Marijuana treatments for autoimmune disorders

Current ratings for:
Marijuana treatments for autoimmune disorders

Ratings require JavaScript to be enabled.

Researchers from the University of South Carolina say that tetrahydrocannabinol, the principal constituent of marijuana, may have another medical use – treating those with autoimmune disorders.

Tetrahydrocannabinol (THC) is known to have analgesic effects so can be used to treat pain. It also aids relaxation and can reduce feelings of nausea and stimulate appetite, making it useful for those undergoing chemotherapy.

Now, a new study, published in the Journal of Biological Chemistry, explores how microRNAs are influenced by THC.

MicroRNAs (miRNAs) are small, single-stranded, non-coding RNAs that play a vital role in regulating gene expression. And the authors claim that the ability to alter miRNA expression may be the key to successful treatment for many autoimmune diseases, including multiple sclerosis, arthritis and type 1 diabetes.

The researchers, from the university’s School of Medicine, injected mice with THC and analyzed their RNA. Of the 609 miRNAs tested, the researchers identified 13 that were highly altered by the THC.

Stopping gene expression

MiRNAs greatly influence the immune system, acting as “brakes” that target more than 60% of all gene expression. Since miRNAs usually suppress the expression of genes, when a miRNA is over-expressed, the affected gene gets silenced.

But when a miRNA is turned off, the affected gene is expressed at a higher level.

The report states that the regulation of gene expression by miRNAs is thought to be vital in a wide range of biological processes. The authors point to emerging evidence that suggests miRNAs “regulate the development, differentiation and function of a variety of immune cells including myeloid cells.”

For this study, the researchers also explored one specific miRNA – miRNA-690 – that was greatly over-expressed by the presence of THC and targets an important protein called C/EBPα. This protein, in turn, triggers myeloid-derived suppressor cells (MDSC), which suppress inflammation.

When the researchers successfully knocked out the miRNA-690, the effect of THC was reversed.

The current study, led by Dr. Venkatesh Hegde, suggests the effects of marijuana may be “a double-edged sword.” Its ability to suppresses inflammation provides effective treatment against inflammatory and autoimmune diseases, but that very action may leave the body open and vulnerable to other diseases.

Lead authors Drs. Prakash and Mitzi Nagarkatti have studied how marijuana can alter immune functions and inflammation for over a decade. They were the first to show that marijuana components trigger MDSC to suppress inflammation.

Dr. Mitzi Nagarkatti, chair of the Department of Pathology, Microbiology and Immunology at USC’s School of Medicine, says the latest study demonstrates that understanding how to control microRNA expression holds tremendous potential for new medical breakthroughs.

She explains:

“MicroRNA therapeutics is an important, rapidly growing area with major pharmaceutical companies getting into this discovery and development. While our study identifies the molecular mechanism of immune-altering effects of marijuana, select microRNA identified here could serve as important molecular targets to manipulate MDSC activity in cancer and inflammatory diseases.”

This is not the first study to herald the medicinal qualities of marijuana. Medical News Today reported last month that chemicals within the plant may protect the body against multiple sclerosis.

Written by Belinda Weber

Copyright: Medical News Today
Not to be reproduced without the permission of Medical News Today.

Add Your Opinion On This ArticleJoin the discussuon

Please note that we publish the name you give us, but we do not publish your email address. We will email you to let you know when your comment has been published but will not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications, operations, or procedures please do not name healthcare professionals by name.


Visit the Source Site

Unprotected sex among U.S. gay men on the rise, study shows

By David Beasley

ATLANTA Wed Nov 27, 2013 4:33pm EST

ATLANTA (Reuters) – The proportion of men in the United States having unprotected sex with other men increased 20 percent from 2005 to 2011, according to a federal study released on Wednesday, raising new concerns over the spread of the HIV virus, which causes AIDS.

Fifty-seven percent of men who have sex with other men reported having unprotected anal sex at least once in the last 12 months, up from 48 percent in 2005, according to the Centers for Disease Control and Prevention.

The study of more than 9,000 men included interviews and HIV testing.

“We are concerned about the increase,” the study’s lead author, Gabriella Paz-Bailey, told Reuters.

An estimated 50,000 people in the United States are infected with HIV each year, a number that has remained steady in recent years, Paz-Bailey said.

Men having sex with other men account for 65 percent of new infections even though they represent only 2 percent of the total population, she added.

The reason for the increase in unprotected anal sex is unclear, but could be because men are increasingly having sex with partners who have the same HIV status as their own in the belief that this lowers their risk of contracting the virus, the study said.

However, the CDC warns that this could be a dangerous strategy.

Men with HIV “might not know or disclose that they are infected and men’s assumptions about the HIV status of their partners can be wrong,” the agency said.

Highlighting the need for increased testing, the study found that men who are not aware of their HIV status are much more likely to have unprotected anal sex with other men than those who have been tested for the virus.

“We think that testing is one our greatest weapons,” Paz-Bailey said. “We know that when men are tested and know their status they are likely to change their behavior.”

CDC recommends annual HIV testing for those at high risk of contracting the virus but in the study only 67 percent of men having sex with other men said they had been tested within the past year.

(Editing by Kevin Gray and Gunna Dickson)

  • Link this
  • Share this
  • Digg this
  • Email
  • Print
  • Reprints


Visit the Source Site

Older women still getting Pap smears despite guidelines

By Kathryn Doyle

Wed Nov 27, 2013 3:41pm EST

NEW YORK (Reuter Health) – Women who’ve had a hysterectomy, and most women over 65, don’t need regular swabs for signs of cervical cancer – but lots of them are getting the test anyway, say U.S. researchers.

Experts recommend that young women start having internal pelvic exams, including a Papanicolaou test, or “Pap smear,” to check for abnormal cells on the cervix, performed by a gynecologist at age 21. The United States Preventive Services Task Force (USPSTF) recommends that women ages 21 to 65 without a history of cervical problems have a Pap smear every three years.

Women over 65 who have had recent regular Paps with normal results, and those who have had total hysterectomies and no longer have a cervix no longer need to have the screening test, according to the government-backed panel.

“There is very little benefit to continue screening women over 65 who are low risk and have no history of abnormal Pap tests, cancer, or precancerous lesions,” Deanna Kepka said. “The procedure is not dangerous but is an unnecessary use of resources.”

Kepka studies public health at the Huntsman Cancer Institute and the College of Nursing at the University of Utah in Salt Lake City.

But according to U.S. national survey data from 2010 analyzed by Kepka’s team, a third of women who had had a hysterectomy also reported having had a Pap smear in the past year.

Two thirds had had a Pap smear since their hysterectomy.

Among the women over 65, half reported a Pap smear in the past three years, according to the results published in JAMA Internal Medicine.

In 2012, the USPSTF, American College of Obstetricians and Gynecologists and the American Cancer Society all agreed that women age 65 and older do not need these tests.

“That was the first time every national guideline matched,” Debbie Saslow said.

Saslow is director of breast and gynecologic cancer for the American Cancer Society.

“Not only do they not recommend the tests, they specifically recommend against them,” she said.

Unnecessary Pap tests can turn up abnormal cells and lead to costly and stressful follow-up tests, she said.

“It costs money to perform unnecessary Pap tests – period,” Kepka said. It may not always cost women money, especially since the Affordable Care Act eliminated co-pays for those kinds of preventive screening tests, but it does cost the U.S. healthcare system money.

Doctors might do the tests anyway because women expect them, or doctors think they expect them, Saslow said.

“A lot of gynecologists think the only reason a woman comes in is for the annual Pap tests,” she said, but women might actually be more inclined to come in for annual checkups if they knew they would not have to disrobe and have an internal exam.

“It is entirely reasonable for a woman to request no more Pap tests if she believes she is in a low-risk category and does not want the exam,” Dr. George F. Sawaya said.

He’s a professor of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology and Biostatistics at the University of California, San Francisco.

“All women over age 65 should ask their clinician if they could end screening,” he said.

In their report, the researchers note that relying on survey answers means it’s possible some women don’t accurately recall what tests they had and when. The study team also lacked data on the specific types of hysterectomies women had.

It is also possible that fewer women have unnecessary tests now compared to 2010 when this study was done, Saslow told Reuters Health, but future studies will need to assess that.

According to the New Mexico state cervical cancer screening registry, for example, only about 8 percent of ineligible women have these tests.

“We don’t know what the true number is, but whatever it is too high,” Saslow said.

“We need to find ways to educate providers and women about this,” she said. “If you don’t have a cervix, don’t get screened for cervical cancer.”

SOURCE: bit.ly/1jCO91Y JAMA Internal Medicine, online November 25, 2013.

  • Link this
  • Share this
  • Digg this
  • Email
  • Print
  • Reprints


Visit the Source Site

Tongue controller for the paralyzed offers greater independence

By Sharon Begley

NEW YORK Wed Nov 27, 2013 2:01pm EST

NEW YORK (Reuters) – From fashion statement to … wheelchair controller?

In an advance that promises to improve the lives of the more than 250,000 people in the United States who are paralyzed from the neck down, researchers announced on Wednesday that they have developed a wireless device that operates specially rigged chairs by means of a tiny titanium barbell pierced through the tongue.

Merely by moving their tongues left or right across their mouths, essentially using it as a joystick, paralyzed patients have been able to move their motorized wheelchairs, as well as computer cursors. Tapping tongue against cheek, quickly or slowly, controls the chair’s speed.

The advance “is more than just a wheelchair control,” said Jason Disanto, 39, who has been paralyzed from the neck down since a 2009 diving accident and tested the device. “It’s an independence system.”

The innovation is especially meaningful for the most seriously paralyzed. Tetraplegics cannot use a joystick to operate their wheelchairs, as people with less severe paralysis can, and in many cases cannot even use voice commands: their voices are often so weak that recognition systems work poorly or not at all.

Even more advanced assistive technologies fall short. Brain-computer interfaces (BCIs), which translate brain waves from the scalp into electrical signals that move a motorized wheelchair or computer cursor, require intense concentration, have slow response times and are vulnerable to electronic interference. The implantable versions are more reliable but can damage brain tissue.

The most popular technology for operating a motorized wheelchair, called sip-and-puff devices and based on inhaling or exhaling into a tube, offers only four commands – forward, back, left and right – and is also slow and cumbersome.

WAY FASTER, WAY MORE AGENCY

Engineer Maysam Ghovanloo of the Georgia Institute of Technology in Atlanta thought he could do better. About five years ago he and his colleagues began developing the tongue-based system. An early version used magnets glued to the tongue, but they fell off. Dr Anne Laumann of the Feinberg School of Medicine at Northwestern University, a co-author of the new paper, had an idea: use piercing to anchor the magnets in place.

The device they came up with is a small magnetic barbell, which creates a magnetic field in the mouth. When users flick their tongues, it alters that field. The change is picked up by four small sensors on a headset with twin extensions curving around the cheeks, and relayed wirelessly to a smartphone, computer or iPod. The software translates the signals and sends them to a powered wheelchair or computer.

For the new study, published in Science Translational Medicine, Ghovanloo and his team tested the tongue system on 11 tetraplegia patients from rehabilitation centers in Chicago and Atlanta and 23 able-bodied volunteers who already wore tongue jewelry.

After just 30 minutes of training, everyone was able to move a computer cursor, clicking on targets on a laptop screen, playing video games and dialing phone numbers. Accuracy and speed improved with practice, even though subjects used the system only one day a week. After six weeks the tetraplegics were, on average, three times faster with the tongue system than with sip-and-puff, which six of the 11 (including Disanto) had been using. It was equally accurate.

Using only tongue movements, the volunteers also navigated a powered wheelchair through a 50-meter-long course with 13 turns, 24 obstacles and occasional alarms signaling “Stop! Emergency!” Here, too, on average the 11 tetraplegics drove the course three times faster with the tongue system than with sip-and-puff, and just as accurately.

“The learning was very, very fast,” Ghovanloo said. “There was a huge improvement in performance from the first session to the second.”

To Disanto, an electrical engineer, the appeal of the system is aesthetic as well as functional.

“With all the equipment that’s in my face” with the sip-and-puff system, “people saw that and not me,” he said.

The tongue system is a vast improvement, but he encouraged the researchers to go even further, and they have: they are developing a version that dispenses with the headset and instead fits inside the mouth, like a retainer.

The tongue system’s ability to operate numerous devices also promises more agency, Disanto said. He currently uses a voice-recognition system and a “head mouse” (an optical sensor that translates head movements into cursor movements) to use his computer, “but this is going to allow people like me to use one system instead of multiple ones,” he said. “I’ll be able to drive my wheelchair and connect to my computer seamlessly, and eventually connect to home devices, using it to work lights, curtains, TV and heat. I’ll be more independent.”

Those home systems already exist, with many smartphones offering apps that control home appliances, lights and heating-and-cooling systems.

“This is another example of how the field of rehab engineering and assistive devices is continuously evolving and benefiting from incorporating the emerging new technologies,” said Dr Daofen Chen, program director at the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

The researchers plan to test the tongue system “using Atlanta as our laboratory,” said Joy Bruce, manager of spinal cord injury at the Shepherd Center, a rehab center in Atlanta where the study was conducted. “We’ll see if patients can use it to navigate in the community – taking the bus, going to work and doing other things they haven’t been able to.”

Ghovanloo’s startup company, Bionic Sciences, is working with Georgia Tech to commercialize the barbell device. The $1 million he got from the 2009 economic stimulus bill is gone, and government science funding has plummeted, so Georgia Tech is setting up a website and planning to use social media to raise money. If Ghovanloo gets the funds, he hopes to test the system in the streets of Atlanta next year.

(Reporting by Sharon Begley; Editing by Michele Gershberg and Prudence Crowther)

  • Link this
  • Share this
  • Digg this
  • Email
  • Print
  • Reprints


Visit the Source Site

Study links high sodium 'fizzy' medicines to raised heart risks

By Kate Kelland

LONDON Wed Nov 27, 2013 1:42pm EST

LONDON (Reuters) – Millions of patients worldwide taking effervescent, dispersible and soluble medicines have an increased risk of heart attacks and strokes because of the high salt content of such drugs, scientists said on Wednesday.

Researchers from Britain’s University of Dundee and University College London found that with some “fizzy” versions of painkillers, vitamin supplements or other common medicines, taking the maximum daily dose would on its own exceed daily recommended limits for sodium, the main component of salt.

High salt intake has been linked to high blood pressure, or hypertension, which is a key risk factor for strokes, heart attacks and other cardiovascular diseases.

In a study published in the British Medical Journal (BMJ), they found that patients taking dispersible forms of drugs had a 16 percent increased risk of a heart attack, stroke or vascular death compared with patients taking the non-high-sodium versions of the same medications.

Jacob George, an honorary consultant in clinical pharmacology at Dundee who led the study, said patients, and consumers of over-the-counter medicines – such as soluble aspirin, effervescent vitamin C, or Bayer’s Alka Seltzer for example – “should be warned about the potential dangers” of high sodium intake in medicines.

Doctors, he added, should be aware of the potential dangers and prescribe fizzy or soluble forms of drugs “with caution, only if the perceived benefits outweigh the risks”.

“There are a lot of patients who need to use these formulations – those who have difficulty swallowing large tablets, for example,” George told Reuters in a telephone interview. “But what we want is for patients to be able to make an informed decision with the help of their doctor.”

Although there is some debate on the issue, many health experts believe that eating too much salt is bad for health and numerous studies have linked excess salt intake to high blood pressure, which can lead to strokes and heart attacks.

The World Health Organisation recommends a daily upper limit of sodium intake of less than 2 grams – equivalent to around 5 grams, or one teaspoon, of salt.

For this latest study, George’s team tracked more than 1.2 million patients, comparing those taking sodium-containing effervescent, dispersible and soluble medicines with those taking non-sodium versions of the same drugs.

The study ran between 1987 and 2010 and patients were tracked for an average of just over seven years.

During this time, over 61,000 new so-called cardiovascular events – including heart attacks and strokes – occurred in the patients being studied.

Factors likely to affect the results, such as body mass index, smoking, alcohol intake, history of various chronic illnesses and use of other medicines, were taken into account.

Beside the 16 percent higher risk of a heart problem or stroke, the team also found patients taking sodium-containing drugs were seven times more likely to develop high blood pressure, and their overall death rate was 28 percent higher.

The researchers acknowledged that there is still some controversy about the link between dietary sodium and heart risks, but say their findings were anyway “potentially of public health importance”.

(Reporting by Kate Kelland)

  • Link this
  • Share this
  • Digg this
  • Email
  • Print
  • Reprints

Visit the Source Site

Study links high sodium ‘fizzy’ medicines to raised heart risks

By Kate Kelland

LONDON Wed Nov 27, 2013 1:42pm EST

LONDON (Reuters) – Millions of patients worldwide taking effervescent, dispersible and soluble medicines have an increased risk of heart attacks and strokes because of the high salt content of such drugs, scientists said on Wednesday.

Researchers from Britain’s University of Dundee and University College London found that with some “fizzy” versions of painkillers, vitamin supplements or other common medicines, taking the maximum daily dose would on its own exceed daily recommended limits for sodium, the main component of salt.

High salt intake has been linked to high blood pressure, or hypertension, which is a key risk factor for strokes, heart attacks and other cardiovascular diseases.

In a study published in the British Medical Journal (BMJ), they found that patients taking dispersible forms of drugs had a 16 percent increased risk of a heart attack, stroke or vascular death compared with patients taking the non-high-sodium versions of the same medications.

Jacob George, an honorary consultant in clinical pharmacology at Dundee who led the study, said patients, and consumers of over-the-counter medicines – such as soluble aspirin, effervescent vitamin C, or Bayer’s Alka Seltzer for example – “should be warned about the potential dangers” of high sodium intake in medicines.

Doctors, he added, should be aware of the potential dangers and prescribe fizzy or soluble forms of drugs “with caution, only if the perceived benefits outweigh the risks”.

“There are a lot of patients who need to use these formulations – those who have difficulty swallowing large tablets, for example,” George told Reuters in a telephone interview. “But what we want is for patients to be able to make an informed decision with the help of their doctor.”

Although there is some debate on the issue, many health experts believe that eating too much salt is bad for health and numerous studies have linked excess salt intake to high blood pressure, which can lead to strokes and heart attacks.

The World Health Organisation recommends a daily upper limit of sodium intake of less than 2 grams – equivalent to around 5 grams, or one teaspoon, of salt.

For this latest study, George’s team tracked more than 1.2 million patients, comparing those taking sodium-containing effervescent, dispersible and soluble medicines with those taking non-sodium versions of the same drugs.

The study ran between 1987 and 2010 and patients were tracked for an average of just over seven years.

During this time, over 61,000 new so-called cardiovascular events – including heart attacks and strokes – occurred in the patients being studied.

Factors likely to affect the results, such as body mass index, smoking, alcohol intake, history of various chronic illnesses and use of other medicines, were taken into account.

Beside the 16 percent higher risk of a heart problem or stroke, the team also found patients taking sodium-containing drugs were seven times more likely to develop high blood pressure, and their overall death rate was 28 percent higher.

The researchers acknowledged that there is still some controversy about the link between dietary sodium and heart risks, but say their findings were anyway “potentially of public health importance”.

(Reporting by Kate Kelland)

  • Link this
  • Share this
  • Digg this
  • Email
  • Print
  • Reprints


Visit the Source Site

Higher BDNF May Delay Dementia

ADVERTISEMENT

Register Today

Earn Free CME Credits by reading the latest medical news in your specialty.

Sign Up

Neurology

Published: Nov 26, 2013 | Updated: Nov 26, 2013

By John Gever, Deputy Managing Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

  • In the Framingham Heart Study, cognitively healthy adults with higher serum levels of BDNF had a reduced risk of future occurrence of dementia and Alzheimer’s disease.
  • These associations were apparent only among women, people ages 80 and older, and those with college degrees.

Risk of dementia was lower in older Framingham Heart Study participants with high levels of brain-derived neurotrophic factor (BDNF) in serum, researchers said.

Individuals 60 and older in the highest quintile of serum BDNF had a 10-year hazard ratio for dementia of all types of 0.49 (95%CI 0.28-0.85) compared with participants in the lowest BDNF quintile, according to Sudha Seshadri, MD, of Boston University, and colleagues.

However, the association was limited to certain subgroups, the researchers reported online in JAMA Neurology:

  • Women (HR 0.65, 95% CI 0.50-0.85)
  • Participants 80 and older at baseline (HR 0.63, 95% CI 0.47-0.85)
  • Participants with college degrees (HR 0.27, 95% CI 0.11-0.65)

When Seshadri and colleagues restricted the analysis to Alzheimer’s disease, the results were very similar, they indicated.

“We suggest that serum BDNF may play a role in the development of Alzheimer’s disease, especially in older women, the group at highest risk for Alzheimer’s disease,” they wrote. “This is of particular interest because serum BDNF levels can be elevated through simple lifestyle measures such as increased physical activity.”

However, they acknowledged that unmeasured confounders could have influenced the results.

Their analysis was based on 2,131 members of the original and offspring cohorts in the Framingham Heart Study who were at least 60-years-old and cognitive normal when serum BDNF measurements were taken. Median follow-up was 10 years.

Dementia of all types was diagnosed in 140 of these participants; 117 developed Alzheimer’s disease.

Serum BDNF levels varied greatly. The mean in the bottom two quintiles was 15.2 ng/mL (standard deviation 4.0) whereas the mean in the upper three quintiles was 328.2 ng/mL (SD 6.0).

After adjusting for age, sex, and cohort, Seshadri and colleagues calculated that each standard deviation in BDNF was associated with a 23% reduction in risk of all-types dementia and of Alzheimer’s disease (95% CI 0.64-0.93 and 0.63-0.95, respectively). The P-value for the all-types dementia trend was 0.002, and for Alzheimer’s disease it was 0.01.

These values did not change when additional adjustments were taken for education level, major cardiovascular risk factors, and APOE genotype.

Cumulative incidence of dementia reached 11% by year 10 in the lowest quintile of BDNF levels, versus about 5.5% in the highest quintile.

But when Seshadri and colleagues looked at subgroups of age, gender, and educational attainment, the BDNF-dementia associations varied widely.

Specifically, they were nearly absent in men, participants younger than 80, and those without at least a college degree. In those groups, point estimates indicated small associations. For example, each standard deviation in BDNF decreased the risk of dementia in men by 12%, but the P-value was about 0.4.

The trend was stronger for those without college degrees: each standard deviation in BDNF reduced the dementia risk by 17% (P=0.07).

There were only 23 participants who developed non-Alzheimer’s dementias, and the researchers did not examine whether BDNF was associated with risks of those forms of dementia.

Seshadri and colleagues argued that the findings suggest a causative role for BDNF in development of Alzheimer’s disease.

“The fact that BDNF levels predicted dementia and Alzheimer’s disease independently of putative risk factors further suggests that it may be an active participant in the mechanism underlying these conditions rather than an incidental risk marker,” they wrote.

In particular, they suggested that BDNF may be a mediator for environmental factors previously seen to be associated with dementia risk, including physical activity, mood, and diet.

This hypotheses “needs further exploration in additional studies,” Seshadri and colleagues wrote.

This study was funded by the NIH.

The authors declared no relevant financial interests.


Primary source: JAMA Neurology
Source reference: Weinstein G, et al “Serum brain-derived neurotrophic factor and the risk for dementia: The Framingham Heart Study” JAMA Neurology 2013; DOI: 10.1001/jamaneurol.2013.4781.

John Gever, Senior Editor, has covered biomedicine and medical technology for 30 years. He holds a B.S. from the University of Michigan and an M.S. from Boston University. Now based in Pittsburgh, he is the daily assignment editor for MedPage Today as well as general factotum on the reporting side. Go Pirates/Penguins/Steelers!

MOST READ IN Neurology

1

FDA Panel Gives Mixed Message on Lemtrada

2

New Prion Disease Includes GI SymptomsCME

3

FDA Reviewers Slam Lemtrada Efficacy, Safety

4

Neurostimulator for Epilepsy Wins FDA Nod

5

New Seizure Drug Wins FDA Approval

TOP CME IN Neurology

CME 105 taken

Statins Get High Marks in New Cardiac Prevention Guidelines

CME 56 taken

AHA: Lowering BP No Help in Acute Stroke

CME 55 taken

New Prion Disease Includes GI Symptoms

CME 48 taken

Bilingual? Dementia May Be Delayed

CME 46 taken

Gabapentin Helps Alcoholics Stay on the Wagon

false


Visit the Source Site

Shortage of rheumatologists – in some U.S. regions closest doctor may be 200 miles away

Current ratings for:
Shortage of rheumatologists – in some U.S. regions closest doctor may be 200 miles away

Ratings require JavaScript to be enabled.

A novel study published in the American College of Rheumatology (ACR) journal, Arthritis & Rheumatism, shows that smaller micropolitan areas of the U.S. – those with less than 50,000 people – have very few or no practicing adult rheumatologist. In some of these areas, individuals have to travel more than 200 miles to reach the closest rheumatologist.

A 2005 ACR workforce study examining the number of adult practicing rheumatologists in the United States estimated there to be roughly 1.7 adult rheumatologists per 100,000 persons. At the time the demand for services and number of rheumatologists were proportionate. However, with the aging U.S. population and lack of growth in the number of rheumatologists, experts projected that by 2010 there would be a shortage of 400 rheumatologists and that number would climb to 2,500 by 2025.

Led by Dr. John FitzGerald from UCLA Rheumatology at the David Geffen School of Medicine in Los Angeles, CA, a team of researchers – members of the ACR Committee on Rheumatology Training and Workforce Issues – analyzed the distribution of rheumatology practices across the U.S. using the ACR membership database. The number of rheumatologists were totaled for each Core Based Statistical Area – a way to categorize geographic regions of the U.S. that includes micropolitan and metropolitan areas. Socio-demographics associated with each CBSA cluster of rheumatologists were examined.

Results show that in 2010 there were 3,920 practicing rheumatologists in the ACR database, with 90% practicing in metropolitan regions, 3% in micropolitan areas, and 7% in rural parts of the country. In populations with less than 50,000 people there was limited access to a practicing rheumatologist, with travel to the nearest practice in 50 of the 479 micropolitan areas being more than 100 miles. Several regions with populations of 200,000 or more were also found to have no practicing rheumatologist in the area. Researchers did report a higher concentration of rheumatology practices in more populous areas with higher median incomes.

“Our study highlights that regional shortages of rheumatologists already exist,” said Dr. FitzGerald. “There are a number of communities across the U.S. that would benefit from additional rheumatology services.”

In a related editorial published also in Arthritis & Rheumatism, Dr. Chad Deal with the Cleveland Clinic in Ohio adds, “FitzGerald et al provide data showing a shortage in rheumatology care, particularly in less populated areas of the U.S. For patients with autoimmune and inflammatory diseases rheumatologists are specialist physicians who are central to early diagnosis and treatment, which evidence suggest is most important within the first few months of disease onset to limit joint damage, improve physical function, and induce remission.”

The study authors and Dr. Deal agree that interventions are needed to increase the supply of rheumatologists to underserved regions. They suggest that the ACR commit to providing updated data on supply of rheumatologists by regions so graduates are aware of practice opportunities; increase funding for fellow positions in areas that lack rheumatology services; and expand the roles of nurse practitioners and physician assistants to help care for patients with rheumatic disease in communities where rheumatologists are in short supply.

Please note that we publish the name you give us, but we do not publish your email address. We will email you to let you know when your comment has been published but will not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications, operations, or procedures please do not name healthcare professionals by name.


Visit the Source Site

Future anti-inflammatory drugs for chronic inflammation diseases may come from coumarins

Current ratings for:
Future anti-inflammatory drugs for chronic inflammation diseases may come from coumarins

Ratings require JavaScript to be enabled.

New methods for the laboratory-scale synthesis of coumarin-based drugs were developed in a recent study completed at the University of Eastern Finland. In his doctoral thesis, Lic. Phil. Juri Timonen also developed new analytical methods for the fast identification of natural and non-natural coumarins. A few of the synthesised coumarins were also found to inhibit some specific reactions generally associated with inflammation.

Coumarin is an aromatic compound, naturally occurring in many plants. In foodstuffs coumarins are found especially in cinnamon and tonka beans. The bioactivity of coumarins has been utilised in many drugs; for example, coumarins exhibit anti-inflammatory as well as anticoagulant activities. One of the best-known drugs based on a coumarin scaffold is Marewan®, a commercial blood anticoagulant.

The study made considerable improvements to the decades-old synthesis method of coumarins. Most of the previous methods are based on heating of the starting material with a strong acid, but the newly developed method also works at room temperature. The improvements also lower the production costs, since the final products are easier to purify.

A commonly used inflammation model showed that some of the synthesised coumarins remarkably reduced the production of typical signalling molecules, such as nitric oxide synthase and nitric oxide itself, which are usually linked to inflammation. In this assay, a murine cell line from mice imitated the inflammatory response. The results also revealed one of the pathways in which coumarins act. Understanding of this pathway and data on nearly 50 tested coumarins may help in the development of future anti-inflammatory drugs for chronic inflammation diseases such as asthma and rheumatoid arthritis.

Developing new analytical methods for natural and non-natural compounds is important in the screening of natural products with biological activity as well as in studies of drug metabolism. By using a mass spectrometric method developed in this study, even very similar compounds can be distinguished and characterized based on their fragmentation during the analysis.

A fragmentation pattern for a given molecule obtained by a mass spectrometer resembles a fingerprint; it is dependent only on the structure of the molecule and two non-identical molecules produce different patterns. The study revealed some interesting details on the fragmentation of synthesized coumarins. This knowledge can be used in the future to predict fragmentation of novel coumarins.

The findings were originally published in European Journal of Medical Chemistry, European Journal of Mass Spectrometry, and Rapid Communications in Mass Spectrometry.


Visit the Source Site