Acyclovir : Acyclovir online and side effects

Save your skin during dry season

2004-10-03T22:45:00.000-07:00

Save your skin during dry season

Winter's byproducts include chapped lips, flaky scalp and body

By Lisa Liddane

Orange County Register

Cold temperatures outdoors and dry, heated air indoors can leave your skin parched. Your scalp and body may become flaky, your chin and nose red and irritated. Your lips may be chapped. Your hands and feet may develop painful cracks.

Here, some advice from board-certified dermatologists Dr. Kristen Kelly, associate clinical professor of dermatology at the University of California, Irvine, and Dr. Susan Goodlerner, spokeswoman for the American Academy of Dermatology:

Face

Wash with a mild facial cleanser and lukewarm, not hot, water. Blot -- don't rub dry -- and use a moisturizing cream.

Scale down use of cleansers and moisturizers with exfoliating ingredients such as acids or anti-acne components if they are making your skin dry.

Remember that even if your skin is typically oily, some parts of the face may be dry during the winter. Use a moisturizer lightly in the oily areas and be liberal with it in dry spots.

Use a sunscreen with a minimum SPF of 15 during the day. Many good facial moisturizers have a built-in sunscreen.

Use a waterproof sunscreen with a minimum SPF of 30 if you are participating in outdoor sports such as skiing, snowboarding and snowshoeing.

Look for UV-A and UV-B protection. Look for at least one of the following ingredients: zinc oxide, titanium dioxide, avobenzone.

Reapply after several hours.

Body

Keep showers and baths short.

Use warm, not hot, water, even if hot water feels better.

Remember that antibacterial soaps can sometimes be drying to the skin.

Use soaps, bath oils and shower gels with moisturizing qualities.

Rinse thoroughly and blot dry.

Apply body cream immediately to seal in moisture.

Scalp

Wash your hair with warm, not hot, water.

To treat dandruff, wash hair most days with a mild shampoo.

Use an anti-dandruff shampoo two to three times a week. These shampoos contain an active ingredient such as selenium sulfide, coal tar, zinc pyrithione or ketoconazole.

If one brand doesn't work, try another.

Leave shampoo on your scalp for the recommended time listed on the instructions for best results.

Rinse thoroughly.

Hands

Choose a lotion or cream that won't easily wash off when you wash your hands.

Use lotion or cream immediately after washing hands with soap and water to seal in moisture.

For extremely dry hands, heavier creams and ointments may be more effective.

Lips

Don't chew on or lick your lips. This will cause them to become dry.

Use a lip moisturizer or lip balm with SPF 15 or petroleum jelly. Reapply throughout the day and night.

Remember that cold sores are contagious -- they're caused by the herpes simplex virus.

Cold sores disappear on their own in about a week.

Some over-the-counter topical ointments may provide temporary relief but if you want tougher treatment, get a prescription for acyclovir ointment (Zovirax).

Basic skin care

At drug/supermarket/ discount stores: Almay, Neutrogena, Aveeno, Cetaphil, Eucerin, Oil of Olay.

At select department stores: Clinique.

At dermatologists' and plastic surgeons' offices: La Roche-Posay.

Skin-care myths

Myth: Dandruff occurs mostly in the winter. Fact: Dandruff occurs throughout the year. Washing the hair and scalp with hot water can make the skin dry but does not cause dandruff.

Myth: You don't need to wear sunscreen in the winter. Fact: Even when it's cloudy, you still need to protect your skin from UV damage.

Myth: Only pricey moisturizers have good quality. Fact: Some drugstore brands, such as Cetaphil, Neutrogena, Eucerin, Aveeno and Oil of Olay, can do a good job of cleansing and moisturizing the skin.

Myth: Soap is not good for the skin. Fact: It depends on the soap. Pure soap can be drying to the skin. Choose one that's appropriate for the condition of your skin, whether it's dry, oily or a combination.

Myth: More is always better when moisturizing the face. Fact: Over-moisturizing areas that are irritated or have acne may worsen the situation.

Source: Dr. Kristen Kelly, associate professor of dermatology, University of California, Irvine.

Antiviral Drug, Valacyclovir, Reduces Genital Herpes Transmission

2004-09-27T02:02:00.000-07:00

Antiviral Drug, Valacyclovir, Reduces Genital Herpes Transmission

An international team of researchers finds that taking a single daily dose of an approved antiviral drug known as valacyclovir can reduce the transmission of genital herpes to uninfected partners by 50 percent. The results are published in the Jan. 1 issue of the New England Journal of Medicine.

The team of researchers led by Dr. Larry Corey, a member of Fred Hutchinson Cancer Research, conducted a study of nearly 1,500 heterosexual monogamous couples in which one partner had genital herpes and the other did not. Infected partners who received a standard daily oral dose each day of valacyclovir were half as likely to transmit herpes simplex type 2 (HSV-2) than infected partners given a placebo.

University of Washington collaborators included Dr. Anna Wald, associate professor of medicine and laboratory medicine, and Dr. R. Ashley Morrow, professor of laboratory medicine.

The strategy potentially could be applied to combat the spread of other sexually transmitted diseases that are caused by viruses. "This is the first demonstration that an antiviral drug can prevent a viral sexually transmitted disease," said Corey, also a professor of laboratory medicine at UW and head of Fred Hutchinson's Fred Hutchinson's infectious diseases program. "The study provides the conceptual framework to extend other viral sexually transmitted diseases, such has HIV infection."

Genital herpes is caused by HSV-2 and infects about 50 million Americans over age 20. The virus is transmitted through sexual contact and is often silent, which contributes to the spread of disease. Those who do develop symptoms experience genital ulcers that are often painful. Infected individuals can transmit the virus even when they are not aware that they are infected or when no symptoms are present, and the infection can remain in the body indefinitely. Almost 80 percent of persons with HSV-2 are not diagnosed because accurate blood tests to detect antibodies signifying infection with the virus have only recently been developed and are not widely used.

Antiviral drugs, such as acyclovir and more recently, valacyclovir and famciclovir, have been known to reduce herpes outbreaks for nearly two decades. In the last few years, Wald, Corey and others have shown that such drugs also reduce the frequency and amount of HSV-2 that is shed from the genital area, which is the major source of herpes transmission. This observation provided the rationale for the current study, which sought to determine whether reducing the amount of viral shedding-even in the absence of clinical symptoms-could prevent herpes transmission.

The study, conducted at 96 centers in the United States, Canada, Europe, South America and Australia, used blood tests for HSV-2 antibody to identify monogamous heterosexual couples in which one partner had genital herpes and one did not. The person with herpes in each couple was randomly assigned to either receive a daily dose of valacyclovir or a placebo. The study was conducted in a double-blind fashion, meaning that neither the researchers nor the participants knew which treatment they received.

Susceptible partners were evaluated monthly for a total of eight months for signs and symptoms of HSV-2 infection and for HSV-2 antibody in the blood. Source partners (those with herpes at the outset of the study) were examined monthly for disease recurrence. Both partners were counseled on safer-sex practices and offered condoms at each visit.

At the end of the eight-month study period, genital herpes had occurred in 41 of the sexual partners of those on placebo versus 21 who took valacyclovir, as judged by the antibody-blood test. Couples who used condoms and valacyclovir had the lowest transmission rate.

The findings that antiviral therapy reduces HSV-2 transmission add an important option in the management of patients with genital herpes who are sexually active, said Wald, an affiliate member of the Clinical Research Division and medical director of the UW Virology Research Clinic, one of the world's leading sites for herpes research.

"We hope the results will encourage more persons to be tested for HSV-2 and more physicians to offer suppressive antiviral therapy for those with HSV-2 infection," she said. Valacyclovir, marketed as Valtrex by GlaxoSmithKline, has recently received approval from the U.S. Food and Drug Administration for use in preventing genital herpes in couples in which one partner has genital herpes.

The effectiveness of antivirals at reducing genital herpes transmission could also help to stem the AIDS epidemic, which affects 42 million people around the world. Scientists have become worried about the increasing genital herpes epidemic worldwide because recent studies indicate HSV-2 may help to spread HIV, which causes AIDS. Persons with genital herpes are two times more likely to acquire the HIV-1 virus. Dr. Connie Celum, UW professor of medicine, Wald and Corey have received funding from the Bill and Melinda Gates Foundation to evaluate whether acyclovir, the parent compound of valacyclovir, can reduce the transmission of HIV by suppressing the HSV-2 virus and reducing its effects on HIV-1 in genital fluids.

"If effective, therapy for HSV-2 could offer another way for decreasing the spread of HIV, which could be helpful until a vaccine for HIV is developed," Corey said. "Also, this approach highlights the importance of working toward developing a vaccine for HSV-2."

Short Course of Acyclovir for Genital Herpes

2004-09-17T04:14:00.000-07:00

Short Course of Acyclovir for Genital Herpes
American Family Physician
August, 2002

Patients with recurrent genital herpes may experiment with shorter courses of antiviral medication as they gain experience with the disease. Studies of viral replication have shown that active viral reproduction ends in the first few days of recurrent infections, well before the resolution of genital lesions or clinical symptoms. Wald and associates conducted a randomized, double-blind, placebo-controlled trial of higher-dose, shorter-course acyclovir in the treatment of recurrent genital herpes.

The study enrolled 131 patients with recurrent genital herpes (i.e., at least three documented outbreaks in the year before the study). Patients were randomized to treatment with either acyclovir at 800 mg or placebo, three times daily for two days. At least one recurrence occurred during follow-up in 64 percent of participants, and 50 percent of participants had two or more episodes of infection. With each recurrence, lesions were cultured for herpes simplex virus every other day until resolution.

Acyclovir was more than twice as likely as placebo (27 percent versus 10.6 percent) to completely abort recurrence of the herpes virus infection. In patients who developed active lesions, viral shedding was reduced by more than one half with acyclovir (25 hours versus 58.5 hours with placebo), and the duration of skin lesions also decreased (four days versus six days with placebo). These results were comparable with results published elsewhere for standard antiviral regimens. There was no significant difference in the likelihood of a subsequent herpes outbreak with the shorter-course regimen. The higher-dose, shorter-course regimen of acyclovir (800 mg three times daily for two days) promoted better compliance than standard dosing (200 mg five times daily for five days) but had the same overall cost because the total drug dosage was similar.

The authors conclude that a shorter course of higher-dose acyclovir for recurrent genital herpes is effective in aborting recurrences, decreasing viral shedding, and speeding clinical resolution of outbreaks.

EU Patent Granted on Medivir's Herpes Project ME-609

2004-09-09T02:48:00.000-07:00

EU Patent Granted on Medivir's Herpes Project ME-609

HUDDINGE, Sweden, March 31, 2004 (PRIMEZONE) -- The European Patent Office today granted a patent on Medivir's herpes project MEa-609. Medivir currently has operational responsibility for development of the project and preparations towards phase III studies are ongoing. The company's ambition is to have a "turn key" project ready for phase III studies. In parallel Medivir is actively seeking a partnership or joint venture for this advanced and for Medivir important project.

The patent (EP0909498B1) has been granted in all the EU countries and in Switzerland, Slovenia, Liechtenstein, Latvia and Lithuania. The patent covers all topical pharmaceuticals that include the antiviral acyclovir and the glucocorticoid hydrocortisone and also claims the use of such products in the treatment of herpes infections. The EU patent extends to 2016, and will most likely be eligible for further extension with a Supplementary Protection Certificate. The previously granted US patent extends to 2016 and claims a substantial number of immunoregulating and antiviral combinations.

ME-609 may be the first pharmaceutical to prevent the outbreak of cold sores. There are no other products in clinical development with the same profile. Current pharmaceuticals just alleviate the symptoms but do not prevent the outbreak of cold sores. Despite their lack of efficacy, the current pharmaceuticals sold for more than USD 500 m in 2002.

Medivir in brief Medivir is an innovative, specialised research company that develops pharmaceuticals with the aim of becoming a sustainable and profitable pharmaceuticals company. The company is located in Huddinge, Sweden and Cambridge, UK. Medivir's research focuses on developing new pharmaceutical compounds based on polymerases and proteases as target enzymes. The Group comprises Medivir AB, its subsidiary Medivir UK Ltd. and Medivir Personal AB. At the end of 2003, the Group had 109 employees. In 1996, Medivir was listed on Stockholmsborsen and since 1 July 2003, the company's shares are traded on the Attract40 segment of the O-list .The research portfolio includes projects in the area of HIV infection, hepatitis, shingles, cold sores, osteoporosis, rheumatoid arthritis (RA), asthma and multiple sclerosis (MS). Medivir has five individual projects in the clinical development phase, all with a unique clinical profile. The company's broad pre-clinical research portfolio includes five defined projects and some ten activities in different pre- clinical phases.

Intimacy does not cause prostate cancer

2004-08-30T23:25:00.000-07:00

Intimacy does not cause prostate cancer
By Peter H. Gott, M.D.

Dear Dr. Gott: Although we are in our early 70s, my wife and I continue to enjoy regular physical intimacy. However, she is afraid that, deaspite my normal PSA prostate cancer test, frequent sex could lead to cancer. Is her concern justified?

Does having sex at an older age predispose a man to have a prostate malignancy?

Dear Reader: No one knows the cause of prostate cancer. Medical professionals have been periodically rocked by assertions that too much sex (how much is too much?) -- or too little sex (what is too little?) -- can contribute to prostate cancer. To my knowledge, this is a non-issue. I am not aware of any reputable medical studies that prove (or even suggest) that sexual activity is in any way related to prostate tumors.

I hope that your wife hasn't raised this issue to cool your ardor!

You are to be envied, actually, for being able to perform satisfactorily at your age; many 70-something men have difficulty in this regard.

Consequently, you may continue your present behavior without worrying about prostate cancer.

To give you related information, I am sending you a copy of my Health Report "The Prostate Gland." Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: In a recent column, you wrote that acyclovir is the preferred drug to treat shingles. However, when I developed shingles, my doctor prescribed cephalexin. I'd always been told that antibacterial medication is not useful for viral infections. Am I incorrect?

Dear Reader: No, you're not. I believe that your physician's choice was not appropriate, unless he suspected that a secondary bacterial infection was complicating your shingles.

Dear Dr. Gott: My 44-year-old husband claims to have a continuous cold, with congestion, runny nose and cough. He works in a plant that makes fiberglass panels. This morning, he told me that two other guys who work with him have the same chronic symptoms.

I believe that colds are not chronic and that something else is going on. Can you help?

Dear Reader: You are correct that colds are not chronic. These viral infections typically last about a week.

I agree that an investigation is in order.

For example, your husband and his two co-workers may be reacting to something in their environment, such as fiberglass particles or allergens in the workplace.

Also, it's possible that the men may have sinus infections or chronic bronchitis (especially if they are smokers).

I believe your best bet is to involve your family physician, who should be able to sort matters out by examining your husband and -- if necessary -- instituting an analysis of possible pollution in the plant. If such a screening confirms the presence of contaminants in the workplace, the situation is hazardous and should be corrected.

On the other hand, if infection is causing the symptoms, an extended course of antibiotics could solve the problem.

Return of the chickenpox: Uglier and meaner

2004-08-24T01:56:00.000-07:00

Return of the chickenpox: Uglier and meaner
By JANE E. BRODY
NY Times News Service

Physicians call it shingles, from the Latin word cingulum, meaning belt or girdle. Scientists call the virus that causes the disease varicella-zoster -- varicella the Latin word for little pox, zoster the Greek word for girdle.

The Italians refer to shingles as St. Anthony’s fire. And some sufferers call its occasional aftermath -- postherpetic neuralgia -- pure and simple torture, the worst pain imaginable, 10 times as bad as giving birth and excruciating enough to drive a person to suicide.

Anyone who has had chickenpox is at risk of eventually developing shingles. The same virus, which resides in the body for life after an attack of chickenpox, causes each disease. Over a 75-year life span, one person in five who once had chickenpox will come down with shingles.

With the incidence of shingles rising as the population ages, medical researchers are working as fast as they can to find a way to prevent it. They will soon know whether booster shots of the chickenpox vaccine will prevent this nasty virus from recurring as natural immunity wanes with advancing age.

A five-year study of vaccine boosters in people who had had chickenpox is nearing completion. More than 37,000 volunteers 60 and older are participating; half of them received the vaccine. The study, started in 1999, is jointly sponsored by the Department of Veterans Affairs, the National Institute of Allergy and Infectious Diseases and the vaccine’s manufacturer, Merck & Co.

If the vaccine is found safe and effective in people over 60, chances are it can also be used to protect younger people, especially those whose immune systems are depressed by disease or by medical treatments like chemotherapy or immune-suppressing drugs.It is unlikely, however, that the chickenpox vaccine as it is now routinely administered to young children will protect all of them from developing shingles, since 15 percent to 25 percent of vaccinated children eventually get chickenpox anyway.

For some, the vaccine fails initially to stimulate production of antibodies to the virus and in others, vaccine-induced immunity wears off with time.

The beginning
Once the chickenpox virus, technically known as herpes zoster, is in your system, it stays for life, hiding out in the DNA of cells at the base of sensory nerves. There the virus waits for an opportunity to bud out and travel down the long nerve fibers to the skin, where it can multiply and create havoc with a person’s life.

In many people, undue stress, which can suppress immune responses, is the precipitating factor. Thus, someone recently widowed, divorced or facing a court battle, or even a student cramming for exams, can become a target.

More often, however, shingles afflicts people whose immune systems are suppressed by disease or treatment or whose natural immunity is diminished with advancing age. Thus, people who are HIV-positive or have aids, transplant recipients taking immune suppressants, cancer patients undergoing chemotherapy or radiation and those with asthma or autoimmune diseases treated with steroids tend to be vulnerable.

Occasionally, a cold, sunburn or other physical problem will bring on an attack.

Others at risk are children whose mothers develop chickenpox five to 21 days before giving birth. Because these infants have no opportunity to acquire antibodies to the virus while in the womb, they are likely to have chickenpox at birth or soon afterward, and a third will develop shingles by age 5.

At first, the symptoms of shingles are vague and confusing. On one side of the body, typically around the rib cage or waist and sometimes on the face, the skin feels irritated, tingly or numb and vaguely painful or itchy or both. The victim may, or may not, feel ill with fever, chills, headache or stomach upset.

Within a few days, however, the telltale tiny virus-filled blisters appear on reddened skin. The blisters resemble the lesions of chickenpox but are more painful than itchy. As with chickenpox, they tend to appear in waves, spreading over one side of the body or face.

Exposure to someone with chickenpox does not bring on an attack of shingles nor can someone with shingles spread it to others. But anyone who has not had chickenpox or is unprotected by the vaccine can catch chickenpox, but not shingles, from a person with shingles blisters.

The blisters scab over in a matter of days, ending the period of contagion, though the pain of shingles can last for weeks. Most people become immune to the virus and experience only one attack, although it may recur in some people with compromised immunity.

The treatment

The trick to preventing most severe cases of shingles is to catch it early and to be treated with an antiviral agent. I remember well my one and only experience with shingles. I was driving for several hours, but the middle of my back felt so irritated I could not lean back in the seat. Upon arriving at my destination, I ripped off my shirt and applied a cold compress to relieve the discomfort. Still, I had no idea what was wrong.

Then in the middle of the night, I awoke with the thought, I have shingles. The next morning, I contacted my doctor who confirmed my self-diagnosis and prescribed acyclovir, now one of several drugs that can suppress herpes viruses. By catching and treating it early, I was spared the blisters and the searing pain they can cause.

Antiviral treatment is best started within 72 hours of the first sign of a shingles rash, and the earlier the better. Early treatment is believed to diminish the risk of developing serious nerve damage, or postherpetic neuralgia, and the long-lasting, often incapacitating pain it can cause. Depending on the severity of a shingles attack, antiviral treatment may be administered orally, by injection or intravenously, with or without other drugs, like prednisone and painkillers.

Aggressive treatment is especially critical in people with suppressed immune systems. Without natural immune defenses to curb the virus, it can spread through the body, and it can be fatal.

The devastating symptoms of postherpetic neuralgia also demand intensive therapy. Antivirals, however, are not effective because the virus is no longer active when the postherpetic neuralgia develops.

Topical treatments like capsaicin cream or lidocaine patches may be used to relieve pain. Low doses of tricyclic antidepressants and antiseizure drugs can enhance the effectiveness of pain medications.

If incapacitating pain persists, trancutaneous electric nerve stimulation (tens), biofeedback, acupuncture or nerve blocks may be tried. Different therapies seem to work better for some people than others, and experts urge people with postherpetic neuralgia not to give up until they have exhausted all possible remedies.

In most people, the symptoms of postherpetic neuralgia abate within three months. Fewer than one patient in four is still in pain at six months and fewer than one in 20 has pain a year later. Still, some cases can persist for years, a torturous ordeal for those who must endure it.

Third Annual Encephalitis Conference

2004-08-16T01:34:00.000-07:00

Third Annual Encephalitis Conference
International organizers are proud to announce the FACES to FACES Encephalitis Conference, to be held in Enfield Connecticut USA on August 6th to August 8th, 2004.

FACES (Friends And Caregivers, Encephalitis Survivors) represents a strong and dedicated group of people striving to share information and support, and to raise awareness on the topic of encephalitis. Previous Conferences held in Ottawa Canada, and Las Vegas Nevada, welcomed survivors, caregivers and loved ones from India and Great Britain, as well as Canada and the United States.

Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection.
Victims are usually exposed to viruses resulting in encephalitis by insect bites or food and drink. The most frequently encountered agents are arboviruses (carried by mosquitoes or ticks) and enteroviruses (coxsackievirus, poliovirus and echovirus). Some of the less frequent agents are measles, rabies, mumps, varicella and herpes simplex viruses.

Patients with encephalitis suffer from fever, headache, vomiting, confusion, drowsiness and photophobia. The symptoms of encephalitis are caused by brain's defense mechanisms being activated to get rid of infection (brain swelling, small bleedings and cell death). Neurologic examination usually reveals a stiff neck due to the irritation of the meninges covering the brain. Examination of the cerebrospinal fluid obtained by a lumbar puncture procedure reveals increased amounts of proteins and white blood cells with normal glucose. A CT scan examination is performed to reveal possible complications of brain swelling, brain abscess or bleeding. Lumbar puncture procedure is performed only after the possibility of a prominent brain swelling is excluded by a CT scan examination.

Treatment is usually symptomatic. Reliably tested specific antiviral agents are available only for a few viral agents (e.g. .acyclovir for herpes) and are used with limited success

Intimacy does not cause prostate cancer

2004-08-12T03:43:00.000-07:00

Intimacy does not cause prostate cancer

By Peter H. Gott, M.D.

Dear Dr. Gott: Although we are in our early 70s, my wife and I continue to enjoy regular physical intimacy. However, she is afraid that, despite my normal PSA prostate cancer test, frequent sex could lead to cancer. Is her concern justified?

Does having sex at an older age predispose a man to have a prostate malignancy?

Dear Reader: No one knows the cause of prostate cancer. Medical professionals have been periodically rocked by assertions that too much sex (how much is too much?) -- or too little sex (what is too little?) -- can contribute to prostate cancer. To my knowledge, this is a non-issue. I am not aware of any reputable medical studies that prove (or even suggest) that sexual activity is in any way related to prostate tumors.

I hope that your wife hasn't raised this issue to cool your ardor!

You are to be envied, actually, for being able to perform satisfactorily at your age; many 70-something men have difficulty in this regard.

Consequently, you may continue your present behavior without worrying about prostate cancer.

To give you related information, I am sending you a copy of my Health Report "The Prostate Gland." Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: In a recent column, you wrote that acyclovir is the preferred drug to treat shingles. However, when I developed shingles, my doctor prescribed cephalexin. I'd always been told that antibacterial medication is not useful for viral infections. Am I incorrect?

Dear Reader: No, you're not. I believe that your physician's choice was not appropriate, unless he suspected that a secondary bacterial infection was complicating your shingles.

Dear Dr. Gott: My 44-year-old husband claims to have a continuous cold, with congestion, runny nose and cough. He works in a plant that makes fiberglass panels. This morning, he told me that two other guys who work with him have the same chronic symptoms.

I believe that colds are not chronic and that something else is going on. Can you help?

Dear Reader: You are correct that colds are not chronic. These viral infections typically last about a week.

I agree that an investigation is in order.

For example, your husband and his two co-workers may be reacting to something in their environment, such as fiberglass particles or allergens in the workplace.

Also, it's possible that the men may have sinus infections or chronic bronchitis (especially if they are smokers).

I believe your best bet is to involve your family physician, who should be able to sort matters out by examining your husband and -- if necessary -- instituting an analysis of possible pollution in the plant. If such a screening confirms the presence of contaminants in the workplace, the situation is hazardous and should be corrected.

On the other hand, if infection is causing the symptoms, an extended course of antibiotics could solve the problem.

Third Annual Encephalitis Conference

2004-08-02T04:20:00.000-07:00

Third Annual Encephalitis Conference
International organizers are proud to announce the FACES to FACES Encephalitis Conference, to be held in Enfield Connecticut USA on August 6th to August 8th, 2004.

FACES (Friends And Caregivers, Encephalitis Survivors) represents a strong and dedicated group of people striving to share information and support, and to raise awareness on the topic of encephalitis. Previous Conferences held in Ottawa Canada, and Las Vegas Nevada, welcomed survivors, caregivers and loved ones from India and Great Britain, as well as Canada and the United States.

Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection.
Victims are usually exposed to viruses resulting in encephalitis by insect bites or food and drink. The most frequently encountered agents are arboviruses (carried by mosquitoes or ticks) and enteroviruses (coxsackievirus, poliovirus and echovirus). Some of the less frequent agents are measles, rabies, mumps, varicella and herpes simplex viruses.

Patients with encephalitis suffer from fever, headache, vomiting, confusion, drowsiness and photophobia. The symptoms of encephalitis are caused by brain's defense mechanisms being activated to get rid of infection (brain swelling, small bleedings and cell death). Neurologic examination usually reveals a stiff neck due to the irritation of the meninges covering the brain. Examination of the cerebrospinal fluid obtained by a lumbar puncture procedure reveals increased amounts of proteins and white blood cells with normal glucose. A CT scan examination is performed to reveal possible complications of brain swelling, brain abscess or bleeding. Lumbar puncture procedure is performed only after the possibility of a prominent brain swelling is excluded by a CT scan examination.

Treatment is usually symptomatic. Reliably tested specific antiviral agents are available only for a few viral agents (e.g. acyclovir for herpes) and are used with limited success.

Intimacy does not cause prostate cancer

2004-07-28T03:30:00.000-07:00

Intimacy does not cause prostate cancer

By Peter H. Gott, M.D.
Dear Dr. Gott: Although we are in our early 70s, my wife and I continue to enjoy regular physical intimacy. However, she is afraid that, despite my normal PSA prostate cancer test, frequent sex could lead to cancer. Is her concern justified?

Does having sex at an older age predispose a man to have a prostate malignancy?

Dear Reader: No one knows the cause of prostate cancer. Medical professionals have been periodically rocked by assertions that too much sex (how much is too much?) -- or too little sex (what is too little?) -- can contribute to prostate cancer. To my knowledge, this is a non-issue. I am not aware of any reputable medical studies that prove (or even suggest) that sexual activity is in any way related to prostate tumors.

I hope that your wife hasn't raised this issue to cool your ardor!

You are to be envied, actually, for being able to perform satisfactorily at your age; many 70-something men have difficulty in this regard.

Consequently, you may continue your present behavior without worrying about prostate cancer.

To give you related information, I am sending you a copy of my Health Report "The Prostate Gland." Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: In a recent column, you wrote that acyclovir is the preferred drug to treat shingles. However, when I developed shingles, my doctor prescribed cephalexin. I'd always been told that antibacterial medication is not useful for viral infections. Am I incorrect?

Dear Reader: No, you're not. I believe that your physician's choice was not appropriate, unless he suspected that a secondary bacterial infection was complicating your shingles.

Dear Dr. Gott: My 44-year-old husband claims to have a continuous cold, with congestion, runny nose and cough. He works in a plant that makes fiberglass panels. This morning, he told me that two other guys who work with him have the same chronic symptoms.

I believe that colds are not chronic and that something else is going on. Can you help?

Dear Reader: You are correct that colds are not chronic. These viral infections typically last about a week.

I agree that an investigation is in order.

For example, your husband and his two co-workers may be reacting to something in their environment, such as fiberglass particles or allergens in the workplace.

Also, it's possible that the men may have sinus infections or chronic bronchitis (especially if they are smokers).

I believe your best bet is to involve your family physician, who should be able to sort matters out by examining your husband and -- if necessary -- instituting an analysis of possible pollution in the plant. If such a screening confirms the presence of contaminants in the workplace, the situation is hazardous and should be corrected.

On the other hand, if infection is causing the symptoms, an extended course of antibiotics could solve the problem.

Test Time...How the "Body Clock" Affects Diagnostic Testing

2004-07-27T03:15:00.000-07:00

Test Time...How the "Body Clock" Affects Diagnostic Testing

The body clock's powerful influence can also be seen in the way it affects diagnostic test results. These results can vary significantly, possibly producing inaccurate readings, depending on the time of day when a test is done.

Consider how the body clock affects blood pressure. Blood pressure isn't constant throughout the day and night: it normally rises in the morning, remains elevated during the day and early evening, and decreases to its lowest level during sleep. So a single reading taken during the day may not give a true picture of whether blood pressure is within the normal range or requires treatment. Some doctors now ask patients to wear special monitoring devices. These provide a complete 24-hour blood pressure pattern by recording blood pressures a number of times during the day.

The body clock also affects skin testing for allergies. Results are lower in the morning, considerably higher in the evening, and greatest just before bedtime.

The body clock may complicate testing for asthma severity. Airway patency, or degree of openness, is poorest during the night and best during midday and evening. The same is generally true for forced expiratory volume and peak expiratory flow readings, which can be up to 50% higher at midday and in the afternoon than overnight or when the patient wakes up. Unless these circadian rhythms are taken into account, daytime evaluation of asthma patients could result in underestimating the severity of the disease.

CIRCADIAN RHYTHMS OF DISEASES
Peak Time of Event/Variable
Michael H. Smolensky, PhD

What's being done to help doctors obtain the most accurate results from diagnostic tests likely to be affected by the body clock? Just heightening their awareness of the problem helps. In addition, medical chronobiologists are working to develop test-interpretation guidelines for doctors that take circadian rhythms into account.
For additional information about Biologic Rhythms, see these MedicineNet.com articles:

Biologic Rhythms
Body Rhythms and Angina
Body Rhythms and Heart Attack
Body Rhythms and Hypertension
Body Rhythms and Allergies
Body Rhythms and Asthma
Biologic Rhythms and Symptoms of Illness
Biologic Rhythms and Diagnostic Testing

References:
The right time? Chronopharmacology - a new science. Nursing RSA Verpleging. 1992;7:23-27. Pharmacology.

Smolensky MH, D'Alonzo GE. Medical chronobiology: concepts and applications. Am Rev Respir Dis.1993;147:S2-S 19.

Time of day medicine dose is taken may boost its efficacy, cut toxicity. JAMA. 1996;275:1 143-1 144. Medical News & Perspectives.

A Day In The Life Of Your Body

2004-07-26T02:48:00.000-07:00

A Day In The Life Of Your Body

How the "Body Clock" Affects Symptoms of Illness

Among the various biologic rhythm cycles that medical chronobiologists study, the 24-hour day/night-activity/rest cycle is considered a key chronobiologic factor in medical diagnosis and treatment. Formally known as the circadian rhythm, it's also referred to as the "body clock."

Why is the 24-hour body clock so important? Because so many of our normal body functions follow daily patterns of speeding up and slowing down, intensifying and diminishing, in alignment with circadian rhythm. Interestingly, so do the symptoms of a number of chronic disorders:

Allergic rhinitis - (nasal inflammation associated with hay fever) - symptoms of sneezing, runny nose, and stuffy nose are typically worse in the early waking hours than during the day.
Asthma - in most patients, symptoms are more than 100 times as likely to occur in the last few hours before awakening than during the day.
Stable angina - chest pain and electrocardiographic (ECG) abnormalities are most common during the first 4 to 6 hours after awakening.
Prinzmetal's angina - ECG abnormalities are most common during sleep; chest pain can occur even while at rest.
Heart attack - most commonly occurs in early waking hours.
Stroke - most commonly occurs in early waking hours.
Hypertension - highest blood pressure readings typically occur from late morning to middle afternoon; lowest occur during early sleep. Therapy now exists that works with your body clock: Please consult your physician. Clinical studies are underway to further this research.
Rheumatoid arthritis - symptoms are most intense upon awakening.
Osteoarthritis - symptoms worsen in afternoon and evening.
Ulcer disease - pain typically occurs after stomach emptying, following daytime meals, and in the very early morning, disrupting sleep.
Epilepsy - seizures often occur only at particular times of the day or night; individual patterns differ among patients.
For additional information about Biologic Rhythms, see these MedicineNet.com articles:

Biologic Rhythms
Body Rhythms and Angina
Body Rhythms and Heart Attack
Body Rhythms and Hypertension
Body Rhythms and Allergies
Body Rhythms and Asthma
Biologic Rhythms Matching Drug Therapy to the Body Clock
Biologic Rhythms and Diagnostic Testing

References:

The right time? Chronopharmacology - a new science. Nursing RSA Verpleging. 1992;7:23-27. Pharmacology.

Smolensky MH, D'Alonzo GE. Medical chronobiology: concepts and applications. Am Rev Respir Dis.1993;147:S2-S 19.

Time of day medicine dose is taken may boost its efficacy, cut toxicity. JAMA. 1996;275:1 143-1 144. Medical News & Perspectives.

A Day In The Life Of Your Body

2004-07-23T02:07:00.000-07:00

A Day In The Life Of Your Body

How the "Body Clock" Affects Symptoms of Illness

Among the various biologic rhythm cycles that medical chronobiologists study, the 24-hour day/night-activity/rest cycle is considered a key chronobiologic factor in medical diagnosis and treatment. Formally known as the circadian rhythm, it's also referred to as the "body clock."

Why is the 24-hour body clock so important? Because so many of our normal body functions follow daily patterns of speeding up and slowing down, intensifying and diminishing, in alignment with circadian rhythm. Interestingly, so do the symptoms of a number of chronic disorders:

Allergic rhinitis - (nasal inflammation associated with hay fever) - symptoms of sneezing, runny nose, and stuffy nose are typically worse in the early waking hours than during the day.
Asthma - in most patients, symptoms are more than 100 times as likely to occur in the last few hours before awakening than during the day.
Stable angina - chest pain and electrocardiographic (ECG) abnormalities are most common during the first 4 to 6 hours after awakening.
Prinzmetal's angina - ECG abnormalities are most common during sleep; chest pain can occur even while at rest.
Heart attack - most commonly occurs in early waking hours.
Stroke - most commonly occurs in early waking hours.
Hypertension - highest blood pressure readings typically occur from late morning to middle afternoon; lowest occur during early sleep. Therapy now exists that works with your body clock: Please consult your physician. Clinical studies are underway to further this research.
Rheumatoid arthritis - symptoms are most intense upon awakening.
Osteoarthritis - symptoms worsen in afternoon and evening.
Ulcer disease - pain typically occurs after stomach emptying, following daytime meals, and in the very early morning, disrupting sleep.
Epilepsy - seizures often occur only at particular times of the day or night; individual patterns differ among patients.
For additional information about Biologic Rhythms, see these MedicineNet.com articles:

Biologic Rhythms
Body Rhythms and Angina
Body Rhythms and Heart Attack
Body Rhythms and Hypertension
Body Rhythms and Allergies
Body Rhythms and Asthma
Biologic Rhythms Matching Drug Therapy to the Body Clock
Biologic Rhythms and Diagnostic Testing

References:

The right time? Chronopharmacology - a new science. Nursing RSA Verpleging. 1992;7:23-27. Pharmacology.

Smolensky MH, D'Alonzo GE. Medical chronobiology: concepts and applications. Am Rev Respir Dis.1993;147:S2-S 19.

Time of day medicine dose is taken may boost its efficacy, cut toxicity. JAMA. 1996;275:1 143-1 144. Medical News & Perspectives.

News

2004-07-21T03:13:00.000-07:00

Every year, thousands of people develop problems with their sense of smell. In fact, more than 200,000 people visit a physician each year for help with smell disorders or related problems. If you experience a problem with your sense of smell, call your doctor. This fact sheet explains smell and smell disorders.

Many people who have smell disorders also notice problems with their sense of taste.

How does our sense of smell work?

The sense of smell is part of our chemical sensing system, or the chemosenses. Sensory cells in our nose, mouth, and throat have a role in helping us interpret smells, as well as taste flavors. Microscopic molecules released by the substances around us (foods, flowers, etc.) stimulate these sensory cells. Once the cells detect the molecules they send messages to our brains, where we identify the smell.

Olfactory, or smell nerve cells, are stimulated by the odors around us--the fragrance of a gardenia or the smell of bread baking. These nerve cells are found in a small patch of tissue high inside the nose, and they connect directly to the brain. Our sense of smell is also influenced by something called the common chemical sense. This sense involves nerve endings in our eyes, nose, mouth, and throat, especially those on moist surfaces. Beyond smell and taste, these nerve endings help us sense the feelings stimulated by different substances, such as the eye-watering potency of an onion or the refreshing cool of peppermint.

It's a surprise to many people to learn that flavors are recognized mainly through the sense of smell. Along with texture, temperature, and the sensations from the common chemical sense, the perception of flavor comes from a combination of odors and taste. Without the olfactory cells, familiar flavors like coffee or oranges would be harder to distinguish.

What are the smell disorders?

People who experience smell disorders experience either a loss in their ability to smell or changes in the way they perceive odors. As for loss of the sense of smell, some people have hyposmia, which is when their ability to detect odor is reduced. Other people can't detect odor at all, which is called anosmia. As for changes in the perception of odors, some people notice that familiar odors become distorted. Or, an odor that usually smells pleasant instead smells foul. Still other people may perceive a smell that isn't present at all.

What causes smell disorders?

Smell disorders have many causes, some clearer than others. Most people who develop a smell disorder have recently experienced an illness or an injury. Common triggers are upper respiratory infections and head injuries.

Among other causes of smell disorders are polyps in the nasal cavities, sinus infections, hormonal disturbances, or dental problems. Exposure to certain chemicals, such as insecticides and solvents, and some medicines have also been associated with smell disorders. People with head and neck cancers who receive radiation treatment are also among those who experience problems with their sense of smell.

How are smell disorders diagnosed?

Doctors and scientists have developed tests to determine the extent and nature of a person's smell disorder. Tests are designed to measure the smallest amount of odor patients can detect as well as their accuracy in identifying different smells. In fact, an easily administered "scratch and sniff" test allows a person to scratch pieces of paper treated to release different odors, sniff them, and try to identify each odor from a list of possibilities. In this way, doctors can easily determine whether patients have hyposmia, anosmia, or another kind of smell disorder.

Are smell disorders serious?

Yes. Like all of our senses, our sense of smell plays an important part in our lives. The sense of smell often serves as a first warning signal, alerting us to the smoke of a fire or the odor of a natural gas leak and dangerous fumes. Perhaps more important is that our chemosenses are sometimes a signal of serious health problems. Obesity, diabetes, hypertension, malnutrition, Parkinson's disease, Alzheimer's disease, multiple sclerosis, and Korsakoff's psychosis are all accompanied or signaled by chemosensory problems like smell disorders.

Can smell disorders be treated?

Yes. Some people experience relief from smell disorders. Since certain medications can cause a problem, adjusting or changing that medicine may ease its effect on the sense of smell. Others recover their ability to smell when the illness causing their olfactory problem resolves. For patients with nasal obstructions such as polyps, surgery can remove the obstructions and restore airflow. Not infrequently, people enjoy a spontaneous recovery because olfactory neurons may regenerate following damage.

What research is being done?

The NIDCD (National Institute on Deafness and Other Communication Disorders) supports basic and clinical investigations of chemosensory disorders at institutions across the Nation. Some of these studies are conducted at several chemosensory research centers, where scientists are making advances that help them understand our olfactory system and may lead to new treatments for smell disorders.

Vision & The Eye

2004-07-20T01:51:00.000-07:00

Vision & The Eye
When you understand how the eye works, it is easier to comprehend why people need glasses or contact lenses to see well.

The eyes are complex sensory organs. They are designed to optimize vision under conditions of varying lighting. The basic elements are similar to those of an average photography camera.

The primary function of the eye is to focus light. For the eye to see, light rays must be bent or "refracted" to meet at a single point through the cornea, the clear window at the front of the eye that provides most of the focusing power. The transparent dome cornea is a firm covering and is susceptible to dryness and abrasion injuries.

The iris of the eye is the color portion behind the cornea. Our eye color is a function of the amount of pigment within the iris (brown eyes have the most pigment, while blue eyes have the least). The iris contains muscles that open and close its central opening called the pupil in response to decreases and increases in light exposure (exactly like the camera aperture).

Light then travels through the lens, where it is fine-tuned to focus properly on the retina, the nerve layer that lines the back of the eye and connects to the brain. The retina acts like the film in a camera, and clear vision is achieved only if light from an object is precisely focused onto it. If the light focuses either in front of or behind the retina, the image you see is blurred. A refractive error means that the shape of eye structures does not properly bend the light for focusing.

Having 20/20 vision means seeing at 20 feet what a normal person sees at 20 feet. However, if vision is measured at 20/40, it means a person has to walk up to 20 feet to see the same size letter that someone with 20/20 vision could see at 40 feet. People whose best- corrected visual acuity (what they see using glasses or contact lenses) is less than 20/200 in the better eye are considered legally blind, even though they still have enough vision to get around.

What are the whites of the eyes?

The white outer layer of the eyeball is called the sclera. The sclera is covered by a fine tissue containing tiny blood vessels called the conjunctiva. (It is the dilation and proliferation of these blood vessels that accounts for the pinkness of conjunctivitis or "pinkeye.")

What is the middle of the eyeball made of?

The central core of the eyeball is a gel-filled area called the vitreous. Behind the vitreous, at the back of the eye is the retina. The retina is composed of 10 fine layers of specialized nervous tissues that respond to light exposure by initiating chemical reactions that are translated into electrical signals which are then transmitted to the back of the brain through a large nerve in the back of the eye (optic nerve).

What muscles move the eyeballs?

Six different muscles located around the eyeball are capable of directing the eyes toward the subject to be seen.

What are tears?

The eyes are protected by the tears normally produced by the tear glands (lacrimal glands) located above the outer portion of each eye. The tears drain from the eyes through the tear ducts, located on the inner portion of the eyes. These ducts drain into the nose. This is why our noses run when we weep!

For more in-depth information about eye care, please read the MedicineNet.com Eye Care article.

Sterile Gloves

2004-07-19T01:53:00.000-07:00

Sterile Gloves
Today, sterile disposable gloves are in common use by doctors, nurses and medical aides; dentists, dental hygienists and dental assistants; emergency medical technicians and ambulance drivers; firefighters and the police; venapuncturists (blood drawers) and lab techs; trainers in boxing, ice hockey and many other sports; ad infinitum.

It was not always so. Until late in the 19th century, most surgeons operated with their bare hands. A few doctors tried cotton or silk gloves but they proved impractical and impossible to sterilize.

The first surgeon to advocate the use of gloves that could be effectively sterilized was Werner Zoege von Manteuffel. He published an article on sterilized rubber surgical gloves to protect patients undergoing surgery from infection. The article appeared in 1897.

You have not heard of Werner Zoege von Manteuffel? He was born in 1857 in northern Estonia and was around 40 when his pioneering paper on sterilized rubber gloves came out. Two years later, in 1899, he became professor of surgery at the university in Tartu, the second largest city of Estonia (the first being the capital, Talinn).

That is all we know of Werner Zoege von Manteuffel, except for one thing. To wear boiled rubber gloves, he used to say, was to have "boiled hands."

Source: Based on I Käbin, BMJ 1998;317:1330

Early Vitamin Use May Boost Risk of Asthma, Food AllergyBy Kathleen DohenyHealthDay Reporter

2004-07-16T02:28:00.000-07:00

Early Vitamin Use May Boost Risk of Asthma, Food AllergyBy Kathleen DohenyHealthDay Reporter
TUESDAY, July 6 (HealthDayNews) -- Early use of multivitamins, a staple in the diets of more than half of all American toddlers, may boost the risk of asthma and allergies, a new study claims.
But it's too soon for parents to change anything unless their doctor advises it, stressed study author Dr. Joshua D. Milner, a clinical fellow at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. A report on the finding appears in the July issue of Pediatrics.
Milner and his colleagues evaluated more than 8,000 children, using data collected from the National Center for Health Statistics' 1988 National Maternal-Infant Health Survey and the 1991 Longitudinal Follow-Up of the same children.
The mothers of the children described whether they had given their children vitamins at an early age, and whether their kids were diagnosed with a food allergy or asthma.
By the age of 3, 851 kids, 10 percent of those studied, were diagnosed with asthmas. By age 3, 396 kids, or 4.9 percent of those studied, were diagnosed with food allergies.
In those kids who were formula-fed and took vitamins before 6 months of age, there was "about a 70 percent increased risk" for a food allergy, compared to kids who were formula-fed but not given multivitamins, Milner said.
For black infants, whether formula-fed or not, there was about a 30 percent increased risk for asthma at age 3 if they took multivitamin before 6 months of age, Milner added.
"Caucasian children had no increased risk for asthma, and breast-fed infants -- breast-fed at all -- did not have an increased risk for food allergies," Milner said.
The researchers could not explain why the asthma risk was stronger for black infants, but they speculated that doctors for some reason may be more likely to diagnose asthma in black infants.
Formula-fed infants may be more at risk for food allergies when they also take a multivitamin because of the higher amount of vitamin D found in formula, they also speculated.
"We have shown an association that may or may not be causal," Milner said. "There could be another reason for the finding."
"Certain vitamins have direct effects on the immune system and can push it in certain directions," he added. "Vitamins A and D can push the immune system in allergic directions; vitamins E and C have been shown in test tubes to push you away from the allergic direction. This doesn't mean if you take vitamin D you will get an allergy."
More than 50 percent of toddlers are given multivitamins, Milner estimated, and about 30 percent to 50 percent of infants take them. For children in general, he said, there is no official recommendation from the American Academy of Pediatrics.
However, the academy did recommend last year that healthy infants during the first two months of life along with children and adolescents should receive 200 international units (IUs) a vitamin D a day to prevent rickets, a skeletal deformity associated with insufficient levels of vitamin D.
Milner said, "The message for parents is they should not do anything differently than what their doctor says right now."
Another expert had mixed feelings about the new study.
"It is a fascinating study, although it has, I am afraid, the potential for a lot more concern than it warrants," said Dr. Dennis Ownby, section chief of Allergy and Immunology in the Department of Pediatrics at the Medical College of Georgia in Augusta. "As with any study like this, it's important to consider the risks and benefits in totality."
"For those who need supplements, the risk of rickets is real and is, in my opinion, a far worse proasthma," said Ownby, who noted that many children diagnosed early in life with asthma often outgrow it by age 6 or so.
"This article does highlight the concern of many health professionals, and especially pediatricians, that often parents get the idea that if a little vitamin is good, more is better. Vitamins, especially vitamin D, do have toxic effects..."
He echoed Milner's advice, that parents consult their pediatrician for guidance on vitamin use.

SOURCES: Dennis R. Ownby, M.D., section chief, Allergy and Immunology, Department of Pediatrics, Medical College blem than of Georgia, Augusta; Joshua D. Milner M.D., clinical fellow, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.; July 2004 Pediatrics

A Little Dust Could Be Good for Tender Skin

2004-07-15T01:21:00.000-07:00

A Little Dust Could Be Good for Tender Skin
WEDNESDAY, July 7 (HealthDayNews) -- High levels of endotoxin, a bacterial toxin found in house dust, may protect infants from eczema, says a study done as part of the ongoing Boston-based Home Allergens and Asthma study.

Researchers collected dust samples from the living rooms of homes that had 400 infants. The dust samples were analyzed for endotoxin, a component of cell walls of various bacteria.

Infants in homes with higher levels of endotoxin were less likely to be diagnosed with eczema in their first year of life. Infants in homes with dogs were also less likely to have eczema, but this relationship weakened after the researchers adjusted for endotoxin exposure.

The risk of eczema was higher in infants whose fathers had a history of eczema and whose mothers were sensitive to at least one allergen.

This study appears to support the controversial theory that early exposure to infectious inflammatory agents changes infants' immune systems and makes them less likely to develop allergies later in life.

But parents shouldn't buy pets or stop cleaning their homes to protect their infants from eczema, said study leader Dr. Wanda Phipatanakul, a pediatric allergist and immunologist at Children's Hospital Boston and assistant professor of pediatrics at Harvard Medical School.

"We now know that there are things in the environment that may be important in eczema. But you need lots of studies to be able to come up with recommendations," she said.

It's not clear what endotoxin does to the immune syste, and previous research has linked endotoxin exposure with wheezing and airway inflammation in people with asthma, she said.

-- Robert Preidt

Pet Allergens Found in All U.S. Homes

2004-07-13T21:39:00.000-07:00

Pet Allergens Found in All U.S. Homes
By Amanda Gardner
HealthDay Reporter
THURSDAY, July 8 (HealthDayNews) -- The truth about pet dander is it may be more ubiquitous than you think.

Regardless of whether a dog or cat is in permanent residence, all homes in the United States contain dog and cat allergens, a new study claims. As a matter of fact, pet dander was present in almost 100 percent of the homes surveyed, even though dogs and cats only lived in half of those residences.

"Folks' sensitivity to cat and/or dog allergens are in all likelihood going to be exposed to detectable levels of those allergens in their environment regardless of where they live," said Dr. Darryl Zeldin, head of the asthma research program at the National Institute of Environmental Health Sciences (NIEHS). He is senior author of the study, which appears in the July issue of the Journal of Allergy and Clinical Immunology.

Such allergens are believed to contribute to asthma.

The researchers used data from the first National Survey of Lead and Allergens in Housing, which had been gathered in 1998 and 1999. The surveyors collected vacuumed dust samples from the bed, bedroom floor, living room floor and living room sofa in 831 housing units containing 2,456 people in 75 locations around the United States.

Dog and cat allergens were detected in 100 percent and 99.9 percent of homes, respectively, even though only 49.1 percent of the homes actually had such a pet. Most of the homes surveyed had levels that surpassed the proposed thresholds.

Sofas had the highest concentration of dog and cat allergens, indicating either that the pet ruled the house or the allergens rubbed off human clothing.

It's also likely allergens will be lower in communities where dog and cat ownership is less common, such as inner cities, Zeldin added.

Why would these allergens be found in homes without cats or dogs?

"One explanation is that the cat and dog allergies are transported on clothing," said Samuel J. Arbes, lead author of the study and clinical research coordinator at the NIEHS. "It's been shown that dog and cat allergens are present in public places -- on bus seats, in taxis, on park benches, in movie theaters, in hospitals, and even in the offices of allergists." This means they can easily be picked up and taken back home.

It's also possible that a pet lived in the house in the past.

The upshot is that reducing exposure to allergens may not be the most efficient route to controlling asthma and allergies. "For people who are allergic to dogs and cats, allergen avoidance may be very difficult, and it may be that people who are very allergic to dogs and cats may have to rely on medications as opposed to trying to avoid exposure," Arbes said.

"So long as the allergens are ubiquitous in communities, it can be very difficult for folks to avoid those allergens," Zeldin said. "Perhaps the approaches should not be on environmental intervention per se, but on other types of ways to modulate the response of an individual to those exposures such as medications, immune therapy or allergy shots."

According to Dr. Michael Marcus, director of allergy, immunology and pediatric pulmonology at Maimonides Medical Center in New York City, decreasing exposure should still help, but it's also necessary to focus on the underlying disease responses, especially because different people have different tolerance levels.

"We have to understand the underlying disease better, whether we're talking about allergic rhinitis or eczema or asthma," he said. "We need to look at the basic problem of the disease instead of trying to avoid the triggers of the disease as the only way of dealing with it."

SOURCES: Samuel J. Arbes, Jr., D.D.S., M.P.H., Ph.D., epidemiologist and clinical research coordinator, National Institute of Environmental Health Sciences, Research Triangle Park, N.C.; Darryl Zeldin, M.D., head, asthma research program, National Institute of Environmental Health Sciences, Research Triangle Park, N.C.; Michael Marcus M.D., director, allergy, immunology and pediatric pulmonology, Maimonides Medical Center, New York City; July 2004 Journal of Allergy and Clinical Immunology.

Dear Dr. Gott: What is the current dogma about hormone replacement therapy in early menopause?

2004-07-13T03:38:00.000-07:00

ASKDR.GOTT/ Peter Gott, M.D.
By Peter H. Gott, M.D.
Dear Dr. Gott: What is the current dogma about hormone replacement therapy in early menopause?

Dear Reader: The current position is not favorable for women who choose HRT.

This issue was addressed in the March 8, 2004, issue of the journal Archives of Internal Medicine. Cardiovascular disease (CVD) has become the leading cause of death in both women and men; it carries three times the risk of breast cancer, which women fear more. However, women tend to develop CVD at older ages than men. The cause of this phenomenon is not known, although it is probably related to the post-menopausal loss of estrogen and its protective effects; increase in cholesterol levels; smoking; and other factors that are, as yet, undefined.

In the study I mentioned, researchers found that HRT did not protect women from heart disease; in fact, there was a "50 percent excess in CVD morbidity and a twofold increased risk for stroke." This trend translated into increased rates of heart attack (especially in women who smoke).

The researchers concluded that "the potential drawbacks of post-menopausal (hormone) therapy should be considered carefully before recommending its widespread use."

Although I am not a gynecologist, it would be irresponsible for me to ignore these findings. Therefore, I recommend that average, healthy, menopausal women avoid hormone replacement therapy unless, under the guidance of their physicians, they should take it because of special circumstances.

To give you related information, I am sending you a copy of my Health Report "Menopause." Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title.

Dear Dr. Gott: My wife quit smoking for six months. During that interval, she developed painful blisters in her mouth and they became infected.

She subsequently quit again, and the blisters returned. She is very uncomfortable with this situation and two mouth specialists are confused.

Dear Reader: So am I.

I suppose that an ingredient in the tobacco smoke could, in some fashion, deactivate the viruses that commonly cause mouth ulcers, but this would be highly unusual, in my experience. Nonetheless, your wife's pattern is intriguing.

I suggest that she have a herpes virus culture taken when the mouth lesions are in their most active stage. If the test confirms the presence of viruses (which I suspect it will), your wife's physician may consider prescribing an antiviral drug, such as acyclovir, to kill the herpes and relieve her symptoms.

In the meantime, she should refrain from smoking because of the recognized hazards of cigarettes, including circulatory problems and cancers of the lungs and mouth.

Dear Dr. Gott: My husband, a marathon runner, has been advised by his physician to have knee replacement surgery. Because an artificial knee lifespan is only about eight years, he's concerned that a second, future replacement might be necessary. In Europe, ceramic products are used, instead of metal, for knee replacement, and appear to fuse better. What is your opinion?

Dear Reader: I am not familiar enough with European ceramic prostheses to advise you. To my knowledge, the U.S. artificial knee is a splendid product that works well and enables patients to maintain normal levels of activity for many years.

The lifespan of the prosthesis will, of course, depend on how strenuously it is used. A sedentary person may well enjoy his artificial knee for a lifetime; a runner may find his wearing out in a matter of years.

Ask your husband's orthopedic surgeon to give him a valid estimate of how long the prosthesis will function given your spouse's level of activity.

Acyclovir Reduces Recurrence Rate for HSV infection

2004-06-29T21:48:00.000-07:00

Acyclovir Reduces Recurrence Rate for HSV infection
Ophthalmology Times
September, 1998

TAMPA After ocular herpes simplex virus (HSV) infection resolves, treatment with acyclovir for 12 months has been shown to reduce the rate of recurrence of ocular and orofacial disease.

When acyclovir was administered at a dose of 400 mg twice daily, the rate of recurrence of ocular HSV disease, which is the most common infectious cause of corneal blindness worldwide, dropped by 45%. The authors reported their findings in the July 30 issue of the New England Journal of Medicine.

'Although treatments have been available for active ocular herpes infections to promote resolution, this is the first time a treatment has been conclusively demonstrated to be effective in the prevention of recurrences,' Roy W. Beck, MD, PhD, said.

'In addition to the clinical importance, the findings provide strong circumstantial evidence that stromal keratitis, which had been thought to be produced by an activated immune response without active virus, may be initiated by viral replication,' he continued.

Dr. Beck was the director of the National Coordinating Center of the Herpetic Eye Disease Study Group and is director of the Jaeb Center for Health Research, Tampa.

The study, funded by the National Eye Institute, was a randomized, placebo-controlled trial of 18 months duration that was conducted at 74 clinical sites in the U.S.; 703 patients were enrolled, with 357 receiving acyclovir and 346 receiving placebo.

Patients were eligible for participation in the study if they had had ocular HSV disease (blepharitis, conjunctivitis, epithelial or stromal keratitis, or iritis) within the previous 12 months and if the disease was inactive for 30 days before enrollment. Patients were excluded if they were receiving antiviral or immunosuppressive therapy, if they had a history of immune dysfunction or renal insufficiency, if acyclovir therapy was contraindicated, or if they had undergone keratoplasty or keratorefractive surgery of the affected eye.

The patients were randomly assigned to receive active treatment (400 mg of oral acyclovir administered twice a day in two capsules for 12 months) or placebo. Patients were examined at 1, 3, 6, 9, and 12 months after the start of treatment and then after months 13, 15, and 18. A total of 575 patients (82%) completed the 12 months of treatment.

No serious adverse effects occurred during treatment, according to the authors.

'The cumulative probability of a recurrence of ocular HSV disease during the 12-month treatment period was significantly lower in the acyclovir group than in the placebo group (19% versus 32%; rate ratio, 0.55; 95% confidence interval, 0.41 to 0.75;p < 0.001).

Past episodes significant

The data also showed that the number of previous episodes of HSV disease affected the recurrence rate.

'In both treatment groups, the number of past episodes of ocular HSV disease was strongly associated with the likelihood of a recurrence (p = 0.04 in the acyclovir group and p = 0.006 in the placebo group),' the authors said.

The cumulative probability of a recurrence during the treatment period was determined using the Kaplan-Meier produce limit method. For example, of the 101 patients in the acyclovir group who had had one previous episode of HSV disease, the cumulative probability of recurrence was 13%. In the 141 patients receiving acyclovir who had had four or more previous episodes of HSV disease, the probably of a recurrence was 25%.

When the authors analyzed the efficacy data based on the type of HSV disease, they found that in the 337 patients who had a history of stromal keratitis, the probability of a recurrence was 14% in the group of patients who received acyclovir and 28% in the placebo group (p = 0.005). The results were similar for epithelial keratitis.

The recurrence rate of orofacial HSV disease was also significantly lower in the acyclovir group compared with the placebo group (19% versus 36%, respectively; p < 0.001). In those patients who had a history of orofacial HSV disease, the cumulative probability of an orofacial recurrence during the 12-month treatment period was 29% in 170 patients in the acyclovir group and 50% in 177 patients in the placebo group, the authors reported.

'Our results show that long-term treatment with acyclovir helps prevent recurrences of ocular HSV disease and orofacial HSV infections in patients with a history of ocular HSV disease.

'Since the form that a recurrence of ocular HSV disease takes is strongly associated with the form of previous episodes, prolonged acyclovir therapy should provide the greatest clinical benefit for patients with a history of stromal keratitis because it should reduce the likelihood of the corneal scarring and loss of vision that can result from recurrent episodes of stromal keratitis,' the authors concluded.

They noted that the role of acyclovir as prophylactic therapy is not certain in patients who have had superficial forms of ocular HSV disease, such as epithelial keratitis, conjunctivitis, and blepharitis. These manifestations of the disease respond to short-term topical antiviral therapy and generally do not result in permanent damage.

Propolis heals herpes lesions faster than acyclovir

2004-06-28T21:50:00.000-07:00

Propolis heals herpes lesions faster than acyclovir

A randomized, single-blind comparative study concluded that the bee product propolis was more effective in the treatment of genital herpes than either placebo or acyclovir, a herpes drug marketed under the trade name Zovirax®. For the study, 90 men and women with recurrent genital herpes were randomly divided into three equal-sized groups and treated with propolis, acyclovir, or placebo ointments. Results were assessed on the third, seventh, and tenth days of treatment. The primary study endpoints were healing time of blisters and time until symptoms disappeared. According to the results, blisters healed significantly faster in people treated with propolis. On day 10 of the study, 24 of 30 people in the propolis group were healed, compared with 14 of 30 in the acyclovir group and 12 out of 30 in the placebo group. Among the 66 percent of women who had vaginal infections in addition to herpes at the initial examination, the incidence of additional infection was reduced by 55 percent after treatment with propolis. No change in vaginal flora was seen in the acyclovir and placebo groups. Vynograd N, Vynograd I, Sosnowski Z. A comparative multi-centre study of the efficacy of propolis, acyclovir and placebo in the treatment of genital herpes (HSV). Phytomedicine 2000; 7(1): 1-6.

Treatment of Recurrent Genital Herpes Infections

2004-06-27T21:34:00.000-07:00

American Family Physician
July, 1998

Acyclovir has been widely used as an effective and well-tolerated drug for the treatment of recurrent genital herpes simplex virus infection. Early initiation of treatment has been shown to reduce duration of viral shedding, time until healing and time until clearance of lesions. Since Acyclovir is administered five times a day for five days, valacyclovir has been proposed as an alternative therapeutic agent. Tyring and associates compared the effectiveness of the two drugs in the treatment of recurrent genital herpes infections.

The double-blind, randomized study included 1,200 immunocompetent patients with recurrent genital herpes. Study subjects underwent therapy with oral valacyclovir, 1,000 mg twice daily; oral acyclovir, 200 mg five times daily, or placebo.

Both valacyclovir and acyclovir significantly decreased the length of the genital herpes episode compared with placebo. The episode resolved in approximately 75 percent of patients within six days of active drug therapy compared with eight days for placebo. Patients who initiated treatment within six hours after the prodrome experienced resolution 11 percent more quickly than those who started therapy after 24 hours. Both active drugs significantly reduced the time until lesion healing compared with placebo. Median healing times were 4.8 days for both active drugs, compared with 6.0 days for placebo. Healing time was faster in younger patients. At least one culture for herpes simplex virus was obtained from approximately 90 percent of the patients in each treatment group. Culture results were negative in 49 percent of the active drug groups, compared with 29 percent in the placebo group. The duration of viral shedding was significantly longer in the placebo group. Both active drugs significantly decreased the duration of pain compared with placebo. On the third day of treatment, only 12 to 15 percent of patients in the active drug groups reported moderate or severe pain, compared with 25 percent of patients receiving placebo. Adverse events were similar in all study groups, with headache, nausea and diarrhea occurring most frequently.

The authors conclude that treatment of recurrent herpes infections with a twice-daily regimen of valacyclovir or a five-times-daily regimen of acyclovir is significantly more effective than placebo in decreasing pain, and shortening the overall length of an episode and the period of viral shedding, with no significant differences between the two regimens. Because of the more convenient dosing schedule and the potential for improvement in compliance, valacyclovir is a useful alternative to acyclovir.

Tyring SK, et al. A randomized, placebo-controlled comparison of oral valacyclovir and acyclovir in immunocompetent patients with recurrent genital herpes infections. Arch Dermatol February 1998L; 134:185-91.

Short Course of Acyclovir for Genital Herpes

2004-06-24T23:14:00.000-07:00

Short Course of Acyclovir for Genital Herpes
American Family Physician
August, 2002

Patients with recurrent genital herpes may experiment with shorter courses of antiviral medication as they gain experience with the disease. Studies of viral replication have shown that active viral reproduction ends in the first few days of recurrent infections, well before the resolution of genital lesions or clinical symptoms. Wald and associates conducted a randomized, double-blind, placebo-controlled trial of higher-dose, shorter-course acyclovir in the treatment of recurrent genital herpes.

The study enrolled 131 patients with recurrent genital herpes (i.e., at least three documented outbreaks in the year before the study). Patients were randomized to treatment with either acyclovir at 800 mg or placebo, three times daily for two days. At least one recurrence occurred during follow-up in 64 percent of participants, and 50 percent of participants had two or more episodes of infection. With each recurrence, lesions were cultured for herpes simplex virus every other day until resolution.

Acyclovir was more than twice as likely as placebo (27 percent versus 10.6 percent) to completely abort recurrence of the herpes virus infection. In patients who developed active lesions, viral shedding was reduced by more than one half with acyclovir (25 hours versus 58.5 hours with placebo), and the duration of skin lesions also decreased (four days versus six days with placebo). These results were comparable with results published elsewhere for standard antiviral regimens. There was no significant difference in the likelihood of a subsequent herpes outbreak with the shorter-course regimen. The higher-dose, shorter-course regimen of acyclovir (800 mg three times daily for two days) promoted better compliance than standard dosing (200 mg five times daily for five days) but had the same overall cost because the total drug dosage was similar.

The authors conclude that a shorter course of higher-dose acyclovir for recurrent genital herpes is effective in aborting recurrences, decreasing viral shedding, and speeding clinical resolution of outbreaks.

BILL ZEPF, M.D.
Wald A, et al. Two-day regimen of Acyclovir for treatment
of recurrent genital herpes simplex virus type 2 infection.
Clin Infect Dis April 1, 2002;34:944-8.

Antiviral Drug, Valacyclovir, Reduces Genital Herpes Transmission

2004-06-23T22:15:00.000-07:00

Antiviral Drug, Valacyclovir, Reduces Genital Herpes Transmission
An international team of researchers finds that taking a single daily dose of an approved antiviral drug known as valacyclovir can reduce the transmission of genital herpes to uninfected partners by 50 percent. The results are published in the Jan. 1 issue of the New England Journal of Medicine.

The team of researchers led by Dr. Larry Corey, a member of Fred Hutchinson Cancer Research, conducted a study of nearly 1,500 heterosexual monogamous couples in which one partner had genital herpes and the other did not. Infected partners who received a standard daily oral dose each day of valacyclovir were half as likely to transmit herpes simplex type 2 (HSV-2) than infected partners given a placebo.

University of Washington collaborators included Dr. Anna Wald, associate professor of medicine and laboratory medicine, and Dr. R. Ashley Morrow, professor of laboratory medicine.

The strategy potentially could be applied to combat the spread of other sexually transmitted diseases that are caused by viruses. "This is the first demonstration that an antiviral drug can prevent a viral sexually transmitted disease," said Corey, also a professor of laboratory medicine at UW and head of Fred Hutchinson's Fred Hutchinson's infectious diseases program. "The study provides the conceptual framework to extend other viral sexually transmitted diseases, such has HIV infection."

Genital herpes is caused by HSV-2 and infects about 50 million Americans over age 20. The virus is transmitted through sexual contact and is often silent, which contributes to the spread of disease. Those who do develop symptoms experience genital ulcers that are often painful. Infected individuals can transmit the virus even when they are not aware that they are infected or when no symptoms are present, and the infection can remain in the body indefinitely. Almost 80 percent of persons with HSV-2 are not diagnosed because accurate blood tests to detect antibodies signifying infection with the virus have only recently been developed and are not widely used.

Antiviral drugs, such as Alacyclovirand more recently, valacyclovir and famciclovir, have been known to reduce herpes outbreaks for nearly two decades. In the last few years, Wald, Corey and others have shown that such drugs also reduce the frequency and amount of HSV-2 that is shed from the genital area, which is the major source of herpes transmission. This observation provided the rationale for the current study, which sought to determine whether reducing the amount of viral shedding-even in the absence of clinical symptoms-could prevent herpes transmission.

The study, conducted at 96 centers in the United States, Canada, Europe, South America and Australia, used blood tests for HSV-2 antibody to identify monogamous heterosexual couples in which one partner had genital herpes and one did not. The person with herpes in each couple was randomly assigned to either receive a daily dose of valacyclovir or a placebo. The study was conducted in a double-blind fashion, meaning that neither the researchers nor the participants knew which treatment they received.

Susceptible partners were evaluated monthly for a total of eight months for signs and symptoms of HSV-2 infection and for HSV-2 antibody in the blood. Source partners (those with herpes at the outset of the study) were examined monthly for disease recurrence. Both partners were counseled on safer-sex practices and offered condoms at each visit.

At the end of the eight-month study period, genital herpes had occurred in 41 of the sexual partners of those on placebo versus 21 who took valacyclovir, as judged by the antibody-blood test. Couples who used condoms and valacyclovir had the lowest transmission rate.

The findings that antiviral therapy reduces HSV-2 transmission add an important option in the management of patients with genital herpes who are sexually active, said Wald, an affiliate member of the Clinical Research Division and medical director of the UW Virology Research Clinic, one of the world's leading sites for herpes research.

"We hope the results will encourage more persons to be tested for HSV-2 and more physicians to offer suppressive antiviral therapy for those with HSV-2 infection," she said. Valacyclovir, marketed as Valtrex by GlaxoSmithKline, has recently received approval from the U.S. Food and Drug Administration for use in preventing genital herpes in couples in which one partner has genital herpes.

The effectiveness of antivirals at reducing genital herpes transmission could also help to stem the AIDS epidemic, which affects 42 million people around the world. Scientists have become worried about the increasing genital herpes epidemic worldwide because recent studies indicate HSV-2 may help to spread HIV, which causes AIDS. Persons with genital herpes are two times more likely to acquire the HIV-1 virus. Dr. Connie Celum, UW professor of medicine, Wald and Corey have received funding from the Bill and Melinda Gates Foundation to evaluate whether acyclovir, the parent compound of valacyclovir, can reduce the transmission of HIV by suppressing the HSV-2 virus and reducing its effects on HIV-1 in genital fluids.

"If effective, therapy for HSV-2 could offer another way for decreasing the spread of HIV, which could be helpful until a vaccine for HIV is developed," Corey said. "Also, this approach highlights the importance of working toward developing a vaccine for HSV-2."