Strokes – Family History a Significant Risk Factor

According to an article published by WebMD, individuals whose parents have had a stroke by age 65 are more likely to have a stroke.

Strokes are generally defined as disturbances of blood flow in the brain as a result of a ruptured blood vessel, a blockage within the lumen of the blood vessel, or some other ischemic process. The ischemic process can cause brain tissue to die, resulting in death or permanent brain injury. In all respects, strokes represent medical emergencies.

Among other things, the following are generally considered to be risk factors for developing a stroke: previous history of strokes, brain trauma, advanced age, increased lipid levels, increased blood pressure, diabetes, atrial fibrillation, and smoking.

The results of the study suggest that a person’s family history of strokes should also be considered in assessing the risk for developing a stroke.

Researchers studied 3,443 people who initially were stroke free and second-generation participants in the Framingham Heart Study. The participants’ parents had reported 106 strokes by age 65, and offspring 128, over the 40-year study. People with a parent who had a stroke by age 65 had twice the risk of having a stroke at any age and four times the risk by 65, after adjusting for conventional risk factors.

Contributing author: Jon Stefanuca

We’ve Heard of MRSA – Now We Learn that Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com

An article in yesterday’s New York Times by Andrew Pollack – Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com – brings to the public’s awareness that  Gram-negative organisms such as Klebsiella pneumoniae and Acinetobacter are becoming almost as common but have very few treatment options in the form of effective antibiotic coverage.        

The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.

Mr. Pollack reports that “[a]ccording to researchers at SUNY Downstate Medical Center, more than 20 percent of the Klebsiella infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide.”

The number of infections occurring annually in hospitals is simply staggering – roughly 1.7 million hospital-associated infections, according to the Centers for Disease Control and Prevention. More horrifying is the CDCP’s estimate that when taking into account all types of bacteria combined, these organisms cause or contribute to 99,000 deaths each year.

“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, Calif., and the author of “Rising Plague,” a book about drug-resistant pathogens.

Mr. Pollack’s article also sheds light on yet another little-known but equally tragic fact – a physician’s choices in treating some of these deadly Gram-negative bacteria are not without significant risks to the patient – neuro and nephrotoxicity.

Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. These drugs were largely abandoned decades ago because they can cause kidney and nerve damage, but because they have not been used much, bacteria have not had much chance to evolve resistance to them yet.

“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”

As many are aware or becoming increasingly aware, the drug-resistant bacteria are believed to be the by-product of overuse of antibiotics by healthcare providers over the past many decades.  Specialists in infectious disease have been vocal advocates for the judicious use of antibiotic therapy and avoidance of the ‘take a pill’ first approach by many front line providers such as internists.

In his article, Mr. Pollack provides a link to a campaign started by the parents of a 27 year old young man, who survived his post-operative, hospital-acquired MRSA infection twice only to die a victim of a Gram-negative organism, Enterobacter aerogenes. These advocates for prevention of hospital-acquired infections, Armando and Victoria Nahum, started the Safe Care Campaign.  A visit to this site is most instructive and we invite you to do so.

Announcement: Newborn Possibilities Program underway in AZ – stem cell research related to cerebral palsy

A posting yesterday in PRNewswire tells of a collaborative research effort called “Newborn Possibilities Program” in Tuscon, Arizona, for preservation of cord blood stem cells “so that if a child is diagnosed with the condition, he or she may be eligible to receive a new treatment being researched under approval from the FDA using the child’s own cord blood stem cells.”

This research initiative is being done as a collaborative effort by the Cord Blood Registry, the world’s largest stem cell bank; Save the Cord Foundation, a nonprofit advocacy organization based in Tucson; Tucson Medical Center, the region’s leading birthing hospital; and Watching Over Mothers and Babies Foundation (WOMB), a local non-profit research foundation.

A statement by the CEO of the Cord Blood Registry, Tom Moore, best describes the goal of this new program:

This program is a way for us to provide a safety net to children at-risk for cerebral palsy and other forms of neonatal brain injury while helping to advance the science of regenerative medicine.  CBR and our collaborators in this unique program share a commitment to advance cord blood stem cell research, expand education about the value of cord blood banking, and improve outcomes for children with neurological disabilities.

In a statement by the founders of one of the program’s collaborating members, Save the Cord Foundation, Anne Sarabia and Charis Ober,  we are provided further insight into the present and future goals of the program:

We believe that cord blood will play a very important role in future medicine and will benefit so many children in our community at risk for cerebral palsy.   Our dream is that this program will inspire other medical institutions to follow and make preserving cord blood the standard of care for all newborns.

Dr. Hugh Miller, head of WOMB and a specialist in Maternal-Fetal Medicine, who will be the program’s director at Tuscon Medical Center, said in the interview:  

The Newborn Possibilities Program is laying the groundwork for potential new treatment options for cerebral palsy and neurological disorders by connecting patients who may be at risk for these conditions and who have access to their cord blood stem cells with FDA-approved research studies. We believe this program will be instrumental in accelerating the pace of research and potentially helping many children.

As those of you who follow our blog postings and/or the recent news concerning stem cell research relating to cerebral palsy are aware, the Food and Drug Administration recently approved  a human clinical trial evaluating the safety and efficacy of using a child’s own newborn blood stem cells to treat cerebral palsy.

Having been involved in handling cases of children with cerebral palsy for many years, I have seen the issues of preservation of tissue, blood and medical records (i.e. fetal monitor strips) go the full gamut.  For years, placental pathologists were begging medical institutions to preserve placentas for further research into perinatal  birth injuries (among other concerns).  There was a time when one institution, which shall remain nameless, had a suspected policy of discarding fetal monitor strips (gee – wonder why that was!) and so on and so on.  It is really heartening to see that this new collaborative program is putting the interests of science, children’s health and knowledge far ahead of any conjured concerns relating to fear of litigation.    Hopefully, this program, in conjunction with all the other research regarding cerebral palsy now going on, will get to the bottom of this horrible disorder and provide new meaningful care options for at least some of the victims of cerebral palsy.

FDA reports says Avandia can hurt heart: NY Times investigative report

From a report in Yahoo News, which is the source for this posting  – FDA reports says Avandia can hurt heart: report:

According to a report by the NY Times yesterday, February 19, 2010, Confidential U.S. government reports recommend that GlaxoSmithKline Plc’s diabetes drug Avandia be pulled from the market because it can hurt the heart.

Two authors of the report, Dr. David Graham and Dr. Kate Gelperin of the FDA, both concluded that it should be removed from the market.

According to Yahoo News, Sales of Avandia, once Glaxo’s second biggest-selling product, plummeted two years ago after a U.S. study linked it to an increased risk of heart attack in a conclusion disputed by Glaxo.

According to the Times reporter, Gardiner Harris, an FDA advisory board voted, 8-7, in 2007 to accept the advice of an independent committee that while Avandia might increase the risk of heart attack, it should stay on the market.

A U.S. Senate investigation into the product “said Glaxo failed to warn patients earlier that Avandia was potentially deadly” – according to the Times report.

The Times said the internal FDA findings reflected a fierce debate inside the agency about Avandia. The newspaper quoted Glaxo as saying it had studied Avandia extensively and that “scientific evidence simply does not establish that Avandia increases” heart attack risk.

At the end of last year, Dr. Janet Woodcock, director of the FDA’s drug center, wrote an internal memorandum that “there are multiple conflicting opinions” about Avandia and ordered officials to assemble another advisory committee to reconsider if the drug should be sold.

The Times quoted FDA Commissioner Margaret Hamburg as saying on Friday, “I await the recommendations of the advisory committee.”