The US Food and Drug Administration (FDA) approved a once-daily bronchodilator — indacaterol maleate (Arcapta Neohaler, Novartis Pharmaceuticals) — for chronic obstructive pulmonary disease (COPD). This bronchodilator may offer better patient adherence than twice-a-day bronchodilators on the market.

Indacaterol maleate is a new molecular entity in the ß2-adrenergic agonist class that helps relax muscles around lung airways to prevent COPD symptoms, such as wheezing and breathlessness. The FDA stated that the long-acting drug is not intended to treat asthma or COPD symptoms that come on fast and strong.

Common adverse effects (> 2% and more common than placebo) are runny nose, cough, sore throat, headache, and nausea.

Indacaterol maleate will carry a boxed warning that, like other long-acting ß2-adrenergic agonists (LABAs), may increase the risk for asthma-related death.

Without use of a long-term asthma control medication, indacaterol maleate and all LABAs are contraindicated in patients with asthma. Indacaterol maleate should not be started in patients with acutely deteriorating COPD, nor should it be used to relieve acute symptoms, which should be managed with concomitant short-acting ß2-agonists.

An FDA advisory panel in March recommended approval of indacaterol maleate after 6 confirmatory clinical trials demonstrated the drug's safety and efficacy. The trials included nearly 5500 patients 40 years and older with COPD who had smoked at least 1 pack of cigarettes for 10 years and exhibited moderate to severe decreases in lung function.

During the advisory panel meeting, John Walsh, the president of the nonprofit COPD Foundation, said that getting patients to faithfully take twice-daily LABAs is a challenge.

"The advantage of a once-daily LABA to increase compliance and impact adherence cannot be overstated," Walsh said.

Administration and Precautions

Indacaterol maleate is supplied as 75-µg inhalation powder hard capsules that should always be used with the Neohaler inhaler only, 75 µg inhaled once daily every day. The capsules are for oral inhalation only and are not to be swallowed. The recommended dose should not be exceeded because excessive use of indacaterol maleate, or use in conjunction with other LABA-containing medications, may cause clinically significant cardiovascular effects and may even be fatal.

Should life-threatening paradoxic bronchospasm occur, use of indacaterol maleate should immediately be discontinued. The inhaler should be used with caution in patients with cardiovascular or convulsive disorders, thyrotoxicosis, or sensitivity to sympathomimetic drugs.

Indacaterol maleate should be used with caution with other adrenergic drugs, as these may potentiate its effects. It should be used with caution with xanthine derivatives, steroids, diuretics, or non–potassium-sparing diuretics, as these medications may potentiate hypokalemia or electrocardiographic changes. Extreme caution is warranted when indacaterol maleate is used with monoamine oxidase inhibitors, tricyclic antidepressants, and drugs that prolong QTc interval, as these may potentiate cardiovascular effects. Because ß-blockers may reduce the efficacy of indacaterol maleate, these should be used with caution and only when medically necessary.

Indacaterol maleate is pregnancy Category C, and it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Because ß-agonists may interfere with uterine contractility, indacaterol maleate should be used during labor only in those patients in whom the benefits clearly outweigh the risks. Caution is warranted when indacaterol maleate is administered to breast-feeding women.

The safety and efficacy of indacaterol maleate in pediatric patients have not been determined; therefore, the drug is not indicated for use in children. No adjustment of dosage is warranted in geriatric patients, based on available data, nor in patients with mild and moderate hepatic impairment. Studies were not performed in patients with severe hepatic impairment nor in those with renal impairment, but the urinary pathway contributes very little to total body elimination.

More information on the FDA's approval of indacaterol maleate is available on the agency's Web site.

Laurie Barclay, MD, contributed to the synopsis.

Clinical Implications

The FDA approved indacaterol maleate as a once-daily bronchodilator to prevent COPD symptoms, such as wheezing and breathlessness. Dosage is 75 µg inhaled once daily every day, which should increase compliance relative to twice-daily inhalers. It is not intended for acute relief of COPD exacerbations.

Common adverse effects seen with use of indacaterol maleate are runny nose, cough, sore throat, headache, and nausea. It will carry a boxed warning that the risk for asthma-related death may be increased. There are several significant drug interactions.

Indacaterol maleate is pregnancy Category C. It should be used during labor only in those patients in whom the benefits clearly outweigh the risks, and caution is warranted when indacaterol maleate is administered to breast-feeding women. Indacaterol maleate is not indicated for use in children. No adjustment of dosage is warranted in geriatric patients nor in patients with mild and moderate hepatic impairment.

courtesy: NIH US-FDA

Ischemic preconditioning

Ischemic preconditioning (IPC) an experimental technique for producing resistance to the loss of blood supply and, thus oxygen, to tissues of many types.

If the blood supply to an organ or a tissue is halted for a short time (usually less than five minutes) and then restored two or more times so that blood flow is resumed, the downstream cells of the tissue or the organ are robustly protected from a final ischemic insult when the blood supply is cut off entirely and permanently.

In an experimental setting if the left anterior descending coronary artery of the animal is ligated the downstream cardiac cellular mass is infarcted and will be injured and then die. If, on the other hand the tissue is subjected to IPC the downstream cellular mass will sustain only minimal to modest damage. IPC protects the tissue by initiating a cascade of biochemical events that allows for an up-regulation of the energetics of the tissue. The locus of this phenomenon is the intracellular organelle, the mitochondrion.

Investigations of various exogenous circulating ligands such as the delta active opiates and opioids simulate the phenomenon of IPC thus protecting the downstream tissues without the IPC intermittent ligating procedure.

The only group of humans who are chronically exposed to an opioid with delta activity are methadone maintained patients treated for heroin dependence and addiction. These patients have a coronary risk profile greater than the general population:

90% smoke. In the general population in the USA ~25% smoke.

Heart Healthy living i.e. attention to lipid control is less frequent than in the general population ~25% of the patients in Methadone Maintenance Programs use the highly ischemogenic cocaine one or more times a year. In the general population in the USA less than 1% are reported to do so.

Preliminary and as yet unpublished surveys of the methadone treated population point to a high degree of protection from myocardial ischemic events. The one published study[citation needed], an autopsy series from the Office of the Chief Medical Examiner of the City of New York demonstrated significantly less evidence for coronary occlusive disease. Simulation of IPC with methadone could not be evaluated in this post mortem investigation.

reffered from : Wikipedia

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a painful progressive condition caused by the compression of a key nerve in the wrist. Carpal tunnel syndrome is characterized by numbness, tingling, pain and weakness. The carpal tunnel is caused by increased pressure on a nerve in the hand entering the confined space carpal tunnel. There are many causes of carpal tunnel include heredity, the reverse use over time, hormonal changes associated with pregnancy and menopause and medical conditions, including diabetes, rheumatoid arthritis, and of thethyroid gland imbalance. It can occur at any age, but it tends to affect those in their 40s and 50s.

This condition is more common in women than in men. Many people with carpal tunnel syndrome have gradually symptoms increasingly over time. Carpal tunnel syndrome typically begins gradually to a vague pain in the wrist which can be extended to your hand or forearm. The first symptoms of CTS include numbness and paresthesia in the fingers, especially the thumb. Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects. 

Several types of drugs have been used in the treatment of carpal tunnel syndrome. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid injections, given in the area of the carpal tunnel, it may provide relief spectacular symptoms.Vitamin B6 (pyridoxine) has been reported to relieve some symptoms of carpal tunnel syndrome. Corticosteroids may be administered by mouth or injected directly into the affected joint wrist. Physiotherapy provides several ways to treat and monitor carpal tunnel syndrome. Many of prevention is also useful for you. Losingweight if you are overweight.

Carpal Tunnel Syndrome Treatment and Prevention Tips 

1. Cool (ice) packs and prednisone or lidocaine can relieve swelling.

2. Corticosteroids can be given directly into the involved wrist joint.

3. Ultrasound treatment can relieve symptoms in some people.

4. Surgery may be required if the symptoms of carpal tunnel syndrome persist.

5. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen may ease pain. 

6. Exercises can reduce the risk of a double crush of the median nerve.

7. Mecobalamin/Methylcobalamin has been helpful in some cases of CTS. 

8. If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard 

Article Source: http://www.articlesbase.com/ - Carpal Tunnel Syndrome Information and Prevention

Male circumcision shown to help prevent HIV transmission

By Dr Ananya Mandal, MD

According to a new study published in the Medical Journal of Australia, male circumcision can be seen as a “surgical vaccine” in the fight against heterosexual HIV transmission. The study based on spread of the virus in Africa showed that there was a reduced rate of transmission in regions where male circumcision was the norm.

According to co-author St Vincent's Hospital Alcohol and Drug Service director Alex Wodak this practice could be introduced as a long-term strategy in reducing heterosexual HIV transmission. He explained, “A wealth of research has shown that the foreskin is the entry point that allows HIV to infect men during intercourse with an infected female partner…Soon after the HIV pandemic was first recognized, much lower HIV prevalence was found in areas of sub-Saharan Africa, where more than 80 per cent of males had been circumcised than in areas where the circumcision rate was less than 20 per cent…Circumcision of males is now being referred to by many as 'surgical vaccine' against a wide variety of infections and adverse medical conditions over a lifetime.”

Speaking on Australia Dr. Wodak said that in the 50’s and 60’s more than 80 per cent of infant males were circumcised and recent Medicare statistics revealed circumcision among Australian boys had increased from 13 per cent in 1998 to 19 per cent in 2009. He said, “If Australia returned to the patterns we had in the 1950s and 1960s, I think that would be beneficial.”

Studies have failed to show similar benefits of male circumcision when it comes to sex between men. According to the World Health Organization there is “compelling evidence that male circumcision reduced the risk of heterosexually acquired HIV infection in men by approximately 60 per cent.”

Dr. Wodak went on to say that this simple surgical procedure also protects from some common sexually transmitted infections and other conditions such as urinary tract infections. He added, “The prospect of the availability of a (HIV) vaccine over the next 20 years is unlikely… Condom use remains essential, with promotion of condom use plus circumcision of males being analogous to seatbelts plus airbags for reducing the road toll.”

However Australian National University department of pediatrics and child health associate Professor Graham Reynolds feels this surgery is not imperative for prevention of infections. He said, “In order to prevent one infection, you circumcise unnecessarily a huge number of children who will never get a urinary infection, who will never get HIV, who will never get any other infection…if we paid proper attention to cleanliness in non-circumcised boys, we would get no problems.”

courtesy-http://www.news-medical.net/news

Dengue fever vaccine in the pipeline

By Dr Ananya Mandal, MD

Australians researchers are moving towards producing the first ever vaccine for dengue fever, the potentially life-threatening infection spread by mosquitoes in the tropics. At present late stage clinical trials are underway for a vaccine that would protect against all four known strains of the disease. Participants are now being recruited in Perth, Adelaide and Brisbane.

According to Associate Professor Peter Richmond, from Perth's Telethon Institute for Child Health Research, participants would be injected with the vaccine and their blood later checked for protective antibodies. He said that this vaccine once developed would be a boon for South east Asia where the disease is a true menace. “There are more than two hundred million infections annually, that's the estimate, and a couple of million (infected people) get a very severe form of Dengue hemorrhagic fever…From a global perspective, having an effective vaccine is very important,” he said.

Considering world population, over fifty percent live in areas at high risk of dengue fever that is usually fatal in children and adults alike. It causes fever and severe headache, vomiting, muscle and joint pain and skin rash. Australia also has sporadic outbreaks of the infection both from travelers and in the northern Queensland range of its specific type of carrier mosquito.

The vaccine is developed and the trials are being sponsored by pharmaceutical company Sanofi Pasteur. The vaccine is expected in five years.

courtesy- http://www.news-medical.net/news/20100920/Dengue-fever-vaccine-in-the-pipeline.aspx

Dilation Of Blood Vessels Restores Muscle Synthesis In Elderly

University of Texas Medical Branch at Galveston researchers believe they've found a way to use widely available blood pressure drugs to fight the muscular weakness that normally accompanies aging.

The discovery draws on research linking the loss of muscle mass with age-related changes in the behavior of the hair-thin blood vessels, or capillaries, which supply muscles with the amino acids they need for growth.

"When a young person eats food, insulin secretion causes the blood vessels in the muscle to dilate, so a lot of blood goes into the muscle and a lot of amino acids are available to build muscle proteins," said UTMB professor Elena Volpi, senior author of a paper on the work ("Pharmacological vasodilation improves insulin-stimulated muscle protein anabolism but not glucose utilization in older adults") now available in the "Online Ahead of Print" section of the journal Diabetes. "Older people's blood vessels have far less response to insulin, but we found that if you give them a drug that causes them to dilate, you can increase the nutritive flow to the muscles and completely restore normal growth."

Drugs that induce blood vessels to widen, called vasodilators, are commonly used to control high blood pressure and prevent angina. The UTMB study used sodium nitroprusside, a drug used in hospitals and administered intravenously.

The researchers enrolled 12 healthy older volunteers for the study, and separated them randomly into two six-person groups. Working in UTMB's Clinical Research Center, the investigators performed the delicate task of inserting catheters into the arteries and veins feeding and draining the subjects' leg muscles, and then used the arterial catheter to infuse the muscles with insulin at levels similar to those generated by a meal. One group of volunteers was given the vasodilator drug, while the other received a placebo.

Blood sample and muscle biopsy analysis produced estimates of muscle protein synthesis and breakdown. The results were impressive: virtually normal muscle growth in the older subjects given the vasodilator with insulin.

"By giving them this vasodilator, we were able to make our 70-year-olds look like 30-year-olds, at least in terms of muscle growth," said postdoctoral fellow Kyle Timmerman, a lead author of the paper. The study was co-led by medical student and graduate research fellow Jessica Lee.

While the researchers cautioned that larger studies would be needed to confirm their findings, they expressed optimism about vasodilator drugs' potential as tools for keeping older people from falling into frailty, and living happier, healthier and more independent lives.

"If by improving blood flow during and immediately after eating we can improve muscle growth in response to meals in older people, then we're going to have a major new tool to reduce muscle loss with aging," Volpi said. "By itself, that could mean a substantially decreased risk of physical dysfunction and disability."

Other authors of the paper include assistant professor Satoshi Fujita, senior study coordinator Shaheen Dhanani, assistant professor Hans Dreyer, graduate student Christopher Fry, assistant professor Micah Drummond, professor Melinda Sheffield-Moore and professor Blake Rasmussen.

The National Institute on Aging, the UTMB Claude D. Pepper Older Americans Independence Center and the UTMB Clinical and Translational Science Award supported this research.

Source:
Jim Kelly
University of Texas Medical Branch at Galveston

courtesyhttp://www.medicalnewstoday.com/articles/198549.php -

Development Of New Drug Treatment For Malaria

As part of the £1.5 million project, researchers are now testing the drug to determine how the treatment could progress to clinical trials. The drug is made from simple organic molecules and will be cheaper to mass produce compared to existing therapies.

Malaria is the world's most deadly parasitic infection, resulting in nearly one million deaths a year. The team at Liverpool have created a synthetic drug based on the chemical structure of artemisinin, an extract of a Chinese herb commonly used in malaria treatment. The new drug, which can be taken orally, is more potent than naturally derived artemisinin.

Artemisinin is known to interact with a substance inside parasite-infected red blood cells, causing a chain of events that destroys malaria. The treatment, however, is difficult to mass produce and can be chemically unstable in the body. Scientists have now found a way of creating the most reactive part of artemisinin synthetically and fusing it with a cage-like structure made of organic molecules to make the drug more chemically stable. The stability of the chemical structure in the body makes the drug last longer, reducing the chance of the parasite reappearing.

Professor Paul O'Neill, from the University's Department of Chemistry, explains: "Malaria affects the world's poorest countries and hospitals are unable to afford expensive treatments. The problem with current artemisinin-based therapies is their limited availability, poor oral absorption and high cost. We have created a new drug that is easily absorbed by the body, chemically stable and highly potent. It is made from very simple organic materials and therefore will be more cost-effective to mass produce than current therapies."

The research is funded by the European Commission and published in Angewandte Chemie Int Ed.

Source:
Samantha Martin
University of Liverpool

courtasy-http://www.medicalnewstoday.com/articles/197982.php