EDITORIAL

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In this issue, we focused on some interesting features like "New Antiplatelet Drug for Diabetics, Milk Protein in HTN, Pacemaker Avert Epileptic Death, New Hope for Leukemic, Vitamin E Alert, Nasal Vaccine".

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Picotamide Better than Aspirin for Diabetics!

A drug called picotamide appears to be a more effective blood-thinner than aspirin for people with diabetes, according to an Italian study. Previous research has suggested that aspirin may not work as well for diabetics in preventing vascular events, such as heart attacks or stroke, as it does for other people. Researchers of the University of Bologna, and colleagues tested picotamide -- which has a double-action anti-platelet effect-- against aspirin in 1200 patients ages 40 to 75 with a history of type 2 diabetes and peripheral arterial disease. The results of their study, published in the European Heart Journal, show that over an average period of 2 years, there were 17 deaths in the picotamide group and 31 in the aspirin group. The 45 percent difference in mortality risk was statistically significant, research team reports. Gastric discomfort occurred in 11 percent of the picotamide group versus 18 percent of those on aspirin, suggesting that picotamide's "tolerability profile was somewhat advantageous over that of aspirin," the authors write. In an accompanying editorial, however, doctors at the University of Perugia, point out that the study was conducted before the widespread use of drugs like ACE inhibitors and anti-cholesterol agents-- which may improve outcomes that overshadow picotamide's benefits. Moreover, they add, additional study will be needed to see if picotamide performs better than aspirin combined with clopidogrel.

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Milk Protein May Reduce High Blood Pressure

A section of a protein derived from milk appears to reduce blood pressure in people with hypertension, results from a small study suggest. After taking the casein peptide, called C12, a group of ten people with high blood pressure experienced an average drop of 9 points in systolic pressure. Diastolic pressure fell by an average of 6 points. Lead author of the University of Pennsylvania in Philadelphia stressed that with only ten people in the study, these findings cannot be used to make treatment recommendations. However, research team are continuing their research, now asking 50 people to take the milk protein fragment every day for 8 weeks. In an interview, Lead author told that this experiment came out of a long history of research. In the 1960s, for instance, investigators found they could help control high blood pressure using sour milk. Previous studies in rodents and humans have suggested that the C12 section of casein may reduce blood pressure as well as ACE inhibitors. To investigate further, researchers asked ten people with hypertension to take C12 either alone or combined with a seaweed extract called alginic acid, which research suggests may help the body excrete sodium in urine. As part of the study, participants took an inactive placebo pill for 5 days and then one of five treatments: a placebo treatment, or high or low doses of C12 either alone or combined with alginic acid. Each participant repeated this five times, in order to try each treatment. When people received the high dose of C12 along with alginic acid, their systolic pressure and diastolic pressure fell significantly more than after the placebo. No patients reported any side effects. Lead author also explained that people likely would not get the same benefits of C12 by drinking lots of milk. Dairy contains a lot of salt, which can be bad for blood pressure, he said, and people would have to consume an impossible amount.

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Pacemakers Could Benefit Epilepsy Patients

People with epilepsy might benefit from the implantation of cardiac pacemakers, finds a new study in this week’s issue of The Lancet. Researchers from London arrived at that conclusion after studying 20 patients with the disease. The results show a significant occurrence of interrupted heart rhythm during seizures among the group. Interrupted heart rhythms during seizures might be responsible for the higher rate of unexplained death seen in epilepsy patients. Treating the condition with a pacemaker could avert many of these deaths. All of the patients in the study received an implantable device to monitor their heart rhythms. Researchers followed the group for about two years. Over that time, the patients experienced a total of 377 seizures. Among 16 patients, heart rate during seizures regularly exceeded 100 beats per minute. Among four patients, serious cardiac inactivity was noted during seizures. These patients received permanent pacemakers to ensure their hearts would be restarted when inactivity occurred during a seizure. The authors believe these findings suggest cardiac pacemakers may be indicated for many people with epilepsy. In an accompanying commentary, researchers from Columbia University in New York agree the study results suggest pacemakers might be appropriate. Yet, they call for more study to clearly define which patients are at highest risk for the heart problem before pacemakers are used widely in this population.

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Cord Blood Offers Hope for Leukemia Patients

Leukemia patients in need of a bone marrow transplant may have new hope, thanks to research conducted on umbilical cord blood. Investigators from the University Hospitals of Cleveland found stem cell transplants from cord blood can be effective in people who don’t have a sibling to serve as a bone marrow donor or those who can’t find a suitable unrelated donor in bone marrow registries. The study looked at results on more than 500 adults with leukemia who were undergoing a transplant to treat the most severe form of the disease. None were able to receive the transplant from a matched sibling. Some of the patients received stem cell transplants from cord blood while the remainder received fully matched transplants from unrelated donors or partially matched transplants from unrelated donors. Results show survival was highest among those who received the fully matched transplants -- 33 percent. However, the cord blood transplants performed as well as the partially matched transplants, with about 22 percent of patients in each group surviving. The authors note there are about 20,000 leukemia patients every year who need a bone marrow transplant, but only about 20 percent of them have a sibling match. The remaining 16,000 patients must seek a donor from bone marrow registries, and only a small percentage of those are able to find a match. Umbilical cord blood, which is normally discarded at birth, could provide an important source of transplants for these individuals

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High-dose Vitamin E Linked to Early Death!

A team of researchers at Johns Hopkins found high doses of vitamin E have been linked to early death. Previous studies have shown that vitamin E may prevent a second heart attack among heart attack patients, and it has been linked with decreased rates of certain cancers. However, the Johns Hopkins team found that, at higher levels, vitamin E is somehow connected to increased risk of death. They reached this conclusion by re-analyzing raw data from 19 major clinical trials on the effects of vitamin E. These trials took place between 1993 and 2004 and involved more than 136,000 patients. They were all double-blind studies. The degree of risk associated with vitamin E supplementation began to rise at 200 IU a day, and a significant risk of early death was found among people who took 400 IU a day or more. Although the elevated risk is alarming, researchers cautioned that most of the people in these studies were over 60 years old and had already been diagnosed with pre- existing conditions, including heart disease. Thus, their findings may not apply to younger people. After releasing their findings, researchers called for more research on low-dose vitamin E. Their analysis showed that levels under 200 IU a day may be beneficial and there is room for additional research to determine the exact optimal dose.

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New Nasal Vaccines may be Given Together

Two new nasally administered vaccines for respiratory infections are being tested, and researchers now say that giving them together to young children appears feasible. Respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV3) are important causes of serious respiratory tract diseases in infants and toddlers, according to a report in the Journal of Infectious Diseases. Investigators from Saint Louis University, Missouri evaluated intra-nasal RSV and PIV3 vaccines given either simultaneously or separately in an early-stage study involving 54 healthy children between 6 and 18 months old. Both the RSV and the PIV3 vaccines induced immunity, the investigators report, and the frequency of protective antibody responses for RSV and PIV3 did not differ significantly between the separate and simultaneous vaccine groups. None of the children developed a respiratory infection resulting from vaccination, the researchers note, and all vaccine recipients showed a similar pattern of illnesses to that seen in placebo recipients. "The results of the present test-of-concept trial provide the framework for future development of bivalent RSV/PIV3 vaccine," the team concludes.

SOURCE: Journal of Infectious Diseases, December 15, 2004

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