12/09/15

The birth of seven puppies by in vitro fertilization comes after decades of research

From: http://www.cbsnews.com/pictures/ivf-puppies-born-first-litter/

Treatment Shows Promise for Some With Emphysema

Study finds more success when stricter criteria used in selecting who gets the treatment

From: http://www.webmd.com/lung/news/20151209/implanted-lung-valves-show-promise-in-some-emphysema-patients?src=RSS_PUBLIC

Common Heart Failure Drugs May Harm More Than Help

Nitrates reduce activity, quality of life, researchers find

From: http://www.webmd.com/heart-disease/heart-failure/news/20151209/common-heart-failure-drugs-may-harm-more-than-help?src=RSS_PUBLIC

The secret links between a bad night’s sleep and diabetes

The link between sleep and diabetes has always been unclear. But the authors of two recent studies tell WebMD what is clear: Poor sleep can lead to all sorts of chronic illnesses, including diabetes.

From: http://www.webmd.com/diabetes/features/diabetes-sleep-connection?src=RSS_PUBLIC

First litter of puppies born by in vitro fertilization

Seven healthy puppies are born using IVF; technique could help save endangered species

From: http://www.cbsnews.com/news/first-litter-of-puppies-are-born-by-in-vitro-fertilization/

More Boston College students sickened at Chipotle

The number students ill with norovirus hits triple digits as Chipotle scrubs down location in Boston

From: http://www.cbsnews.com/news/number-of-boston-college-students-sickened-at-chipotle-grows/

Pancreatic Cancer-Research -Mark Truty, M.D.-Mayo Clinic

From: Mayo Clinic http://www.youtube.com/watch?v=jZoZ1R6NhhE

Pancreatic Cancer-Symptoms and Genetics-Mark Truty, M.D.-Mayo Clinic

From: Mayo Clinic http://www.youtube.com/watch?v=ZSRB8ZxUMv4

Pancreatic Cancer-Diet and Pain Management-Mark Truty, M.D.-Mayo Clinic

From: Mayo Clinic http://www.youtube.com/watch?v=UbU6GwOuhLc

Pancreatic Cancer-Types of Surgery and Survival-Mark Truty, M.D. -Mayo Clinic

From: Mayo Clinic http://www.youtube.com/watch?v=KyAyQgxofG0

Pancreatic Cancer-Introduction and Treatments-Mark Truty, M.D.-Mayo Clinic

From: Mayo Clinic http://www.youtube.com/watch?v=dxe9FM01gv0

Drugs May Protect the Heart During Chemotherapy

Researchers also found lower risk of complications that can interrupt breast cancer treatment

From: http://www.webmd.com/breast-cancer/news/20151209/drugs-may-protect-the-heart-during-chemotherapy?src=RSS_PUBLIC

Reversing the effects of the new anti-clotting drugs

The oral anticoagulant warfarin (Coumadin) became available for prescription in 1954. This anti-clotting drug commanded national attention when President Dwight Eisenhower received the drug as part of his treatment following a heart attack. No other oral anticoagulant was successfully developed and marketed in the United States until 2010.

Warfarin is a dangerous drug. Along with insulin, it is responsible for the most emergency hospitalizations due to adverse drug reactions. Whereas insulin causes low blood sugar, warfarin is notorious for the complication of major bleeding. Warfarin is plagued by hundreds of drug-drug and drug-food interactions. The optimal dose is determined by monitoring the level of anticoagulant in the blood. Standard-intensity anticoagulation with warfarin is usually targeted to achieve prothrombin blood test results, expressed as international normalized ratio (INR), within a range of 2.0 to 3.0. If the INR is greater than 3.0, the warfarin dose is decreased to prevent excessive bleeding. If the INR is lower than 2.0, the warfarin dose is increased to prevent excessive blood clotting. This approach is slow, cumbersome, and frustrating. Even when the INR tests within the desired range, catastrophic bleeding complications, such as bleeding into the brain, can still occur.

Patients and health care providers complain about the difficulties and inconveniences of trying to use warfarin properly. Multiple algorithms and even genetic testing have been undertaken with the hope of deriving an easy-to-follow dosing scheme, but these efforts were disappointing overall.

Enter the new anticoagulants

In a remarkable five years spanning 2010 through 2014, four novel oral anticoagulants underwent pivotal trials for stroke prevention in atrial fibrillation, as well as treatment of pulmonary embolism and deep vein thrombosis. The four new drugs have better safety profiles than warfarin, and some are more effective than warfarin for stroke prevention in people with atrial fibrillation. All four were rapidly approved by the Food and Drug Administration to treat these thrombotic conditions. One, dabigatran (Pradaxa), is a direct thrombin inhibitor — that is, it inactivates clotting factor II (thrombin). The other three — rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa) — inactivate clotting factor X. None of these target-specific novel anticoagulants requires regular laboratory monitoring. They are administered in fixed doses. There are virtually no restrictions on foods such as green leafy vegetables, as there are with warfarin. And there are only about a dozen important drug-drug interactions.

As this wave of new oral anticoagulants came to market, there were predictions (which turned out to be false) that warfarin would rapidly become an infrequently used anticoagulant. At Harvard-affiliated Brigham and Women’s Hospital, we have about 3,500 patients in our Anticoagulation Management Service who still receive warfarin. So, why were the initial predictions wrong? And why does warfarin continue to command more of the “market share” than these target-specific designer-drug anticoagulants?

The biggest concern is that the novel oral anticoagulants have not, until now, had specific antidotes to counteract major bleeding. Warfarin is a vitamin K antagonist, so a dose of vitamin K is an antidote to warfarin — though one that works slowly and unreliably. But the fear with the novel oral anticoagulants has been that the rare episode of major bleeding might not be controllable or rapidly reversed.

New antidotes pave the way for greater use of the new anticoagulants

The landscape changed drastically in October 2015, when the FDA approved a dabigatran antibody as an antidote to dabigatran. After a rapid intravenous injection of the antidote, dabigatran is attracted to its own antibody at least 300 times more strongly than to thrombin (clotting factor II). When dabigatran and its antibody bond, thrombin is liberated from dabigatran and can do what clotting factors do best—stop the bleeding. In an ongoing clinical trial, laboratory evidence of anticoagulation from dabigatran was reversed within minutes of injecting the dabigatran antibody antidote. Hospitals across the United States now have the dabigatran antibody available for emergency use.

Though catastrophic bleeding from the novel oral anticoagulants is extremely rare, the availability of antidotes reassures health care providers, patients, and their families. It changes the psychology of prescribing and tilts the balance more strongly toward the novel agents.

As for rivaroxaban, apixaban, and edoxaban, a universal antidote is in late and successful stages of clinical development. This antidote is not an antibody, but it is an attractive “decoy” for these three anticoagulants, all of which target clotting factor X. The antidote is more attractive to the anticoagulants than factor X is, even though it is only slightly modified from the structure of factor X. The decoy, which is inert, “fools” these three anticoagulants. They then detach from clotting factor X and bind to the decoy instead, liberating the unbound clotting factor X to stop the bleeding.

In summary, these two antidotes are important “backups” to our arsenal of novel anticoagulants. They permit us to prescribe the new agents with increased confidence.

The post Reversing the effects of the new anti-clotting drugs appeared first on Harvard Health Blog.

From: Samuel Z. Goldhaber, MD http://www.health.harvard.edu/blog/reversing-the-effects-of-the-new-anti-clotting-drugs-201512098791

Uninsured Face Average $969 Penalty In 2016

Average penalties are set to rise 47 percent next year for Americans who can afford insurance but choose to remain uncovered, according to a Kaiser Family Foundation analysis.

From: http://www.webmd.com/health-insurance/20151209/uninsured-people-eligible-for-obamacare-face-average-969-penalty-in-2016?src=RSS_PUBLIC

Is it a cold or the flu? How to tell - and what to do

Doctors say it's really important to know the difference

From: http://www.cbsnews.com/news/is-it-a-cold-or-is-it-the-flu/

8-year-old with rare breast cancer undergoes mastectomy

Utah girl was diagnosed with an extremely rare form of breast cancer that specialists had never seen in a child so young

From: http://www.cbsnews.com/news/8-year-old-with-rare-breast-cancer-recovering-from-mastectomy/

Katie Burbank, RN Awarded ISONG Founders Award for Excellence in Genetics Nursing Practice

From: Mayo Clinic http://www.youtube.com/watch?v=sbPziowVzJg

Dentistry Without the Drill? New Study Offers Hope

Tooth decay happens, but many cavities take years to develop and can be avoided, study shows

From: http://www.webmd.com/oral-health/news/20151209/dentistry-without-the-drill--new-study-offers-hope?src=RSS_PUBLIC

Agriculture Secretary Vilsack Appoints New NAREEE Advisory Board Members

WASHINGTON, Dec. 9, 2015 – Agriculture Secretary Tom Vilsack today announced the appointment of nine individuals to serve on the National Agricultural Research, Extension, Education, and Economics (NAREEE) Advisory Board.

From: http://www.usda.gov/wps/portal/usda/usdahome?contentid=2015/12/0336.xml&contentidonly=true

Why has U.S. life expectancy stalled out?

Research reveals some of the things you can do to help increase your chances of living longer

From: http://www.cbsnews.com/news/why-has-u-s-life-expectancy-stalled-out/

Stop Your Periods With Continuous Birth Control

Birth control doesn’t just prevent pregnancy. It can also help with your periods. WebMD examines which ones can lighten them -- or stop them altogether.

From: http://www.webmd.com/sex/birth-control/features/no-more-periods?src=RSS_PUBLIC

Breast Cancer Drugs Battle Disease's Return

Afinitor lowered risk by a third, while Xgeva lowered chances by 18 percent, researchers report

From: http://www.webmd.com/breast-cancer/news/20151209/breast-cancer-drugs-battle-diseases-return?src=RSS_PUBLIC

Mom-to-Be's Smoking Tied to Poorer Fitness in Sons

Higher body mass index in mother also linked to worse performance by young men on running test

From: http://www.webmd.com/baby/news/20151209/mom-to-bes-smoking-tied-to-poorer-fitness-in-sons?src=RSS_PUBLIC

USDA Announces Early Release of Commodity Tables for USDA’s Agricultural Projections to 2025

WASHINGTON, Dec 9, 2015 — On Dec. 11, 2015, at 11am EST, the U. S. Department of Agriculture (USDA) will release selected tables from its upcoming USDA Agricultural Projections to 2025 report. USDA will post online tables containing long-term supply, use, and price projections to 2025 for major crops and livestock products, and will include supporting U.S. and international macroeconomic assumptions.

From: http://www.usda.gov/wps/portal/usda/usdahome?contentid=2015/12/0335.xml&contentidonly=true

Talk Therapy vs Meds for Major Depression

Study finds both treatments can help

From: http://www.webmd.com/depression/news/20151208/talk-therapy-antidepressants-offer-similar-results-for-major-depression?src=RSS_PUBLIC

People with Type 2 Diabetes May Be Overtested

Study finds those with good control get blood sugar measured too often at doctor's office

From: http://www.webmd.com/diabetes/news/20151208/people-with-type-2-diabetes-may-be-overtested?src=RSS_PUBLIC

Blood Thinner + Certain Diabetes Drugs = Bad Combo

Together, warfarin and sulfonylureas raise risk of hospitalization, study shows

From: http://www.webmd.com/diabetes/news/20151208/blood-thinner-certain-diabetes-drugs-are-a-bad-combo?src=RSS_PUBLIC

Meet Vincent, the Cat With the Titanium Legs

High-tech prosthetics are giving disabled shelter kitty new mobility, veterinary surgeons say

From: http://pets.webmd.com/cats/news/20151208/meet-vincent-the-cat-with-the-titanium-legs?src=RSS_PUBLIC

How to distinguish between cold and flu

Up to 20 percent of Americans come down with the flu every year, and on average, adults get two or three colds

From: http://www.cbsnews.com/videos/how-to-distinguish-between-cold-and-flu/

Dozens of Boston College students sick after eating at Chipotle

Health officials say norovirus is likely to blame for the latest illness outbreak at Chipotle

From: http://www.cbsnews.com/videos/dozens-of-boston-college-students-sick-after-eating-at-chipotle/

WHO : TDR - Preventing malaria and schistosomiasis due to climate change in Cote d’Ivoire

From: World Health Organization http://www.youtube.com/watch?v=o2OIzW5uU8Q

New report signals country progress in the path to malaria elimination

New estimates from WHO show a significant increase in the number of countries moving towards malaria elimination, with prevention efforts saving millions of dollars in healthcare costs over the past 14 years in many African countries.

According to the "World Malaria Report 2015", released today, more than half (57) of the 106 countries with malaria in 2000 had achieved reductions in new malaria cases of at least 75% by 2015. In that same time frame, 18 countries reduced their malaria cases by 50-75%.

From: http://www.who.int/entity/mediacentre/news/releases/2015/report-malaria-elimination/en/index.html

Wednesday, December 9, 2015

Enter the new anticoagulants

New antidotes pave the way for greater use of the new anticoagulants

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