'
12/10/08 7:01 PM
AAPDecember 03, 2008 03:36pm
Health & Lifestyle
AUSTRALIANS are consuming too much salt, say nutritionists who blame not only fast food but also
healthier alternatives such as canned vegetables and baked beans.
Less than 5 per cent of all sausages and beef burgers sold in the nation's supermarkets contained
acceptable levels of salt, a Nutrition Society of Australia conference has also heard.
Jacqui Webster, a senior project manager based at Sydney's The George Institute for International
Health, said Australians were consuming well over the maximum recommended intake of six grams
of salt a day.
"Despite being aware of the adverse health effects of salt, most Australian consumers are taking little
action to reduce their intake,'' Ms Webster told the conference.
"Consuming too much salt, or sodium, can lead to serious health problems including high blood
pressure, cardiovascular disease, stroke, osteoporosis and stomach cancer.
"There is also some evidence that it adds to the severity of asthma symptoms.''
Ms Webster said the 2007 Australian National Children's Nutrition and Physical Activity Survey
showed boys were consuming around 9g of salt daily, while girls came in at the maximum 6g.
She said it was also likely that many adults consumed in excess of the 9g of salt each day.
Ms Webster said foods contributing to high salt diet included bread, processed meats, baked beans,
canned vegetables, table sauces, some breakfast cereals and fast food.
Research in the UK showed processed foods accounted for 75 per cent of salt in a person's diet, with
10 per cent from natural foods like fish and vegetables.
The remaining 15 per cent was salt added at the table or during cooking.
Given the dire health consequences, Ms Webster said reducing salt in the diet should be "considered
on the same level of importance as reducing obesity, alcohol and tobacco consumption''.
Leading nutritionists from around Australia and the world are attending the conference in Adelaide.
AAPDecember 03, 2008 03:36pm
Health & Lifestyle
AUSTRALIANS are consuming too much salt, say nutritionists who blame not only fast food but also
healthier alternatives such as canned vegetables and baked beans.
Less than 5 per cent of all sausages and beef burgers sold in the nation's supermarkets contained
acceptable levels of salt, a Nutrition Society of Australia conference has also heard.
Jacqui Webster, a senior project manager based at Sydney's The George Institute for International
Health, said Australians were consuming well over the maximum recommended intake of six grams
of salt a day.
"Despite being aware of the adverse health effects of salt, most Australian consumers are taking little
action to reduce their intake,'' Ms Webster told the conference.
"Consuming too much salt, or sodium, can lead to serious health problems including high blood
pressure, cardiovascular disease, stroke, osteoporosis and stomach cancer.
"There is also some evidence that it adds to the severity of asthma symptoms.''
Ms Webster said the 2007 Australian National Children's Nutrition and Physical Activity Survey
showed boys were consuming around 9g of salt daily, while girls came in at the maximum 6g.
She said it was also likely that many adults consumed in excess of the 9g of salt each day.
Ms Webster said foods contributing to high salt diet included bread, processed meats, baked beans,
canned vegetables, table sauces, some breakfast cereals and fast food.
Research in the UK showed processed foods accounted for 75 per cent of salt in a person's diet, with
10 per cent from natural foods like fish and vegetables.
The remaining 15 per cent was salt added at the table or during cooking.
Given the dire health consequences, Ms Webster said reducing salt in the diet should be "considered
on the same level of importance as reducing obesity, alcohol and tobacco consumption''.
Leading nutritionists from around Australia and the world are attending the conference in Adelaide.
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