Beans, Broccoli and Bluefin could help new moms beat the “Baby Blues”

According to an article published last week in the Canadian Journal of Psychiatry, postpartum depression may be caused by low levels of omega-3 fatty acids.

For the 70-80% of all new mothers who experience some negative feelings or mood swings after the birth of their child could the answer lie with legumes?

Women are at the highest risk of depression during their childbearing years, and the birth of a child may trigger a depressive episode in vulnerable women. Postpartum depression is associated with diminished maternal health as well as developmental and health problems for her child.

Symptoms of “baby blues” include:

  • Weepiness or crying for no apparent reason
  • Impatience
  • Irritability
  • Restlessness
  • Anxiety
  • Fatigue
  • Insomnia
  • Sadness
  • Mood changes
  • Poor concentration

Gabriel Shapiro of the University of Montreal and the Research Centre at the Sainte-Justine Mother and Child Hospital says “The literature shows that there could be a link between pregnancy, omega-3 and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains.”

Because omega-3 is transferred from the mother to her fetus and later to her breastfeeding infant, maternal omega-3 levels decrease during pregnancy, and remain lowered for at least six-weeks following the birth.

Furthermore, in addition to the specific circumstances of pregnant women, it has been found that most people in the US do not consume sufficient amounts of omega-3. “These findings suggest that new screening strategies and prevention practices may be useful,” said Shapiro.

And while there are plenty of commercial omega-3 supplements, don’t forget that these clever little fatty acids are also present in seafood, (especially salmon, anchovies, tuna and sardines) as well as in oils, beans, nuts and seeds, winter squash, broccoli and my personal favorite – cauliflower.

Although Shapiro’s study was preliminary and the further research is needed to clarify the link, new moms could do worse than use salmon to stave off sadness or anchovies as the answer to anxiety!

Doctors Deficient in Anaphylaxis Care

Having just returned from the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting, we’re spoiled for choice of news. But among all the science there was one stand out shocker.  In a session on Sunday, physicians presented the results of a survey, sponsored by the Asthma and Allergy Foundation of America (AAFA). During this, they revealed that a disturbingly high proportion of primary care and emergency physicians don’t know how to treat anaphylaxis.

Interviews with 318 physicians indicated that:

  • substantial numbers do not always provide epinephrine to patients – even those  they believe are having anaphylactic reactions
  • they often fail to refer anaphylaxis patients for follow-up care
  • they believe incorrectly that some patients should not receive epinephrine auto-injectors

Myron Zitt, MD, says the results reveal “likely deficiencies in physician knowledge,” and corroborate results from earlier chart review studies.

In the telephone-based survey, researchers conducted interviews lasting an average of 19 minutes with approximately 100 emergency room physicians, 100 allergists, 50 adult primary care physicians, and 50 pediatricians.

82% to 99% of respondents in each group said they had treated at least one anaphylaxis case.

Although epinephrine is supposed to be given to all patients having such reactions, about 10% of emergency room physicians and 20% of primary care and pediatric physicians said they had done something else.  These “something else’s” included prescribed another drug, sending the patient to a hospital, or an “other” action.

Prescribing of auto-injectors for patients to take home also was far from universal. Barely 60% of emergency room physicians said they did. In fact, emergency physicians were generally bad at all phases of follow-up care. They rarely referred patients for diagnostic tests, they almost never demonstrated use of an auto-injector, and seldom explained that auto-injectors have an expiration date.

Another disturbing finding from the survey, Zitt said, was that many physicians of all types – even the allergists – mistakenly believed that some patients should never receive epinephrine.

In the same session, Akhil Chouksey, MD, reported that anaphylaxis care in a major teaching hospital usually failed to meet guidelines established by a consortium of allergy societies including the ACAAI.  In a 10-year review of anaphylaxis cases only 15% met the standards of care recommendations i.e. that epinephrine be administered within 30 minutes of triage, that auto-injectors be prescribed at discharge, and that patients be referred to an allergist or immunologist for follow-up investigations and treatment.

The review also found that in 26% of cases in which anaphylaxis was definitively confirmed, the patients never received epinephrine.  Antihistamines, such as benadryl (diphenhydramine), were given in nearly all cases but epinephrine was omitted in one-quarter. In fact, epinephrine was only the third most commonly administered medication, with corticosteroids such as methylprednisolone, taking the second spot after antihistamines.

During the question-and-answer period, an audience member suggested that, when patients present with relatively mild symptoms, the treating physicians may decide that epinephrine isn’t needed at that point.  Zitt countered, that this was a very dangerous approach.

The national guidelines state explicitly that there are no absolute contraindications to epinephrine. Nevertheless, 16% of the pediatric allergists and 32% of the other allergists said there were such contraindications, as did 38% of adult primary care and emergency physicians.

Also common were beliefs that schools, restaurants, and ambulances always stock epinephrine. In fact, Zitt said, there are no general requirements for schools or restaurants to do so, and approximately half of all ambulances do not have epinephrine on hand.

Clearly there is much work still to be done in terms of education.  SRxA’s Word on Health suggests a first step would be to instill a healthy fear of anaphylaxis into doctors and the general public while simultaneously removing the fear of epinephrine.

Or as Dr Zitt says, “Give epinephrine first, ask questions later.”

A mobile ear for pregnancy problems

In much of Africa, only the very richest have access to quality healthcare. Nowhere is this more apparent than in family medicine. According to the UN, a woman dies from complications in childbirth every minute and eight million babies die each year before or during delivery or in the first week of life. The maternal mortality ratio in Africa is the highest in the world and has actually increased over the last 20 years. In 2007, experts warned that if nothing was done to arrest this trend there would be 2.5 million maternal deaths, 2.5 million child deaths and 49 million maternal disabilities in the region over the next 10 years. Now, thanks to the ingenuity of a group of computer science students, a primitive 19th century device and some 21st century technology, something is being done. The Pinard Horn, named after the French doctor who invented it back in the 19th Century, is a medical device used to monitor the heart rate of a fetus during pregnancy. It functions similarly to an ear trumpet by amplifying sound. The wide end of the horn is held against the pregnant woman’s belly, while the doctor, nurse, or midwife listens through the other end. Despite its antiquity, the Pinard Horn is still used in many parts of the world and can be very effective in the right hands. It can determine the age, position and heart rate of the fetus, along with an indication of its overall health. But to do this consistently, can take many years of practice. This led the three Ugandan computer science students to think about improving the design. “We saw the technology gap and started thinking about how we might bridge it.” In developed countries, ultrasound is the answer, but these machines are expensive. Even if a hospital could afford one, few expectant mothers could. And so, a new project, known as WinSenga was born.  The new device still consists of a plastic trumpet, but with a highly sensitive microphone inside. It is placed on a women’s abdomen just like the original horn, but now it connects to a Windows-based phone running an app that plays the part of the midwife’s ear. The system picks up the fetal heart rate, transmits it to the phone, and then the phone runs an analysis. The app, developed in conjunction with Unicef medics then recommends a course of action, if necessary, for the mother and her unborn child. “When I first heard the idea, I thought it was brilliant,” says Davis Musinguzi, a medic and Unicef advisor. “But being software developers, they needed guidance on the medical component of the application.” The doctor advised on the medical parameters, procedures and standards that needed to be part of the software. The value of going mobile is pretty clear, allowing carers to visit mothers wherever they are. The students, Joshua Okello, Aaron Tushabe and Josiah Kuvuma won the 2012 Microsoft East and Southern Africa Imagine Cup competition before losing out in the finals held at Sydney. Still, the event partly inspired the name of the new device. The “Win” part comes from the software giant’s own products, while “Senga” refers to the local Ugandan name for the traditional “birth attendants” who used to help village mothers-to-be with their antenatal care and their births. Their loss at the world finals has not held them back. The students have since been approached for potential partnerships and are currently looking for funding to launch a six-month field trial of their system. If that’s successful, then WinSenga could launch as a product. While the team says it’s too early to talk about pricing, they are heartened that the cost of smartphones is rapidly dropping across Africa, making their system much more attractive to potential clients. While they wait for funding, the WinSenga team is far from idle. Despite the fact that all three team members still have busy university schedules, they have already launched an expanded version of the software designed to assist healthcare workers and mothers during labor. The group’s website also promises a version called WinSenga Plus, which would assist with postnatal care as well. And as if that isn’t enough, WinSenga say they are almost ready to launch an Android version of their application, and will then start work on a version for iOS. The use of mobile technology is a relatively new intervention to improving health services,” says Dr. Musinguzi.  “WinSenga and other devices and apps that are coming on to the market, will have to prove themselves to healthcare professionals by reducing the burden of doing what they have always done.” It will take training and investment, he says, but it “will pay off in the long run”. Kudos to you gentlemen. You’re winners in our book!

The Buzz on Bee Venom

While many of us, myself included, may be sad to say goodbye to summer, at least the cooler temperatures should mean fewer biting and stinging insects.  And while that’s good news for people, myself included, who seem to attract and be bitten by every venomous bug out there, there are some people, it seems, who just can’t get enough.

At least when it comes to bees. Thanks, in part, to HRH the Duchess of Cambridge, aka Kate Middleton, everyone’s buzzing about bee venom.  It’s being touted as the latest magic ingredient and can be found in an increasing number of skin creams, lip-plumping potions and face masks.

People are calling bee venom a “natural Botox” thanks to its ability to stimulate collagen production and elastin to smooth, lift and tighten skin. Venom also contains a compound called melittin, which has been shown to have anti-inflammatory properties.

Which led SRxA’s Word on Health to wonder if it works.  Turns out that much of the clinical research into bee venom has focused on its effect s in patients with cancer and arthritis. Studies of its use in skin-care have been limited.

When applied to the skin bee venom causes tingling but has no lasting effect.

I couldn’t find any legitimate scientific studies of the benefit of bee venom either topical or injected,” says David Leffell MD, a professor of Dermatology and Surgery at Yale School of Medicine.

He is skeptical of the extent that bee venom could smooth or tighten skin. There is evidence, however, that the honey also in many of the products could be beneficial as a moisturizer, he says.

But given that one gram of venom costs about $304 – more than eight times the current value of gold, that’s a lot of money for a moisturizer!

And good news for beekeepers, many of whom are able to add this lucrative sideline to their established honey businesses. Salons and spas are also boarding the bee bandwagon and charging over $100 for 30 minute bee-venom facials.

Have you, or would you try bee venom over botox?  Buzz us with your comments.

Cure for hepatitis C gets closer

About 170 million people worldwide are estimated to have been infected with Hepatitis C.

Among them, many celebrities including: actor  Larry Hagman; Rolling Stone Keith Richards; American Idol judge Steven Tyler; Baywatch babe Pamela Anderson; stuntman Evel Knievel and “Dr Death” Jack Kevorkian.

Currently there is no cure for this bloodborne, liver destroying virus and until recently there has been no specific treatment. Although interferon injections have been used, the  flu-like symptoms and other side effects often lead patients to discontinue or delay treatment.

However, in the last two years, two new injectable treatments were approved for use and clinical trials of oral medicines demonstrate promising results.

Earlier this month Abbott Laboratories released impressive data from a small mid-stage trial combining its experimental protease inhibitor ABT-450 boosted by the antiviral drug ritonavir, along with a polymerase inhibitor and ribavirin. The combination achieved a 95% cure rate in one arm of the study.

Separately, Gilead reported results from the Electron study, showing that of 88% of the 25 patients who completed 12 weeks of treatment with GS-7977 and ribavirin, had undetectable levels of virus four weeks after completion of treatment.

And last Thursday, at a liver disease meeting in Europe, researchers released interim data showing that a combination regimen of  GS-7977 from Gilead Sciences Inc and daclatasvir  from Bristol-Myers Squibb Co led to a 100% response rate in previously untreated patients with the most common form of hepatitis C.

GS-7977 is a nucleotide polymerase inhibitor. Daclatasvir  is from a new class of drugs known as NS5A inhibitors. Both are designed to block enzymes essential to replication of the hepatitis C virus.

All 44 of the patients who had the most common and difficult to treat type of hepatitis C (Genotype 1)  had undetectable levels of the virus in their blood four weeks after completing treatment, while 40 out of 44 patients with Genotypes 2 or 3 had undetectable levels of virus at four weeks following treatment -a 91% response rate.

The experimental drugs were considered to be well tolerated with the most frequent side effects being fatigue, headache and nausea. Full results from the trial are expected later this year.

Despite these promising results the 2 companies have decided not to pursue a collaboration.  Gilead is now commencing a trial of GS- 7977 in combination with its own experimental NS5A inhibitor, while Bristol-Myers is testing its drug daclatasvir with a compound similar to GS-7977.

The race for a cure seems to be well and truly on…and whoever comes first the real winners will be the people already infected.

Chronic Disease on the Catwalk

Chronic disease plagues personal lives and public policy. Sheer numbers only begin to give a glimpse of the associated suffering, cost and scope of the problem. In the United States there are more than 110 million Americans with a chronic disease. Europeans are not far behind. According to the World Health Organization, the chronic disease burden in Europe is now the leading cause of mortality and morbidity. Diabetes, cardio-vascular disease, just to name a few, pose a growing challenge to populations throughout Asia-Pacific, Africa and South America.

As the world’s population ages and the number of older adults multiplies we can anticipate growth in the rate as well as the number of people with chronic diseases such as arthritis and hypertension. We will also see growth in diseases that are only now receiving broader public attention, e.g., Alzheimer’s disease, depression, even some types of cancers that are being redefined as a chronic condition.

Will chronic disease become so prevalent that it becomes the new normal? It just might and here are some early indications. Disease, or rather the number of people managing one condition or more, is now a large enough market to influence the design and fashion industries to develop new medically-inspired products. For example: Bang & Olufsen the Danish, high-end design company invested in Medicom. Bang & Olufsen Medicom designs and manufactures intelligent compliance devices for asthma and diabetes. Not surprisingly, their inhalers and glucometers are anything but ordinary.  Medicom claims they seek to use intelligent technology such as smart devices that connect via bluetooth to the internet/cloud and elegant design to motivate and even “inspire” both physician and patient while reminding and encouraging compliance. Medicom’s injection systems and pill boxes appear to be more like stylish desk ornaments  than tools to treat a chronic medical condition. Medically-inspired yet fashionable products to manage disease and well-being are going mainstream.

A quick trip to stores such as Brookstone shows the growing demand for products to treat the maladies of stress, fatigue and pain. Some Apple stores already have third-party stylish iPod-ready devices to monitor blood pressure, pulse rate, etc. Glasses are no longer thought of as vision correctors, instead they have become a fashion accessory. Mainstreaming disease and producing products that are fashion statements may be dismissed by many as a waste of money or in poor taste given the dire impact of disease on people and economies.  However, given the suffering as well as economic cost of the chronic disease challenge, maybe it’s not a bad thing if we can look a little cooler along the way.

Cancer Calling

The question of whether or not cell phones cause cancer is not new. Until now we’ve shied away from reporting such stories because the debate literally has our brains buzzing and our pockets vibrating. Now however, after reviewing details from dozens of published studies, an international panel of experts says: yes – cell phones could cause cancer.

During a weeklong meeting, 31 experts from the International Agency for Research on Cancer (IARC) reviewed possible links between cancer and the type of electromagnetic radiation found in cellphones, microwaves and radar. The agency has credibility and the ear of the world. As the cancer arm of the World Health Organization (WHO), their assessment will now be sent to the WHO and national health agencies for possible guidance on cellphone use. The group classified cellphones in category 2B, meaning they are possibly carcinogenic to humans. Other substances in that category include the pesticide DDT and gasoline engine exhaust.

These recent findings are at odds with the results of a large 2010 study that found no clear link between cellphones and cancer. But some advocacy groups contend the study raised serious concerns because it showed a hint of a possible connection between very heavy phone use and glioma, a rare but often deadly form of brain tumor. The study was controversial because it began with people who already had cancer and asked them to recall how often they used their cellphones more than a decade ago. In about 30 other studies done in Europe, New Zealand and the U.S., patients with brain tumors have not reported using their cellphones more often than unaffected people. Furthermore, because cellphones are so popular, it may be impossible for experts to compare cellphone users who develop brain tumors with people who don’t use the devices.

According to a survey last year, the number of cellphone subscribers worldwide has hit 5 billion, or nearly three-quarters of the global population. People’s cellphone habits have also changed dramatically since the first studies began years ago and it’s unclear if the results of previous research would still apply today.  Since many cancerous tumors take decades to develop, experts say it’s impossible to conclude cellphones have no long-term health risks. The studies conducted so far haven’t tracked people for longer than a decade.

However, before you throw away your phone it’s worth noting that in the past the IARC has given the same classification to pickled vegetables and coffee!

The end of swine flu?

Word on Health breathed a big sigh of relief earlier this week when the World Health Organization (WHO) declared the official end of the influenza A (H1N1) pandemic.

According to WHO the virus has largely run its course and we are now in the “post-pandemic period.” In other words, the virus is now expected to take on the behavior of the seasonal flu virus.

Does that mean we can expect to see few people wearing surgical masks in airplanes and on the Metro?  Will it be safe to leave our homes and desks without our bottles of hand sanitizer?

Can we revise our infectious disease presentations once again and consign H1N1 to the box of viruses of former concern, along with Ebola and SARS?

Was all the fuss worth it?

Responding to concerns that the agency acted too hastily in declaring a pandemic  last June, the WHO said it was “the right call.”  WHO Director-General Margaret Chan added that “we have been aided by pure good luck.” Chan noted,  if the virus had mutated then the current death toll of around 18 500 could have been much higher.

For those of you who can’t quite shake off the fear of H1N1, the good news is that the regular 2010 flu shot will contain protection against swine flu too.

Generic drug could save lives of accident victims

A study just published in The Lancet suggests that routine use of the generic drug tranexamic acid in trauma patients could save as many as 100,000 lives a year.  Lead researcher, Ian Roberts, commented: “This is one of the cheapest ways ever to save a life,” adding that the drug “should be available to doctors treating trauma patients in all countries.”

The CRASH-2 trial was undertaken in 274 hospitals in 40 countries and included  20,211 adult trauma patients.  Those with, or at risk of, bleeding received either tranexamic acid, or placebo, within 8 hours of injury. Results showed that treatment with tranexamic acid reduced deaths from hemorrhage by 15% percent, and deaths from any other cause by 10%, compared to placebo.

Tranexamic acid is an antifibrinolytic agent.  In other words, it prevents breakdown of blood clots.  It is routinely used to control bleeding in women with heavy menstrual periods, bleeding associated with uterine fibroids, to control blood loss in orthopedic surgery and as a mouth rinse after dental extractions or surgery in patients with prolonged bleeding time from acquired or inherited disorders.

Following the study, Roberts and colleagues submitted an application to the World Health Organization to include tranexamic acid on its essential medicines list.