Archive for February, 2010

Psychotropic drugs boost fall risk in the elderly

Sunday, February 28th, 2010

A new analysis of studies including nearly 80,000 people aged 60 and older confirms that certain types of widely prescribed drugs, such as antidepressants and sedatives, can increase their risk of falling.

Falls often have serious consequences for older people, such as injuries leading to disability and admission to a nursing home, or even death.

While prescription drugs are recognized as contributing to fall risk among older people –who are likely to be on lots of medications — discovering just which drugs are the problem is still a “challenge,” Dr. Carlo A. Marra of the University of British Columbia in Vancouver and colleagues note in the Archives of Internal Medicine.

To update a review of studies on this subject published in 1996, Marra and his team identified 22 studies published between 1996 and 2007 including 79,081 people 60 and older, some of whom lived independently, and some of whom were institutionalized. They analyzed the risk of falling associated with nine classes of drugs.

Three classes turned out to significantly boost fall risk: sedatives and hypnotics, typically prescribed as sleeping aids; antidepressants; and benzodiazepines, which include tranquilizers like Xanax and Valium.

The researchers also saw an increased risk in patients taking non-steroidal anti-inflammatory drugs — like aspirin– and drugs for treating psychosis, but they note that people may be taking these drugs to treat conditions that would in and of themselves increase their risk of falling.

Prescription drug use among the elderly is on the rise, Marra noted in an interview with Reuters Health. He pointed out that one recent Canadian study found 1 in 7 people over 80 had filled a prescription for an antidepressant.

Older people who are taking any of the drugs associated with falls should talk about the medication with their physician and their pharmacist, Marra advised.

“Perhaps between their practitioner and themselves they can come up with safer alternatives,” Marra said.

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Research Yields Clues to Severe Form of Sinusitis

Monday, February 22nd, 2010

U.S. researchers say they’ve identified a protein that causes nasal and sinus polyps in 15 percent to 30 percent of people with chronic sinusitis.

The condition is one of the most serious forms of sinusitis, a constant irritation and swelling of the nasal passages. Polyps – unhealthy overgrowths of sinus tissue — can block the sinus passages and make it difficult or impossible to breathe through the nose. This often leads to pain, swelling and infections.

“This type of sinusitis isn’t subtle — you can spot the patients with polyps across the room. They’re breathing through their mouths, they talk with nasal voices, they’re constantly sniffling, and their faces are swollen,” Dr. Jean Kim, an assistant professor in the departments of otolaryngology and allergy and clinical immunology at the Johns Hopkins University School of Medicine, said in a news release.

Kim and colleagues analyzed sinus tissue from patients and concluded that a protein called vascular endothelial growth factor (VEGF) — which is known to stimulate blood vessel growth — causes the cell overgrowth that causes the polyps.

The protein may offer a target for new treatments for the condition, which typically resists all current therapies. Surgery is a common treatment but the polyps nearly always regrow. Oral steroids only temporarily treat the problem and have a number of harmful side effects.

“In the future, we might have a nasal spray with an anti-VEGF agent in it,” Kim said.

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Sleep Disorders Plague Cancer Patients

Monday, February 15th, 2010

Insomnia and sleep disorders affect more than three-quarters of cancer patients undergoing chemotherapy, a rate nearly three times higher than that of the general population, a new study finds.

The problem is more common in younger patients and in those with lung and breast cancers, said University of Rochester Medical Center researchers, who assessed sleep problems in 823 cancer patients.

Questionnaires completed by patients after their first two chemotherapy treatments revealed that 37 percent suffered from insomnia symptoms and another 43 percent had insomnia syndrome, which means they had difficulty falling asleep and staying asleep at least three nights per week, the researchers reported in the Nov. 23 online edition of the Journal of Clinical Oncology.

“These numbers are very high, and something we can’t ignore,” study author Oxana Palesh, a research assistant professor of radiation oncology, said in a news release from the medical center. “The good news is that insomnia is a very treatable problem that can be addressed quickly so it doesn’t compound other symptoms.”

Sleep problems — which are generally combined with fatigue and depression — haven’t typically been studied to determine their causes and impact on patients’ quality of life, she noted.

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Smoking During Pregnancy, Lead Exposure Raise ADHD Risk in Kids

Monday, February 8th, 2010

Children whose mothers smoked during pregnancy or who were exposed to lead have more than double the risk of having attention-deficit hyperactivity disorder (ADHD) as other children, new research shows.

And with exposure to both cigarettes and lead, the chances of having ADHD soared. Children whose mothers smoked during pregnancy and whose blood showed signs of lead exposure had eight times the risk of having ADHD.

“When you have both exposures, there is a synergistic effect,” said study author Dr. Tanya Froehlich, a developmental and behavioral pediatric specialist and an assistant professor of pediatrics at Cincinnati Children’s Hospital Medical Center.

The researchers concluded that about 38 percent of ADHD cases among children aged 8 to 15 in the United States may be caused by prenatal exposure to tobacco smoke, while 25 percent of ADHD cases are due to lead exposure, according to the study in the Nov. 23 online issue of Pediatrics.

Froehlich and her colleagues used data on 2,588 children aged 8 to 15 from around the nation who took part in the 2001-2004 National Health and Nutrition Examination Survey. Tobacco exposure was assessed by asking mothers if they smoked during pregnancy, while lead concentrations were measured by a blood test.

About 8.7 percent of children met the criteria for ADHD, which is marked by inattentiveness, difficulty focusing, impulsivity and hyperactivity, according to the study. The ADHD group included 16.8 percent of children whose mothers smoked during pregnancy, compared to 6.6 percent of children whose mothers did not smoke.

Lead exposure was divided into three groups: low, medium and high. About 5.2 percent of children who had the lowest lead blood levels had ADHD. About 9.1 percent of children in the middle range had ADHD, while 13.6 percent of children in the highest third had ADHD, the researchers found.

About 28.6 percent of children who were exposed to both prenatal smoking and who had higher blood lead concentrations had ADHD, Froehlich said.

Researchers did not find a strong link between exposure to secondhand cigarette smoke during childhood and ADHD.

Alarmingly, even children in the upper third had lead exposure levels lower than what the federal government considers “elevated.” The U.S. Centers for Disease Control and Prevention considers levels of 10 micrograms per deciliter “actionable,” Froehlich said. In the study, children in the upper third had blood lead levels that were 1.3 micrograms per deciliter or greater; children in the middle group had levels between 0.9 and 1.3 micrograms per deciliter.

Previous research has shown lead is toxic to children’s brains and is associated with lower IQs and hyperactivity in children.

“There is no such thing as a ’safe’ level of lead,” said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, N.Y. “We know the lower the lead level, the better. This is an interesting and important study in that it looks at the combined effects of lead and prenatal cigarette exposure.”

Though much remains unknown about the specific causes of ADHD, “we have long believed ADHD is at least in large part due to abnormalities of dopamine in the brain,” Adesman said. Previous research has shown lead exposure and cigarette smoking may alter the brain’s metabolism of dopamine.

About 250,000 U.S. children aged 1 to 5 have blood lead levels greater than 10 micrograms of lead per deciliter of blood, according to the CDC. Though blood lead levels have generally dropped in recent years, children, particularly those in poor, inner-city neighborhoods, may still be exposed to lead from peeling paint in old buildings. Leaded paint was banned for most residential uses in the United States in 1978.

Children may also ingest lead from old water pipes, soil and toys. In the last few years there have been multiple recalls, some by major toy manufacturers such as Mattel and Fisher-Price, of products manufactured in China that contained unsafe levels of lead.

“Lead is out there, and we need to take precautions, such as making sure we keep kids away from peeling paint and make sure they practice good hand washing before they eat if they are playing in the soil,” Froehlich said.

In addition, good nutrition, including making sure children have adequate levels of iron and calcium, can also protect from lead exposure. Children with iron and calcium deficiencies absorb more lead than children with better diets, Froehlich explained.

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