Blog — Page 13 — Lucia Zamorano, MD, PLC

Second Bapineuzumab Trial Fails in Alzheimer’s

Pauline Anderson

A second phase 3 trial investigating bapineuzumab IV in patients with mild to moderate Alzheimer’s disease (AD) has been stopped, essentially spelling the end of the program to investigate this agent in patients with this type of dementia.

The 18-month, randomized, double-blind, multicenter studies were examining the efficacy and safety of bapineuzumab, a monoclonal antibody that targets beta-amyloid (Aß), in patients who carry the apolipoprotein E epsilon 4 (ApoE4) genotype and in those who do not.… [Continue Reading]

Perioperative Anticoagulation Management

Author: Brian James Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: William A Schwer, MD

In performing noncardiac surgery on patients on anticoagulation, the major concern is when it is safe to perform surgery without increasing the risk of hemorrhage or increasing the risk of thromboembolism (eg, venous, arterial) after discontinuing treatment. In treating patients on long-term Coumadin perioperatively, consider the risks of hemorrhage or thromboembolism versus the benefit from the operation. When considering noncardiac surgery, these factors and the need to weigh the risk of hemorrhage against that of thromboembolism must analyzed on an individual patient basis. Certain procedures (eg, oncologic procedures, threats to limb or life) are easy analyses. More complex discussions must be had for such cases as hernia repair of other elective nonurgent operations. … [Continue Reading]

Pathogenesis of Migraine – Role of Neuromodulators

The pathogenesis of migraine is still, today, a hotly debated issue. Recent biochemical studies report the occurrence in migraine of metabolic abnormalities in the synthesis of neurotransmitters and neuromodulators. These include a metabolic shift directing tyrosine metabolism toward the decarboxylation pathway, therein resulting in an unphysiological production of noradrenaline and dopamine along with increased synthesis of traces amines such as tyramine, octopamine, and synephrine. This biochemical alteration is possibly favored by impaired mitochondrial function and high levels of glutamate in the central nervous system (CNS) of migraine patients.

The unbalanced levels of the neurotransmitters (dopamine and noradrenaline) and neuromodulators (eg, tyramine, octopamine, and synephrine) in the synaptic dopaminergic and noradrenergic clefts of the pain matrix pathways may activate, downstream, the trigeminal system that releases calcitonin gene-related peptide. This induces the formation of an inflammatory soup, the sensitization of first trigeminal neuron, and the migraine attack. In view of this, we propose that migraine attacks derive from a top-down dysfunctional process that initiates in the frontal lobe in a hyperexcitable and hypoenergetic brain, thereafter progressing downstream resulting in abnormally activated nuclei of the pain matrix.… [Continue Reading]

Evidence Grows That Cancer Has Its Own Stem Cells

While scientists hotly debate the existence of cancer stem cells, three related new studies, all conducted on mice, provide some supporting evidence.

Stem cells are the foundation for healthy cell growth in the body. Some researchers believe that malignant stem cells also exist — so-called cancer stem cells that generate tumors and resist treatment by simply re-growing afterward.… [Continue Reading]

Tighten Opioid Label Restrictions, Physicians Tell FDA

A coalition of 37 physicians that includes pain management and addiction experts petitionedthe US Food and Drug Administration (FDA) yesterday to tighten label restrictions for opioid analgesics as a way to combat the epidemic of addiction and fatal overdoses associated with these drugs.

Under the proposed label changes, opioids would no longer be indicated for moderate noncancer pain. The petition notes that moderate to severe pain is the FDA-approved indication for nearly all instant-release opioids as well as extended-release versions when 24/7 pain relief is needed for a long stretch of time. Such “overly broad indications” imply that the FDA has established that long-term use of opioids is safe and effective, the petition states. “An increasing body of medical literature suggests that long-term use of opioids may be neither safe nor effective for many patients, especially when prescribed in high doses.”… [Continue Reading]

Ceramides in Blood May Signal Alzheimer’s Disease Risk

High levels of a family of lipids called ceramides in the blood may be predictive of developing Alzheimer’s disease, a new study suggests.

Women with the highest levels of ceramides had a 10-fold higher risk of developing Alzheimer’s compared with those with the lowest levels, said Michelle M. Mielke, PhD, from the Mayo Clinic, Rochester, Minnesota.

“The study is small — that’s a limitation, and it was a preliminary study. However, given the small sample size, to have hazard ratios that are near 10 was quite striking and we didn’t expect to see that at all,” Dr. Mielke told Medscape Medical News.… [Continue Reading]

Bapineuzumab Fails in Phase 3 Alzheimer’s Trial

Pfizer Inc has announced topline results of a phase 3 trial of bapineuzumab showing treatment failed to meet the co-primary endpoint of change in cognitive or functional performance versus placebo in patients with mild to moderate Alzheimer’s disease (AD) who are positive for the apolipoprotein E4 (ApoE4) risk allele.

Bapineuzumab is an investigational monoclonal antibody that targets amyloid-ß (Aß) under development by the Alzheimer’s Immunotherapy Program (AIP), a partnership between Janssen Alzheimer Immunotherapy R&D LLC (Janssen AI) and Pfizer Inc.… [Continue Reading]

YouTube Videos of Vertigo Treatment Mostly Accurate

Video demonstrations of a common maneuver for managing benign paroxysmal positional vertigo (BPPV) are readily available on YouTube, and most are accurate depictions of the treatment, according to a new study.

The study, published in the July 24 issue of Neurology, shows that 64% of 33 videos had correct information on how to perform the Epley maneuver, with most of the other videos having only minor deviations from the accepted approach, said lead author Kevin A. Kerber, MD, assistant professor of neurology at the University of Michigan Health System in Ann Arbor.

A relatively common condition, BPPV is caused by freely moving particles called canaliths that are trapped in the semicircular canal of the inner ear. A main symptom of BPPV is transient, positionally triggered dizziness.… [Continue Reading]

Hand Tremors – Not Always Parkinson’s Disease

Try holding a piece of paper with your hand extended out in front of your body for a short time and you’ll likely see a slight tremble of the hand. This is totally normal and goes largely unnoticed. It’s caused by the motions of your body processes — your heart beating and your chest moving as you breathe — which have a kind of ripple effect on muscles all over your body.

However, with age, tremors of the hands and other areas of the body can become more noticeable, and can even begin to affect normal actions such as handwriting, holding a cup, eating with utensils or even speaking.

This may be annoying or embarrassing — or lead to fear that you may have a disease such as Parkinson’s. For some, tremors worsen, making it increasingly difficult to perform day-to-day tasks. … [Continue Reading]

Tinnitus – Notice the noise less

Whether it’s a ringing, buzzing, roaring, whistling or a hissing noise, tinnitus (TIN-i-tus) is the label for those sounds you hear in your ear or head. It can range in severity from being only mildly annoying or temporary to being so loud and constant that it interferes with your ability to concentrate or get a good night’s sleep.

Occasionally tinnitus may be a sign of something serious, but usually it’s not. Still, the more irritating tinnitus becomes, the more it may result in fatigue and sleep problems, unwanted stress, memory problems, anxiety, depression, and irritability. For most people with tinnitus, there’s no cure. However, various management strategies may help reduce the amount of noise you hear, distract your attention from the tinnitus, or help you
find ways to mask the noise.… [Continue Reading]

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