RISUG trial back on the track after 2 yr halt

HAPPY DOCTORS DAY (MARCH 30)

 
Male Contraceptive Method:

RISUG (Reversible Inhibition of Sperm Under Guidance): a reversible, nonhormonal contraceptive that provides 10 or more years of protection after a 10-15 minute procedure. Researchers received approval this week to begin enrolling additional study volunteers, after a delay of nearly four years. In the RISUG study, doctors inject a gel into the tube that sperm travel through after they are produced (known as the vas deferens). The gel then disables the sperm as they swim by. In study animals, male fertility returns if the RISUG is flushed out with another injection that dissolves the gel.
  In 2002, when enrollment in the Indian study was halted, more than 140 men were already using RISUG. Concern about side effects and insufficiency of safety data caused a temporary suspension of the project. However, expert panels subsequently concluded that the major side effect -- several weeks of non-painful scrotal swelling in about a third of the subjects --was not enough to stop the study.
  Currently, RISUG's developers (ICMR, India and affiliated researchers) are arranging a collaboration with US researchers. Lissner says that to gain FDA approval, US researchers will have to begin with animal tests, so studies in North American men would not start for several years.
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Abstract from EurekAlert! 30 March 2006 post
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Other useful links on current research in contraception:
http://www.malecontraceptives.org/methods/risug.php
http://www.mcip.info/
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Updated clinical guidelines

Recently Updated Clinical Guidelines at National Guideline Clearinghouse (NGC):

March 27, 2006

1. Anakinra for rheumatoid arthritis

MAJOR RECOMMENDATIONS

• On the balance of its clinical benefits and cost effectiveness, anakinra is not recommended for the treatment of rheumatoid arthritis, except in the context of a controlled, long-term clinical study.
• Patients currently receiving anakinra for rheumatoid arthritis may suffer loss of well-being if their treatment were discontinued at a time they did not anticipate. Therefore, patients should continue therapy with anakinra until they and their consultant consider it is appropriate to stop.

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2. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis

MAJOR RECOMMENDATIONS

• Combination therapy with peginterferon alfa and ribavirin is recommended within its licensed indications for the treatment of people aged 18 years and over with moderate to severe chronic hepatitis C (CHC), defined as histological evidence of significant scarring (fibrosis) and/or significant necrotic inflammation.
• People with moderate to severe CHC are suitable for treatment if they have:
  • not previously been treated with interferon alfa or peginterferon alfa, or
  • been treated previously with interferon alfa (as monotherapy or in combination therapy), and/or
  • previously received peginterferon alfa monotherapy only and responded at the end of treatment but subsequently relapsed, or did not respond at the end of treatment.
• People currently being treated with interferon alfa, either as combination therapy or monotherapy, may be switched to the corresponding therapy with peginterferon alfa.
• Treatment for the groups identified in the first two recommendations (see above) should be as follows.
  • People infected with hepatitis C virus (HCV) of genotype 2 and/or 3 should be treated for 24 weeks.
  • For people infected with HCV of genotype 1, 4, 5 or 6, initial treatment should be for 12 weeks. Only people showing, at 12 weeks, a reduction in viral load to less than 1% of its level at the start of treatment (at least a 2-log reduction, see Section 4.1.2.5 of the original guideline document) should continue treatment until 48 weeks. For people in whom viral load at 12 weeks exceeds 1% of its level at the start of treatment, treatment should be discontinued.
  • People infected with more than one genotype that includes one or more of genotypes 1, 4, 5, or 6 should be treated as for genotype 1.
• People satisfying the conditions in the first two recommendations (see above) but for whom ribavirin is contraindicated or is not tolerated should be treated with peginterferon alfa monotherapy. Regardless of genotype, individuals should be tested for viral load at 12 weeks, and if the viral load has reduced to less than 1% of its level at the start of treatment, treatment should be continued for a total of 48 weeks. If viral load has not fallen to this extent, treatment should stop at 12 weeks.
• People for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic HCV infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification.
• There is insufficient evidence to recommend combination therapy using peginterferon alfa or interferon alfa in people who:
  • have previously been treated with combination therapy using peginterferon alfa, and/or
  • are younger than 18 years of age, and/or
  • have had a liver transplantation. Treatment of CHC recurrence after liver transplantation (whether or not the person had been treated with interferon alfa or peginterferon alfa therapy at any time before transplantation) should be considered as experimental and carried out only in the context of a clinical trial.

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3. Guidance on the use of liquid-based cytology for cervical screening

4. Myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction

5. British guideline on the management of asthma. A clinical national guideline This updates a previously published guideline summary.

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ALERT! mifepristone & sepsis risk

FDA MedWatch announced alert on March 17, 2006 for proper prescription and follow up of women who are prescribed mifepristone for medical abortion following two newly reported cases of death from sepsis following medical abortion with mifepristone and misoprostol. FDA urges in particular, physicians and their patients should fully discuss early potential signs and symptoms that may warrant immediate medical evaluation. Previously reported four cases of death from sepsis were because of Clostridium sordellii sepsis.
Currently approved regime for medical abortion by FDA is as follows^#:

The approved Mifeprex regimen for a medical abortion through 49 days' pregnancy is:

• Day One: Mifeprex Administration: 3 tablets of 200 mg of Mifeprex orally at once
• Day Three: Misoprostol Administration: 2 tablets of 200 mcg of misoprostol orally at once.
• Day 14: Post-Treatment: the patient must return to confirm that a complete termination has occurred. If not, surgical termination is recommended to manage medical abortion treatment failures.
• The safety and effectiveness of other Mifeprex dosing regimens, including use of oral misoprostol tablets intravaginally, has not been established by the FDA.

This post has partial summary from FDA website.
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#: It is highly recommended and disclaimed hereby to refer to FDA website links on " Mifeprex (mifepristone) Information & Sepsis and Medical abortion update: Public Health Advisory" for up-to-date, complete and authentic information on given blog post. For complete disclosure/disclaimer details, click here.
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P.S.: NEJM article on Fatal Toxic Shock Syndrome Associated with Clostridium sordellii after Medical Abortion: Four case reports
N Eng J Med 2005;353:2352-2360
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Hope for Huntington's Disease patients

FK506 (Tacrolimus): Hope for Huntington's Disease (HD) patients

01 Feb 2006

Researchers are working at Institut Curie and other labs to find out role of Tacrolimus (Immunosupressant) in preventing mutant Huntingtin protein's cumulative toxicity to neurons and thereby giving ray of hope to many patients with currently incurable HD. Read more at....
Title: Inhibition of Calcineurin by FK506 Protects against Polyglutamine-Huntingtin Toxicity through an Increase of Huntingtin Phosphorylation at S421: Abstract of  February 1, 2006 issue of The Journal of Neuroscience
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Online manuals for ACLS providers

Here are NGC redirected links for ACLS providers to refresh their skills and theory base from AHA journal.

From American Heart Association

Acute coronary syndromes: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Adult basic life support: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Advanced life support: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Defibrillation: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

First aid: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Managing abnormal blood lipids. A collaborative approach.

Neonatal resuscitation: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Pediatric basic and advanced life support: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

Stroke: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.

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SBA

Rituximab to be studied for the role in preserving Insulin store in early Type 1 DM

Rituximab to be studied for the role in preserving Insulin store in early Type 1 DM
16-Mar-2006

Rituximab (Rituxan® and MabThera®) - a monoclonal antibody against CD-20 B Cells will be studied in this April to evalauate its possible role in halting progression auto-immune destruction of beta islets of pancreas seen in early pathogenesis of Type 1 DM. The study will test rituximab in recently diagnosed type 1 diabetes patients who are at least 8 years old and who still have some pancreas function. The patients will receive treatments once a week for four weeks. Two-thirds of the participating patients will receive rituximab, and the rest will receive a placebo. Being an international research trial, Indiana University School of Medicine scientists will begin the study and will enroll 66 patients over two years. The study is funded by TrialNet, a National Institute of Health, federally-funded research initiative.
Original link EurekAlert!
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sirolimus-eluting stent is superior to vascular brachytherapy in-stent restenosis following bare-metal stent placement

Study performed at Mayo Clinic, Rochester, Minn. shown sirolimus-eluting stent is superior to vascular brachytherapy in-stent restenosis following bare-metal stent placement. Read early release article at JAMA. 2006;295:1264-1273 [Abstract at EurekAlert!]

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SBA

Top ten contact dermatitis allergens identified in Mayo Clinic study

Original Article at EurekAlert!

Research also confirms utility of patch testing to discover allergens and finds patients satisfied with testing, yet they recall only half of their allergens

A new Mayo Clinic study reveals the most common causes of allergic contact dermatitis, a skin inflammation resulting in swollen, reddened and itchy skin due to direct contact with an allergen. Topping the list were:

1. Nickel (nickel sulfate hexahydrate) -- metal frequently encountered in jewelry and clasps or buttons on clothing
2. Gold (gold sodium thiosulfate) -- precious metal often found in jewelry
3. Balsam of Peru (myroxylon pereirae) -- a fragrance used in perfumes and skin lotions, derived from tree resin
4. Thimerosal -- a mercury compound used in local antiseptics and in vaccines
5. Neomycin sulfate -- a topical antibiotic common in first aid creams and ointments, also found occasionally in cosmetics, deodorant, soap and pet food
6. Fragrance mix -- a group of the eight most common fragrance allergens found in foods, cosmetic products, insecticides, antiseptics, soaps, perfumes and dental products
7. Formaldehyde -- a preservative with multiple uses, e.g., in paper products, paints, medications, household cleaners, cosmetic products and fabric finishes
8. Cobalt chloride -- metal found in medical products; hair dye; antiperspirant; objects plated in metal such as snaps, buttons or tools; and in cobalt blue pigment
9. Bacitracin -- a topical antibiotic
10. Quaternium 15 -- preservative found in cosmetic products such as self-tanners, shampoo, nail polish and sunscreen or in industrial products such as polishes, paints and waxes

Read original and full article at EurekAlert!
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