Key findings from American Heart Association (AHA) 2010 scientific sessions

The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago, Illinois, November 13-17, 2010.

Key trials presented at the sessions include:

• ADVANCE: New LVAD equivalent to HeartMate II, nonrandomized study shows
• RAFT: CRT shows survival benefit for patients with class 2 and 3 HF who have low EF and wide QRS
• EMPHASIS-HF: Eplerenone shows large benefits in milder heart failure
• ASCEND HF: Nesiritide safe but of limited dyspnea benefit in acute HF
• ROCKET AF: Rivaroxaban noninferior to warfarin, but superiority analyses at odds
• CLOSURE I: No overall benefit, no reduction in stroke or TIA with PFO closure
• GRAVITAS: No benefit of doubling dose in clopidogrel nonresponders
• P-OM3: Omega-3 PUFA caps don't suppress paroxysmal AF in randomized trial
• BASKET-PROVE: DES as safe as bare-metal stents in larger coronary arteries, with less TVR 
• DEFINE: Large effects on LDL and HDL cholesterol with CETP inhibitor anacetrapib
• SYMPLICITY HTN: Catheter-based renal denervation reduces BP in patients with resistant hypertension
• ASCOT CRP: Analysis fuels debate over JUPITER-based CRP indication for statins
• ACT: No benefit of N-acetylcysteine to reduce contrast-induced nephropathy

Some drug interactions

Questioner: Edie
Question: My 85 year old mother has been taking some form of sleeping pills for the past 50 years the last 20 years at least has been restoral she is prescribed 30 mg. (there is times she binges and takes 2 pills a night) She also takes Xanax, Tylenyol with Codeine.  Should someone her age (or any age) be taking this much medication.  She has recently started drinking again.  What are the dangers/risks of her taking this much medication?  I am working with her Dr. to take the administration of the medications out of her hands as she is getting more and more abusive.
Answer: There is risk of major interaction between Tylenol (acetaminophen) and alcohol. Consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity. There is moderate risk of interaction between (1) alcohol with codeine, Xanax (alprazolan) and Restoril (Temazepam). CNS depressant effects of these drugs may be potentiated. (2) codeine, alprazolam and Temazepam with each other.  Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.
There is no need for her to take codeine, acetaminophen or alcohol. The are not helpful in getting to sleep. Stopping these three will dramatically reduce risk of adverse effects. 

Patient of prostatitis due to E.coli not responding to ciprofloxacin, levofloxacin and doxycycline

Questioner: Wong
Question- I have been diagonsed with prostatitis. The offending organism is E.coli. I have been treated with Ciprofloxacin for 7 days and levofloxacin for 6 weeks with no improvement in symptoms. A later culture and sensitivity test showed that the bacteria is resistant to ciprofloxacin. Then I tried doxycycline for a month with no improvement. I asked my doctor to test other prostate-penetrating drugs on the bacteria, but he said he can't dictate what the lab does. I'm thinking about using sparfloxacin, gatifloxacin, or minocycline, but due to the E.coli being resistant to ciprofloxacin and lack of symptomatic response to doxycycline, do you think that the bacterial would be resistant to these drugs as well?


Please give your opinion (with reasoning) in comments.

New molecular entities (NMEs) approved in 2010

• Asenapine (Saphris, Merck & Co., Inc.)
• Bepotastine (Bepreve, ISTA Pharmaceuticals)
• Dronedarone (Multaq, Sanofi-aventis)
• Liraglutide (Victoza, Novo Nordisk)
• Tocilizumab (Actemra, Genentech)
• Ustekinumab (Stelara, Centocor Ortho Biotech)
• For details see http://www.medscape.com/viewarticle/731720

• New Drug Review 2010

  Jack DeRuiter, PhD; Pamela L. Holston, RPh, BS, BA
  Posted: 11/10/2010; US Pharmacist © 2010 Jobson Publishing

Onabotulinumtoxin A for Migraine

The US Food and Drug Administration (FDA) has approved onabotulinumtoxinA (Botox; Allergan Inc) for headache prophylaxis in patients with adult chronic migraine who suffer headaches on 15 or more days per month, each lasting more than 4 hours.

    To treat chronic migraine, onabotulinumtoxinA is given approximately every 12 weeks as multiple injections around the head and neck. The recommended dose is 155 units (1 mL) divided across 7 head and neck muscles, administered at intervals of at least 12 weeks.

The most common adverse reactions reported by patients being treated with onabotulinumtoxinA for chronic migraine were neck pain (9%) and headache (5%).

Marketed as Botox and Botox Cosmetic, onabotulinumtoxinA has a boxed warning that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism.Symptoms include swallowing and breathing difficulties that can be life-threatening.

 Source: FDA New Drug Web site (www.fda.gov)

Which is more important for universities and colleges-Teaching or Research?

In universities here, research is the main criterion for appointment as well as promotion and  good researchers generally pay less attention to teaching. However, I feel one cannot remain abreast with recent developments in the field without being involved in research and the teaching will be very dogmatic. Also, only researchers can infuse a spirit of enquiry and innovation in their students.So, there is a need to balance the 2, not their separation. Quality of teaching must be an equal, if not more important, criterion for grading and promotion of teachers. What do you say?

Fish oil: benefits versus harms

There are reports about prooxidant effects and aging accelerating effects of fish oils. Whatever we ingest has benefits as well as harms and we have to weigh the two. In case of fish oil, the benefits far outweigh the harms. 0.5-1.8 g/day is the recommended dose for healthy people. Higher doses will be harmful. See http://healthyomega3.com/fish-oil-dosage/

Great advice on how to help your child (and yourself) sleep well

Excerpts from 'The No-Cry Sleep Solution for Toddlers and Preschoolers' by Elizabeth Pantley

Gentle Ways to Stop Bedtime Battles and Improve Your Child's Sleep

The following sleep ideas are of value to almost any sleeper, regardless of age. These tips can bring improvement not only in your child’s sleep, but also in her daytime mood and, last, but certainly not least – improvements in your own sleep and outlook as well.

• 1. Maintain a consistent bedtime and awaking time seven days a week.Your child’s biological clock has a strong influence on her wakefulness and sleepiness. When you establish a set time for bedtime and wake up time you “wind” your child’s clock so that it functions smoothly.Aim for an early bedtime. Toddlers and preschoolers respond best with a bedtime between 6:30 and 7:30 P.M, and most children will actually sleep better and longer when they go to bed early.
• 2. Encourage regular daily naps.Daily naps are important since an energetic child can find it difficult to go through a long day without a rest break. A nap-less child will often wake up cheerful and become progressively moodier, fussier or hyper-alert as the day goes on, and as he runs out of steam. Moreover, the length and quality of naps affects nighttime sleep – good naps equal better night sleep.
• 3. Set your child’s biological clock.Take advantage of your child’s natural biology so that he’s actually tired when bedtime arrives. Darkness causes an increase in the release of melatonin, the body’s sleep hormone, and it is the biological “stop” button. You can help align your child’s sleepiness with his bedtime by dimming the lights in your home during the hour before bedtime. Exposing your child to morning light is like pushing a “go” button in her brain — one that says, “Time to wake up and be active.” So keep your mornings bright!
• 4. Develop a consistent bedtime routine.Routines create feelings of security. A consistent, peaceful bedtime routine allows your active child to transition from the motion of the day to the tranquil state required to fall asleep. A specific before-bed routine naturally and easily ends with sleep.An organized routine helps you coordinate the specifics that must occur before bed: bath, pajamas, tooth-brushing. It helps you to function on auto-pilot at the time of day when you are most tired and least creative.
• 5. Create a cozy sleep environment.You may have never given much thought to where your child sleeps, but it can be one of the keys to better sleep. Make certain the mattress is comfortable, the blankets are warm enough, the room temperature is right, pajamas are comfy and the bedroom is welcoming.
• 6. Provide the right nutrition to improve sleep.Foods can affect energy level and sleepiness. Carbohydrate-rich foods can have a calming effect on the body, while foods high in protein or sugar generate alertness, particularly when eaten alone. A few ideas for pre-bedtime snacks are: whole wheat toast and cheese, bagel and peanut butter, oatmeal with bananas, or yogurt and low-sugar granola.Vitamin deficiencies that are due to consistently unhealthy food choices can affect a child’s overall health, including her sleep. Make your best effort to provide your child with a daily assortment of healthy foods.
• 7. Help your child to be healthy and fit.Many children don’t get enough daily physical activity. Too much TV watching, coupled with a lack of activity amounts to a sedentary lifestyle – which prevents good sleep. Children who get ample daily physical exercise fall asleep more quickly, sleep better, stay asleep longer and wake up feeling more refreshed.Avoid physical activity in the hour before bedtime, though, since exercise is stimulating and has an alerting effect – so they’ll be jumping on the bed instead of sleeping in it!
• 8. Teach your child how to relax and fall asleep.Many children get in bed but aren’t sure what to do when they get there! It can be helpful to follow a soothing pre-bed routine that helps create feelings of sleepiness. A common component of the bedtime ritual is story time, and for good reason. A child who is listening to a parent read, or tell a tale, will tend to lie still and focus on the story. This quiet stillness will allow him to become sleepy.

Commit to working with these eight ideas and you’ll likely see improvements in your child’s sleep, and yours too.

Excerpted with permission by McGraw-Hill Publishing from The No-Cry Sleep Solution for Toddlers and Preschoolers (McGraw-Hill 2005).