Copyright © 2008 The Seattle Times Company

Copyright © 2008 The Seattle Times Company

Anticoagulant bleeding higher with antidepressants

Last Updated: 2008-02-01 17:05:43 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Among patients taking "coumarin" type anticoagulant drugs, treatment with a newer class of antidepressants called selective serotonin reuptake inhibitors (SSRI) - such as Prozac (paroxetine) and Zoloft (sertraline) -- increases the risk of serious bleeding, according to findings from a Dutch study.

Some but not all previous studies examining the effects of concurrent treatment with SSRI antidepressants and anticoagulants have indicated an increased bleeding risk, Dr. Tom Schalekamp and associates explain in the Archives of Internal Medicine.

To further explore the risk of combining treatment with these drugs, the research team at Utrecht University used a database containing medication histories for more than 2 million residents of the Netherlands beginning in 1985, linked to hospital admission records.

The researchers identified 1,848 patients who were hospitalized for hemorrhage while taking a coumarin-type drug -- either acenocoumarol or phenprocoumon -- with whom they matched 5,818 non-hospitalized subjects also taking a coumarin.

Use of SSRIs -- sertraline, paroxetine, fluoxetine, fluvoxamine, escitalopram or citalopram -- raised the risk of hospitalization due to bleeding outside the gastrointestinal tract, but had no effect on hospitalization due to bleeding within the tract.

The risk for non-gastrointestinal bleeding was on a par with that posed by combined treatment with NSAID drugs, like ibuprofen. However, unlike SSRIs, NSAIDs also raised the risk of gastrointestinal bleeding among coumarin users.

The investigators observed no increased risk of bleeding associated with the non-SSRI antidepressants nortriptyline and mirtazapine.

Following discontinuation of either SSRIs or NSAIDs, the risk of major non-gastrointestinal bleeding was immediately attenuated, the authors note.

"Given the limitations of our study, we cannot advise against concurrent use of SSRIs and coumarin anticoagulants," Schalekamp's group writes. "However, intensified monitoring of users of SSRIs seems justified."

One option to reduce risk of bleeding in patients treated with a coumarin is to use a different class of antidepressant when treatment for depression is necessary, they add.

SOURCE: Archives of Internal Medicine, January 28, 2008.

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Vitamin D deficiency tied to higher blood pressure

Last Updated: 2008-02-01 16:39:43 -0400 (Reuters Health)

By Joene Hendry

NEW YORK (Reuters Health) - Low blood concentrations of vitamin D may be associated with higher blood pressure in whites, indicating a risk of developing hypertension, or high blood that requires medical treatment, researchers report. However, this relationship was not noted among blacks.

"Though easily corrected by taking a vitamin D supplement or having causal sunlight exposure, vitamin D insufficiency is highly prevalent in the United States," Dr. Vin Tangpricha told Reuters Health.

Tangpricha and colleagues, all from Emory University School of Medicine in Atlanta, looked at the association between systolic blood pressure - the top number of the blood pressure reading representing the pressure during contraction of the heart muscle -- and vitamin D levels among 7,699 adults without high blood pressure. Forty-seven percent were male, 61 percent were white, and 39 percent were black.

The study population had participated in the third National Health and Examination Survey conducted from 1988 to 1994, which provides the most recent nationally representative data on vitamin D concentrations among U.S. adults, the investigators report in the American Journal of Clinical Nutrition.

Overall, 61 percent of whites and 92 percent of blacks had vitamin D deficiency. Most (63 percent) of the participants were 18 to 49 years old, and 37 percent were 50 years or older when systolic blood pressure and vitamin D measurements were obtained.

The investigators found that white participants with sufficient vitamin D levels had a 20-percent lower rise in age-associated systolic blood pressure compared with those with insufficient vitamin D levels. This relationship was not statistically significant in blacks.

"This paper does not provide direct evidence that vitamin D supplementation will lower blood pressure," Tangpricha cautions.

He and colleagues suggest that further research examine in more detail how vitamin D status affects blood pressure in black and white populations. Improved methods for detecting vitamin D deficiency are also necessary, they conclude.

SOURCE: American Journal of Clinical Nutrition, January 2008.

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Dermatologists Can Offer Top Tips To Help Keep Lips In Tip Top Shape

While winter's harsh, windy weather is often to blame for dry, cracked lips, sometimes the cause of lip irritation is harder to pinpoint. In fact, several types of foods, cosmetic products, medications or even bad habits have been linked to dry lips. The key is determining the source of the irritation and modifying your daily regimen to eliminate the problem.

Speaking at the 66th Annual Meeting of the American Academy of Dermatology, dermatologist Margaret E. Parsons, MD, FAAD, assistant clinical professor of dermatology at the University of California at Davis, discussed the most common causes of lip irritation, available treatments and preventative measures to keep lips healthy.

"When I treat a patient for dry lips, the first thing I try to determine is what this patient might be doing or not doing that could be contributing to the problem," said Dr. Parsons. "In some cases, it might be a new lipstick that contains an ingredient irritating to the skin or an anti-aging facial product that inadvertently comes in contact with the lips that could be the culprit. Or, someone might be working outdoors or participating in sports and not protecting their lips from wind and sun damage with a lip balm, especially one with sunscreen. Once we determine the cause, there are some simple, tried-and-true treatments that work well for most patients."

Mother Nature

Dr. Parsons noted that not only can winter's outdoor elements contribute to dry, cracked lips, but the conditions indoors during this season can play a role in irritating the lips. Heat used to warm the indoor temperature dries out the air and lowers the humidity level, which can lead to dry skin and lips. At the other end of the weather spectrum, the intense summer sun can lead to sunburned or sun-irritated lips.

"When working outdoors or engaging in sports, men and women should apply a lip balm with an SPF of 15 or higher year-round to protect their lips from sun damage," said Dr. Parsons. "By wearing lipstick particularly the products in recent years with sunscreen women have protected their lips better than men, which could explain why men have significantly more skin cancers on their lips than women."

Cosmetics

In some cases, products that you put on your lips lipsticks, lip balms or the newer lip plumpers, which are applied topically to make lips appear fuller can cause dry or irritated lips.

"Lip plumpers often contain chemicals used to intentionally irritate the lips and make them appear fuller, such as capsaicin (derived from chili peppers), mint, or menthol, among others," explained Dr. Parsons. "For some, this irritation is mild, causing a slight swelling and fuller appearance. For others, this irritation is significant and causes painful swelling and redness."

Dr. Parsons added that the ingredient phenol used in some of the traditional lip balms and other lip products can irritate and actually contribute to further drying out the lips. Even though phenol is used in low concentrations in lip products, it is the same chemical used in deep-penetrating facial peels that removes the top layer of skin.

Foods

Spicy foods, the acid found in citrus foods and even the cut edge of a mango peel (which contains the chemical toxicodendron found in poison ivy) can burn the lips and lead to dryness and irritation. In addition, people with nut allergies could react to lip products that contain nut-based products, such as shea butter.

Medications

Although many people might not suspect their medications to be the root of their lip problems, Dr. Parsons explained that patients who cannot attribute their dry or irritated lips to other common factors should take a close look at their medicine cabinet. For example, some oral acne medications, such as isotretinoin, can cause considerable lip dryness even though they do not come into direct contact with the lips. Products applied topically, such as acne medications containing benzoyl peroxide or retinoids and anti-aging products such as alpha-hydroxy acids or retinoids, could cause considerable lip dryness when they come into contact with the lip area. Vitamin E and aloe vera gel also can be irritating to many people with sensitive skin.

Similarly, patients with eczema or other skin conditions that make the skin more sensitive could be more susceptible to allergic reactions from lip products. Dr. Parsons advised patients with any underlying skin conditions or who regularly use medications to check with their dermatologist to determine if these are contributing factors to their lip problems.

"Lip Smacking"

Another cause of dry, chapped lips that is common in younger children is what dermatologists refer to as "lip-smacking." This habit, which can be hard to break the more the lips become irritated, can be formed when children are nervous about something, such as starting school. In particularly bothersome cases, a mild prescription product may be needed to accelerate the healing process.

Tips and Treatments

In most cases, applying petroleum jelly or a lip product containing petrolatum or mineral oil will soothe and heal irritated lips. Dr. Parsons also recommends the following tips to prevent lip irritations and to keep lips healthy and moisturized:

-- Opt for lip products, such as lipsticks or lip moisturizers, which contain sunscreen whenever possible to protect lips from harmful sun exposure.

-- Be smart about what you put on your lips. Avoid lip plumpers or other products that intentionally irritate lips to make them appear fuller, as the chemicals they contain can be irritating to some people.

-- Apply a petrolatum-based product at bedtime, which Dr. Parsons refers to as the perfect time for patients to "grease up" their lips.

-- Choose a simple product with few additives to minimize possible irritation.

-- See a dermatologist if lips are not getting better with simple at-home treatments or if new symptoms develop.

"Caring for your lips shouldn't be an after-thought," added Dr. Parsons. "By incorporating good lip care into your overall skin care regimen, you can maintain healthy lips, avoid some of the common sources of irritation and protect your lip area from possible skin cancers."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.

American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
United States
http://www.aad.org

Don't Let Hair Loss Tangle You Up: Dermatologists Can Identify Common Hair Disorders And Offer Solutions

Noticing a few extra hairs in your comb lately? Is your new hairstyle a result of trying to conceal areas of thinning hair rather than a fashion choice? Are you paying more attention to the multitude of advertisements promoting hair growth? If you answered yes to any of these questions, you might be one of the millions of people experiencing some form of hair loss. But to whom should you turn for help? The key to managing the condition is to consult a dermatologist, a physician trained in the diagnosis and treatment of all forms of hair loss.

Speaking at the 66th Annual Meeting of the American Academy of Dermatology, dermatologist Amy J. McMichael, MD, FAAD, associate professor of dermatology at Wake Forest School of Medicine in Winston-Salem, N.C., discussed the most common forms of hair loss, current treatment options and possible futuristic therapies.

"For both men and women, hair loss can be devastating and adversely affect one's overall quality of life," said Dr. McMichael. "As with most medical conditions, the key to controlling the hair loss cycle is to seek treatment early. The problem is that most people tend to ignore the first signs of hair loss or delay treatment, hoping that their hair will regrow on its own. Since there are many types and causes of hair loss, it is vital that patients seek a proper evaluation by a dermatologist at the first sign of a problem."

Androgenetic Alopecia (Pattern Hair Loss)

The most common form of hair loss, androgenetic alopecia (commonly referred to as male- or female-pattern hair loss) is a hereditary condition that affects men and women. In male-pattern hair loss, a receding hairline is common, as well as hair loss on top of the scalp. Women, on the other hand, typically maintain their frontal hairline but tend to have visible thinning over the front and top of the scalp. However, occasionally a man will experience female-pattern hair loss and a woman will show signs of male-pattern hair loss for reasons unknown to researchers.

A significant amount of research in male-pattern hair loss has identified the enzyme that can be blocked to stop the production of dihydrotestosterone (DHT), which is a byproduct of the male hormone testosterone that is linked to baldness in men. This research has led to the development of finasteride, the FDA-approved medication for treating male-pattern hair loss.

While the cause of female-pattern hair loss is not as clearly understood as male-pattern hair loss, Dr. McMichael discussed several treatment options that work well for many women. Currently, minoxidil 2 percent is the only FDA- approved treatment for female-pattern hair loss. Available over the counter in 2 percent and 5 percent solutions, minoxidil must be applied topically and works on hair follicles to reverse the shrinking process and stimulate new growth on the top of the scalp. Minoxidil also is FDA-approved for use by men.

"There are some cases where dermatologists will use other treatments off-label to treat hair loss in women, such as the anti-androgens spironolactone and flutamide that work by blocking the male hormone testosterone at the cellular level of the hair follicle," said Dr. McMichael. "Even higher doses of finasteride have been used in women to regrow hair. But it is important that women and especially younger women see their dermatologist for hair loss, especially if other symptoms such as acne or abnormal menstrual cycles also are present. In some cases, hair loss along with these other symptoms may indicate a more serious medical condition, such as a tumor or polycystic ovary disease."

Another proven technique for men and women looking to restore their hair is hair transplantation. Dr. McMichael noted that the technology involved in this surgical procedure has improved significantly over the years, with tiny hair grafts now being implanted through various new techniques to create a natural look that is virtually undetectable. However, Dr. McMichael cautioned that hair transplants are simply filling in lost hair and should still be used in conjunction with a topical or oral medical therapy to prevent further hair loss.

Recently, a new light treatment based on the technology of Low Level Laser Therapy (LLLT), also known as Laser PhotoTherapy, was approved by the FDA to regrow hair. This technology was developed after it was noted that some patients undergoing laser hair removal would experience increased hair growth in spots surrounding the treatment area. As such, the concept of scattering light to generate hair growth was born �" albeit with only a small percent of patients undergoing the light procedure actually growing more hair. However, Dr. McMichael believes more studies need to be done to validate its effectiveness. "Unfortunately, I don't think the new light therapy lives up to its promise of regrowing hair for most patients," said Dr. McMichael. "But as we gain a better understanding of this technology, it is possible that we can refine it to be more effective in the future."

Telogen Effluvium

Typically triggered by a event such as an illness, child birth, loss of a loved one or surgery telogen effluvium is a form of hair loss that occurs as a result of the body's natural physiologic response to a stressor. As a result, there is a sharp increase in the amount of hair that is shed. Dr. McMichael noted that patients might not link an event to their hair loss, since hair typically doesn't shed for about three months after a stressful event due to the slow hair loss cycle.

"In about 75 percent of patients experiencing hair shedding, we can link the cause to a past event," said Dr. McMichael.

While in most cases, hair will fully regrow on its own in a few months without any medical intervention, Dr. McMichael adds, "In other cases, iron deficiency, a thyroid problem or even improper nutrition may be the source of this type of hair loss, which is why it is important to see a dermatologist for proper diagnosis and treatment."

Alopecia Areata

Alopecia areata is an autoimmune condition in which the body makes antibodies to its own hair, causing patches of complete hair loss on the scalp or other parts of the body. Specifically, the white blood cells attack the hair follicles and put them in a sleeping state, causing the hair to fall out. While it cannot be predicted who will develop alopecia areata, the condition is thought to have some component that is a genetically inherited. Patients with another autoimmune disease or a family history of a known autoimmune disease seem to be prone to this form of hair loss.

Despite the lack of FDA-approved treatments for alopecia areata, Dr. McMichael said that dermatologists may use combination therapies off-label such as injectable steroids, topical steroids or minoxidil 5 percent to regrow hair in affected areas. In limited cases, potent oral corticosteroids can be used to slow hair loss and jumpstart hair regrowth.

In addition, dermatologists use two other forms of treatment to restore hair growth which involve the deliberate manipulation of the body's white blood cells. In irritant treatment, dermatologists trick the immune system into sending white blood cells to the scalp to get in the way of those white blood cells that are trying to cause hair loss. In contact sensitization, dermatologists apply irritants to the scalp to create a small allergic reaction. When this happens, white blood cells are again tricked into rising to the surface of the scalp to fight this inflammation in essence diverting their attention away from the hair follicles.

Central Centrifugal Scarring Alopecia

A common form of hair loss that affects mostly African-American women is known as central centrifugal scarring alopecia. This type of hair loss is characterized by hair loss on the top of the scalp and is commonly accompanied by hair loss in the area in front of the ears, which is called traction hair loss. In Dr. McMichael's practice, the African-American patients she treats for this condition are between 25 and 65 years of age. Many patients delay treatment for this condition as they think their hair loss will be temporary and not a sign of a more serious and potentially permanent condition. Unfortunately, this delay in treatment can lead to progressive hair loss that, in some cases, is irreversible.

"Even though we are seeing more and more cases of central centrifugal scarring alopecia in our practices, there are very few published studies on the condition and its treatment," said Dr. McMichael. "Once diagnosed, we can use anti-inflammatory medications, such as steroids and oral antibiotics, to reduce the inflammation. Topical minoxidil also works in some cases to stimulate hair growth in unscarred hair follicles."

Dr. McMichael added that she expects more novel therapies to be used in the future to reverse or prevent hair loss, which may include alternative medicines, nutritional supplements and new combination therapies.

"There is interesting cellular biology research taking place throughout the world in which researchers are figuring out how to grow human hair cells in a lab so they can be produced from one or two cells and transplanted into patients," said Dr. McMichael. "In the meantime, we have many effective treatments that we can use once a patient's hair loss is properly diagnosed."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.

American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
United States
http://www.aad.org

Tackling Triglycerides: 8 Ways To Solve A Big Fat Problem

When it comes to heart health, the largest and most common form of fat in food and the bloodstream triglycerides has taken a back seat to "bad" LDL cholesterol and "good" HDL cholesterol in the public's awareness. That's changing as researchers get a grip on how triglycerides influence the risk of heart disease, reports the February 2008 issue of the Harvard Heart Letter.

Triglycerides are in the danger zone when they slide above 200 milligrams per deciliter of blood. To keep triglycerides in check, lifestyle changes are usually the best place to start, notes the Harvard Heart Letter. These eight steps can lead to impressive reductions in triglycerides:

1. Beware of bad fats. Cut back on saturated fat (found in red meat and full-fat dairy foods) and trans fat (in some fried and commercially prepared foods).

2. Go for good carbs. Eat whole grains and cut back on sugary drinks and foods.

3. Check your alcohol. Moderate drinking is good for the heart, unless you are a "responder" in whom alcohol dramatically boosts triglycerides. To determine if you're a responder, avoid alcohol for three weeks and have your triglycerides tested.

4. Go fish. Omega-3 fats in some fish lower triglycerides. Have fish twice a week.

5. Aim for a healthy weight. If you are overweight, aim to lose at least 5% to 10% of your weight to lower triglycerides.

6. Get moving. Exercise lowers triglycerides and boosts HDL.

7. Stop smoking. Smoking isn't good for triglyceride levels (or anything else).

8. Get help from a medication. Niacin, fibrates, fish oil, and cholesterol-lowering statins have all been shown to lower triglycerides.

Harvard Heart Letter
Harvard Health Publications Harvard Medical School 10 Shattuck St., Ste. 612
Cambridge, MA 02115
United States
http://www.health.harvard.edu

Laser Surgery Damage Is More Than Skin Deep, UK

As more and more laser treatment horror stories hit the headlines, consultant surgeon Brian Newman urges people to consider their options before undergoing laser cosmetic surgery.

BBC newsreader Kate Silverton is the latest of a long line of people who have suffered at the hands of laser treatment and endured facial scars as a result of the technique.

Newman, who has clinics in Harley Street, Greater Manchester and Glasgow, has pioneered an alternative thermocoagulation technique to treat thread veins and rosacea which leaves no scarring and sees outstanding results.

Having trained 300 surgeons across the globe in this groundbreaking technique, Dr Newman views laser surgery, particularly for veins on the face and legs, as an outdated and often damaging option for people with these problems. Indeed, he claims more than 70 per cent of his clients come to him as a result of failed laser treatment.

Commenting on the issue, Newman said: "It's outrageous people should suffer with the after effects of laser treatment such as scarring, as well as the significant down time post- treatment when they have paid considerable sums and sought professional medical help. It's an unnecessary stress to endure when there are non-invasive alternatives out there which have outstanding results.

"I've been a consultant surgeon for 30 years and am surprised laser treatment is still widely used as we've come a long way since then in medical technology particularly in the treatment of veins. People need to be educated before they commit to life changing surgery as the impact is not only about aesthetics, it is a deeply emotional one."

Thermocoagulation is a pain-free, non-invasive treatment used by Dr Newman and his team of surgeons. Microwave technology is used in the process to penetrate tissue and eradicate thread veins and facial redness with immediate results. There is no risk of scaring or pigment changes, but most importantly patients can walk-in and walk-out with no risk of bruising or severe redness often seen after some laser treatments. The treatment is completely safe with virtually no immediate side effects.

Dr Newman has treated thousands of patients using this technology and ensures each patient has their own video case record - a much more advanced means of capturing the success of treatment and guaranteeing no risk of skin damage.

http://www.drnewmansclinic.co.uk

How To Really Talk To Your Therapist: Four Collaborative Steps

People who go into therapy frequently report good experiences where the patient feels understood and well-supported by the therapist, who uses his or her therapeutic skills to facilitate a discovery and healing process.

But what if your therapy frustrates you? What if your therapist is off base and you don't seem to be making progress? What happens if you can't communicate with your therapist?

Here are several tips for getting more out of your therapy by learning how to REALLY communicate with your therapist.

Take ownership of your therapy

It's tempting to believe your therapist has all the answers, and it may seem easiest to let the therapist make all decisions about treatment. You might even feel afraid of asking questions or discussing concerns about your therapy.

Remember that therapists are human beings and have the same flaws as the rest of us. Therapy is a subjective process, and the therapist can only give his or her own subjectively colored opinion, which has been shaped by his training and life experiences. That viewpoint may not always be the right one for you.

As the "consumer" in the therapy partnership, it's your responsibility to look after your best interests and to be an active participant in your therapy. If something isn't working, it's up to you to talk about it with your therapist. The message is clear: Take your therapist off the pedestal and take ownership of your therapy.

Plan out what to say in advance

As an active partner in your own therapy, you may need to express concerns, ask questions, or even give your therapist negative feedback about how you believe the therapy is going. Confronting your therapist with your concerns may be difficult, but it can be made easier if you plan out what you want to say.

Before talking to your therapist, take a few minutes to organize your thoughts. Write down your concerns, the specific changes you want to request, and any questions you want to ask. Next, review what you've written with an eye for how you are planning to express yourself. If your tone or words are accusatory, it may be difficult to have a productive conversation with the therapist.

A useful way to phrase your statements is with "I" language, such as "I feel confused" or "I see things this way." You will want to make it clear that you are not necessarily putting the therapist in the wrong; you are simply talking about how therapy is working or not working, from your perspective. "I" language feels much less confrontational than outright criticism, and keeps the door open for discussion and negotiation without the other person becoming defensive.

For example, you might say, "I feel like my therapy isn't going very well and I'm not sure we're on the same page; can we talk about that today?" This is more likely to set a positive tone than, "This just isn't working because you don't understand me!"

Keep your wits about you

After you've planned out what you want to say, it's time to have the conversation with your therapist. You should try to remain as calm as possible. You will, of course, have strong emotions, but letting your emotions take over will prevent you from having a constructive discussion.

Keep in mind that you and your therapist are on the same team. More than anything else, you both want to work to help you achieve your personal goals. Unless something is very wrong, your therapist is not likely to be "against you."

Enlist a third party to consult with you and your therapist

If the therapist stands firm in his recommendations for your therapy, and you still do not agree, what can you do? Your first reaction might be to find a new therapist. While this could be the right decision, there is another option you may want to try first: getting another opinion. You and your therapist could decide to invite another therapist to join you as a consultant.

The consultant in this situation works collaboratively with you and your therapist to provide a fresh perspective, allowing you to move beyond your communication impasse to a direction you can both endorse. Once his job is completed, the consultant removes himself and the therapy pair goes back to "business as usual".

You and your therapist have already invested your time and energy into the process and you are both committed to the same goal: helping you achieve your objectives for emotional growth and healing. If and when a difference of opinion does occur, rather than giving up and walking away, it is usually well worth the effort to try a collaborative solution first.

Good therapists usually welcome a patient's active involvement in his or her therapy. Seasoned therapists are aware of the extent to which their observations reflect opinion rather than fact. Therefore, they tend to be delighted by the possibility of finding creative solutions to therapy impasses, generated together with the patient.

If, as a patient, you don't find yourself encountering this kind of openness, and your attempts to encourage your therapist to take you seriously fall on deaf ears, then it may be time to find a new therapist who can better support you in your goals.

Steven Frankel M.D., a Distinguished Fellow of the American Psychiatric Association, is a graduate of Yale University Medical School. He is certified by the American Board of Psychiatry and Neurology in both general and child psychiatry as well as by the American Psychoanalytic Association. He is an Associate Clinical Professor at the University of California Medical School. He is the founder and director of The Center for Collaborative Psychology and Psychiatry in Kentfield, CA. His ideas are developed in his many professional papers and three books, Intricate Engagements, Hidden Faults, and his latest work: Making Psychotherapy Work: Collaborating Effectively with Your Patient.

http://www.collaborativepsychology.com

One-A-Day Eye Vitamin For Age Related Macular Degeneration

For the 76 million baby boomers born in the U.S. between 1946 and 1964, the fear of facing permanent vision loss due to Age-Related Macular Degeneration (AMD) is very real. AMD is the leading cause of irreversible blindness in the U.S. for people over the age of 55.

The National Eye Institute (NEI) reports that high doses of antioxidants slow the progression of AMD or may even prevent it altogether. According to the NEI-supported Age-Related Eye Disease Study (AREDS) conducted over a 10 year period, high dose antioxidant and zinc taken by mouth by those at risk for developing advanced AMD reduce the risk of progression by 25% and the risk of moderate vision loss by 19%.

In a 2006 Study (MERG) an Alabama company, Macular Health LLC, developed a breakthrough one-a-day eye vitamin at the University of Alabama Callahan Eye Foundation Hospital in Birmingham, Alabama. The Macular Health vitamin showed a 16% improvement in macular function after taking it for only 12 weeks and many of the patients in the study regained as much as 1-3 lines on the eye chart (see attached support documentation for additional details).

In November 2006, the American Academy of Ophthalmology recognized this study as the first documenting improvement in eye health in patients with AMD using new testing technology.. The MERG (Multi-Focal Electro-Retinogram) was used to gauge the overall health of the Macula before and after using the Macular Health Eye Vitamin.

"I believe Macular Health is the best product available. This is the first time in my career I've seen patients with better vision," says John O. Mason, III, M.D. a Birmingham, Alabama eye surgeon and professor of ophthalmology who has been treating AMD patients for more than 14 years.

"We followed the guidelines of the AREDS study, which was published in 2001, but also added ingredients not available during that time such as Lutein, Bilberry and Zeaxanthin. We were able to put it all in a small pill that is to be taken once a day which is much easier for seniors who are already taking handfuls of pills every day," stated Macular Health LLC CEO and President, Jeffery McAnnally.

AMD patient Mr. Dill comments since starting the Macular Health eye vitamin, he has regained some of his lost vision. Mrs. Dill stated, "We've been so impressed with the results of the Macular Health eye vitamin that I made copies of the information and have been distributing it to all of our friends and relatives." Another AMD patient Barney Headley states, "I would highly recommend Macular Health to anyone who has AMD. It has been nothing short of a miracle and I can now see to read small print and also drive my car again".

CEO and President Jeffery McAnnally developed Macular Health LLC in 2003, with the help of an ophthalmologist who has a family history of AMD. Macular Health is now being sold throughout the United States and is a leader in the ophthalmic nutri-ceutical industry. For additional information visit http://www.MacularHealth.com.

-- Who should take combination vitamins and zinc? National Eye Institute
-- AREDS - Age-Related Eye Disease Study--Results

http://www.MacularHealth.com

Researchers Seek To Deny HIV Its Safe Havens In The Human Body

A drug already used to treat parasitic infections, and once looked at for cancer, also attacks the human immunodeficiency virus (HIV) in a new and powerful way, according to research published online in the open access journal Retrovirology.

Past research has established that HIV has "learned" to hide out in certain human cells where it is safe from the body's counterattack, cells that come to serve as viral reservoirs. Operating from these havens, the virus slowly builds its numbers over more than a decade until it finally becomes capable of dismantling human immune defenses. In the end stages, this process leaves patients vulnerable to the opportunistic infections of AIDS. The newly published work explains for the first time how the virus makes chemical changes that keep its chosen reservoirs alive long past their normal lifespan. The new study also provides the first evidence that an existing ant-parasite drug can reverse this deadly longevity.

"AIDS continues to take nearly 3 million lives worldwide each year, and novel treatment approaches are urgently needed," said Baek Kim, Ph.D., associate professor in the Department of Microbiology & Immunology at the University of Rochester Medical Center. "We think our results are profound because, in discovering exactly how HIV hides in the body, we think we have learned how to take away its hiding places. Without them, the virus would have a much harder time causing disease," said Kim, lead author of the new study.

Secret to Long Life

Cell division is a process central to life. A parent cell divides into two cells, each containing copies of the same genes. This enables a single-cell human embryo to divide and grow into the vast number of cells that make up the human body. Different cell types divide at various speeds. T cells, for example, sense foreign organisms have invaded the body, and quickly divide and grow into a large, specifically designed army to attack the invader. Macrophages, on the other hand, are designed to roam the body engulfing and digesting dead tissue and bacteria. To assume this special role, they give up the ability to divide.

Unlike most viruses in its family, HIV has the ability to infect both non-dividing macrophages and rapidly dividing T cells, a key to its deadliness. Given its choice, HIV would prefer to infect rapidly dividing T cells, because with each division comes another opportunity for the virus to copy itself using the T cells' genetic machinery. On the other hand, T cells sense they are infected and quickly commit suicide, taking out the virus as well. So quickly do T cells self-destruct that the virus would lose its battle with the human immune system if it did not have long-lived macrophages to hide in during the early years of infection, Kim said.

Many cells can "choose" to die when they sense cancer-causing flaws in their own genes, or when they are being used as a virus factory. Certain biochemical pathways call for cell suicide and others postpone it, with the two forces counterpoised to control lifespan. Cancer and AIDS result in part from problems in these pathways.

Past studies found that HIV-infected macrophages can serve as viral reservoirs because some unknown factor extends their lifespan. In the brain, for example, macrophages secrete toxins produced by the virus they carry, including the transactivator (tat) protein, which causes nearby nerve cells to commit suicide. When enough nerve cells die, patients gradually lose memory, speaking ability and decision-making skills despite the best available treatment. Presumably, such toxicity should cause brain macrophages to self-destruct as well, but that is not the case. Macrophages live on, and no one had known why until the publication of two papers by Kim's team, one in January 2008 and the other in January 2007.

The earlier paper reported that macrophages infected with HIV live abnormally long, and that the long life may be related to the presence of the HIV protein tat. In the current study, researchers found the exact mechanism by which HIV turns on a series of cell survival signals in human macrophages: tat-related manipulation of the PI3K/Akt kinase pathway. Phosphatidylinositol 3 kinases (PI3K) are enzymes that turn on another enzyme, Akt, to prevent cell suicide and extend cell lifespan. Akt has been implicated in cancer, where cells live too long.

Kim's team discovered that a molecule called PTEN (phosphatase and tensin homologue deleted on chromosome 10) normally interferes with Akt signaling, and thus, limits cell lifespan. That is unless something interferes with PTEN. In a series of experiments, Kim's team observed that the presence of HIV tat in infected macrophages lowers PTEN levels by 40 percent, enabling the PI3K/Akt pathway to kick back on and keep macrophages alive. The study also found that an existing drug, miltefosine (Impavido®), inhibits PI3K/Akt pathway, and thus, promises to counter the effect of HIV tat on PTEN, Kim said. The treatment was first identified in Germany in the early 1980s as a potential treatment for breast cancer, but is used today to treat a common, parasitic infection called leishmaniasis.

Furthermore, researchers found that HIV-infected macrophages survive longer only when exposed to stress (e.g. toxins secreted by the virus infecting them). Most cells are expendable, and are ordered to self-destruct if exposed to enough stress. The PI3K/Akt pathway, however, kicks on when cells are designed to survive despite surrounding toxicity (e.g. immune cells). Thus, the toxic environment created by HIV ensures the long-term production of HIV within long-lived macrophage reservoirs.

The current study was conducted jointly by the Medical Center and the University of Utah School of Medicine. Along with Kim, joining the effort in Rochester were Pauline Chugh, Birgit Bradel-Tretheway, Sanjay B. Maggirwar and Stephen Dewhurst. Carlos Maximiliano and Vicente Planelles led the effort in Utah. Retrovirology publishes peer-reviewed, high-impact articles on basic retrovirus research. The journal is edited by Kuan-Teh Jeang, M.D., Ph.D., head of the Molecular Virology Section at the National Institute of Allergy and Infectious Diseases, with the help of a respected editorial board, and has an impact factor of 4.32.

"Miltefosine puts an end to the long lives of HIV-infected macrophages," Kim said. "The fact that it is already used in humans could accelerate the process of seeking government approval for a new, anti-HIV use for miltefosine, or something like it. In the next phase, we will conduct studies seeking to show that Akt inhibition ends the survival of HIV-infected macrophage reservoirs under real-life conditions."

Source: Greg Williams
University of Rochester Medical Center

Chimp virus vaccine 'could wipe out malaria'

By FIONA MACRAE

A vaccine that could eradicate malaria has reached the stage of human trials.

The jab is based on a virus which causes colds and stomach trouble in chimpanzees but does not harm humans.

So far, it has triggered an immune response against the malaria parasite in everyone tested by the Oxford University researchers.

In contrast, previous jabs made by the team have had a success rate of just 40 per cent.

Malaria claims one life every 30 seconds, or more than a million a year. Around 2,000 Britons catch it each year while on holiday abroad and around ten die.

Attempts to produce a vaccine have been hampered because the malaria parasite spends much of its life hiding inside the liver - where it cannot be reached by the anti-bodies most jabs rely on to fight infection.

But the new vaccine harnesses the power of other immune system weapons called killer T cells, which can enter the liver. The jab is comprised of a mild form of the chimp virus, which stimulates the production of T cells.

It also carries malaria genes - meaning that the T cells produced are programmed to attack the parasite.

Researcher Dr Sarah Gilbert said: "We're very excited by the results. If the vaccine works really well and is used in combination with drugs and methods like bed nets, malaria could be eradicated."

The researchers, who are funded by the Wellcome Trust, are part-way through trials on 32 volunteers.

Their work has shown that the vaccine causes few side-effects other than the occasional sore arm.

Further trials, in which volunteers will actually be infected with malaria to show the jab works, are planned for this summer, with large-scale trials in Africa to follow.

If effective, it is likely the jab will be combined with a second vaccine which fights the parasite after it leaves the liver for the bloodstream, where it quickly multiplies.

Lead researcher Professor Adrian Hill said: "Few people think you can get a really strong protection from malaria based on a single component."

The vaccine, which is around five years from the market, fights the most deadly form of malaria.

However, the same technique could potentially be used to create vaccines against other strains of the parasite, as well as other hard-to-beat infections such as TB and HIV.

Dr Colin Sutherland, a malaria expert from the London School of Hygiene and Tropical Medicine, said that even if the vaccine is not completely effective it could cut the severity of illness.

But he warned that malaria is more complex than any illness already controlled by vaccination, and that eradication could take up to 40 years.

Why tackling that itch feels so good: Scratching helps to block unpleasant thoughts

Doctors have put their finger on why it feels so good to scratch an itch.

Scans reveal that scratching numbs part of the brain linked to unpleasant thoughts and memories.

It also raises activity in brain regions related to compulsion - perhaps explaining why we sometimes can't help but scratch and scratch.

Understanding how the process works could lead to better treatments for severe itching, including eczema, which affects up to six million Britons.

The U.S. researchers used a hi-tech version of the MRI scanners used every day in British hospitals to shed light on how scratching affects the brain.

Doctors from Wake Forest University in North Carolina repeatedly used a small brush to scratch the legs of 13 healthy volunteers.

Scans showed that the parts of the brain linked to bad emotions and memories became much less active during the scratching.

Dermatologist Dr Gil Yosipovitch said: "We know scratching is pleasurable, but we haven't known why. It's possible that scratching may suppress the emotional components of itch and bring about its relief."

The imaging studies also showed that some areas of the brain were made more active by the scratching, including a region is associated with compulsive behaviour.

"This could explain the compulsion to continue scratching," said Dr Yosipovitch, whose research is reported in the Journal of Investigative Dermatology.

"It's important to understand the mechanism of relief so we can develop more effective treatments.

"For some people, itch is a chronic condition that affects overall health."

The U.S. research follows the British discovery last month of a rogue gene that causes itchy skin.

Apart from eczema sufferers, likely beneficiaries of new treatments include diabetics and liver patients, who are often plagued by the urge to scratch.

Webchat: Jane Clarke answers your questions

Britain's leading nutritionist Jane Clarke joined us for an exclusive webchat to answer all your dietary dilemmas. This time she tackled home baking, dieting after Christmas and how to reduce bloating...

Admin: Welcome to this afternoon's webchat with Jane Clarke. Jane will be here answering your questions for the next hour. Jane's replies cannot apply to individual cases and should be taken in a general context. Contact your GP with any health problems.

Admin: Hello Jane, thanks for joining us today.
Jane: It's good to be here - what is particularly exciting is I'm writing on my computer from home - so very remote technology!

Sharon: Hi Jane. I am aware that cakes, biscuits and pastries are not especially good for you and they are always the things to cut out when trying to eat healthily and lose weight. However does it make any difference if they are home baked from scratch, using wholemeal flour whenever possible, as they are not full of the additives and preservatives of commercially produced products? Also how can you work out the calories in for example in a Victoria sponge?
Jane: It makes a big difference to make your own. The main reason being that you can choose the type of fat you use, so there won't be (assuming you're using butter or a non-hydrogenated fat containing spread) any nasties is such as trans fats, which as you point out aren't good for us.
Jane: You can also choose wholemeal flour-I tend to use a combination of wholemeal and white in baking cakes by the way as 100 per cent wholemeal does tend to make a cake a little heavier, so I like to use about 50 per cent white too.
Jane: Obviously using wholemeal flour gives you more fibre and you too can use less sugar than some of the ready made ones - lastly there won't be any additives or preservatives in your home made ones. As to where to find the calories of certain foods, look to websites such as weightwatchers, the supermarket websites, such as Sainsbury's also I think have some useful calorie counters.

Faye: What would you suggest for easy lunches to prepare for eating at work that'll help pick me up for the afternoon? I don't eat meat.
Jane: ish is a good starting point and tinned fish can work well with the purse too. The advantage of a tinned fish such as salmon or sardines (which I know they can be a little strong smelling), is they're so good for you, since they're rich in omega 3 fatty acids. You can then put them with crackers such as ryvita or oat cakes, with slices of tomato, cucumber, and a salad. People do tend to find that if they eat a lunch which contains some protein rich food, such as eggs, seafood, tofu, etc that they tend to be less sleep-inducing than a big heavy sandwich or jacket potato.
Jane: Women need to be aware that you only want to eat 2 portions of oily fish a week. Men can have up to four, but since we have some concerns about the build up of toxins in the body from these oily fish, we safeguard any future babies by suggesting women of child bearing age just stick to two, 140g portions a week.

Sarah: Dear Jane, I have to take aspirin daily and would like to take cod liver oil to help with osteoarthritis but am concerned that this may have the effect of thinning the blood too much. Would cod liver oil have this effect or is there a safer alternative supplement or anti-inflammatory diet I could try? Thank you.
Jane: I would double check with your doctor, but I have never come across people taking aspirin being told to stay away from cod liver oil. But this is only one way to have an anti-inflamatory effect to help counteract your arthritis. Do look up the daily mail site and search for articles I've written on this.

Naomi: I am a 28 year old woman who has been diagnosed with PCOS. After seeing the hospital consultant and two GPs regarding manging symptoms the only thing they will recommend is losing weight. Because one of the problems associated with PCOS is the inability to maintain weight loss, are there any recommendations you have for making this easier whilst maintaining a high paced and busy lifestyle?
Jane: The link between PCOS and eating/diet means that eating a diet which reduces the amount of insulin your body produces can reduce yuor PCOS symptoms and also your weight.
Jane: The way you need to eat is based around a diet which is low GI-for info about this, like the last question, look up articles I've written on this, but essentially it means that you stick to lean proteins, fresh fruits vegetables, wholegrains etc and avoid the rapidly absorbed sugars.
Jane: I have seen so much success with women suffering from PCOS - it's very worthwhile, however hard and slow the weight loss may be, to keep persevering with eating and exercising well. Good luck!

I: I have increased the amount of water I drink, this mostly being Perrier water. Is this okay?
Jane: This should be absolutely fine - it's a nice water, I like it, but equally, to save money too, nutritionally, there is nothing wrong with water from your tap - although it doesn't have the bubbles.
Jane: Some of the other bottled waters can be somewhat too high in salt for my liking, which can have an impact on blood pressure etc, but check out an article I wrote about this, on the Daily Mail website.

Kym: I've piled on the pounds after Christmas Jane, help me fill this void in my stomach from eating too many mince pies. Every time I mention the D word my stomach starts rumbling.
Jane: Check out www.dailymail.co.uk/vitality - although they called it a diet, it is so NOT a deprivation based plan - it's full of gorgeous appetising ingredients, meals, that should get you off your starting block. Even if every recipe doesn't tempt you, choose the ones which do, and take the plunge and start tomorrow. Keep in touch and let me know how you're doing.

Anon: Hi I have started a new eating programmed for bulimics, I find an organised eating pattern has helped. I eat at regulalr times and whatever I fancy to take the focus off my weight. BUT I am gaining weight. I know I shouldn't worry about my weight as I was very slim but now I am the higher end of the BMI. I want to focuse on beauty foods rather than slimming foods to motivate me to choose something other than chocolate as a snack.
Jane: Like the question before I would look out my Vitality diet from last year for some ideas, as these included lots of antiageing beautifying ingredients, such as the vitamin C rich fruits and vegetables, which can help improve skin.
Jane: Other than the vitamin C rich foods, you should also think about incorporating nuts, chicken, lean red meat into your day as these are rich in zinc, another good skin boosting nutrient and as long as you're careful with the quantities of nuts, you should still be able to stay within the weight range you need to be at.
Jane: I do see patients in my practice with this problem, so if you felt you needed some more support/advice, then do check out my website www.janeclarke.com for more details, as with your history of an eating disorder, this might be helpful.

I: I love cakes and biscuits, however I started eating healthily and have one biscuit with my tea at night - will a regular biscuit do or should I choose one of the diet ones, if so which brand do you recommend? Thank you
Jane: The disadvantages of the diet brands fall into a few categories for me. The first being that sometimes low fat ones have more sugar and therefore more calories than the normal ones. Secondly, they're called diet biscuits, so you can feel slightly miffed and fed up with eating something you would rather have not eaten, which makes you far more likely to want to eat something else afterwards.
Jane: Thirdly they can be high on the additives, salt, etc and I really do think that one proper, delicious biscuit is better than a diet brand, so I would stick to what you fancy and stick to the one - which isn't always easy - will power is needed big time!

Lindylou: How do I avoid a bloating stomach?
Jane: The first thing is to keep a food diary, alongside noting how your stomach is, ie flat or bloated, as you then after say a couple of weeks could see if you have any foods specifically which don't suit you.
Jane: I would look at your speed of eating too, as eating too quickly, means that you swallow lots of air, which can bloat you. Also look at cutting out fizzy drinks.
Jane: Eating too much of any one type of food, such as bread could make you bloated, so try to keep a balance with your diet, so that you're not overly relying on one type of food.
Jane: You could think too about replenishing your gut with some good probiotic bactetia - such as acidophillus and bifidus, check on previous articles I've written about this, as this will help.

Dal: My 2 1/2 year-old daughter has had a reoccurring cold, cough, high temperature and ear infection, one after each other that lasts for days, this winter. Her diet is full of fruit and vegetables, and the whole family eat healthily. What else can I do to prevent her feeling so rotten, without reaching for the antibiotics? And when does the immune system start working? Thanks in advance.
Jane: The immune system starts working from day one - she has been fighting bugs ever since she was born - what she is now experiencing is an immune sytem which is struggling to fight the amount of bugs coming her way.
Jane: It is by the way par for the course as miserable as it is for her immune system to be challenged like this, as this is how she builds up a stronger immune system in the long run. But it's miserable seeing them suffer. Perhaps you should check out my new book Yummy Baby, published by Mitchel Beazley for ideas about boosting her immune response - including using honey and other remedies.

Robyn: Dear Jane, I read your comments regarding food combining with interest. I suffer from IBS and have worked through trial and error to find ways of managing it over a period of years; mainly exercise and lots of vegetables. However, I still frequently suffer bloating in the afternoon and also (sometime awful!) gas. Sometimes my gastric discomfort keeps me awake at night. Is there anyway to find out what foods (or combinations) could be triggering this discomfort? I have tried elimination diets excluding dairy and wheat and neither had significant effect. I look for patterns but nothing is apparent.
Jane: Have you tried eating more cooked vegetables and fruit and watching the raw, as sometimes this can make a difference? I presume you keep a detailed food and symptom diary, if not, then start as this can take the pressure off trying to remember what you've eaten etc.
Jane: Do look up previous articles, but you too may like to try something soothing gut wise, like drinkiing aloe vera juice. It doesn't taste that great but it can really work.

Nastaran: I'm having difficultly in losing excess fat around the lower regions of my body (bum and thighs), whenever I limit my food in take in terms of carbohydrates and exercise intensively, I always lose weight from my upper body, my chest and arms, often making me look annorexic, from a nutritional perspective is there anything I can do to target these areas?
Jane: I'm afraid that all the diets which suggest that you can target areas, are completely misleading you - you can't. Your body has an annoying habbit of taking it from wherever it fancies and you can't change this.
Jane: The only thing you can do is exercise to build up the muscles to pull those areas you want to shrink, in.

lulu: I really love seeded bagels, are they fattening? I like having one of those massive ones you get from the well known supermarkets...they seem to fill me up but I wonder if they're contributing to my weight gain?
Jane: Any massive portion can lead to weight gain - so even though there is nothing wrong with bread per se, quantiy has an impact. If you love the massive ones, cut them in half, freeze them and eat half in one meal.

Admin: Only time for one more question this time...

Lesley: Do you have any dietry advise for cancer patients?
Jane: Cancer treatment varies depending on which type of cancer you're suffering from what treatment you're undergoing and how you're feeling.
Jane: I would suggest you either come and see me in my practice (www.janeclarke.com), if you can, as I could take you through what's best for you specifically, but another option would be to look up cancer charities such as the World Cancer Research fund.
Jane: Of course there are general things, such as boosting antioxidants to help you fight cancer cells, but since the body is unique, if you can get some individual face to face advice as this can be a huge support.

Admin: Thanks to Jane for joining us today. We couldn't get through all the questions, but don't worry - Jane will be joining us again on 28th February at 1pm.

Folate 1 year before conception cuts early birth risk

Last Updated: 2008-01-31 11:37:03 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Women who take folic acid supplements for at least 1 year before they become pregnant can dramatically reduce their risk of delivering prematurely, according to a new study.

Approximately 38,000 pregnant women, who took folic acid for 12 months or longer before pregnancy, had a 50-percent decrease in the incidence preterm birth between 28 and 32 weeks of pregnancy -- and a 70-percent reduced incidence of very early birth between 20 and 28 weeks of pregnancy.

The protective effect of folic acid supplementation for at least 1 year remained robust after the researchers adjusted the data for age, race, prior preterm birth and other factors that could impact a woman's risk of delivering before the normal 40 weeks gestation.

The study included only women pregnant with a single infant and excluded pregnancies in which there were medical or obstetrical complications.

Dr. Radek Bukowski, assistant professor of obstetrics and gynecology at the University of Texas Medical Branch at Galveston reported the findings Wednesday at the Society for Maternal-Fetal Medicine's annual meeting in Dallas, Texas.

The U.S. Public Health service currently recommends that all women of childbearing age take 400 micrograms of folic acid daily to prevent birth defects of the brain and spinal cord, such as spina bifida and neural tube defects, should they become pregnant.

The new study provides women with yet another reason to take folic acid daily, Janis Biermann, senior vice president of education and health promotion of the March of Dimes Foundation, noted in a telephone interview with Reuters Health.

"Take folic acid everyday, whether you are pregnant or not," she said. "If all women took folic acid before they get pregnant and during early pregnancy it could help to reduce neural tube defects by up to 70 percent and it may help reduce the rates of preterm birth as well."

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

US warns of suicidal actions with epilepsy drugs

Last Updated: 2008-01-31 15:48:34 -0400 (Reuters Health)

WASHINGTON - U.S. health officials alerted doctors on Thursday that medicines used to treat epilepsy and psychiatric disorders may raise the risk of suicidal thoughts and behavior.

The Food and Drug Administration said it analyzed studies of 11 epilepsy drugs including Pfizer Inc's Neurontin, Abbott Laboratories Inc's Depakote and Johnson & Johnson's Topamax. The studies included nearly 44,000 patients.

The analysis found patients treated with the drugs faced about twice the risk of suicidal thoughts or behavior compared to others who got a placebo.

The FDA estimated there were two more cases per every 1,000 patients given the drugs instead of a placebo.

About 0.4 percent of patients given the drugs reported suicidal thoughts or actions, compared with 0.2 percent of placebo patients, the FDA said.

Four people who were taking one of the epilepsy drugs committed suicide, while none of the placebo patients did.

The agency said it expected the risk was shared by all anti-epileptic drugs and that changes to the drugs' prescribing instructions would be applied broadly throughout the class.

Officials at Pfizer, J&J and Abbott could not immediately be reached for comment.

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Epsom salt can prevent cerebral palsy: U.S. study

Last Updated: 2008-01-31 13:59:04 -0400 (Reuters Health)

By Maggie Fox

WASHINGTON - Giving a woman an infusion of Epsom salts when she goes into premature labor can help protect her baby from cerebral palsy, U.S. researchers reported on Thursday.

Magnesium sulfate, popularly known as Epsom salts, cut the rate of cerebral palsy in half, Dr. John Thorp, a professor of obstetrics at the University of North Carolina at Chapel Hill, and colleagues reported.

"We have a cheap, widely available treatment already in hand that cuts in half the risk of babies being born with an extremely disabling disorder," Thorp said in a statement.

"And virtually every delivery room in the United States is already stocked with magnesium sulfate solutions that are given to pregnant women during childbirth for other reasons."

Dr. Alan Fleischman, medical director of the birth defect charity March of Dimes, was more cautious. "I think it is an important study," he said in a telephone interview.

But he noted that more study was needed to understand how the treatment works, and said the children were not protected from more subtle brain damage that affected intellectual and cognitive function.

Thorp's team presented their findings to a meeting of the Society for Maternal-Fetal Medicine in Dallas.

They gave either magnesium sulfate or a placebo to 224 women going into early labor or with ruptured membranes. The women's pregnancies were at between 24 to 31 weeks -- a full-term pregnancy goes 40 weeks.

Babies born as prematurely as that can suffer brain damage and other problems including cerebral palsy, a range of conditions that affect control of movement and posture.

PROTECTING THE BRAIN

The magnesium did not prevent any deaths among the premature babies. But 4.2 percent of the babies born to women given magnesium developed cerebral palsy, versus 7.3 percent of those born to women who got the placebo.

The researchers followed the infants that were born for up to two years.

It is not clear how the magnesium works but it may stabilize the blood vessels, prevent the damage caused by having oxygen cut off and also help prevent immune system damage to the brain, Thorp's team said.

"Magnesium sulfate may impact on blood flow in the fetal brain and help to decrease damage in the brain," Fleischman said in a telephone interview.

One question he had was why magnesium sulfate could protect against cerebral palsy but not the other brain effects of being born prematurely.

Fleischman agreed there was little downside to using magnesium sulfate, if done properly. "Obstetricians are comfortable with it and they use it frequently," he said.

"It was first was used for pre-eclampsia, to prevent women from going into eclampsia, which is a seizure." It can also inhibit premature labor, he noted.

An earlier study in Australia, which included more than 3,000 women, had similar results. The March of Dimes estimates that 500,000 people have cerebral palsy in the United States.

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Researchers Seek HIV Vaccine Trial Participants: PENNVAX-B Tests a DNA Vaccine’s Potential to Help Subjects Fend Off HIV

Newswise — University of Pennsylvania School of Medicine researchers are recruiting healthy, HIV-negative adults to participate in a phase I clinical trial of an experimental HIV vaccine called PENNVAX-B, a DNA-based vaccine which is made using synthetic DNA-based HIV genes.

Approximately 120 trial participants will be divided into several vaccine groups to test the safety and immunogenicity of various cytokine “molecular adjuvants” that previous studies have shown to help boost immune response to the vaccine in monkeys.

“This study is unique in that it tests the ability of a novel DNA vaccine to tailor immune responses against the HIV pathogen using molecular adjuvants delivered in a plasmid form,” says David Weiner, PhD, a Penn professor of Pathology and Lab Medicine who developed the vaccine. “If successful, it will support future studies of this novel vaccine and be an important baseline for growth of this technology platform.”

The study, which also includes a site at the University of Alabama at Birmingham, is expected to last for two years. Researchers are seeking male and female participants in good health between the ages of 18 and 50 who are not infected with HIV or Hepatitis B or C. Each participant will be followed for 12 months. Those who have participated in a previous HIV vaccine trial are not eligible to participate, nor are those who have active syphilis, diabetes, some types of asthma and various other diseases. Women who are pregnant or nursing are also ineligible to participate.

The vaccine development and the clinical trial are sponsored by the Division of AIDS at the National Institute of Allergy and Infectious Diseases, the National Institutes of Health and the Department of Health and Human Services. The study is conducted under the HIV Vaccine Trials Network. Wyeth Pharmaceuticals is an industry partner for the vaccine.

Editor’s note: For more information about the PENNVAX-B trial, please call 215-349-8091 or email joseph.quinn@uphs.upenn.edu.

PENN Medicine is a $3.5 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is currently ranked #3 in the nation in U.S.News & World Report's survey of top research-oriented medical schools; and, according to most recent data from the National Institutes of Health, received over $379 million in NIH research funds in the 2006 fiscal year. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System includes three hospitals — its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation’s “Honor Roll” hospitals by U.S.News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center — a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.

Novel Vaccine Concept: Protein from Herpes Virus Serves as Potent Vaccine Enhancer

Newswise — Creating vaccines to protect people against viral diseases like AIDS, cervical cancer and infectious hepatitis is a delicate balancing act: If the immune system’s response to the vaccine is too strong, toxic side effects can kill the patient. If it’s not strong enough, the virus will spread faster than the immune system can kill it.

A new vaccine design strategy developed by scientists at The Wistar Institute Vaccine Center could be the answer. The secret is using a herpes simplex protein called glycoprotein D to block a specific receptor molecule on antigen-presenting cells, or APCs. These sentinel cells monitor the body for foreign antigens – molecules that can stimulate an immune response – from invading viruses.

When they detect viral antigens, APCs signal the body’s immune system to activate T cells to attack and destroy cells infected with the virus. At the same time, they also send inhibitory signals to prevent overreaction by the immune system. One of thee inhibitory signals is blocked by glycoprotein D from herpes virus.

In a study that will be published February 6 in Nature Medicine and is available online, Wistar scientists showed that vectors, which are vaccine delivery systems, made by fusing the glycoprotein D with genes from target antigens increase the immune system’s response to those antigens in cell cultures and laboratory mice. The researchers used antigens from HIV, the virus that causes AIDS, and from HPV-16, a human papilloma virus that causes cervical cancer.

Hildegund C.J. Ertl, M.D., director of The Wistar Institute Vaccine Center and senior author of the study, says using glycoprotein D to deliver antigens has a major advantage over other vaccine approaches. “It allows us to lower the dose but still get a stronger immune response,” she says.

Glycoprotein D is part of the herpes viral envelope and is expressed on the surface of cells infected with the herpes simplex virus. Glycoprotein D binds to a receptor molecule called HVEM (herpes virus entry mediator) on antigen-presenting cells. By locking onto the HVEM receptor, glycoprotein D prevents HVEM from binding to another molecule called BTLA on T and B lymphocytes – white blood cells that attack disease-causing pathogens.

Binding between HVEM and BTLA is the first step in an inhibitory signaling pathway that reduces the immune system’s response to the presence of a virus. Blocking this inhibitory pathway allows the body to mount a stronger immune response by generating more antigen-specific CD8+ T cells to attack cells infected with the virus.

The researchers found that fusing HIV and HPV antigens to glycoprotein D enhances the immune response to those antigens. Mice injected with vaccines that included antigens fused to glycoprotein D generated more virus-killing CD8+ T cells than mice injected with the same vaccines and antigens, but without the glycoprotein D carrier protein.

Researchers also inoculated identical strains of laboratory mice with vaccines containing genes for the cancer-causing proteins E7, E6 and E5 from the HPV-16 virus. One group of animals received HPV-16 genes spliced into the genetic code for glycoprotein D; another group received the same antigens without glycoprotein D. Ten to 14 days later, both groups of animals were injected with a fast-growing tumor cell line that normally generates extensive tumors in mice within 14 days.

Mice that received vaccines with the glycoprotein D-antigen combination were fully protected against cancer, says Wistar’s Marcio Lasaro, Ph.D., lead author of the study. However, mice inoculated with vaccines containing the same HPV-16 genes, but without glycoprotein D, developed tumors after being inoculated with the same tumor cell line.

“It’s important to point out that the molecules we targeted in mice are similar to those in humans, and all the basic in-vitro studies in the paper were done with human molecules, making it likely that the method will also work in people,” Lasaro says.

Ertl says the ability of the glycoprotein D carrier protein to enhance the immune response could be particularly important to the development of a long-sought vaccine for AIDS. “The problem with HIV vaccines is that they might look good in mice and primates, but comparable doses in humans are too toxic,” she says. “If you lower the dose to avoid toxic side effects, you don’t get the immune response you need.” She believes that using glycoprotein D may solve that problem.

Ertl and her colleagues are planning future studies to further elucidate the mechanism behind the carrier protein’s effectiveness. If studies in research animals continue to be positive, they hope to conduct human clinical studies with HIV and HPV vaccines currently under development at The Wistar Institute Vaccine Center.

The Wistar Institute has filed for patent protection on the glycoprotein D carrier protein technology.

Ertl is corresponding author of the study. Wistar co-authors are Nia Tatsis, Ph.D., Shih-Wen Lin, John J. Rux, Ph.D., E. John Wherry, Ph.D., and Scott E. Hensley (now at the National Institute of Allergy and Infectious Diseases). Lin is also affiliated with the University of Pennsylvania. J. Charles Whitbeck, Gary H. Cohen, and Roselyn J. Eisenberg are with the University of Pennsylvania.

The research was supported by the National Institute of Allergies and Infectious Diseases (NIAID) and the Commonwealth Universal Research Enhancement Program of the Pennsylvania Department of Health.

The Wistar Institute is an international leader in biomedical research with special expertise in cancer research and vaccine development. Founded in 1892 as the first independent nonprofit biomedical research institute in the country, Wistar has long held the prestigious Cancer Center designation from the National Cancer Institute. Discoveries at Wistar led to the creation of the rubella vaccine that eradicated the disease in the United States, human rabies vaccines used worldwide, and a rotavirus vaccine approved in 2006. Today, Wistar is home to preeminent research programs studying skin cancer, lung cancer, and brain tumors. Wistar Institute Vaccine Center scientists are creating new vaccines against pandemic influenza, HIV, and other diseases threatening global health. The Institute works actively to transfer its inventions to the commercial sector to ensure that research advances move from the laboratory to the clinic as quickly as possible. The Wistar Institute: Today’s Discoveries – Tomorrow’s Cures. On the web at www.wistar.org