Day: 07/29/2010

Prophylactic azithromycin helps avoid bronchiolitis obliterans in lung recipients

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Azithromycin is not only an effective treatment for bronchiolitis obliterans syndrome (BOS) after lung transplantation, it can also prevent the condition in the first place, a Belgian team reports in the European Respiratory Journal, online June 18.

“This paper is indeed one of the first randomized placebo controlled studies to prevent BOS after lung transplantation,” said senior investigator Dr. Geert M. Verleden at University Hospital Gasthuisberg, Leuven. “It clearly demonstrates that azithromycin in addition to current immunosuppressives is able to prevent BOS at least at 2 years after transplantation.”

Dr. Verleden and colleagues randomly assigned 83 lung transplant patients to either prophylactic azithromycin, 250 mg three times a week, or to placebo for 2 years.

BOS occurred in 12.5% of the patients on azithromycin compared with 44.2% in those given placebo. The hazard ratio for BOS-free survival was 0.27 (p=0.02) favoring azithromycin. The azithromycin group also had a greater forced expiratory volume in 1 second (FEV1).

However, rejection rates and overall survival were similar in the two groups.

“To us at least, this does not mean that every patient should now be treated with additional azithromycin, first of all since the results on survival are identical in the azi and the placebo group (because the ones who developed BOS were all shifted to active azithromycin),” Dr. Verleden said.

If patients are not treated prophylactically, “Of course then a close follow-up of the patients with pulmonary function testing and regular bronchoscopy with BAL (to look for neutrophilia) is then warranted. If this cannot be provided due to several logistic reasons, then we would advise to add (azithromycin) after transplantation ASAP.”

A second reason for not using azithromycin routinely is that the necessary duration of treatment is not known. “Whether azi has an effect later on (after more than 2 years) will have to be further investigated and currently we have one additional year of treatment in most of our patients but these data still need to be worked out,” Dr. Verleden continued.

His group has noticed that when azithromycin is started and then stopped later on, BOS may recur, Dr. Verleden said. “We do have patients who are taking azithromycin already for 8 years without any problems,” he added.

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brian cox

What do you get when you cross a rock star with a physics professor? You get Professor Brian Cox!

Cox made his start not as a scientist, but as a musician when his band signed a record deal in the late 80s. He then went on to join another group called D:Ream several years later, whose hit song “Things Can Only Get Better” was chosen as Tony Blair’s well known theme song for his election campaign in 1997. The typical lifestyle of successful musicians includes a lot of things, but higher education is not at the top of that list. Then again, Brain Cox is anything but typical.

During his years with D:Ream, Cox also pursued degrees in science. He ultimately earned a degree in physics and a PhD in High Energy Particle Physics, all while continuing to perform with a band that was topping music charts in the UK. Once he had completed his schooling, his love for physics and the endless possibilities of the universe still waiting to be discovered was strong enough to cause a major career change. Brian is now completely dedicated to physics research and education, was awarded an OBE in the Queen’s birthday honors list for services to science, and has forged yet another well deserved claim to fame.

Professor Cox currently holds a chair in Particle Physics at the University of Manchester. But teaching is only the beginning of this former musician’s scientific contributions. He also works on the ATLAS Experiment at CERN in Geneva with the world famous Large Hadron Collider (LHC). Here, he spends his time smashing protons together at unbelievably high speeds and studying the results. The findings from these collisions could help us discover the forces that created our universe. Hey, if finding out how the universe was born isn’t a good start to a physics resume, we don’t know what is!

As if the ATLAS Experiment wasn’t impressive enough, Cox is also a part of the FP420 R&D Experiment. He and a team of highly respected scientists from 10 different countries are working to design changes to the Large Hadron Collider that would improve measurements taken from proton collisions. It may even allow researchers to find and record results that the current design can’t detect at all!

Professor Brian Cox is a highly unusual and incredibly exciting combination of both his past and former lives. As the host of Wonders of the Solar System, he leads viewers on a journey to some of the Solar System’s most powerful, beautiful and awe-inspiring places with energy and enthusiasm that are nothing short of contagious.

Professor Brian Cox: Not Your Typical Physicist

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brian cox

What do you get when you cross a rock star with a physics professor? You get Professor Brian Cox!

Cox made his start not as a scientist, but as a musician when his band signed a record deal in the late 80s. He then went on to join another group called D:Ream several years later, whose hit song “Things Can Only Get Better” was chosen as Tony Blair’s well known theme song for his election campaign in 1997. The typical lifestyle of successful musicians includes a lot of things, but higher education is not at the top of that list. Then again, Brain Cox is anything but typical.

During his years with D:Ream, Cox also pursued degrees in science. He ultimately earned a degree in physics and a PhD in High Energy Particle Physics, all while continuing to perform with a band that was topping music charts in the UK. Once he had completed his schooling, his love for physics and the endless possibilities of the universe still waiting to be discovered was strong enough to cause a major career change. Brian is now completely dedicated to physics research and education, was awarded an OBE in the Queen’s birthday honors list for services to science, and has forged yet another well deserved claim to fame.

Professor Cox currently holds a chair in Particle Physics at the University of Manchester. But teaching is only the beginning of this former musician’s scientific contributions. He also works on the ATLAS Experiment at CERN in Geneva with the world famous Large Hadron Collider (LHC). Here, he spends his time smashing protons together at unbelievably high speeds and studying the results. The findings from these collisions could help us discover the forces that created our universe. Hey, if finding out how the universe was born isn’t a good start to a physics resume, we don’t know what is!

As if the ATLAS Experiment wasn’t impressive enough, Cox is also a part of the FP420 R&D Experiment. He and a team of highly respected scientists from 10 different countries are working to design changes to the Large Hadron Collider that would improve measurements taken from proton collisions. It may even allow researchers to find and record results that the current design can’t detect at all!

Professor Brian Cox is a highly unusual and incredibly exciting combination of both his past and former lives. As the host of Wonders of the Solar System, he leads viewers on a journey to some of the Solar System’s most powerful, beautiful and awe-inspiring places with energy and enthusiasm that are nothing short of contagious.

Antidepressants: Another weapon against chronic pain

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Some of the more effective and commonly used medications for chronic pain are drugs that were developed to control other conditions. Antidepressants are a mainstay in the treatment of many chronic pain conditions — even when depression isn’t a factor.

Tricyclics used most often

Tricyclic antidepressants are the most common type used for pain. They include:

  • Amitriptyline
  • Imipramine (Tofranil)
  • Clomipramine (Anafranil)
  • Nortriptyline (Pamelor)
  • Desipramine (Norpramin)
  • Doxepin (Sinequan)

Types of pain relieved

Tricyclic antidepressants seem to work best for pain caused by:

  • Nerve damage from diabetes (diabetic neuropathy)
  • Nerve damage from shingles (postherpetic neuralgia)
  • Tension headache
  • Migraine
  • Fibromyalgia
  • Low back pain

The painkilling mechanism of these drugs is still not fully understood. Tricyclic antidepressants may increase neurotransmitters in the spinal cord that reduce pain signals. But they don’t work immediately. You may have to take a tricyclic antidepressant for several weeks before it starts reducing your pain.

Side effects usually mild

Side effects of tricyclic antidepressants may include:

  • Drowsiness
  • Dry mouth
  • Constipation
  • Weight gain
  • Difficulty with urination
  • Changes in blood pressure

To reduce or prevent side effects, your doctor will likely start you at a low dose and slowly increase the amount. Most people are able to take tricyclic antidepressants, particularly in low doses, with only mild side effects. The doses that are effective for pain are typically lower than the doses used for depression.

Other antidepressants that may help

Drugs such as venlafaxine (Effexor) and duloxetine (Cymbalta) can relieve many of the same types of painful conditions that are eased by tricyclic antidepressants. Known as serotonin and norepinephrine reuptake inhibitors (SNRIs), these drugs don’t work quite as well as tricyclic antidepressants, but they also don’t produce as many side effects.

Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil) and fluoxetine (Prozac) don’t appear to help relieve pain on their own. However, fluoxetine appears to boost the painkilling effects of some tricyclic antidepressants.

Angiotensin Receptor Blockers (ARBs): Ongoing Safety Review for Cancer Risk

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MedWatch logo MedWatch - The FDA Safety Information and Adverse Event Reporting Program


AUDIENCE: Cardiology, Oncology, Family Practice

ISSUE: A recently published study – a meta-analysis combining cancer-related findings from several clinical trials – suggested use of ARBs may be associated with a small increased risk of cancer.

BACKGROUND: ARBs are used in patients with high blood pressure and other conditions. Brand names include Atacand, Avapro, Benicar, Cozaar, Diovan, Micardis, and Teveten.

The meta-analysis included data from over 1,000 patients in several long-term, randomized, controlled clinical trials evaluating ARBs for which adverse events related to cancer were captured during the study. The mean duration of follow-up ranged from 1.7 to 4.8 years.

The study reported the frequencies of new cancer occurrence to be 7.2% for patients receiving ARBs compared to 6.0% for those not receiving ARBs (risk ratio = 1.08, 95% Confidence Interval: 1.01-1.15). No statistically significant difference in cancer deaths was noted.

RECOMMENDATION: FDA has not concluded that ARBs increase the risk of cancer. The Agency is reviewing information related to this safety concern and will update the public when additional information is available. FDA believes the benefits of ARBs continue to outweigh their potential risks.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

Drunken Psoriasis

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Reviewers examine a possible link between alcohol misuse and psoriasis, particularly the role of cutaneous ethanol in precipitating the disease.

Alcoholism is common in patients with psoriasis, but the cause-and-effect relation is not clear. Psoriasis and its painful physical and social consequences may drive patients to drink, or alcoholics may perform comparatively less-effective skin care and develop worsened psoriasis. The effect may also be a direct one: Alcohol might alter cutaneous biology.

These authors review the mechanisms by which such a process might operate: Measurable quantities of alcohol are secreted through human skin via both sweat glands and epidermal lipids. Ethanol enhances skin permeability and disrupts the skin barrier. At relevant concentrations, alcohol stimulates keratinocyte proliferation, enhances T helper cell 1 cytokine production, and increases lymphocyte proliferation. Acute alcohol exposure inhibits inflammatory cell activation, whereas chronic exposure increases it. Patients with alcoholic liver disease produce more tumor necrosis factor-{alpha}, a critical activating cytokine for psoriasis.

Comment: Alcohol ingestion may join the list of such other psoriasis-activating villains as obesity, smoking, drugs, trauma, psychological stress, infections, and endocrine factors. New “bracelet” transdermal detection systems that monitor alcohol concentrations in sweat correlate well with blood alcohol levels. Such devices might allow study of blood alcohol level and disease activity in real time, providing more direct evidence of a role for activation of psoriasis by ingested alcohol.


Published in Journal Watch Dermatology July 16, 2010