Study Examines Reliability Of ‘Probe To Bone’ Test

An often-used tool to diagnose very common and sometimes limb-threatening bone infections in persons with diabetes may not be as reliable as many once believed, based on a recent study by a transatlantic team of researchers. The study, published to the Web ahead of print in February’s edition of the journal Diabetes Care, longitudinally evaluated a large sample of persons with diabetes with wounds, and tested the commonly performed “probe to bone” test. The test, which uses a sterile instrument to feel for bone inside a wound, has been thought by many to be highly predictive of bone infection.

“It certainly makes sense that if you can feel bone, then it must be infected,” noted David G. Armstrong, DPM, PhD, Professor of Surgery at Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, and a co-investigator on the study. “Unfortunately, though, this doesn’t always seem to be the case. The test, if used by itself in a normal clinical setting, isn’t much better than flipping a coin. We therefore recommend it be used with other aids, such as biopsy or appropriate imaging tools.”

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The two-year longitudinal study was the result of partnerships from Texas A&M University, Rosalind Franklin University of Medicine and Science, the Leiden University Medical Center (Netherlands) and the University of Washington School of Medicine.

Rosalind Franklin University of Medicine and Science educates medical doctors, health professionals and biomedical scientists in a personalized atmosphere. The University is located at 3333 Green Bay Road, North Chicago, IL 60064, and encompasses Chicago Medical School, College of Health Professions, Dr. William M. Scholl College of Podiatric Medicine, and School of Graduate and Postdoctoral Studies. Visit at http://www.rosalindfranklin.edu/ and http://www.lifeindiscovery.com/.

Contact: Kathy Peterson
Rosalind Franklin University of Medicine and Science

Older Adults Face Double Whammy When It Comes To Body Fat

When it comes to body fat, today’s older adults face a double whammy, according to new research from Wake Forest University School of Medicine and colleagues. Up until age 80, older adults not only gain fat as they age — but because of the obesity epidemic — they actually begin their older years fatter.

The result is an increased risk of diabetes, heart disease, high blood pressure, arthritis and disability, according to Jingzhong Ding, M.D., Ph.D., lead author and a researcher on aging at Wake Forest Baptist.

The study, reported in the current issue of the American Journal of Clinical Nutrition, focuses on changes in body composition related to aging and in the population over time. It is significant because the researchers used DEXA (dual-energy X-ray absorptiometry) to measure actual body fat to determine the proportion of fat versus lean mass (muscle and organs).

The measurements were made on 1,786 well-functioning older adults from Pittsburgh, Pa., and Memphis, Tenn., from 1997 to 2003. Participants were 70-79 at the time of enrollment, a critical period for the development of disability. Body composition — especially the combination of too much body fat and a decrease in muscle — is believed to contribute to disability.

“This study provides a better picture of age-related changes in body composition and it’s not a good picture,” said Ding, an assistant professor of gerontology and geriatric medicine. “It demonstrates that up until age 80, both older men and women gained fat but lost lean mass each year. These age-related changes were compounded by the obesity epidemic.”

In addition to measuring the effects of aging on body composition, the researchers also looked at the effects of the obesity epidemic, which most scientists agree began in the late 1970s. Between 1976-80 and 1999-2000, the rate of obesity doubled in older adults.

The scientists divided participants into 10 groups based on their birth years (from 1918 to 1927). They found that at the same age, those born later — who had spent more years during the period when obesity was increasing — had a higher percentage of body fat. For example, among 80-year-old men, those born in 1927 had about 10 pounds more fat and 3.75 pounds of muscle, compared to those born in 1918.

“The combined effects of aging and the obesity epidemic results in bigger body size and less lean mass among the elderly,” said Ding. “This may lead to disability and other illnesses in the elderly and could be dramatic in the coming years. It points out the great public health importance of developing appropriate interventions that target fat loss while preserving skeletal muscle to prevent disability and other obesity-related illnesses.”

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The research was supported, in part, by the National Institute on Aging. The researchers analyzed data from the Health Aging and Body Composition (ABC) Study, a large study investigating the effects of body composition on morbidity, disability and mortality in the elderly.

Other centers involved in the study were the University of Pittsburgh, University of Queensland in Australia, UV Medical Center in the Netherlands, University of North Carolina at Chapel Hill, University of California at San Francisco, University of Tennessee Health Science Center, University of Florida and North Florida/South Georgia Health System.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in family medicine, 20th in geriatrics, 25th in primary care and 41st in research among the nation’s medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

U.K. Should Increase Efforts To Support Health Systems In Developing Countries, Report Says

The United Kingdom should do more to help train and support health workers in developing countries in an effort to strengthen their health care infrastructures, Lord Nigel Crisp, former chief of the U.K. National Health Service, said in a report released on Tuesday, BBC News reports. Unless their health systems are strengthened, developing countries will not be able to achieve the U.N. Millennium Development Goals related to controlling the spread of HIV/AIDS, tuberculosis and malaria, according to the government-commissioned report. There is a shortage of 4.3 million health workers worldwide, BBC News reports (BBC News, 2/13). The report calls for NHS to establish a scholarship program that would help train health workers in developing countries. In addition, the report recommends new arrangements to support health workers who volunteer to work in developing countries to ensure that they are able to return to their jobs with no break in pension contributions (Press Association/Guardian, 2/13). Crisp also calls for the creation of a Web site, called the Global Health Exchange, on which developing countries can advertise their resource needs. In addition, NHS hospitals can offer redundant equipment through the Web site, and health workers can offer volunteer services, the report says. The report also calls for a Global Health Partnership Center to act as a single informational resource for individuals and organizations seeking to help global health systems (BBC News, 2/13). Secretary of State for International Development Hilary Benn and Secretary of State for Health Patricia Hewitt welcomed the report and announced about $1.9 million over two years for the Global Health Workforce Alliance to help find solutions to health worker shortages in developing countries (Department of Health release/eGov Monitor, 2/13).

The report is available online.

“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Serious Proliferation Of Multiresistant Staphylococcus In Intensive Care Units

Multiresistant bacteria are a severe problem that costs lives at hospitals the world over. A new doctoral thesis from Karolinska Institutet in Sweden shows that the spread of disease between seriously ill patients in intensive care units is surprisingly rife.

The number of infections caused by multiresistant bacteria and mycobacteria in Swedish hospitals has risen dramatically in recent years, giving rise to prolonged care and higher death rates. The situation is most serious in intensive care units, where between 10 and 20 per cent of patients contract some kind of hospital-related infection.

Specialist physician Christina Agvald Ohman studied the infection route of bacteria strains at a Swedish intensive care unit for her thesis. The results of her work show that the spread of infection between patients is surprisingly high. Between 70 and 80 per cent of the patients who were in care at the unit for three to five days were involved in the spread of infection.

“Infections are mainly spread via staff and equipment, which could be avoided if the hygiene rules were properly followed,” says Dr Agvald Ohman. “By far the most important rule, which is easily forgotten, is to wash your hands properly after contact with each patient.”

The bacteria strain under study was a type of Staphylococcus normally found on the skin of healthy people, but which can easily establish itself in the respiratory passages of ill people; it is also one of the most common causes of hospital-related blood poisoning. Dr Agvaldhman believes that other types of bacteria are transmitted in a similar way.

Hospital-related infections not only cause personal suffering for the patients, they are also a financial burden. One day’s intensive care costs about SKr 35,000, and according to common estimates prolong hospitalisation by six to twelve days.

The study was carried out at Karolinska University Hospital in Huddinge, Stockholm County, where it has already spurred extensive action to prevent hospital-related infections.

“I’m convinced that these problems are just as serious at other intensive care units, and I hope that my results can help raise the general motivation surrounding hygiene in healthcare,” says Dr Agvald-пїЅ-hman.

Thesis:

“Colonisation, infection and contagion of multiresistant bacteria and mycobacteria amongst intensive care patients”, Department of Clinical Science, Intervention and Technology. Public defence will take place on February 16.

KAROLINSKA INSTITUTET
SE-171 77 Stockholm
http://info.ki.se/index_se.html

Research Findings In Allergy-Immunology Unveiled

Investigators are presenting more than 380 abstracts on preliminary findings in the diagnosis and treatment of allergic diseases at the ACAAI Annual Meeting in Philadelphia, Nov. 9-15. Following are highlights of some key investigations on allergic rhinitis and ocular allergies.

ALLERGIC RHINITIS

“Patient Perspectives on the Symptoms of Allergic Rhinitis and the Effect of Allergic Rhinitis on Daily Living.” (Abstract #29: Nov. 12 at 2:00 p.m.) – Michael S. Blaiss, M.D., Memphis, et al – Allergic rhinitis (AR) is a chronic inflammatory disease of the upper airways affecting 10 percent to 25 percent of the world’s population. Of the 2,500 adults with AR who were surveyed by telephone interview, 40 percent reported that congestion was the most frequent symptom and was extremely bothersome. Post-nasal drip (28 percent), runny nose (26 percent) and red, itching eyes (23 percent) were also reported by patients as extremely bothersome symptoms. Approximately one third of patients with nasal allergies also suffered from asthma.

“Yuletide Allergy Symptoms.” (Abstract #P200: Nov. 11-12, Noon – 1:00 p.m.) – Michael Alexander, M.D., Niagara Falls, Canada, et al – This investigation using completed questionnaires from four atopic subjects, and testing with airborne sampling and tree trunk tape lifts, demonstrates that patients with seasonal allergic rhinitis can experience symptoms caused by a Christmas tree in their homes. Christmas trees are a significant source of allergens, particularly mold. Airborne sampling revealed increased mold spores with the introduction of the tree, and a secondary burst of mold spores with the removal of the tree.

“3-Year Treatment of Children with Triamcinolone Acetonide Aqueous for Allergic Rhinitis Does Not Affect Statural Growth.” (Abstract #P217: Nov. 11-12, Noon – 1:00 p.m.) – David Skoner, M.D., Pittsburgh, Pa., et al – Guidelines recommend intranasal corticosteroids for patients with allergic rhinitis (AR) but concerns remain as to possible adverse effects on growth. In an ongoing investigation, the 3-year results show that no statistical difference (at the 0.0005 level) was detected in the height of 19 children (aged 6.1 – 14.0 years at entry) receiving triamcinolone acetonide aqueous treatment for allergic rhinitis.

“Impact of Congestion Associated with Allergic Rhinitis on Sleep, Daytime Somnolence and Fatigue, and Work and School Productivity.” (Abstract #P220: Nov. 11-12, Noon – 1:00 p.m.) – Donald.E. Stull, M.D., Bethesda, Md., et al – Investigators report that symptoms associated with allergic rhinitis (AR) include impaired sleep resulting in day-time somnolence and fatigue, reduced productivity at work or school, and increased health care costs. This study explored the impact of congestion relative to the broader collection of AR symptoms. Authors conclude that nasal congestion alone has a significant, negative impact on patients’ lives, accounting for most of the negative impact of AR symptoms on sleep adequacy. Congestion increases the likelihood of sleep problems, symptoms during sleep time, sleep disturbance, shortness of breath or headache, snoring, daytime somnolence and fatigue.

“Global Climatic Change and its Impact on Oak Pollen Season in the Midwestern US.” (Abstract #P278: Nov. 11-12, Noon – 1:00 p.m.) – Gregory G. Pendell, M.D., et al, Kansas City, Mo. – Authors note that the last decades of the 20th century have been reported to be warmer than any comparable period in the past 1,000 years. This investigation, using a Burkhard spore trap operating from February to November during 1997 through 2006 in the urban core of Kansas City, shows that oak pollen season appears to begin a half day earlier each year. Authors conclude that the trend to an earlier oak pollen season in the Midwest should reach statistical significance in the next five years.

NON-ALLERGIC CONJUNCTIVITIS

“Non-allergic, Non-infectious Conjunctivitis. Potential for Urban Eye Syndrome?” (Abstract #P201: Nov. 11-12, Noon – 1:00 p.m.) – Bobby Lanier, M.D., Fort Worth, Texas – Investigators determined by phone survey that almost 25 of 100 patients with non-allergic rhinitis also suffer from ocular symptoms. Itching was the most common symptom (91 percent) following by burning (82 percent), redness (73 percent) and dry eye (55 percent). Seasonality was the most common trigger (77 percent) followed closely by environmental (68 percent), chemicals (50 percent), pollution (36 percent) and animals (9 percent).

IMMUNOTHERAPY

“Safe and Effective Rapid Desensitization: A Cumulative Experience of 1,540 Patients.” (Abstract #20: Nov. 12 at 1:45 p.m.) – William Smits, M.D., Fort Wayne, Ind., et al – Conventional immunotherapy is effective in the treatment of allergic rhinitis, allergic asthma and chronic rhinosinusitus. Authors note that rapid desensitization (or rush immunotherapy) offers the advantages of rapid response, improved compliance and cost effectiveness, but safety continues to be a primary concern for this procedure. Investigators confirm in this study of 1,540 patients that maintenance immunotherapy can be reached quickly, safely and effectively under careful supervision, but caution must be exercised when using this procedure as anaphylaxis does occur.

“Sublingual Immunotherapy for Treatment of Poison Ivy Dermatitis.” (Abstract #P154: Nov. 11-12, Noon – 1:00 p.m.) – M.S. Morris and M. Learned, La Crosse, Wis. – Each year 10 to 50 million Americans develop an allergic reaction after contact with poison ivy according to the investigators. Results of this preliminary retrospective chart review of 115 patients indicate that sublingual immunotherapy may be a viable treatment option for decreasing sensitivity for patients with poison ivy dermatitis. Authors note that this thereapy may allow patients who have occupation or hobbies which bring them into frequent contact with poison ivy to decrease the frequency and severity of outbreaks.

METAL ALLERGY

“Systemic Delayed Hypersensitivity (DH) to Cobalt (Co) after Metal Alloy Knee Arthroplasty.” (Abstract #P6: Nov. 11-12, Noon – 1:00 p.m.) – Frederick C. Cogen, M.D., Meadowbrook, Pa. – Investigators note that joint arthroplasty with insertion of a metal alloy prosthesis is an increasing procedure in our aging population. Reporting on two cases and a cohort of 35 patients with failed knee replacements that had positive patch tests to cobalt, authors caution physicians to be aware of the entity of metal induced systemic delayed hypersensitivity following arthroplasty. They suggest patch testing may be useful in diagnosing DH in arthroplasty failures, and perhaps, in choosing the optimal implant for those with a history of DH to metals.

“Stainless Steel Allergy after the Nuss Procedure for Repair of Pectus Excavatum.” (Abstract #P195: Nov. 11-12, Noon – 1:00 p.m.) – Maripaz B. Morales, M.D., Suffolk, Va., et al – This study evaluated metal allergy and its effects on the increasing use of implantable nickel and chromium bars for minimally invasive pectus excavatum repair treatment with the Nuss procedure in pediatric patients. Investigators conclude that allergy symptoms often are misdiagnosed as infection, but require different treatment. They suggest patients with a history of metal allergy or atopy be tested and a titanium bar be used for this procedure. Because the consequences of metal allergy may include the need to replace the bar, pediatric surgeons should be aware of this occurrence.

SKIN DISORDERS, SEMEN ALLERGY

“Prevalence of Thyroid Disease and Anti-thyroid Antibodies in Patients with Chronic Idiopathic Urticaria.” (Abstract #63: Nov. 13 at 2:30 p.m.) – Yazan Said, M.D., Long Beach, Calif., and Harb Harfi, M.D., Riyadh, Saudia Arabia – Investigators characterize chronic idiopathic urticaria/angiodema (CIU/A) as recurrent or persistent urticarial lesions and/or angioedema, lasting more than six weeks, and a debilitating disease with only supportive therapy. In this study of 165 CIU/A patients, they found an increased prevalence of thyroid disease and auto-antibodies, which may support the role of auto-immunity in its pathogenesis. Authors recommend testing for thyroid function and anti-thyroid antibodies in these patients since its treatment may help control CIU/A.

“Resurgence of Bedbug Bites Misdiagnosed as Allergic Skin Rashes in Inner-City Population.” (Abstract #P199: Nov. 11-12, Noon – 1:00 p.m.) – Sreenivasrao Amara, M.D., et al, Brooklyn, N.Y. – There is an increase in reports of bites from bedbugs (Cimex lectularius), a nocturnal bloodsucking parasite, in the U.S. and worldwide. Investigators report six patients with multiple, cutaneous manifestations misdiagnosed as allergic reactions that were proven bedbug bites. They recommend health care professionals be alert to screen for bedbug bites in any patient with a new refractory rash.

“Seminal Plasma Protein Hypersensitivity: The First Case Report in a Puerto Rican Woman.” (Abstract #P32: Nov. 11-12, Noon – 1:00 p.m.) – Jennifer Collins, M.D., et al, New York, N.Y. – Human seminal plasma protein hypersensitivity is a rare and often misdiagnosed phenomenon, with 80 cases existing in the medical literature including individuals from Europe, the United States, Australia, India, Japan, Israel and Korea, according to the authors. Authors note that, to their knowledge, this investigation is the first case report of seminal plasma protein hypersensitivity in a Puerto Rican female who underwent intravaginal desensitization.

About ACAAI

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.

American College of Allergy
85 W. Algonquin Rd., Ste 550
Arlington Heights, IL 60005
United States
http://www.acaai.org/

Complementary Medicine Has A Role In The Treatment Of Allergic Diseases

Complementary or alternative medicine (CAM) has increased tremendously in popularity in the United States. At a symposium held at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI), a team of experts discussed the safety and efficacy of CAM for the management of allergic diseases.

“As the United States has reached the 300 million person mark and with the world population approaching 7 billion, only 10 percent and at most to 30 percent of our health care is actually delivered by what we consider conventional or biomedical-oriented practitioners,” said Leonard Bielory, MD, professor of medicine, pediatrics & ophthalmology, and director, Asthma & Allergy Research Center at UMDNJ – New Jersey Medical School in Newark.

“The remaining 70 to 90 percent ranges from self-care according to folk principles to care given in an organized health care system based on an alternative tradition or practice,” said Dr. Bielory.

Under the broad umbrella term of CAM fall a very wide and diverse number of modalities. These include the use of herbals, vitamins and other supplements, acupuncture and traditional Chinese medicine (TCM), homeopathy, naturopathy, chiropractic medicine, massage therapy, and Ayurveda. Often included into this mix are energy therapies such as Qi gong and bioelectromagnetic treatments, as well as mind-body practices that encompass prayer, meditation or even dance.

CAM for Allergic Diseases

This topic is of great importance to the subspecialty of allergy and immunology because one of the most common reasons that patients turn to CAM is for treating allergic diseases.

“Although the most commonly used CAM is related to prayer, the most commonly reported CAM adverse events tend to be ‘allergic’ reactions from herbal agents that include urticaria, contact dermatitis, and anaphylaxis,” said Dr. Bielory.

However, the possibility of more serious side effects exists, and some of the agents may have unfavorable interactions with prescription drugs. One survey found that 12 percent of asthmatic patients were using eucalyptus oil, which can reduce mucous membrane inflammation of the upper respiratory tract and act as a decongestant. However, eucalyptus oil can increase the effect on the central nervous system of drugs such as Ativan, Valium, barbiturates, narcotics, alcohol, and some antidepressants.

Echinacea is commonly used to treat allergic rhinitis and the common cold, but it can trigger an allergic reaction in patients who have allergies to plants in the Asteraceae or Compositae family (ragweed, chrysanthemums, marigolds, daisies). Anaphylaxis is also a potential side effect. The FDA has determined that there is no scientific evidence to support the use of Echinacea in the common cold.

Traditional Chinese Medicine

“There has been a recent surge of interest in TCM in Western countries, as it is low cost and has shown favorable safety profiles,” said Xiu-Min Li, MD, an associate professor of Pediatric Allergy & Immunology at the Mount Sinai School of Medicine in New York. She is also director of the Center of Excellence for Chinese Herbal Therapy for Allergy and Asthma funded by NIH.

Herbal therapy is in the mainstream of modern medical practice in China for treating asthma, although the role for TCM in Western countries has not been established as there are no FDA approved botanical drugs for treating asthma.

Dr. Li and colleagues have received a grant from the National Center for Complementary and Alternative Medicine to investigate a three-herb Chinese formula known as ASHMI, as a therapy for allergic asthma. Studies of the herbal formula first looked at its mechanism of action in an animal model, characterized the active components of the herbs, and have completed an investigation with asthma patients.

The study, conducted as a collaborative project with Weifang Asthma Hospital in China, investigated the efficacy and safety of ASHMI in 91 patients with asthma. In this randomized, double-blind active-controlled study, patients received either ASHMI or prednisone for four weeks.

“In the animal study, we found that ASHMI was effective in suppressing AHR, eosinophilic inflammation and airway remodeling, and had an immunomodulatory effect on Th1/Th2 responses,” said Dr. Li.

“In our clinical trial, there was significantly improved lung function and symptom scores in patients who used ASHMI,” said Dr. Li. “There was a beneficial immunoregulatory effect on Th1/Th2 balance. This study indicates that ASHMI may be an effective, safe, and well-tolerated botanical drug.”

There is an ongoing FDA approved clinical trials at Mount Sinai School of Medicine to investigate whether ASHMI can reduce or replace corticosteroids in persistent moderate-to-severe asthma.

Probiotics

Another area of growing interest is in the use of probiotics to both treat and prevent allergic disorders. Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora.

“Microflora or healthy bacteria within the gut appear to be an important part of our mucosal protection while also supporting healthy bowel functions,” said Renata J. M. Engler, M.D., from the Uniformed Service University of Health Sciences at Walter Reed Hospital in Washington, D.C. “When the healthy bacterial flora is disrupted as with antibiotic therapy, illnesses such as vaginitis and serious bowel infections may occur more easily. In addition, there is a growing body of evidence that the healthy bacteria may interact beneficially with the immune system overall.

“Although too early to translate into specific clinical recommendations, the evolving data suggest that probiotics may have a role in modulating the natural history of atopic dermatitis in the infant, particularly through the mother before the birth of the infant,” she said.

Probiotics are currently proposed as beneficial for the treatment of acute diarrhea in both adults and children, the prevention of diarrhea caused by antibiotics, and to support remission of pouchitis.

“Further study is needed to define the optimum use of probiotics in the treatment and prevention of allergic diseases,” said Dr. Engler.

Patient information on allergic diseases including asthma is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at http://www.acaai.org/.

About ACAAI

The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.

American College of Allergy
85 W. Algonquin Rd., Ste 550
Arlington Heights, IL 60005
United States
http://www.acaai.org/

Number Of New Diabetes-related Kidney Failure Patients More Than Doubles In 10 Years

The number of newly diagnosed end-stage renal disease (kidney failure) patients with diabetes increased by 114% over 10 years, from 1,066 in 1995 to 2,139 in 2004, according to a new report released recently by the Canadian Institute for Health Information (CIHI). This increase in the presence of diabetes among new end-stage renal disease (ESRD) patients correlates with an increase in the incidence of diabetes in the Canadian population overall. ESRD refers to a condition in which the kidneys are permanently impaired and can no longer function to maintain life. For the first time, CIHI’s annual report on end-stage organ disease, Treatment of End-Stage Organ Failure in Canada, 1995 to 2004, includes a special focus chapter on diabetes, a major risk factor in renal failure. Over the course of the decade, more than 17,000 kidney failure patients were diagnosed with diabetes.

“Diabetes is the fastest growing cause of end-stage renal disease,” says Margaret Keresteci, CIHI’s Manager of Clinical Registries. “In fact, diabetes is now a factor in more than 40% of all registered ESRD patients, up from 25% 10 years ago. It’s important to note that the type of diabetes driving the increase is linked to obesity and lifestyle factors.”

Type 2 diabetes plays dominant role

While the number of ESRD patients with type 1 diabetes (formerly known as insulin-dependent or juvenile diabetes) declined from 526 in 1995 to 303 in 2004 (down 42% in 10 years), the number of patients with type 2 diabetes (which is linked to obesity and lifestyle) more than tripled over the same period, from 540 to 1,836. Among kidney failure patients with type 2 diabetes, 30% were determined to be obese.

“The reduction of type 1 diabetes in kidney failure patients may be attributed to improved interventions and treatments over time,” explains Keresteci. “What’s remarkable is the surge in cases among patients with type 2 diabetes – a disease that is often preventable. Addressing ways to reduce the prevalence of this illness could help limit the devastating health consequences, including ESRD, associated with it.”

More diabetics among seniors, Aboriginal people with kidney failure

In the period between 1995 and 2004, kidney failure patients aged 65 and older had the highest overall rate of diabetes, more than doubling from 124 per million in 1995 to 270 per million in 2004.

The greatest increase was seen in those over 75 years of age. For that group the rate of new kidney failure cases tripled between 1995 and 2004 (250 patients per million in 2004, up from 79 patients per million in 1995).

Also, in 2004, the Canadian Organ Replacement Register (CORR) reported that Aboriginal Canadians with ESRD had considerably higher rates (more than 2.5 times – 168 per million) of diabetes, compared to non-Aboriginal Canadians with ESRD (64 per million). The largest difference was seen in adults between the ages of 50 and 70.

Lower survival rate for dialysis patients with diabetes

Overall, the five-year survival rate for kidney failure patients on dialysis ranged from 20% for those 75 years of age and older to 89% for those younger than 18 years of age.

For patients on dialysis, CIHI’s analysis found survival rates were worse for diabetic kidney failure patients than for non-diabetic patients. This was more pronounced among younger patients. Diabetic patients on dialysis between the ages of 18 and 65 had a 19% lower five-year survival rate when compared to those without diabetes. A smaller difference in long-term survival was seen between diabetic and non-diabetic kidney failure patients over 65, with a 6% difference between the two groups. Lower survival rate for diabetic kidney transplant recipients

Kidney transplant recipients with diabetes had a higher risk of mortality than those without it. Non-diabetic recipients had 93% five-year survival rates, compared to 82% for those with type 2 diabetes. Five-year survival was poorest among diabetic kidney recipients transplanted with deceased-donor organs (79%), while the survival rate for diabetic kidney recipients with living-donor organs was 88%.

Other report highlights

Additional highlights included in Treatment of End-Stage Organ Failure in Canada, 1995 to 2004:

Renal replacement therapy for ESRD patients (dialysis and renal transplant):

* At the end of 2004, there were 18,827 patients on dialysis and 12,099 living with a functioning kidney transplant, for a total of 30,924 Canadians with kidney failure registered in the CORR.

Liver transplantation:

* The number of patients waiting for a liver transplant grew steadily over the 10 years, (from 149 to 667), with an overall increase of 348%.

Heart transplantation:

* Between 1995 and 2004, 1,571 patients received a first heart transplant and 58 required a subsequent transplant.

Lung transplantation:

* The number of adult lung transplants increased by 64% between 1995 and 2004 (from 78 to 128).

Pancreas transplantation:

* Two-thirds of the 510 pancreas transplants performed in Canada between 1995 and 2004 were simultaneous pancreas-kidney transplants.

Organ donors:

* Between 1995 and 2004, there were 4,251 deceased donors. On a yearly basis the number of deceased donors dropped from 426 in 1995 to 417 in 2004.

* Between 1995 and 2004, there were 3,751 living donors (kidney and liver living donors only). On a yearly basis the number of living donors increased from 230 in 1995 to 476 in 2004.

Canadian Organ Replacement Register

Data are from the Canadian Organ Replacement Register (CORR), a national longitudinal database on end-stage organ failure managed by CIHI. CORR captures the level of activity and outcome of vital organ transplant and dialysis activities, following recipients with end-stage organ failure from their first treatment to their deaths. CORR became a registry of CIHI in 1995. About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

The report and the following are available from CIHI’s website at http://www.cihi.ca.

Number of ESRD Patients, With and Without Diabetes, Canada, 1995 to 2004

Proportion of ESRD Patients (on Dialysis) With a Diagnosis of Diabetes, Canada, 1995 to 2004 (Figure 56 in the report)

Diabetes and Body Mass Index (BMI) in Newly Diagnosed ESRD Patients in Canada, 1995 to 2004 (Figure 62 in the report)

Unadjusted Five-Year Survival in ESRD Patients on Dialysis, With or Without Diabetes, by Age, 1995 to 1999 (Followed to 2004)

Unadjusted Five-Year Survival in Patients With Kidney Transplant, With or Without Diabetes, 1995 to 1999 (Followed to 2004)

For further information please go to:
Canadian Institute For Health Information
CIHI–Taking health information further

Major Discovery Is Promising Target For New Diabetes Therapies

Researchers at Columbia University Medical Center have uncovered the complex structure of a protein that serves as a central energy gauge for cells, providing crucial details about the molecule necessary for developing useful new therapies for diabetes and possibly obesity. A paper published online in the journal Science details this structure, helping to explain one of the cell’s most basic and critical processes.

“Understanding this important protein’s molecular structure and mechanism provides a major step forward for the rational design of new drugs to target diabetes and obesity,” said Lawrence Shapiro, Ph.D., associate professor of Biochemistry and Jules and Doris Stein Professor of Research to Prevent Blindness at Columbia University Medical Center, and senior author of the paper.

The protein, known as AMP-activated protein kinase or AMPK, controls metabolic decisions of cells. For example, it controls the decision regarding whether fat is stored or burned, based on the amount of energy in the cell. When the energy level of a cell is high, meaning that the cell contains high amounts of an energy-carrying molecule known as ATP, AMPK directs cells toward “anabolic” activities like storing the extra energy as fat. When ATP is low, AMPK turns off anabolic activities, and activates “catabolic” functions, like burning fat to make energy.

AMPK provides an especially promising drug target for people with type 2 diabetes. These patients are insulin-resistant, meaning that their cells are not responsive to insulin which normally helps glucose get out of the bloodstream, where it does damage, and into cells. When AMPK detects low levels of ATP in the cell, it works through a different mechanism to increase how much glucose the cell takes in and uses to create ATP. Research in rodent models has shown that AMPK activators can lessen the pathologies associated with diabetes, including problems that diabetics have regulating blood sugar.

Dr. Shapiro explained that researchers do not yet know how to activate AMPK without activating other proteins and causing potentially toxic side effects. However, he notes that this development in understanding the atomic resolution structure of the protein provides researchers a powerful new tool for the design of useful therapeutics.

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Contact: Craig LeMoult
Columbia University Medical Center

Biogel(R) Gloves Have Met Newest FDA Guidelines For Many Years

For many years, Biogel(R) gloves, manufactured by Molnlycke Health Care US, LLC, have featured AQL (Acceptable Quality Level) for freedom from holes well below the recommended maximums that the Food and Drug Administration (FDA) will be requiring in two years.

Effective December 19, 2008, the new FDA maximum AQL for exam gloves will be 2.5 percent and 1.5 percent for surgical gloves. By lowering AQLs, the FDA is requiring higher barrier standards for the gloves which should result in fewer occurrences of bloodborne pathogen transmissions between patients and healthcare workers.

“We’re pleased that the FDA is raising the requirements for all surgical and exam glove manufacturers,” explains Milt Hinsch, technical services director. “However, the ruling isn’t surprising as most US glove manufacturers have been meeting the new standards for a couple of years already. Additionally, this brings the FDA more in line with benchmarks used by two other influential regulators — the International Organization for Standardization (ISO) and ASTM International (ASTM).”

“Molnlycke offers a full line of Biogel sterile surgical gloves, which have been the industry’s gold standard for years,” Hinsch adds. “In addition to being the only major medical glove company with an exclusively powder-free glove line, our surgical gloves in the US maintain a freedom from holes AQL of 1.0 percent. This exceeds both the new standard from the FDA and existing ASTM AQL of 1.5 percent.”

The Biogel clinical team recommends the use of latex, deproteinised latex and non-latex gloves to address all needs across general surgery, general exam, and specialty needs as steps in creating a Latex-SAFE environment. Hospitals and surgical centers should always opt for powder-free glove choices as part of a Latex-SAFE environment to decrease the risk of latex sensitization.

About Molnlycke Health Care US, LLC

Molnlycke Health Care US, LLC, consists of two divisions – Surgical and Wound Care. Focusing on prevention of surgically-related infections for both patients and healthcare workers, the Surgical Division (formerly Regent Medical Americas, LLC) encompasses the world’s leading manufacturer and supplier of powder-free surgical gloves (Biogel(R) surgical gloves); the number one supplier (by value) of skin cleanser (Hibiclens(R) and Hibistat(R) antiseptics); and BARRIER(R) protective clothing. A leader in trauma and pain management, the Wound Care Division’s market dynamics are driven by an aging population, higher incidence of pressure ulcers and increased home treatment.

Molnlycke Health Care US, LLC
Molnlycke Health Care

Beauty Product Oil Can Lead To Antibiotic Resistance

Repeated exposure to low doses of Tea Tree Oil a common ingredient in many beauty products can increase the chances of suffering from “superbug” infections, University of Ulster scientists have revealed.

They discovered that exposure to low doses of Tea Tree Oil make pathogens such as MRSA, E. coli and Salmonella more resistant to antibiotics, and capable of causing more serious infections.

Dr Ann McMahon and Professor David McDowell, members of the University’s Food Microbiology Research Group, said: “We have been growing pathogens such as MRSA, E-coli and Salmonella in low concentrations of tea tree oil. These concentrations are not sufficient to kill the bacteria, but can switch on their defense mechanisms. Unfortunately, these defense mechanisms have the added effect of making bacteria more resistant to antibiotics, and able to cause “harder to treat” infections.”

Tea Tree Oil is used commercially in many products including shampoos, body lotions and toiletries, but there is no legislation requiring manufacturers to state the concentration of tea tree oil in these products. This increases the risks that people will use low concentrations of tea tree oil, which fail to kill bacteria, but increase their resistance to antibiotics. So, if a person uses tea tree oil products on their skin repeatedly, any MRSA on their skin could develop increased resistance to the antibiotics which are used to control MRSA infections.

“The bottom line is that tea tree oil should not be used at low concentrations less than 4% to make sure that bacteria are killed, not just stressed. Otherwise we are just arming the bacteria against treatment by antibiotics.”

Publishing their findings in the Journal of Antimicrobial Chemotherapy, the scientists said: “Although tea tree oil may be an effective antimicrobial agent when appropriately used at high (bactericidal) concentrations, its application at low (sub-lethal) concentrations may contribute to the development of antibiotic resistance in human pathogens”.

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