Face Masks - Some Guidance for Pandemic Use

Obviously, we all hope we'll look back on this brief blog post and laugh that we were so worried about the Swine Flu virus. However - just in case - here are some tips on proper face mask use.

First off, remember that face masks sold in drug stores are not very effective. The only type that the US Government would recommend are N95 masks, which are called "respirators." They filter out 95% of anything which is .3 microns and larger, which means that they will, if fitted properly, help with "close quarters" situations where the flu virus is lurking about.

As happened in the SARS scare a few years ago, face masks and respirators became very hard to find. People were hoarding them. Right now, doing a search for N95 Face Mask on eBay, you can find plenty of people selling them inexpensively and they have them in stock. Expect these prices to go up dramatically if a pandemic does take off -- that is, if you are lucky to find them. It wouldn't hurt to spend $10 or $15 on a box of N95's, so I'd suggest you go to eBay and grab a box or two.

Here are the USG comments on reducing the risk of infection during a pandemic:

• Avoid close contact and crowded conditions whenever possible, rather than relying on the use of masks or respirators;

• In crowded settings, consider using face masks to protect noses and mouths from other people's coughs and reduce the likelihood of coughing on others; and

• Use an N95 respirator when contact with an infectious person cannot be avoided, such as when caring for a sick person at home.

According to the guidance, people should consider wearing a face mask during an influenza pandemic if they are sick with the flu and think they might have close contact with other people, live with someone who has flu symptoms or will spend time in a crowded public place.

People should consider wearing a respirator during an influenza pandemic if they are well and expect to be in close contact with people who are sick with pandemic flu.

More information about masks and respirators and about community preventive measures is available at the U.S. government’s pandemic flu Web site.

More detail is available by clicking on the blog headline.

Dave

Immune Fighting Effects of Probiotics

Scientists from University College Cork (Ireland) have been using probiotics successfully against a number of animal diseases. This has helped them to understand some of the ways in which they work -- this knowledge could lead to new probiotics that prevent and even treat human diseases.

Presenting his work at the Society for General Microbiology meeting in early April, Dr Colin Hill described how his team had used three animal models of disease that have human counterparts – bovine mastitis, porcine salmonellosis (a gastrointestinal disease) and listeriosis in mice (an often fatal form of food poisoning) – to demonstrate the protective effects of probiotics.

“In all three animal diseases, we observed a positive effect in that the animals were significantly protected against infection," said Dr. Hill, whose team had blended their own probiotic substances together specifically for these experiments.

Probiotics were also used to control disease in animals that were already infected. The results of these tests proved that administering safe bacteria to an infected animal was as effective as the best available antibiotic therapies in eliminating the infectious agent and resolving the symptoms.

In each instance the protection was linked to a particular bacterial species, and the mechanism of action varied from direct antagonism (where the probiotic directly kills the pathogenic bacteria) to effects mediated by the host immune system. For example Lactobacillus salivarius UCC118 protected mice against listeriosis (a disease which can affect pregnant women) by producing an antimicrobial peptide that eliminates Listeria monocytogenes in the gut of the animal. In another mechanism, Lactococcus lactis could be used to treat mastitis by eliciting an immune response that overwhelmed the infectious
bacterium.

Dr Hill added, “It is likely that using probiotics rather than antibiotics will appeal to at-risk individuals since they are safe, non-invasive, do not create resistant bacteria and can even be administered in the form of tasty foods or beverages”.

Dave

Grapefruit Juice - Positive Effect in Combination with Cancer Drug

Researchers at the University of Chicago Medical Center have found that combining eight ounces of grapefruit juice with the drug rapamycin can increase drug levels, allowing lower doses of the drug to be prescribed. They also showed that the combination can be effective in treating various types of cancer.

This is interesting information, because it now appears that studies are ongoing to take advantage of the drug interaction that occurs with grapefruit. For twenty years, pharmacists have pasted "DO NOT TAKE WITH GRAPEFRUIT JUICE" stickers on various pill bottles because the juice can interfere with the enzymes that break down and eliminate certain drugs. This interference has always been considered dangerous, because It can make the drugs more potent.

However, in data presented at the AACR 100th Annual Meeting in Denver last week, the Chicago researchers examine ways to exploit this fruit's medication-altering properties. They have identified a drug that can be reduced to much lower dosage levels when combined with this citrus juice.

"Grapefruit juice can increase blood levels of certain drugs by three to five times," said study director Ezra Cohen, MD, a cancer specialist at the University of Chicago Medical Center. "This has always been considered a hazard. We wanted to see if, and how much, it could amplify the availability, and perhaps the efficacy of rapamycin, a drug with promise for cancer treatment."

The clinical trial was designed to test whether doctors could use grapefruit juice to boost rapamycin's bioavailability to the patient's advantage -- to determine how much the juice altered drug levels, and then to assess its impact on anti-cancer activity and side effects.

Cancer specialists became interested in rapamycin when they learned that it disrupted a biochemical pathway involved in the development of the new blood vessels that tumors need to grow. But the drug is so expensive, and so poorly absorbed. Less than 15 percent of rapamycin goes to work in the body when taken by mouth.

That's why it is great that substances known a furanocoumarins, plentiful in grapefruit juice, can decrease the breakdown of rapamycin. This makes the drug reach higher levels in the bloodstream; in fact, two-to-four times the levels seen without a juice boost, and thus increases the amount of the drug that reaches its targets.

"That means more of the drug hits the target, so we need less of the drug," said Cohen. And when a drug like this is so expensive, that has a very serious bottom line benefit to all. "This is an opportunity for real savings," Cohen said. "A daily glass of juice could lower the cost by 50 percent."

Dave

Pomegranate for Prostate

There are new long-term research results being presented at the 104th Annual Scientific Meeting of the American Urological Association. Researchers there have found that men who had undergone treatment for localized prostate cancer benefitted from drinking pomegranate juice.

In this two-stage clinical trial, researchers followed a total of 48 participants over six years. Eligible participants had a rising PSA after surgery or radiotherapy, and the patient treatment was to drink eight ounces of pomegranate juice daily. There are still patients who are currently in their sixth year of treatment; these active patients who remain on the study have a median total follow-up of 56 months. (These participants continue to experience a significant increase in PSA doubling time following treatment, from a mean of 15.4 months at baseline to 60 months post-treatment, with a median PSA slope decrease of 60 percent, 0.06 to 0.024. In other words, the drink appears to dramatically slow down the disease.)

There were important differences between this group which currently drinks pomegranate juice and those who had dropped out earlier. The drop out's have had a faster progression of the cancer.

“This study suggests that pomegranate juice may effectively slow the progression of prostate cancer after unsuccessful treatment,” said Christopher Amling, MD. “This finding and other ongoing research might one day reveal that pomegranate juice is an effective prostate cancer preventative agent as well.”

Parts of this ongoing study suggest that some patients may be more sensitive to the effects of pomegranate juice on PSA doubling time. Phase three of this study is currently underway to further evaluate the benefits of pomegranate juice in placebo-controlled trials.

Dave

As Hormone Replacement Therapy Use Goes Down, So Do Women's Heart Attacks

The number of myocardial infarctions, or heart attacks, in menopausal women each year appears to be going down because the popularity of hormone replacement therapy (HRT) has declined. A new study, which appears in the May issue of the journal Medical Care, looked at whether the decreased use of HRT has affected the rate of cardiovascular health outcomes. It certainly looks like a positive trend for women's health.

Before 2002, physicians believed that HRT reduced the risk of coronary heart disease by up to 50 percent in menopausal women. However, a report by the Women’s Health Initiative in 2002 revealed that HRT actually had the opposite effect — it increased the risk of heart attack in these women. As a result, the use of HRT has "declined dramatically in women aged 50 to 69, going from more than 30 percent to less than 15 percent,” said lead study author Kanaka Shetty, M.D.

Shetty (RAND Corporation in Santa Monica) and colleagues evaluated data from 1990 to 2005 for women between the ages of 40 and 79. The researchers used U.S. death records, hospital discharge data and national surveys of medication usage.

They found that the decreased use of HRT did not reduce the number of hospitalizations or deaths from stroke. However, it was indeed linked to a decrease in heart attacks among women.

The study found that for every 10,000 additional HRT users in one year, there will be 25 more heart attacks.

Dave

Vitamin D Insufficiency and Asthma

A new study is being reported on which provides evidence for a link between vitamin D insufficiency and asthma severity.

In Costa Rica, more than 600 children had their serum levels of Vitamin D tested, and these were inversely linked to several indicators of allergy and asthma severity. It seems that hospitalizations for asthma, use of inhaled steroids and total IgE levels were both shown to be much higher whenever Vitamin D was insufficient. This study will appear in the first issue for May of the American Journal of Respiratory and Critical Care Medicine and is linked to the headline of this post.

Costa Rica is a country known to have a high prevalence of asthma. Juan Celedón, M.D. and his colleague Augusto Litonjua, M.D. of Harvard Medical School recruited 616 children with asthma to be assessed for allergic markers, including both allergen-specific and general sensitivity tests, and assessed for lung function and circulating vitamin D levels.

They found that children with lower vitamin D levels were significantly more likely to have been hospitalized for asthma in the previous year; these youngsters also tended to have airways with increased hyperreactivity and were likely to have used more inhaled corticosteroids. They were also significantly more likely to have several markers of allergy, including dust-mite sensitivity.

“This study suggests that there may be added health benefits to vitamin D supplementation” said Dr. Celedón. Current recommendations for optimal vitamin D levels are geared toward preserving bone health, such as preventing rickets in children and osteoporosis in adults. But these levels may not be sufficient to deal with issues of allergies and asthma.

“This study also provides epidemiological support for a growing body of in vitro evidence that vitamin D insufficiency may worsen asthma severity, and we suspect that giving vitamin D supplements to asthma patients who are deficient may help with their asthma control” wrote the authors, noting that a clinical trial should be the next step in this research.

“Whether vitamin D supplementation can prevent the development of asthma in very young children is a separate question, which will be answered by clinical trials that are getting under way,” he said.

Dave

Binge Drinking in Teens Compromises Brain Development

Many parents don't realize the extent of alcohol consumption that goes on in high school. Sadly, new research shows that even relatively infrequent exposure to large amounts of alcohol during the teen years may compromise the integrity of the brain’s white matter, which is critical for the efficient relay of information within the brain.

The preliminary findings – published online in advance of the July issue of the journal Alcoholism: Clinical & Experimental Research – indicate that binge drinking may be detrimental to the developing adolescent brain. This heavy drinking is common among adolescents, with 55% of high-school seniors reporting having gotten drunk, and a quarter of them reporting having consumed five or more drinks in a row during the previous two weeks. It's the intense nature of the drinking in each experience that leads to this problem.

“Because the brain is still developing during adolescence, there has been concern that it may be more vulnerable to high doses of alcohol,” said Susan F. Tapert, PhD, at the VA San Diego Healthcare System and associate professor of psychiatry at the University of California, San Diego School of Medicine. “This study showed that teens with histories of binge drinking episodes have lower coherence of white matter fibers in a variety of brain regions.”

The article describes “White matter” as the part of the brain made up of the axons of neurons – long filaments that extend from the cell bodies and carry the electrical signals that relay messages between neurons. The area appears white because of the axons’ protective myelin covering.

Tapert and colleagues used an MRI technique called diffusion tensor imaging, or DTI, to measure the integrity of white matter in the brains of 28 teenagers – 14 who had and 14 who did not have histories of binge drinking. These tests allowed the researchers to observe alterations to the structure of fibers within the brain’s white matter.

The 28 participants were age 16 to 19, and none had a history of an alcohol or other drug use disorder. 14 of the teens who reported drinking at least four (for females) or five (for males) alcoholics beverages in one sitting during the three months prior to DTI imaging were considered "binge" drinkers. The control teens were matched on age, gender and level of education.

According to Tapert, the teen binge drinkers exhibited lower levels of white matter fiber coherence, as measured in 18 separate areas of the brain, relative to the controls.

“Those who reported engaging in binge drinking showed lower levels of brain organization,” said Tapert. She added that this could be either a risk factor for increased alcohol use or an effect of the alcohol. “While long-terms studies that follow teens over time are essential to clarify the cause and effect of these brain changes, I would say that drinking to the point of being drunk may be detrimental to the adolescent brain.”

Dave