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Obesity An Advantage In MHD Patients
Main Category: Urology / Nephrology News
Article Date: 19 Nov 2006 - 4:00 PST
Despite significant improvements in dialysis treatments, currently
over 20% of the 350,000 maintenance hemodialysis (MHD) patients
in the United States die each year. A study published in Hemodialysis
International finds that this high mortality rate may be attributed
to malnutrition.
MHD patients experience what has been termed the "obesity
paradox," wherein obesity is associated with increased chance
of survival. "A larger body fat mass as seen in obesity probably
represents protective reserves that may mitigate the adverse effects
of malnutrition in patients," according to Kamyar Kalantar-Zadeh
M.D., author of the study.
MHD patients tend to have a high degree of protein-energy malnutrition
and inflammation. The combination of these two conditions, termed
Kidney Disease Wasting (KDW), leads to increased risk of death.
Conversely, it has been shown that an increase in protein intake
yields the greatest survival in patients.
The study suggests that improved diet as well as appetite-stimulating
agents may be a way to improve nutrition and, consequently, outcome
in MHD patients. Understanding the factors that lead to KDW will
be the key to improving survival in MHD patients, as well as in
the 20 to 40 million Americans who exhibit similar risk-factor paradoxes
such as those with chronic heart failure, AIDS, rheumatoid arthritis
and malignancy.
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This study is published in Hemodialysis International.
Kamyar Kalantar-Zadeh M.D., is Associate Professor of Medicine
& Pediatrics and Director of Off-Campus Dialysis Expansion &
Epidemiology at the UCLA David Geffen School of Medicine, Los Angeles,
CA.
Hemodialysis International is published quarterly and contains
original papers on clinical and experimental topics related to dialysis
in addition to the Annual Dialysis Conference supplement. This journal
is a must-have for Nephrologists, Nurses and Technicians worldwide.
The journal contains original articles, review articles, commentary
and latest news to keep readers completely updated in the field
of hemodialysis. Edited by international and multidisciplinary experts,
Hemodialysis International disseminates critical information in
the field. For more information visit: http://www.blackwell-synergy.com/loi/hdi.
Blackwell Publishing is the world's leading society publisher,
partnering with 665 academic and professional societies. Blackwell
publishes over 800 journals and, to date has published more than
6,000 books, across a wide range of academic, medical, and professional
subjects. For more information visit: http://www.blackwellpublishing.com/
Contact: Sean Wagner
Blackwell Publishing Ltd.
Flu vaccine helps cut heart attacks, deaths
Last Updated: 2006-11-16 10:31:10 -0400
(Reuters Health)
By Julie Steenhuysen
CHICAGO - Getting a flu shot can reduce the
incidence of death, heart attack or unplanned procedures to open clogged heart arteries
in patients with coronary artery disease, Polish researchers said on Wednesday.
The study adds to a growing body of evidence suggesting that people
with heart trouble should get a flu shot every year.
We know that people with underlying cardiopulmonary disease die
of flu. It's only logical that if you are able to prevent flu with
vaccine, you can prevent these deaths," said Dr. Arnold Monto, professor
of epidemiology at the University of Michigan.
"Flu puts these people over the edge," said Monto, who serves on
the World Health Organization's Influenza Pandemic task force.
The study, which was conducted in Poland and presented at the American
Heart Association meeting in Chicago, involved 658 patients with
coronary artery disease. Of those, 325 received an active flu vaccine
and 333 received a placebo.
After 296 days, patients who did not receive the vaccine were nearly
twice as likely to have a heart attack, undergo an unplanned angioplasty
to open blocked arteries or die from heart-related causes.
Monto said the study was significant because it compared groups
who received the vaccine and groups who did not.
He said such a trial would be considered unethical in the United
States because of U.S. guidelines recommending that heart patients
get flu shots.
Flu is responsible for 36,000 deaths and 225,000 hospitalizations
in the United States each year, yet only one in three adults with
heart disease got flu shots last year, according to the American
College of Cardiology.
"The study reinforces the principle that patients who have underlying
cardiac disease -- particularly coronary artery disease -- are somewhat
protected by having the influenza vaccine," said Dr. Leroy Rabbani,
a cardiologist at Columbia University Medical Center in New York,
Rabbani said other studies have shown a link between inflammation
and heart attacks. "Anything that can decrease the opportunity for
infection such as flu vaccine will be beneficial," he said.
The American Heart Association and the American College of Cardiology
in September issued a scientific advisory asking heart doctors to
give flu shots to their patients.
Coronary artery disease occurs when the arteries that supply blood
to the heart muscle become hardened and narrowed. It is the most
common type of heart disease and the leading cause of death in the
United States in both men and women.
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reserved. Republication or redistribution of Reuters content, including
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Flu Vaccine Appears Safe For Young Children
Main Category: Flu / SARS News
Article Date: 28 Oct 2006 - 5:00 PST
Use of the influenza vaccine in children 6 to 23 months is not associated
with an increased risk for a medical visit for any serious conditions,
according to a study in the October 25 issue of JAMA.
Influenza is a leading vaccine-preventable cause of illness and
death in the United States. Children younger than 2 years experience
higher rates of illness from influenza than any other age group
except individuals older than 65 years, according to background
information in the article. Until recently, the trivalent inactivated
influenza vaccine was recommended only for adults and children with
known chronic medical conditions that could put them at higher risk
from influenza infection, such as asthma. But based on the increasing
evidence of high rates of illness from influenza infection in young
children, the Centers for Disease Control and Prevention recommended
use of this vaccine in all children 6 to 23 months old, including
healthy children with no chronic medical condition, beginning in
the winter season of 2004-2005. By January 31, 2005, 48 percent
of all children in this age group in the United States had received
trivalent inactivated influenza vaccine. However, its safety in
young children has not been adequately studied in large populations.
Simon J. Hambidge, M.D., Ph.D., of Kaiser Permanente Colorado,
Denver, and colleagues evaluated the safety of trivalent inactivated
influenza vaccine in a large population of children 6 to 23 months
old. The researchers analyzed data on significant medically attended
events that occurred after vaccination, during "risk windows",
compared with events that occurred in two control periods, one before
vaccination and the second after the risk window. These medically
attended events, such as acute respiratory tract infection, asthma,
cough and pneumonia, were reviewed at eight managed care organizations
in the United States that comprise the Vaccine Safety Datalink.
The participants received trivalent inactivated influenza vaccine
between January 1, 1991, and May 31, 2003 (45,356 children with
69,359 vaccinations). The researchers found that no conditions were
significantly more likely to occur within either the 3-day, the
1- to 42-day, or the 15- to 42-day risk windows compared with both
control windows. During the 1-14 day risk window, there was a very
slight increase in visits for mild vomiting and diarrhea to outpatient
doctor's clinics, but less visits for asthma, cough, and the common
cold.
"While our findings offer reassurance regarding the safety
of the vaccine in the youngest children, large safety studies of
influenza vaccine in children in the newly recommended age group
of children 3 to 5 years old are needed. Our study, the largest
safety study of trivalent inactivated influenza vaccine in children
aged 6 to 23 months, adds to prior evidence that influenza vaccine
is safe in infants and young children," the authors conclude.
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(JAMA. 2006;296:1990-1997.)
Please see the article for additional information, including other
authors, author contributions and affiliations, financial disclosures,
funding and support, etc.
Contact: Jacque Montgomery
JAMA and Archives Journals
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