Cumulative Updates: Stroke Guideline | New Anti-Platelet drug in Phase 3

Here are cumulative updates (shortlist) happened in recent two weeks. I am unable to post frequent regular updates because of tight schedule and limited internet connectivity. Alternately, use feed station for keeping eye on medical news.

1. Updated guidelines for treatment of acute ischemic stroke:
By American Heart Association/American Stroke Association (Apr 19, 2007, ahead of print issue of Stroke)

Major Recommendations/Changes since 2003 guidelines

• Intravenous tPA is still recommended as the key treatment of stroke in patients presenting within 3 hours of the onset of stroke symptoms
• Time is the key, activation of emergency medical services ASAP is the topmost priority
• Upcoming role of intra-arterial tPA in patients with inaccessible intravenous line
• Comaprision of benefits Vs risks using Mechanical Embolus Removal in Cerebral Embolism (MERCI) retriever (FDA approved) or tPA.
• CT scan still remains preferred modality with only primary intetion to exclude hemorrhage event and plan for tPA treatment
• MRI is acceptable alternative provided quick access is available

..... guidelines truncated

Refer Medscape article (link) or Stoke journal (May 2007 issue) for complete guidelines.

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2. Newer Anti-platelet drug in Phase 3 clinical trial:
Newer class of oral anti-platelet drug (platelet PAR-1 receptor blocker) named TRA-SCH 530348 (Schering-Plough Inc.). In fact, it blocks the platelet PAR-1 receptor to which thrombin binds, thus inhibiting thrombin-induced activation of platelets, and is therefore classified as a thrombin-receptor antagonist (TRA). Recently reported phase 2 trial showed fewer ischemic events without increasing bleeding when added to standard antiplatelet therapy with aspirin and clopidogrel in patients undergoing PCI. Researchers from Duke and TIMI group have now planned two major phase 3 trials which will be accessing effect of this novel agent compare to placebo without adjuvant standard anti-platelet regime. Two groups of patients will include one for the treatment of acute coronary syndrome (ACS) patients (more than 10000 patients), and one for secondary-prevention in patients who have had a prior MI or stroke or who have existing peripheral arterial disease.
.....update truncated

Original press release at http://www.schering-plough.com/schering_plough/news/release.jsp?releaseID=987054
Courtesy: Medscape

SBAmin.com is down: Server Shifting In Progress

Copy of original post:

Site Status: DOWN | Blog Status: Healthy

Dear Visitor,

Because of an ongoing data corruption error, we are shifting site servers to new, stable ones. Henceforth, SBAmin.com may not be available for next 24-48 hours. However, Blog Junction (status: Healthy) is active throughout site maintenance period.
Also, please note change in email contact information. Kindly do not email me at Instead use this link OR email me at till further update.

I'll be updating here soon as site status becomes OK.

Sorry for inconvenience!

Regards,
Samir
21 April 2007 1227 +0530
Baroda India
T: (0091) 93762 26975
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Declining Breast Cancer & HRT effect

Hormone Replacement Therapy (HRT) is again in the news, once again with possible causal association for developing breast cancer. Statistical analysis performed by M.D.Anderson's team revealed strong association (but no cause-to-effect relationship) between declining breast cancer cases and parallel decline in use of HRT in post-menopausal women since mid-2002. The decline occurred primarily in women age 50-69, the researchers find, and was predominantly seen in estrogen-receptor(ER)-positive cancer. Ravdin and Berry strongly stress, however, that their study is not suggesting that all women stop their use of HRT. "This study is not saying that an individual woman will reduce her absolute risk of developing breast cancer by 15 percent by immediately discontinuing use of HRT," Berry says.

Read brief report at EurekAlert! 18 Apr 2007
Original article: Ravdin PM et al. | The Decrease in Breast-Cancer Incidence in 2003 in the United States | N Engl J Med 2007(Apr 19);356:1670-1674

Inhaled Insulin (Exubera) - Falling Star

Inhaled Insulin (Exubera) was brought in market in early-2006 and since then, it's being criticized for its added efficacy and long-term safety profile over standard subcutaneous insulin regime. Recently, National Institute for Health and Clinical Excellence (NICE, UK Government) has published guideline on use of inhaled insulin for the treatment of type 1 and 2 diabetes. Authors of guideline group do not recommend inhaled insulin for the routine treatment of diabetes.

Also, inhaled insulin should be used as an alternative option in only those subgroup of diabetic patients in whom other treatment modalities are ineffective or intolerable and interestingly, in patients suffering from specific phobia of "blood injection injury type" who are not willing to take standard subcutaneous insulin injections. Several other studies also recommend data collection for evaluating long-term safety profile of inhaled insulin and it's effect on lung functions.

Reference:
1. NICE guideline (Dec 2006): Inhaled insulin for the treatment of diabetes (types 1 and 2)
2. Exubera | Pfizer Inc.
3. FDA approval of Exubera
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