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18 Stomach Acid Suppression Increases Pneumonia Risk: Of 364,683 individuals from the Netherlands who developed 5,551 cases of pneumonia for the first time, researchers found that current use of all acid-suppressive drugs was associated with a 27% increase in the risk of pneumonia, with higher risks for specific classes of acid-suppressive drugs (such as proton pump inhibitors or H2-receptor antagonist drugs). Robert J.F. Laheij, Nijmegen, Netherlands, JAMA. 2004; 292:1955-1960. High Blood Pressure Very Common in Aging: From the CDC’s 1999-2000 National Health and Nutrition Examination Survey, data on 4,805 adult found 58% with either hypertension or prehypertension. Prehypertension is a reading between 120/80 and 139/89. The highest prevalence of either prehypertension or hypertension was: among non-Hispanic blacks 63%, especially men 69%; among all those surveyed age 60 and over 88%; among those with less than a high school education 65%; and among those with body-mass indexes over 30, which indicates obesity. Youfa Wang, Qiong Joanna Wang, Univ. Illinois, Arch Int Med 10/25/04. For more, see Hypertension. Periodontitis Extremely Common in Middle Age: Of 108 patients with coronary artery disease (CAD) with a mean age of 59.2 vs. a similar group of 62 people without CAD found moderate to severe periodontitis in 91% of cardiac patients vs. 66% of non-cardiac patients. E.H. Rompen, Liege, Belgium. Journal of Periodontology October 26, 2004. Ed: I don’t know which is the cause and which the effect. However, I was impressed by how common periodontitis is among non-cardiac patients. Use Colgate Total toothpaste with triclosan and a generic Listerine type mouthwash. For more, see Dental How Lithium Works: Lithium's actions include its direct inhibitory actions on inositol monophosphatase, inositol polyphosphate 1-phosphatase, glycogen synthase kinase-3, fructose 1,6-bisphosphatase, bisphosphate nucleotidase, and phosphoglucomutase enzymes. Lithium's intracellular downstream targets include adenylate cyclase, the phosphoinositol cascade (and its effect on protein kinase C), arachidonic acid metabolism, and effects on neurotrophic cascades. Molecular effects of lithium. Quiroz JA, Gould TD, Manji HK. NIMH Mol Interv. 2004 Oct;4(5):259-72. Ed: If you understand most of this, you're doing better than I am. Glial Brain Cell Dysfunction in Depression: Glial fibrillary acidic protein (GFAP) is a major protein of astrocyte intermediate filaments and a specific marker for astrocytes. GFAP levels in cerebella of 60 subjects divided equally among schizophrenia, bipolar disorder, major depression, and normal controls found levels were reduced by 32%, 17% and 14.5% in depressed, bipolar, and schizophrenic cerebella. Only the depressed value was significantly different (p=0.015). This adds to reports of reductions in GFAP/glial cell counts in other brain regions of subjects with major depression, thus suggesting a downregulation of glial function in this disorder. Glial fibrillary acidic protein is reduced in cerebellum of subjects with major depression, but not schizophrenia. Fatemi SH, Laurence JA, Araghi-Niknam M, Stary JM, Schulz SC, Lee S, Gottesman II. University of Minnesota. Schizophr Res. 2004 Aug 1;69(2-3):317-23. Wolfram Gene SNPs Increase Mood Disorders: Wolfram syndrome is an extremely rare autosomal-recessive disorder that predisposes the development of type 1 diabetes and progressive optic atrophy. The WFS1 gene encodes a transmembrane protein called wolframin, which may serve as an endoplasmic reticulum calcium channel in pancreatic beta-cells and neurons. Researchers found a 26-fold increased risk for psychiatric disorders in WFS1 mutation carriers. In another study of 28 single-nucleotide polymorphisms (SNPs) of the WFS1 gene in 224 unrelated patients with major depressive disorder and bipolar disorder and in 160 healthy control subjects, five SNPs were associated with major depressive disorder, and three SNPs with bipolar disorder. The GTA haplotype, formed by SNPs 684CG, 1185CT and 1832GA, confers a risk for major depression with an OR of 1.59 (p=0.01) and for bipolar disorder an OR of 1.89 (p=0.03). Polymorphisms in the wolframin (WFS1) gene are possibly related to increased risk for mood disorders. Koido K, Kks S, et al. University of Tartu, Estonia. Int J Neuropsychopharmacol. 2004 Oct 11:1-10. Ed: This is a minor, but apparently real increase. It shows the extreme complexity and diversity of human genetics. White Matter Densities More Common in Bipolars: In contiguous 3-mm thick MRI slices as well as fluid attenuated inversion recovery (FLAIR) images of 43 bipolar patients and 39 healthy controls, bipolars had a greater prevalence of white matter hyperdensities (WMH) (Bipolar, grade 1 = 11.6%, grade 2 = 9.3%, grade 3 = 7.0%; Controls, grade 1 = 5.1%, grade 2 = 2.6%, grade 3 = 0%). This difference is mainly due to the differences in deep WMH (Bipolar, grade 1 = 14.0%, grade 2 = 14.0%; Controls, grade 1 = 7.7%, grade 2 = 0%). White matter hyperintensities in subjects with bipolar disorder. Ahn KH, Lyoo IK, et al. Harvard-McLean. Psychiatry Clin Neurosci. 2004 Oct;58(5):516-21 Vitamin C Vaginally Helped Vaginitis: In a 6-day
DB PC study of 100 women with non-specific vaginitis (discharge, fishy odor, and
presence of clue cells), vitamin C vaginal tablets (250 mg) was given once a
day. Two weeks after the end of treatment significantly more patients were still
affected by non-specific vaginitis after placebo (36%) vs. 14% with vitamin C.
The clue cells disappeared in 79% after vitamin C vs. 53% on placebo. Bacteria
disappeared in 77% on vitamin C vs. 54% placebo, while lactobacilli reappeared
in 79.1 and 53.3%, respectively. Efficacy and safety of Vitamin C vaginal
tablets in the treatment of non-specific vaginitis; A randomised, double blind,
placebo-controlled study. Petersen EE, Magnani P., Freiburg D-79106, Germany. Eur
J Obstet Gynecol Reprod Biol. 2004 Nov 10;117(1):70-75. For more, see Candida-Yeast.
Atherosclerosis May Cause Alzheimer’s: Schizophrenic Brain Damage in Thalamus: In an MRI study of 49 controls and 71 schizophrenic patients, prefrontal and dorsomedial thalamic gray matter reductions seem to be specific to schizophrenia, anterior thalamic reductions seem to be a marker of liability to psychosis in general. Biol Psychiatry. 2004 Oct 15;56(8):544-52 Cycloserine Didn’t Help Schizophrenia in Small Study: Low dose d-cycloserine (DCS) is a partial agonist at the glycine site of the NMDA-associated receptor complex, noncompetitively enhancing NMDA neurotransmission. In a DB PC study of 22 schizophrenic patients with prominent negative symptoms, cycloserine 50 mg/day added to stable anti-psychotic medications did not show any superior results to placebo although both groups improved. Effects of d-cycloserine on negative symptoms in schizophrenia. Duncan EJ, Szilagyi S, et al. Emory University. Schizophr Res. 2004 Dec 1;71(2-3):239-48. Ed: This study failed due to its small size and the impact of improvement in the placebo group, an odd coincidental occurrence. Glycine, very similar but cheaper, is still a good strategy as an add-on for schizophrenia. Cycloserine Helps Autism: In a DB PC study of 3 doses of cycloserine, the drug significantly improved the CGI and social withdrawal and was well tolerated. Further controlled studies of d-cycloserine in autism appear warranted. A Pilot Study of D-Cycloserine in Subjects With Autistic Disorder. Posey DJ, Kem DL, et al. Indianapolis, IN. Am J Psychiatry. 2004 Nov;161(11):2115-2117. Nortriptyline Added 8% to One Year Abstinence from Cigarettes: In a DB PC study of 160 smokers of over 9 cigarettes/day, all received 8 weeks of a transdermal nicotine patch, five group counseling sessions, and active nortriptyline or placebo treatment. Subjects in extended treatment continued taking drug or placebo to week 52 and received an additional 9 monthly counseling sessions, with checkup telephone calls midway through each session. At week 52, point-prevalence abstinence rates with missing subjects imputed as smokers were 30% for placebo brief treatment, 42% for placebo extended treatment, 18% for active brief treatment, and 50% for active extended treatment. Extended nortriptyline and psychological treatment for cigarette smoking. Hall SM, Humfleet GL, et al. University of California, San Francisco. Am J Psychiatry. 2004 Nov;161(11):2100-7. Ed: The "placebo" abstinence rates of this study are amazingly good. The counseling may have been unusually successful. Too bad its hard to replicate that. Imipramine with Lithium Better than Fluvoxamine with Lithium: In a two-phase study of 138 patients hospitalized for severe depression, after four weeks, 23% of imipramine-treated patients and 15% of fluvoxamine-treated patients had fully recovered. Lithium was then added to those not fully recovered. At the end of phase II, 59% imipramine-treated patients versus 40% fluvoxamine-treated patients had recovered, signicantly favoring imipramine. Both strategies were well tolerated. Comparison of two-phase treatment with imipramine or fluvoxamine, both followed by lithium addition, in inpatients with major depressive disorder. Birkenhager TK, van den Broek WW, et al Rotterdam, the Netherlands. Am J Psychiatry. 2004 Nov;161(11):2060-5. Ed: Dual-action anti-depressants frequently do better than SSRI anti-depressants. This study unfortunately had no group not having added lithium after four weeks, so there is no way of knowing whether that added any additional benefit. SSRI Failed to Help Elderly Depressed: In an 8-week DB PC study of 174 elderly over age 74, the SSRI citalopram (Celexa) at 10-40 mg/day did no better than placebo. Am J Psychiatry. 2004 Nov;161(11):2050-9. Antidepressant pharmacotherapy in the treatment of depression in the very old: a randomized, placebo-controlled trial. Roose SP, Sackeim HA, et al. New York State Psychiatric Institute. Am J Psychiatry. 2004 Nov;161(11):2050-9. Ed: A dual action anti-depressant such as nortriptyline or even the non-medication supplement 5-HTP with the addition of vitamin D, folic acid, and fish oil would have been better strategies. ACE Inhibitor Didn’t Aggravate Cholesterol Status: In the 2.6-year, 508-patient PHYLLIS DB PC study, progression of carotid atherosclerosis occurred with hydrochlorothiazide but not with fosinopril. Progression could also be avoided by associating pravastatin with hydrochlorothiazide. Zanchetti A, Crepaldi G, et al. University of Milan, Italy. Stroke. 2004 Oct 28 Vitamin A No Benefit Child Lung Infections: In a systematic review of double-blinded, randomized, controlled intervention studies of high-dose vitamin A or placebo in children aged between 1 mo and 6 y presenting with acute non-measles lower respiratory tract infection, five quality studies with 2177 children found no significant differences in any of the recovery measures or mortality between the intervention and control groups. Vitamin A for acute respiratory infection in developing countries: a meta-analysis. Brown N, Roberts C. Southampton, United Kingdom. Acta Paediatr. 2004 Nov;93(11):1437-42. Hepatitis B Vaccine Linked to Small Increase in MS: In a case-control study of 163 MS victims in Britain and 1,604 carefully matched controls, 6.7% of MS patients vs. 2.4% of controls had had a recent hepatitis B vaccination. 93% of MS patients had not had hepatitis B vaccinations at all. Miguel Hernan, Harvard, Neurol 9/04. Hepatitis B infects 350 million worldwide vs. 2.5 million for MS. Thus, the authors consider the risk to be reasonable. For more, see Multiple Sclerosis.
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