Drug tackles hepatitis C: Positive pilot study for new anti-viral.: "Drug tackles hepatitis C Positive pilot study for new anti-viral. 27 October 2003 HELEN R. PILCHER

A new drug may help those with hepatitis C. The molecule, which slams the brakes on virus replication, looks good in a preliminary trial. Some 170 million people worldwide are infected with hepatitis C virus (HCV), which can cause cirrhosis and liver cancer. The new treatment could help those who carry strains that are resistant to current drugs — around half of all sufferers."

Any further info about this drug?

NEJM -- Paraneoplastic Syndromes Involving the Nervous System: "Paraneoplastic Syndromes Involving the Nervous System Robert B. Darnell, M.D., Ph.D., and Jerome B. Posner, M.D.

The term "paraneoplastic syndromes" refers to symptoms or signs resulting from damage to organs or tissues that are remote from the site of a malignant neoplasm or its metastases. Paraneoplastic syndromes can affect most organs and tissues. Widely known examples include cancer cachexia,1 hypercalcemia,2 Cushing's syndrome,3 and Trousseau's syndrome.4 Most of these paraneoplastic syndromes occur because the tumor secretes substances that mimic normal hormones or that interfere with circulating proteins. A few paraneoplastic neurologic disorders are caused by similar mechanisms (e.g., carcinoid myopathy and encephalopathy).5 However, most or all paraneoplastic neurologic disorders are immune-mediated. We ..."

Too long to be good! ;) - KK

Pfizer Wins FDA Approval of Inspra for Heart Failure: "Pfizer Wins FDA Approval of Inspra for Heart Failure NEW YORK (Reuters) Oct 08 - Pfizer Inc. on Wednesday said U.S. regulators approved the company's drug, Inspra (eplerenone tablets), for congestive heart failure patients who have already had a heart attack. The U.S. Food and Drug Administration approved Inspra last year for treating high blood pressure. Inspra, a selective aldosterone blocker, will compete with older classes of drugs such as ACE inhibitors and calcium channel blockers."

Haven't heard of eplerenone before. A congener of Amrinone? - KK

Family Physicians Often Fail to Distinguish Between Systolic and Diastolic

Family Physicians Often Fail to Distinguish Between Systolic and Diastolic Dysfunction


Martha Kerr

Oct. 9, 2003 (New Orleans) — A study of patients with heart failure cared for by family physicians revealed that 73% of the practitioners did not identify diastolic dysfunction on echocardiogram (ECG) results, even though there was evidence of it on the ECG.

Investigator Denise Sur, MD, and colleagues, from the Department of Family Medicine at the University of California David Geffen School of Medicine in Los Angeles, reviewed the charts and ECGs of 86 patients seen at their clinic. Results of the study were presented here at the American Academy of Family Physicians (AAFP) annual scientific assembly.

Evidence of diastolic dysfunction was present in 43% of patients with a diagnosis of chronic heart failure. However, "In 73% of cases, family physicians did not acknowledge that there was diastolic dysfunction on the [ECG], even though there was evidence of it," Dr. Sur told Medscape. Dr. Sur reported that the elderly were more likely to have diastolic dysfunction than younger patients with heart failure.

Can someone elaborate on the ECG differentials between Systolic and Diastolic dysfunction? - KK

High-Protein Diet Helpful in Type 2 Diabetes: "High-Protein Diet Helpful in Type 2 Diabetes Laurie Barclay, MD Oct. 6, 2003 — A five-week high-protein diet improves glycemic control and lipid profiles without adversely affecting renal function in type 2 diabetes, according to the results of a study published in the October issue of the American Journal of Clinical Nutrition. The editorialist praises the study design, but all agree that long-term outcomes studies are now needed."

Very interesting... - KK

Repetitive Transcranial Magnetic Stimulation to Treat Parkinson: "Journal Watch Neurology August 21, 2003 Repetitive Transcranial Magnetic Stimulation to Treat Parkinson Disease Posted 10/06/2003 Summary Repetitive transcranial magnetic stimulation (rTMS) of the brain is a noninvasive, well-tolerated technique that can modify cerebral cortex excitability both locally and at remote, but functionally connected, areas (Lancet Neurology 2003; 2:145). Initial research on rTMS for motor function in Parkinson disease (PD) showed promising results (Neurology 1994; 44:892), but later research failed to confirm initial findings (e.g., Neurology 1999; 52:768) and has yielded mostly conflicting results. Now, two groups of researchers report results with further variations on rTMS in PD..."

Sounds interesting. - KK

Flash: Plant Estrogens Don't Help: "Flash: Plant Estrogens Don't Help Posted 10/07/2003 Summary Phytoestrogens, commonly found in edible plants such as soybeans and red clover, bind weakly to the estrogen receptor and are marketed widely as a nonhormonal treatment alternative for hot flashes. But, do they work? In this double-blind trial, 62 postmenopausal symptomatic women were randomized to receive phytoestrogens (isoflavonoids, 114 mg/day) or placebo for 3 months; after a 2-month washout period, the women crossed over to the other arm for 3 months. All women previously had been treated for breast cancer and complained of incapacitating hot flashes, night sweats, and sleeplessness."

hmm... didn't have a clue about this - KK

NEJM -- Development of Autoantibodies before the Clinical Onset of Systemic Lupus Erythematosus: "Development of Autoantibodies before the Clinical Onset of Systemic Lupus Erythematosus Melissa R. Arbuckle, M.D., Ph.D., Micah T. McClain, Ph.D., Mark V. Rubertone, M.D., R. Hal Scofield, M.D., Gregory J. Dennis, M.D., Judith A. James, M.D., Ph.D., and John B. Harley, M.D., Ph.D."

Screeing for SLE? - KK

NEJM -- Risk of Cervical Cancer Associated with Extending the Interval between Cervical-Cancer Screenings: "Risk of Cervical Cancer Associated with Extending the Interval between Cervical-Cancer Screenings George F. Sawaya, M.D., K. John McConnell, Ph.D., Shalini L. Kulasingam, Ph.D., Herschel W. Lawson, M.D., Karla Kerlikowske, M.D., Joy Melnikow, M.D., M.P.H., Nancy C. Lee, M.D., Ginny Gildengorin, Ph.D., Evan R. Myers, M.D., M.P.H., and A. Eugene Washington, M.D."

Do we follow the 1 year rule in SAT? - KK

NEJM -- Enfuvirtide, an HIV-1 Fusion Inhibitor, for Drug-Resistant HIV Infection in North and South America: "Enfuvirtide, an HIV-1 Fusion Inhibitor, for Drug-Resistant HIV Infection in North and South America Jacob P. Lalezari, M.D., Keith Henry, M.D., Mary O'Hearn, M.D., Julio S.G. Montaner, M.D., Peter J. Piliero, M.D., Benôit Trottier, M.D., Sharon Walmsley, M.D., Calvin Cohen, M.D., Daniel R. Kuritzkes, M.D., Joseph J. Eron, Jr., M.D., Jain Chung, Ph.D., Ralph DeMasi, Ph.D., Lucille Donatacci, M.S., Claude Drobnes, M.D., John Delehanty, Ph.D., Miklos Salgo, M.D., Ph.D., for the TORO 1 Study Group"

This might prove to be the wonder-drug we've been searching for! - KK

NEJM - Fondaparinux for Symptomatic Pulmonary Embolism: Fondaparinux is a pentasaccharide that selectively inhibits coagulation factor Xa. It is administered by subcutaneous injection and does not require laboratory monitoring. This large study compared fondaparinux and unfractionated heparin in the initial treatment of symptomatic pulmonary embolism. Fondaparinux was as effective and safe as heparin. Fondaparinux may be used as an alternative to intravenous heparin in the initial treatment of hemodynamically stable patients with symptomatic pulmonary embolism"

Selective Factor Xa inhibitor might just get rid of the tedious monitoring associated with heparin therapy - KK

NEJM - Ximelagatran versus Warfarin to Prevent Venous Thromboembolism after Total Knee Replacement: " The efficacy of ximelagatran, an orally administered thrombin inhibitor, was compared with that of warfarin for thromboprophylaxis after total knee replacement. Both drugs were given for 7 to 12 days postoperatively, ximelagatran at a dose of 24 or 36 mg twice daily and warfarin with a target international normalized ratio of 2.5. The higher dose of ximelagatran was superior to warfarin in the prevention of venous thrombosis. Ximelagatran does not require coagulation monitoring and hence can be given at a fixed dose. The short-term efficacy of this drug is promising, but its value for long-term anticoagulation is still unclear."

Another one of the new generation of anti coagulants. But transaminases might prove to be problem. - KK

NEJM - Somatic and Germ-Line Mutations of the HRPT2 Gene in Sporadic Parathyroid Carcinoma: " Because mutations in the parafibromin gene (HRPT2) occur in a familial syndrome characterized by susceptibility to parathyroid carcinoma, such mutations were sought and found in patients with sporadic cases of parathyroid carcinoma. Moreover, germ-line mutations of HRPT2 were found in some patients with apparently sporadic parathyroid carcinoma. Mutations in HRPT2 probably have a causative role in parathyroid carcinoma. The finding of germ-line mutations of the gene in apparently sporadic cases points to a variant of the familial syndrome with low penetrance and raises questions about the value of genetic testing in carriers of the mutant gene."

Syndromaniacs take note. "hyperparathyroidism–jaw tumor (HPT-JT) syndrome" ;) - KK

NEJM - Can We Prevent Cerebral Palsy?: "This Sounding Board article reviews the available evidence and concludes that — at least at present — cerebral palsy is not preventable in the vast majority of cases. This conclusion has medicolegal implications for many claims relating cerebral palsy to malpractice by physicians."

This is for Maya. - KK

NEJM - Drug Therapy: Schizophrenia: "Schizophrenia has varied and ominous symptoms that generally begin in late adolescence or early adulthood and usually continue throughout life. This Drug Therapy article discusses the new generation of antipsychotic medications, as well as recent developments in brain imaging and in knowledge of the pathophysiology and molecular genetics of this devastating disease. Despite advances, schizophrenia, which affects 1 percent of the population, remains an enigmatic illness that places a substantial burden on patients, their families, and society."

Medicine PGs: Go through this. Might be useful. - KK