ARAB TIMES, FRIDAY, JULY 23, 2010 HEALTH 31 Health Gluten allergy culprits identified Rehab-first promising for ACL tear, says study NEW YORK, July 22, (Agencies): Attention, weekend athletes: Don’t be too quick to agree to surgery for a common type of knee ligament tear. A study of Swedish amateur athletes — mostly soccer players — found that those who got an ACL reconstruction right away plus physical therapy fared no better than athletes who started out with rehab and got the surgery later if they still needed it. Of those in the rehab-first program, fewer than half went on to get the surgery within two years, researchers reported in Thursday’s issue of the New England Journal of Medicine. “It seems that if you start out with rehabilitation only ... you have a good chance of ending up with an equally good outcome as if you had early ACL surgery,” said Richard Frobell of Lund University Hospital in Sweden, an author of the Pregnant women work. “Maybe we will be surprised that a lot of people actually do not need an ACL reconstruction.” Frobell stressed that the study did not include professional athletes. They usually seek surgery to get back into action quickly rather than waiting to NEW YORK, July 22, (RTRS): see if rehabilitation works. Pregnant women need no About 200,000 Americans each year longer give up their morning cup have surgery to replace the anterior of coffee. cruciate ligament, or ACL, which is A research review by The crucial for knee stability. It can get torn American College of in sports like football and soccer that Obstetricians and require planting the foot and pivoting. Gynecologists had found that Doctors already knew that not every moderate caffeine consumption patient with a torn ACL needs surgery; probably won’t increase the risk of a miscarriage or premature a middle-aged jogger or cyclist can birth. often get by with a knee brace and Until recently, studies have rehabilitation, experts say. Frobell said had conflicting findings about his work suggests that the same stratethe effect of moderate caffeine gy might work for athletes who want to consumption on pregnancy return to more strenuous sports like complications but a College soccer, at least on lower competitive committee has reviewed the evilevels. dence. Some patients with a damaged ACL “I think it’s time to comfortably can cope well at a high level. But docsay that it’s OK to have a cup of tors can’t reliably predict which ACL coffee during pregnancy,” Dr patients will turn out to be “copers,” William Barth, the chair of the College committee, told Reuters and Frobell acknowledged his work Health. doesn’t help with that. The College’s Committee on Doctors and patients currently Obstetric Practice said that 200 decide on whether to do the surgery milligrams of caffeine a day — depending on individual factors like about the amount in a 12-ounce just what physical activities the patient cup of coffee — doesn’t signifiplans to pursue and the overall health cantly contribute to miscarof the knee, said Dr Bruce Levy, a riages or premature births. Mayo Clinic surgeon. That definition of “moderate The operation is an outpatient procecaffeine consumption” would dure that involves replacing the ACL also include drinking about four with tissue from the patient or a cadav8-ounce cups of tea or more er. Risks include infection and stiffness than five 12-ounce cans of soda a day, or eating six or seven that may require more surgery. The surdark chocolate bars. gery costs $10,000 or more, depending The committee said the evion whether cadaver tissue is needed. dence was not clear on whether The new study focused on 121 consuming more than 200 mg of Swedish amateur athletes, ages 18 to caffeine a day might increase 35, mostly soccer players with some pregnancy risks. volleyball players. They had new, comThe group considered two plete ACL ruptures. Half were randomrecent studies, each of which ly assigned to get surgery right away followed more than 1,000 pregplus physical therapy, and the other nant women. half to start with the rehab to improve One study, led by Dr David the knee. The rehabilitation required Savitz of The Mount Sinai about 60 sessions on average, two or Medical Center in New York, found no increased rate of misthree times a week, Frobell said. That carriage for women who conworks out to about five to seven sumed low, moderate, or high months. levels of caffeine at different Two years later, both groups reported points in their pregnancy. In the about the same amount of improveother, Dr De-Kun Li and his colment in ratings for things like pain, perleagues at Kaiser Permanente’s formance in sports and how much their Division of Research in Oakland knee interfered with their lives. And found a higher risk of miscarabout 40 percent of each group had riage in women who consumed returned to their previous level of more than 200 mg of caffeine sports intensity, as measured by that per day, but no extra risk at activity’s stress on the knee. lower levels. Among those treated with physical The committee also pointed to two other studies that found therapy first, those who eventually got that a mother’s moderate cafthe surgery turned out no better than feine intake did not make it any those who didn’t. more likely she would deliver a ❑ ❑ ❑ baby prematurely. Research has shown that cafGluten allergy: Researchers have feine is able to cross the placenidentified three fragments in gluten that ta, which led to worries that it appear to trigger a disorder in people could cause miscarriage or prewho are allergic to the wheat protein. mature birth. The findings, published on Thursday In the United States, about 16 in the journal Science Translational percent of all pregnancies end Medicine, may lead to a more targeted in miscarriage and about 12 cure instead of what sufferers practice percent of babies are born prenow — life-long abstinence from food maturely. containing gluten, such as cereal, pasta, Barth said previous studies cookies and beer. were mixed and unclear about “If you can (narrow down) the toxicthe link between caffeine and pregnancy risks. It was the new ity of an allergen to a few components, findings from large groups of that enables you to make a highly tarwomen that allowed the commitgeted therapy in a way that you no tee to feel confident that moderlonger need to target the whole immune ate caffeine intake was safe. system,” said researcher Robert Anderson of The Walter and Eliza Hall Institute of Medical Research in Without a bone marrow transplant, Victoria, Australia. For people with the allergy, gluten which works best with a matching causes an overreaction in the immune donor, such “bubble babies” have to system that damages the lining of the live in germ-free environments and small intestine, leaving it unable to usually die within a year. Doctors hope absorb vitamins, minerals and other gene therapy will work when no donor is available. nutrients from food. But its success has been limited by The sufferer is subject to chronic fatigue and risks osteoporosis, infertili- the threat of leukemia, and the new ty, miscarriage and even cancers of the study looks at the long-term impact of digestive tract — symptoms of what is a treatment that the researchers last used in 2002. called celiac disease. The team, led by Salima HaceinIn the study, 244 people with celiac disease in Australia and Britain ate Bey-Abina of the Paris Descartes food with gluten over three days and University, reported in the New researchers then analysed the immune England Journal of Medicine that the treatment provided a long-term cure for cells in their blood samples. SCID, in most cases. ❑ ❑ ❑ “All children except one, including ‘Bubble boy’ treatment: A 10-year the three survivors of T-cell acute study of nine boys born without the leukemia, could live normally in a nonability to ward off germs has found that protected environment and cope with gene therapy is an effective long-term microorganisms without harmful contreatment, but it carries a price: four of sequences while growing normally,” them developed leukemia. they concluded. The technique is designed to help The median age of the boys when boys with X-linked severe combined they got the gene therapy was seven immunodeficiency disease, or SCID, a months. The one death was from rare mutation that prevents the body leukemia. from making mature T cells or natural Leukemia is much easier to treat in killer cells, which are vital tools for young children than SCID. The success fighting infections. rate is usually 90 percent or more. ‘Okay to have a cup of coffee’ Maurice Leroux, a former employee of Ferodo-Valeo holds a piece of asbestos in this Oct 24, 2007 file photo, in Condé-sur-Noireau. Despite proven links to cancer, a ban in the European Union and four other countries, and reams of damning scientific tests, asbestos is still selling like hotcakes in the developing world, a report said July 21, 2010. (AFP) Asbestos trade thriving in developing world: report Despite proven links to cancer, a ban in the European Union and restrictions in the United States, industry lobbyists have ensured that asbestos is still selling like hotcakes in the developing world, a report said Wednesday. An investigation conducted by the International Consortium of Investigative Journalists and the BBC found that the asbestos industry has ignored waves of asbestos-related disease around the world that have led to bans or restrictions in 52 countries, and continues to ply the mineral in developing nations. More than half of the two million metric tonnes of asbestos that were mined worldwide in 2009 was exported to developing countries like India and Mexico, where demand is high for cheap building materials, the report said. Most of the asbestos sold in those countries is used in cement for corrugated roofing, in water pipes and for home construction. The asbestos industry’s growth has been fueled by “a marketing campaign involving a global network of industry groups led by the Canadian-governmentbacked Chrysotile Institute,” said David Kaplan, director of the ICIJ. Chrysotile is another name for white asbestos, the most common form of the mineral. The asbestos industry has spent “nearly 100 million dollars US in public and private monies since the mid-1980s to keep asbestos in commerce,” said Kaplan. (AFP) Enrolment of new patients not allowed US issues ‘hold’ on Avandia study In this file photo, a pharmacist holds a bottle of Avandia pills at Maximart Pharmacy in Palo Alto, Calif. Federal health officials say new patients should not be enrolled in a study of GlaxoSmithKline’s controversial diabetes pill Avandia, after experts last week said the drug increase heart risks. (AP) Health ‘Umbrella may offer less protection’: Hiding out under a beach umbrella may offer you far less protection from the sun’s harmful ultraviolet radiation than you expect, according to a new study by Spanish researchers. As much as 34 percent of ultraviolet radiation, found to cause skin cancer and cataracts, reaches the ground covered by a beach umbrella, the University of Valencia researchers found. This is because the umbrellas catch almost all of the direct rays but not the diffused radiation that penetrates through from the sides, according to the research published in the journal Photochemistry and Photobiology this week. To carry out the study, researchers placed an ultraviolet ray sensor on the base of a blue and white canvas umbrella with a radius of 80 centimetres (12 inches) and a height of 1.5 metres. “The umbrella intercepts the direct radiation that comes from the sun, but part of the diffused radiation, which makes up approximately 60 percent of the total, reaches the sensor from the sky not covered by the umbrella,” study coauthor Jose Antonio Martinez-Lozano said. (AFP) ❑ ❑ ❑ ‘Blue Cross reaps surpluses’: Blue Cross Blue Shield’s nonprofit health plans raised insurance premiums even as they set aside millions of dollars in surpluses over the past decade, according to a report published on Thursday. For example, Blue Cross Blue Shield of Arizona policyholders faced double-digit rate increases in recent years while the company’s surplus grew to seven times the regulatory minimum. The surpluses — mandated to ensure the payment of all medical claims — were built up partly to fund business expansion and new products, said the report from Consumers Union, the nonprofit watchdog and publisher of Consumer Reports. “These are nonprofit companies,” said Sondra Roberto, a report co-author. “The priorities should be to provide affordable health care coverage to the greatest extent possible. “And so if these other priorities such as product development or technology upgrades are competing with that function of providing affordable coverage, we want a light shined on that,” said Roberto. Blue Cross, a nonprofit association of independent, locally-run insurance companies, had more than $32 billion in surplus in its plans in 2008, according to the report. “To put these blunt caps, or bright line sort of rules on, that limits the flexibility of the company and really puts it at a greater risk of being unable to do the things it needs to do,” said Bob Kolodgy, the association’s chief financial officer. Blue Cross said the recent healthcare overhaul law will extend coverage to millions of new individuals with unpredictable results. “So when you look at requiring plans to lower those reserves at this time, we think it would be extremely dangerous given health reform’s going to require plans to have strong reserves going into this new era,” said Alissa Fox, a senior vice-president at Blue WASHINGTON, July 22, (AP): US government health officials are barring new patients from enrolling in a safety study of GlaxoSmithKline’s controversial diabetes pill Avandia, a week after a panel of experts ruled that the drug increases heart risks. The Food and Drug Administration said it issued a “partial clinical hold” on the study to update researchers on the latest concerns about Avandia, which has been under scrutiny since 2007. Last week a panel of experts voted that the drug appears to increase heart risks, but a majority ultimately voted to leave the drug on the market because the evidence was not definitive. The FDA is currently reviewing the panel’s opinions and deciding what action to take. GlaxoSmithKline said in a statement it would halt recruitment for the so-called TIDE trial and update the study’s chief investigators on last week’s meeting. Patients already in the study will be permitted to continue participating. The London-based drugmaker agreed to conduct the trial in 2007, after safety questions about Avandia were first publicized. The TIDE study is designed to give a definitive assessment of whether Avandia’s heart risks are greater than its chief competitor Actos. Last week, the FDA’s panel of outside advisers voted 20-10 that the trial should continue if Avandia stays on the market. However, Avandia’s critics have argued that the trial is unethical since current evidence already shows Avandia is riskier than Actos, which is made by Japan-based Takeda Pharmaceuticals. “It’s the ethically correct thing to do,” said Dr Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. “It was the only decision the FDA could have made.” Attention Nissen first drew attention to Avandia’s risks in a 2007 medical journal article estimating the drug increases heart attack risk by 43 percent. He noted that the FDA’s advisory panel specifically voted last week that Avandia increased risk of heart attacks more than Actos. “I still think there’s a very good chance that the FDA will decide to remove Avandia from the market,” Nissen said. The TIDE study is supposed to enroll 16,000 patients, though safety concerns surrounding Avandia have slowed recruitment. Glaxo reported last week that just 1,100 patients have volunteered for the study. The FDA said TIDE’s researchers should update the informed consent forms used to describe the risks of the study to potential recruits. But Yale University cardiologist Dr Cross. (RTRS) ❑ ❑ No extra heart benefit seen HDL may mean little for statin users CHICAGO, July 22, (RTRS): People with high levels of the so-called good cholesterol HDL tend to have fewer heart attacks but HDL may offer little protective benefit in people who take statins to lower harmful LDL cholesterol, US researchers said on Wednesday. An analysis of a large study of healthy people who took AstraZeneca’s statin drug Crestor to prevent heart attacks found having high HDL was not a good predictor of heart attack risk. “HDL is a very powerful predictor of future risk” of heart disease, said Paul Ridker of Brigham and Women’s Hospital in Boston, whose study appears in the journal Lancet. But “once we get LDL into these very low ranges with very potent statins, HDL no longer predicts future risk of heart disease,” he said in a telephone interview. The findings raise questions about drugs in development to raise HDL to prevent heart attacks, he said. Several companies are working on HDL-raising drugs, which would likely be combined with statins in hopes of developing even more potent weapons against heart disease. Tiny Canadian biotech ResVerlogix has an experimental drug in clinical trials that increases production ApoA-1 in the blood, which then raises HDL — a compound that helps ferry harmful fats out of the blood. Raising HDL through increased ApoA-1 is a different approach from other HDL boosters, such as a class known as CETP inhibitors that included torcetrapib, Pfizer’s most spectacular clinical failure. Merck & Co and Roche are still developing CETP inhibitors. Current drugs that raise natural levels of HDL, such as niacin, cause unpleasant side effects such as flushing. No Difference In the original study, called JUPITER, patients with average to low levels of lowdensity lipoprotein or LDL were given Crestor or rosuvastatin, which cut their bad cholesterol concentrations to levels seen in Aboriginal populations but rarely seen in Western patients. People in the study who took Crestor had 54 percent fewer heart attacks and 48 percent fewer strokes after two years compared with people who took a placebo. In the new analysis, Ridker and colleagues looked to see if HDL was still a predictor of heart attack risk in people who took Crestor. They found that HDL was still protective in people who got the placebo, but in those whose cholesterol was lowered by the statin, having high HDL made no difference in predicting which patients would have heart problems. The findings suggest higher HDL concentrations may not be a good measure of heart risk in people who lower their bad cholesterol levels with statins, Dr Derek Hausenloy of The Hatter Cardiovascular Institute at University College London said in a commentary. “Whether increasing HDL cholesterol in patients with very low LDL cholesterol has any beneficial effects on cardiovascular risk remains to be shown directly in large randomized trials,” he said. Ridker agrees. “In my heart of hearts, I believe the only way to address whether or not new agents that increase HDL will be effective is through well-done carefully taken out clinical trials. There is no other way to get there,” he said. Harlan Krumholz questioned how doctors could get patients to give truly informed consent to participate in a study “where the best-case scenario is that they are not harmed by the drug.” “I just wonder if patients in this trial really understand that the entire point is to determine if those randomized to the arm with Avandia are at higher risk,” said Krumholz, who is also a professor at Yale. Public Citizen’s Dr Sidney Wolfe said the FDA’s move is an “important halfstep,” but said it would not help patients who are already enrolled in TIDE. “It doesn’t really speak to the health risks of the people staying in the trial,” said Wolfe, who has petitioned the FDA to withdraw Avandia. “My guess is most, if not all the people in that study would drop out if they were given information about how much more dangerous Avandia is compared with Actos.” The FDA first approved Avandia in 1999 and it quickly became the top-selling diabetes pill in the world. However, US sales have plummeted from $2.2 billion in 2006 to $520 million last year as safety concerns swirled around the drug. The drug works by increasing the body’s sensitivity to insulin, a key protein needed for digestion that diabetics don’t adequately produce. The FDA added a black box warning to the drug in 2007. New studies on the drug’s safety combined with pressure from safety advocates has prompted the agency to take another look at the drug. The FDA is expected to make a decision on whether to keep the drug on the market in coming months. ❑ Woman gets madcow disease: A 42year-old Italian woman was reported as the second ever case of madcow disease in humans in the country and is currently hospitalised in desperate conditions, the ANSA news agency said Wednesday. The woman was diagnosed with a variant of the Creutzfeldt-Jakob disease (CJD) at a Milan neurological hospital in the past months and Kolodgy Fox was then transferred to a hospital in Livorno, in western Tuscany, when she was already in a coma, ANSA said. It is still unclear how the woman contracted the disease. In 2009, Italy’s health ministry had reported the woman’s disease as a “likely variant of the CJD”. The only previous case of madcow disease in humans in Italy was reported in 2002 on the island of Sicily. (AFP)