Seizure drug helps women with hot flashes sleep

Gabapentin, a drug used to treat seizures, improves the quality of sleep in menopausal women bothered by hot flashes, University of Rochester Medical Center researchers report in the Journal of Women’s Health.

Approximately 40 percent of menopausal women have trouble sleeping. They often have trouble falling asleep and staying asleep throughout the night.

In a previous study, the Rochester researchers found that gabapentin helps alleviate hot flashes. Their current study, they say, is the first to show sustained benefits in sleep quality with gabapentin.

To determine the impact of gabapentin on sleep, the researchers used data from their previous of gabapentin in 59 postmenopausal women who experienced 7 to 20 hot flashes daily. The subjects took either 300 milligrams of gabapentin three times a day or a placebo.

Based on the Pittsburgh Sleep Quality Index — a well-known and validated sleep questionnaire, they found that women who took gabapentin reported better quality sleep than those who took placebo.

“Gabapentin improves sleep quality but does not have the potential dependency problems of some other sleep medications and does not involve the use of hormone replacement therapy,” Dr. Michael E. Yurcheshen, who led the study, noted in a university-issued statement.

“It has minimal side effects and it is a generic drug,” said Yurcheshen, who is based at the Strong Sleep Disorders Center. “That makes it a very attractive treatment for these problems in this patient population.”

Electronic Nose Sniffs out Toxins

Imagine a polka-dotted postage stamp-sized sensor that can sniff out some known poisonous gases and toxins and show the results simply by changing colors.

Support for the development and application of this electronic nose comes from the National Institute of Environmental Health Sciences, part of the National Institutes of Health. The new technology is discussed in this month’s issue of Nature Chemistry and exemplifies the types of sensors that are being developed as part of the NIH Genes, Environment and Health Initiative (GEI) (http://www.gei.nih.gov/index.asp).

Once fully developed, the sensor could be useful in detecting high exposures to toxic industrial chemicals that pose serious health risks in the workplace or through accidental exposure. While physicists have radiation badges to protect them in the workplace, chemists and workers who handle chemicals do not have equivalent devices to monitor their exposure to potentially toxic chemicals. The investigators hope to be able to market the wearable sensor within a few years.

“The project fits into the overall goal of a component of the GEI Exposure Biology Program that the NIEHS has the lead on, which is to develop technologies to monitor and better understand how environmental exposures affect disease risk,” said NIEHS Director Linda Birnbaum, Ph.D. “This paper brings us one step closer to having a small wearable sensor that can detect multiple airborne toxins.”

The paper’s senior author is Kenneth S. Suslick, Ph.D., the M.T. Schmidt Professor of Chemistry at the University of Illinois at Urbana-Champaign. Suslick and his colleagues have created what they refer to as an optoelectronic nose, an artificial nose for the detection of toxic industrial chemicals (TICs) that is simple, fast, inexpensive, and works by visualizing colors.

“We have a disposable 36-dye sensor array that changes colors when exposed to different chemicals. The pattern of the color change is a unique molecular fingerprint for any toxic gas and also tells us its concentration,” said Suslick. “By comparing that pattern to a library of color fingerprints, we can identify and quantify the TICs in a matter of seconds.”

The researchers say older methods relied on sensors whose response originates from weak and highly non-specific chemical interactions, whereas this new technology is more responsive to a diverse set of chemicals. The power of this sensor to identify so many volatile toxins stems from the increased range of interactions that are used to discriminate the response of the array.

To test the application of their color sensor array, the researchers chose 19 representative examples of toxic industrial chemicals. Chemicals such as ammonia, chlorine, nitric acid and sulfur dioxide at concentrations known to be immediately dangerous to life or health were included. The arrays were exposed to the chemicals for two minutes. Most of the chemicals were identified from the array color change in a number of seconds and almost 90 percent of them were detected within two minutes.

The laboratory studies used inexpensive flatbed scanners for imaging. The researchers have developed a fully functional prototype handheld device that uses inexpensive white LED illumination and an ordinary camera, which will make the whole process of scanning more sensitive, smaller, faster, and even less expensive. It will be similar to a card scanning device.

“One of the nice things about this technology is that it uses components that are readily available and relatively inexpensive,” said David Balshaw, Ph.D., a program administrator at the NIEHS. “Given the broad range of chemicals that can be detected and the high sensitivity of the array to those compounds, it appears that this device will be particularly useful in occupational settings.”

A postage stamp sized optical sensor array (small square silver colored device) for toxic gases and the sampled color changes associated with a few representative poison gases (chlorine, fluorine, hydrofluoric acid, hydrogen cyanide, B2H2, hydrazine, cobalt chloride, H2S, phosphine, ammonia, NO2, and sulphur dioxide).

The NIEHS supports research to understand the effects of the environment on human health and is part of NIH. For more information on environmental health topics, visit our Web site at http://www.niehs.nih.gov.

Tamiflu saves lives of severely ill flu patients

Roche AG’s antiviral drug Tamiflu helped prevent deaths from seasonal flu in severely ill patients who had chronic underlying health problems, Chinese researchers said on Sunday.

A study of 760 older, severely ill patients in Hong Kong found that Roche and Gilead Sciences Inc’s drug Tamiflu cut the rate of death by 37 percent.

More than 60 percent of patients in the study had underlying chronic illnesses, and 78 percent had been hospitalized with complications from seasonal flu.

The study, done by researchers at the Chinese University of Hong Kong and presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco, suggests the drug can help save the lives of seriously ill flu patients, Dr David Reddy, who leads Roche’s pandemic flu task force, said in a telephone briefing.

Known generically as oseltamivir, Tamiflu is one of two antiviral drugs that work well against H1N1 swine flu.

The study took place in two hospitals in Hong Kong between 2007 and 2008. About half the patients in the study got Tamiflu and half got no treatment. Death rates were about the same at both hospitals.

“In this study, Tamiflu improved the survival rate by reducing the rate of death by 37 percent in this high-risk group of patients with severe seasonal flu compared to no treatment,” Reddy said.

The U.S. Centers for Disease Control and Prevention is recommending that the very old and people with chronic medical conditions should be treated with antiviral drugs — either Tamiflu or GlaxoSmithKline and Biota’s Relenza — when they have flu-like symptoms.

Health officials caution against using either drug in otherwise healthy people who have moderate or mild flu symptoms, however, because of the fear of resistance. Influenza viruses very quickly change to put up a strong defense against antiviral drugs. Last year the seasonal H1N1 virus developed strong resistance to Tamiflu. Two older flu drugs, amantadine and rimantadine, now have very little effect against influenza viruses.

Health Tip: If You Smoke While Pregnant

If you smoke while pregnant, you’re exposing the baby to a host of dangerous chemicals, the American College of Obstetricians and Gynecologists says. And the nicotine in tobacco causes less oxygen and nutrients to reach the baby.

The ACOG says these problems are more likely to affect pregnant women who smoke:
-Ectopic pregnancy, where the fertilized egg begins to develop outside the uterus.
-Vaginal bleeding.
-Abnormalities in how the placenta attaches to the uterus.
-A stillbirth.
-A low-birthweight infant, born weighing less than 5.5 pounds.

Health Tip: Take Medications Safely

Many medications may seem harmless, but they can still cause harm if not taken correctly.

The University of Virginia Health System offers these suggestions to help prevent problems with medications:
-Understand that even vitamins, herbs, supplements and over-the-counter medications can have adverse effects if taken incorrectly.
-Always follow label instructions, paying particular attention to any warnings.
-Learn how other medications and foods may interact with a particular medicine.
-Don’t be afraid to ask questions of your doctor or pharmacist if your prescription changes or if you take a new medicine.
-Learn about any potential side effects of medications you take, and always call your doctor if you have any problems.
-Keep medications stored safely, and keep a record of all medications you take.
-Make sure all of your doctors have a complete list of your medications.

Study Shows 1% of Americans Have Been Infected With West Nile

One in every 100 Americans has been infected with the West Nile virus, whether they know it or not.

That number has grown steadily since the virus first appeared in North America in 1999, according to a study in the October issue of the journal Emerging Infectious Diseases.

Several West Nile vaccine trials are under way or are being planned, and these findings could not only help yield needed antibodies to the virus, they may help determine future vaccines’ effectiveness, said the study authors, from the U.S. Food and Drug Administration and Baxter Bioscience.

“It’s important to know this because we don’t test people routinely for West Nile virus,” said Dr. Maria Alcaide, an assistant professor of infectious diseases at the University of Miami Miller School of Medicine.

The majority of people — about 80 percent — who become infected with West Nile virus have no symptoms at all. Up to 20 percent may experience flu-like symptoms such as fever, headache and body aches or even nausea and vomiting. Only about one in 150 people will suffer severe illness, resulting in meningitis or encephalitis. People aged 50 and older are at higher risk for developing severe complications.

The authors of the study tested lots of blood donations for the presence of antibodies to the West Nile virus, then extrapolated this number to the general population. Each lot contained blood donations from thousands of individuals, making the testing process much more efficient.

“If you looked at each individual, you would have to do thousands of tests to find one infection,” Alcaide explained.

In 2003, about one half of 1 percent of the U.S. population had been infected with the virus. Today the number is approximately 1 percent, which corresponds well with other estimates, the study authors stated.

“As WNV [West Nile virus] infections often remain asymptomatic, the antibody levels in individual lots of IGIV [immune globulinintravenous], which are each derived from the plasma donations of thousands of healthy individuals, can also be an important public health tool to determine how many people have experienced past WNV infections from a very large sample size,” said study senior author Thomas Kreil, senior director of viral vaccines and global pathogen safety at Baxter Bioscience in Vienna, Austria.

“Also, the findings are important because they show that intravenous immunoglobulin contains antibodies to West Nile virus, possibly providing protection against WNV infection for patients who take IGIV, but this has not yet been shown in clinical studies,” he added.

The U.S. Centers for Disease Control and Prevention estimates that 3 million West Nile virus infections occurred between 1999 and 2008.

Despite its lowered visibility due to the new H1N1 swine flu, West Nile remains a public health threat. “It’s true that we haven’t talked about it as much, but it doesn’t mean it’s not going on,” Alcaide said.

West Nile virus is normally passed from an infected mosquito to a bird, and then from the bird to other mosquitoes. The mosquitoes then pass the virus on to humans. Infections tend to peak in the summer.

Health officials recommend removing any standing water where mosquitoes are likely to breed. People should also wear insect repellant and long-sleeved clothing whenever outside.

In addition to the standard DEET-containing products, the CDC also endorses mosquito-repellent products containing oil of lemon eucalyptus and Picaridin.

Antiviral Drugs Should Be Used Cautiously to Fight Flu, U.S. Says

Antiviral medications such as Tamiflu and Relenza, which are effective in treating the H1N1 swine flu, should be taken only by people hospitalized with the flu or those at high risk for complications from the disease, U.S. health officials said Tuesday.

Those at risk include people with underlying health conditions, such as asthma or diabetes, as well as the very young, the elderly, and pregnant women, officials said.

Because the H1N1 swine flu remains mild for the vast majority of people who get it, most people won’t need these medications at all, according to new guidelines for antiviral drug use issued by the U.S. Centers for Disease Control and Prevention.

“Antiviral medicines are a critical part of our tool kit in countering influenza, both the 2009 H1N1 influenza virus and seasonal flu strains,” Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases, said during an afternoon news conference.

But, Schuchat added, “most children, adolescents and adults who have influenza-like illness do not need antiviral medicine.”

One reason why: If too many people take antiviral medicines it could increase the risk that the virus would become resistant to these drugs, Schuchat said.

“We have seen a bit of antiviral resistance already with the 2009 H1N1 strain, and we hope this won’t take off,” she said. “A critical feature is to use these antivirals very carefully so they can have benefit and not lead to problems.”

Because most people who get the flu — whether H1N1 swine flu or seasonal flu — will not be tested to see what type of flu they have, the new guidelines are based on symptoms, not a particular flu strain, Schuchat said.

“A key point of the antiviral guidance is that hospitalized patients who are suspected to have influenza need prompt treatment with antiviral medicines,” she said. “That can be a very important way to reduce the severity of illness. We don’t want providers to wait until test results are available, but we want them to start antivirals when you suspect influenza.”

The new guidelines also recommend that, when high-risk people have been in contact with someone who has the H1N1 swine flu, doctors should wait to see if flu symptoms develop before starting treatment with antivirals.

“Instead of starting antivirals, we give providers an option we call ‘watchful waiting,’ and wait and see if fever develops,” Schuchat said. “And, when fever or respiratory problems develop, give antivirals then.”

Another key to the best use of antivirals in people at risk for complications is to start the drugs as soon as flu symptoms appear, Schuchat said.

She stressed, however, that the new guidelines leave room for judgment and discretion on the part of doctors. “Every patient is different, and we want clinicians to have that opportunity to customize care for each patient,” she said.

The recommendations include:
Treatment with antivirals is recommended for people at higher risk for complications. These include children younger than 5 years old, adults 65 and older, pregnant women, people with chronic medical or immunosuppressive conditions, such as patients on chemotherapy, and people younger than 19 years of age who are receiving long-term aspirin therapy.
Treatment should not wait for lab tests because testing can delay treatment and a negative rapid test for flu does not rule out influenza.
For some high-risk patients, doctors may choose to give them antiviral prescriptions that can be filled should symptoms appear.

Schuchat noted that cases of H1N1 swine flu — now the predominant flu strain in the United States — have already started to increase, especially in southeastern states. “The H1N1 flu never went away this summer,” she said. “It is not surprising that we are seeing this uptick in cases.”

The good news is that the H1N1 virus still hasn’t mutated into a more dangerous form, which means that the vaccine currently being tested should be a good match, she said.

Blood Test Narrows Down Need for Antibiotics

A simple blood test may be able to help doctors determine which patients need antibiotics and which do not.

A new study published in the Sept. 9 issue of the Journal of the American Medical Association found that use of the test resulted in less antibiotic use.

If the protocol winds up in widespread use, it could significantly cut down on side effects associated with antibiotic use, not to mention slowing the spread of “killer” bacteria which become stubbornly resistant to these medications.

“It certainly holds a lot of promise,” said Dr. Donald M. Yealy, co-author of an editorial accompanying the study and chair of emergency medicine at the University of Pittsburgh. “We need a way to make a better determination of need.”

Overzealous use of antibiotics is commonly acknowledged as the main factor driving microbial resistance worldwide.

“What’s not disputed is that antibiotics have changed health,” Yealy said. “But there’s also no doubt that they’re currently often overused.”

“I think this is very exciting,” said Dr. Ann Falsey, a professor of medicine at the University of Rochester Medical Center who specializes in infectious disease. “There’s been a great deal of antibiotic overuse, with a great number of adverse effects both to patients individually and to the global flora becoming more resistant. This is one tool that can help clinicians make better decisions.”

According to background information in the article, in the northwestern hemisphere antibiotics are most often prescribed for lower respiratory tract infections (LRTIs). LRTIs can mean anything from bronchitis, which is likely to go away on its own, to community-acquired pneumonia (CAP), which can be life-threatening.

Up to three-quarters of LRTI patients are treated with antibiotics, even though most of these infections are viral and don’t respond to antibiotics. There is some indication that the use of antibiotics has declined in children over the past 12 years, research released last month suggested.

This Swiss team randomly assigned almost 1,400 patients with LRTIs who came to emergency rooms at six hospitals to receive antibiotics based on results of a PCT test, or based on standard guidelines.

PCT stands for procalcitonin, a chemical found in the blood. The test was provided by BRAHMS Inc., which makes the test.

Patients in the PCT group were on antibiotics for shorter periods of time: 5.7 days vs. 8.7 days in the control group. The same pattern held true in the subgroups of patients with CAP (7.2 days in the PCT group vs. 10.7 days in the control group); those with chronic obstructive pulmonary disease (2.5 vs. 5.1 days); and those with acute bronchitis (1 day vs. almost 3 days). Fewer people in the PCT group had adverse events (19.8 percent vs. 28.1 percent).

But the test has a few hurdles to pass before it can be widely adopted, experts stated.

“It’s a nice initial clinical trial, but we need to see if it will change behavior,” Yealy said. “We also don’t know if this will apply to other settings.”

Most of the patients in this trial had pneumonia and many of them had severe pneumonia, a group which often does need antibiotics.

The bigger issue is use in less ill populations, said Yealy, who tells of a recent promotion by a local supermarket chain promising free generic antibiotics to people with prescriptions.

“There is pressure to increase antibiotic use,” he said.

“I’m cautiously optimistic,” said Dr. Lilian Abbo, an assistant professor of infectious diseases at the University of Miami Miller School of Medicine. “It’s unclear if we can extrapolate the findings. The study was conducted in Switzerland, it was an elderly population, and a high number had pneumonia. More studies are needed to interpret this and to incorporate it into practice.”

The test is available in the United States, but is not approved for this purpose, Yealy said.

“This was one specific manufacturer’s test,” Yealy noted. “It may not apply to others.”

Trio of Gene Variants Discovered That May Raise Alzheimer’s Risk

Two international teams of scientists have uncovered three gene variants that up the risk for Alzheimer’s disease, the most common form of dementia among the elderly and the seventh-leading cause of death in the United States.

Teams led by Dr. Philippe Amouyel of the Institut Pasteur de Lille in France, and Julie Williams, a professor of psychological medicine at Cardiff University School of Medicine in Wales, zeroed in on defects in the CLU, CR1 and PICALM genes, and also found another 13 gene variants that are solid candidates for further investigation, according to findings that appear in the Sept. 6 online issue of Nature Genetics. Until now, only four gene variants had previously been definitively associated with Alzheimer’s — APP, PS1, PS2 and APOE.

“Although the role of these two new genes [CLU and CR1] . . . is not yet known in detail, previous studies suggest that they may be involved in the elimination of the major component of amyloid plaques,” explained Amouyel, the leader of the team that studied the CLU and CR1 genes. “Genetic variants at CLU, CR1 and APOE may influence susceptibility to late-onset forms of the disease.”

According to Amouyel, one group of researchers carried out a two-stage analysis of genetic samples from more than 20,000 subjects. In parallel, Williams ran a similar study, discovering the PICALM gene mutations and independently discovering the CLU gene variants.

Most of the DNA samples came from France and other European countries, but U.S. labs contributed to Williams’ study as well, including the National Institute on Aging (NIA) Laboratory of Neurogenetics, the Mayo Clinic and the Washington University School of Medicine in St. Louis.

“This is the most important finding in the genetic [component] of Alzheimer’s in more than 10 years,” said study co-author Alison Goate, a professor of genetics in psychiatry at Washington University School of Medicine and a member of the Alzheimer’s Association Medical & Scientific Advisory Council.

Experts estimate that as many as 5.3 million Americans are living with Alzheimer’s disease, which progressively kills brain cells. Alzheimer’s typically attacks people over the age of 65. Symptoms include a range of cognitive, psychiatric and physical problems that eventually lead to death.

The sheer global impact of the illness and the lack of a cure were the driving forces behind the current research.

According to Amouyel, “the identification of these three genes has been possible, thanks to two major elements: first, the possibility to compare thousands of patients through a major collaboration between scientists; and second, the capacity to analyze genetic markers distributed all over the entire genome with high-tech tools, such as DNA chips.”

Relatively little is known about how the newly discovered genes may increase the risk of Alzheimer’s. But researchers have noted increased levels of CLU in the brains and cerebrospinal fluids of Alzheimer’s patients. PICALM may play a role in the health of nerve cell synapses and may affect beta-amyloid deposits in the brain.

Each of the new genes probably contributes about 8 percent to an individual’s risk of developing Alzheimer’s, Goate said. In addition to genetic factors, there are likely to be environmental and lifestyle variables that also contribute to the risk, she noted.

“Identifying gene variants like CLU and PICALM advances our understanding of the many genetic factors that may contribute to overall risk for this devastating neurological disorder,” Marcelle Morrison-Bogorad, associate director of NIA’s neuroscience and neuropsychology of aging program, said in a statement. “This knowledge may then lead to novel disease pathways that can be targeted to develop new treatments.”

In another genetic discovery reported in the same journal, Dutch researchers say they have found two new gene variants linked to amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. The variants appear to play a role in the neural pathways that are involved in this deadly disease, which involves the steady loss of neurons that results in muscle atrophy, paralysis and, finally, death.

Antioxidant pills do not prevent metabolic syndrome

People who want to forestall heart disease and diabetes may do better by choosing antioxidant-rich foods instead of antioxidant supplements, a new study suggests.

Researchers found that among more than 5,200 middle-aged adults, antioxidant supplements had no effect on the risk of developing metabolic syndrome over seven-plus years.

Metabolic syndrome refers to a collection of risk factors for type 2 diabetes, heart disease and stroke — including high blood pressure, abdominal obesity, low levels of “good” HDL cholesterol, elevated triglycerides and high blood sugar. The condition is diagnosed when a person has at least three of those risk factors.

The current findings, reported in the American Journal of Clinical Nutrition, suggest that taking antioxidants in capsule form may not thwart metabolic syndrome.

On the other hand, men and women who began the study with relatively high blood levels of certain antioxidants — particularly vitamin C and beta-carotene — were less likely than those with lower levels to develop metabolic syndrome.

The implication is that even though antioxidant supplements might not cut the risk of metabolic syndrome, antioxidant-rich foods just might, according to the researchers, led by Dr. Sebastien Czernichow of the French national research institute INSERM, in Paris.

Blood levels of vitamin C and beta-carotene are “rather good surrogate markers” of people’s fruit and vegetable intake, Czernichow told Reuters Health in an email.

“This reinforces the guidelines for an adequate intake of this food group and goes against the regular use of antioxidant pills,” he said.

The study included 5,220 adults with an average age of 49 who were randomly assigned to take either a mix of vitamins C and E, beta- carotene, selenium and zinc in capsule form or inactive placebo capsules.

After an average of 7.5 years, 263 study participants had been diagnosed with metabolic syndrome. There was no significant difference in risk between the supplement and placebo groups.

There were differences, though, when the researchers looked at participants’ antioxidant blood levels at the study’s outset. The one-third with the highest vitamin C levels had about half the risk of metabolic syndrome as those with the lowest levels.

Similarly, the third with the highest beta-carotene levels had only one-third of the risk of metabolic syndrome as those with the lowest beta-carotene concentrations.

In contrast, higher zinc levels in the blood were linked to an increased risk of metabolic syndrome. It’s not clear why this is, but the researchers speculate that high zinc levels might, in some people, reflect heavy consumption of red meat — one of the prime food sources of the mineral.

Good food sources of vitamin C include citrus fruits, strawberries and cantaloupe, and vegetables such as red peppers, broccoli and tomatoes.

Beta-carotene, which is converted in the body into vitamin A, is found in foods such as carrots and sweet potatoes, and leafy greens like spinach and kale.