Archive for September, 2011

Can diseased skeletal muscle falsely elevate cardiac troponin T (cTnT)?

Diseased Skeletal Muscle: A Noncardiac Source of Increased Circulating Concentrations of Cardiac Troponin T

Allan S. Jaffe, Vlad C. Vasile, Margherita Milone, Amy K. Saenger, Kalen N. Olson, and Fred S. Apple
J Am Coll Cardiol published 28 September 2011, 10.1016/j.jacc.2011.08.026
http://content.onlinejacc.org/cgi/content/abstract/j.jacc.2011.08.026v1

 The purpose of this study was to determine whether there is immunoreactive cardiac troponin T (cTnT) expression in diseased skeletal muscle that might cause possible false-positive increases in cTnT.

 

Conclusions of the studyindicate that there are forms in diseased skeletal muscle that could cause increases in circulating levels of cTnT. Clinicians need to be aware of the possibility that noncardiac increases in cTnT may occur and lead to a possible false-positive diagnosis of cardiac injury when skeletal muscle pathology is present.

The Drug Shortage Crisis

http://www.medpagetoday.com/PublicHealthPolicy/FDAGeneral/28749?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g380841d0r&userid=380841&email=ndmsmd@aol.com

MedPage Today

No Easy Fix for Drug Shortage Crisis

By Joyce Frieden, News Editor, MedPage Today
Published: September 26, 2011

“……FDA called the meeting Monday in response to increasing reports of shortages for a variety of drugs, including chemotherapy drugs, drugs used in surgery and sedation, and antibiotics, as well as total parenteral nutrition products.

According to the FDA, there were 178 drug shortages reported last year, and even more so far in 2011. Edward Cox, coordinator of the drug shortage program at FDA, noted that in 2010:

  • 54% of the shortages were due to quality or manufacturing issues
  • 21% were due to delays and capacity issues
  • 11% due to discontinuations
  • 5% due to raw material issues ……..”

Older women who experience a hip fracture…..

http://www.medpagetoday.com/Orthopedics/Orthopedics/28742?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g380841d0r&userid=380841&email=ndmsmd@aol.com

By Nancy Walsh, Staff Writer, MedPage Today
Published: September 26, 2011

Mortality High in Year After Hip Fracture

“Older women who experience a hip fracture have a twofold increase in mortality risk in the first year after the fracture, researchers found.  During the 12 months following the fracture, 16.9% of the women died, compared with 8.4% of controls, for an odds ratio of 2.3 (95% CI 1.9 to 2.8)……”

Paramedic Practicing Preventive Medicine: What a concept!

http://www.nytimes.com/2011/09/19/us/community-paramedics-seek-to-prevent-emergencies-too.html?nl=todaysheadlines&emc=tha23

NY Times

September 18, 2011
Responding Before a Call Is Needed
By KIRK JOHNSON

EAGLE, Colo. —”….[A] new vision is gaining ground — that emergency workers should not wait around for crises to happen, but rather go out and prevent them…….One driving force for rethinking medical intervention in homes and communities is that starting next year under the health care overhaul, Medicare will no longer reimburse health care providers if a patient is readmitted to a hospital within 30 days of his or her discharge with a preventable repeat of the previous diagnosis. That will create sharp new incentives, medical experts say, for follow-up home care.

Here in Colorado, a $1.5 million investment for the pilot project — mostly in labor, including a traditional paramedic to replace Mr. Creek on the emergency squad and a first-ever director of family medicine — is expected to produce about $10 million in medical cost savings over five years in an area of about 15,000 people….”

FDA: Over-the-counter asthma inhalers containing chloroflouorocarbons (CFCs) will no longer be made or sold after Dec. 31, 2011

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm272872.htm

For Immediate Release: Sept. 22, 2011
Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

Users of Primatene Mist will need a prescription product to treat their asthma

The U.S. Food and Drug Administration says users of epinephrine inhalers containing chlorofluorocarbons (CFCs) should plan now to get a prescription for a replacement product because these inhalers will not be made or sold after Dec. 31, 2011.

Epinephrine inhalers, marketed by Armstrong Pharmaceutical Inc. as Primatene Mist, are the only FDA-approved inhalers for the temporary relief of occasional symptoms of mild asthma that are sold over-the-counter in retail stores without a prescription. The product uses CFCs to propel the medicine out of the inhaler so that consumers can breathe it into their lungs.

However, Primatene Mist will no longer be available by year’s end because no CFC-containing epinephrine inhalers can be made or sold after Dec. 31, 2011, to comply with obligations made under the Montreal Protocol on Substances that Deplete the Ozone Layer. This is an international agreement signed by the United States, in which countries agreed to phase-out substances that deplete the ozone layer, including CFCs, after certain dates.

“If you rely on an over-the-counter inhaler to relieve your asthma symptoms, it is important that you contact a health care professional to talk about switching to a different medicine to treat your asthma,” said Badrul Chowdhury, M.D., director of the Division of Pulmonary, Allergy and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research.

The FDA began public discussions about the use of CFCs in epinephrine inhalers in January 2006. The FDA finalized the phase-out date for using CFCs in these inhalers and notified the public in November 2008. Many manufacturers have changed their inhalers to replace CFCs with an environmentally-friendly propellant called hydrofluoroalkane (HFA). There is currently no HFA version of epinephrine inhalers.

There are, however, many other safe and effective inhalers to treat asthma symptoms. All of these inhalers require a prescription, which must come from a licensed health care professional (physician, physician’s assistant or nurse practitioner). Current epinephrine inhaler users that don’t have a health care professional to write them a new prescription can ask a family member or friend what doctor they use and would recommend, or they can visit a federally-qualified health center, local clinic, community health center, or minute-clinic (sometimes located in pharmacies) to see a health care professional and get a prescription.

Primatene Mist already carries a prominent notice about the phase-out date on its product label, and the FDA encourages Armstrong Pharmaceutical to further educate consumers as the deadline approaches to ensure an incident-free transition. The agency also will continue to work with retailers and pharmacies to facilitate a smooth phase-out of this CFC product and is prepared to review applications for replacement products.

For more information:

• Phase Out of Epinephrine CFC Metered-Dose Inhalers1

• Epinephrine CFC Metered-dose Inhalers – Questions and Answers
2

• Consumer Update:  Primatene Mist with Chlorofluorocarbons No Longer Available After Dec. 31, 2011
3

The Elderly: Vitamin D, Parathyroid Hormone, and Cardiovascular Events

Vitamin D, Parathyroid Hormone, and Cardiovascular Events Among Older Adults
Bryan Kestenbaum, Ronit Katz, Ian de Boer, Andy Hoofnagle, Mark J. Sarnak, Michael G. Shlipak, Nancy S. Jenny, and David S. Siscovick
J Am Coll Cardiol 2011;58 1433-1441
http://content.onlinejacc.org/cgi/content/abstract/58/14/1433

 Vitamin D deficiency and PTH excess are common in older adults

Objectives: To evaluate associations of 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) concentrations separately and in combination with incident cardiovascular events and mortality

Conclusions: Among older adults, 25-OHD deficiency is associated with myocardial infarction and mortality; PTH excess is associated with heart failure.

GlideScope

Difficult Airway Management in the Emergency Department: GlideScope
Videolaryngoscopy Compared to Direct Laryngoscopy
Published online: 12 September 2011
Jarrod M. Mosier, Uwe Stolz, Steven Chiu, John C. Sakles
DOI: 10.1016/j.jemermed.2011.06.007
Journal of Emergency Medicine

Link: http://www.jem-journal.com/article/S0736-4679%2811%2900627-5/abstract

For difficult airways with the presence of blood or small mandible, or a large tongue or obesity, GlideScope had a higher success rate at first attempt than Direct Laryngoscopy.

Heart disease & a short-term risk for VTE

Medwire:  “Patients with heart disease have an increased short-term risk for venous
thromboembolism (VTE), particularly isolated pulmonary embolism (PE), compared with the
general population……”
http://www.medwire-news.md/38/94605/Cardiology_News/Heart_disease_increases_short-term_risk_for_isolated_pulmonary_embolism.html

http://circ.ahajournals.org/content/early/2011/09/06/CIRCULATIONAHA.111.025627.short

Heart Disease May Be a Risk Factor for Pulmonary Embolism Without Peripheral Deep Venous Thrombosis by Henrik T. Sørensen, et al.

CIRCULATIONAHA.111.025627 Published online before print September 6, 2011, doi: 10.1161/​CIRCULATIONAHA.111.025627

Telaprevir (Incivek) & Hepatitis C

Source reference:
Sherman KE, et al “Response-guided telaprevir combination treatment for hepatitis C virus infection” N Engl J Med 2011; 365: 1014-1024.

 

By Michael Smith, North American Correspondent, MedPage Today
September 14, 2011
“Response-guided therapy with the protease inhibitor telaprevir (Incivek) can cut the treatment period for hepatitis C (HCV) in half…”