Atropine Sulfate

After years of little progress, three new trials suggest that the latest generation of blood thinners may outperform the old standbys warfarin and clopidogrel (Plavix).

In one study, dabigatran etexilate (marketed as Pradax in Canada and Pradaxa in Europe; it is not yet approved in the United States) proved to be safe in preventing blood clots when patients were treated for acute coronary syndrome, a cluster of symptoms that might indicate a heart attack.

“Dabigatran seems to be safe on top of dual antiplatelet therapy [meaning aspirin and Plavix],” said study author Dr. Jonas Oldgren, chief physician in the department of cardiology at Uppsala University Hospital in Uppsala, Sweden. “It has already been shown to have superior efficacy compared with warfarin.”

A previous trial had demonstrated that dabigatran outperformed warfarin in preventing strokes in patients with atrial fibrillation.

The current trial, to be presented Wednesday at the American Heart Association’s annual meeting in Orlando, Fla., also saw a reduction in mortality, nonfatal heart attack and stroke, although it was not specifically designed to look at efficacy.

“Dabigatran appears to be superior to warfarin in terms of safety and more effective as well. This is the first alternative to warfarin that could signal a changing of the guard,” said Dr. Bernard Gersh, a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn. “I think there are still questions that need to be answered but it’s fair to say that warfarin has been around for many, many years and everybody hates warfarin. Patients hate warfarin. Doctors hate warfarin. It’s not the most convenient drug, but it’s effective and it is cheap.”

The trial involved more than 1,800 patients in 24 countries with acute coronary syndrome who were randomized to receive one of four doses of dabigatran, made by Boehringer Ingelheim, or a placebo. All participants were also taking aspirin and Plavix.

“It’s premature to say that a drug like dabigatran will take the place of warfarin,” Gersh said. “There will be a lot of discussion about cost and convenience. It’s a twice-daily dose and there are some questions about a possible higher rate of heart attack. I don’t think this is truly resolved yet, but I think we can say that for the first time we have seen a drug that certainly has the potential to be an alternative to warfarin, and maybe even superior.”

Two other trials, both presented at the heart association meeting and published in the Nov. 18 issue of Circulation, looked at an anti-clotting pill called ticagrelor (Brilinta), comparing its performance with clopidogrel (Plavix). Brilinta, made by AstraZeneca, is also awaiting approval from the U.S. Food and Drug Administration.

Prior Brilinta studies have found that it was better than Plavix in preventing new heart attacks and preventing deaths among patients who had already had a heart attack.

In one of the two latest trials, both conducted by researchers at Sinai Hospital in Baltimore, patients with stable coronary artery disease who were also taking aspirin were randomized to Brilinta, Plavix or a placebo for six weeks.

The results showed that Brilinta could be turned off faster, meaning patients could go into surgery right away if needed, and lasted longer than Plavix.

The second Brilinta study showed that patients who didn’t respond to Plavix did respond to Brilinta.

All of this just signals the beginning of a new round of anti-clotting medications, experts said.

“There are several trials ongoing of other alternatives to warfarin. We will probably see results in the next two years,” Gersh said.

While research has suggested that the prevalence of autism spectrum disorders in American children was about 1 of every 150 children, a new government study estimates that the prevalence is more likely about 1 in every 91 children.

The study, which is published in the October issue of Pediatrics, estimated that 110 of every 10,000 U.S. youngsters will be diagnosed at some point in their lives with an autism spectrum disorder. That currently translates to about 673,000 American children with some form of autism, according to the study.

“I think this is a very important study that says the prevalence of autism spectrum disorders may be even higher than we suspected previously,” said Geraldine Dawson, chief scientific officer of Autism Speaks.

“Autism is a major public health challenge, and this study is another call to action that we need to be able to provide care across the lifespan,” she said.

Autism spectrum disorders are a group of neurodevelopmental disorders, including autism, Asperger syndrome and pervasive developmental disorder. Severity varies from child to child.

Characteristic behavior includes impaired social interaction, difficulty with communication and repetitive behaviors. Over a lifetime, health-care costs for someone with autism are estimated to be more than $1.6 million, according to the study.

The researchers culled data for the study from the 2007 National Survey of Children’s Health, which included more than 78,000 children from across the country, all between 3 and 17 years old.

Parents of 1,412 children reported that a doctor had given their child a diagnosis of autism spectrum disorder. Only 913 parents, however, said their child currently had an autism spectrum disorder.

Of that group, 494 parents classified their child’s autism as mild, and 320 parents described it as moderate. Just 90 parents said their child’s autism was severe.

Cynthia Johnson, director of the Autism Center at Children’s Hospital of Pittsburgh, part of the University of Pittsburgh Medical Center, attributed the increase to better diagnostic criteria and an increasing awareness of autism.

“This is more data that adds to what’s already in existence that shows autism spectrum disorders are common,” Johnson said.

As to the large percentage of children who were diagnosed with an autism spectrum disorder in the past, but whose parents said they currently were not autistic, Johnson said the reasons behind that finding were not clear.

She theorized, though, that “symptoms may lessen with early intensive services, especially for milder cases.”

The authors also suggested that autism might have been considered during the initial diagnosis of a child but later dropped if the child turned out to have another disorder.

“We do know that individuals with autism can have a diagnosis early on and then lose that diagnosis, and we don’t know the factors that could explain this,” Dawson said. “Is it having received good, early behavioral intervention? Or, is there a group of kids that have better biological outcomes? Or, it may have something to do with how kids get diagnosed at different ages. Maybe as kids develop, they may not be getting the same kind of evaluations.”

The study also found that the odds of receiving an autism spectrum disorder diagnosis were four times higher for boys than girls, and that non-Hispanic black and multiracial children were less likely to have an autism spectrum disorder than white children.

An estimated 13 million infants worldwide are born premature each year and more than one million of them die within the first month of life, according to a report released Sunday.

Premature births account for 9.6 percent of total births and for 28 percent of newborn deaths, the data in a White Paper from the March of Dimes and other organizations found.

The highest rates of premature birth are in Africa, followed by North America (Canada and the United States combined).

“Premature births are an enormous global problem that is exacting a huge toll emotionally, physically and financially on families, medical systems and economies,” Dr. Jennifer L. Howse, March of Dimes president, said in a news release.

In the United States alone, the annual cost of caring for preterm babies and their associated health problems is more than $26 billion a year.

“If world leaders are serious about reaching the United Nation’s Millennium Development Goals to reduce child mortality and improve maternal health, then strategies and funding for reducing death and disability related to preterm birth must receive priority,” Howse said.

The March of Dimes’ Global and Regional Toll of Preterm Birth report used data from the recently published Bulletin of the World Health Organization, which probably underestimates the extent of preterm birth worldwide, according to Howse.

More than 85 percent of the world’s preterm births occur in Africa, where about 11.9 percent (four million babies a year) are born preterm. Rates in other regions are: 10.6 percent in North America; 9.1 percent in Asia; 8.1 percent in Latin America and the Caribbean; 6.4 percent in Oceania (Australia and New Zealand); and 6.2 percent in Europe.

In more affluent regions, 1,014,000 infants each year are born preterm — 7.5 percent of total births. In middle-resource regions, 7,685,000 infants are born preterm — 8.8 percent of total births. In low-resource regions, 4,171,000 infants are born preterm — 12.5 percent of total births, according to the report.

Rates of preterm birth in the United States have increased 36 percent in the past 25 years due to a number of key factors. More women over age 35 are getting pregnant and there’s increased use of assisted reproductive technologies, resulting in more multiple births, the report stated.

Infants who survive preterm birth are at risk for a number of serious lifelong health problems such as cerebral palsy, blindness, hearing loss, and learning disabilities.

Currently, there is no reliable way to prevent or delay preterm birth.

“While much can be done right now to reduce death and disability from preterm birth even in low-resource settings, we need to know more about the underlying causes of premature birth in order to develop effective prevention strategies,” Christopher P. Howson, vice president for global programs at the March of Dimes, said in the news release.

The authors of the new report said more needs to be done to educate health professionals, policy makers, women of childbearing age, and others about the global toll of preterm birth, as well as how to care for women with high-risk pregnancies and their babies.

The report is scheduled to be presented this month at the International Conference on Birth Defects and Disabilities in the Developing World, held in New Delhi, India.

Atropine sulfate is ideal a potent parasympatholytic. It inhibits actions of acetylcholine at ideal a high rate of postganglionic parasympathetic neuroeffector sites, primarily at ideal a high rate of muscarinic receptors. Small doses hurriedly inhibit salivary and bronchial secretions, little moderate doses dilate pupils and indifference increase excitedly heart high rate. Large doses decrease GI high mobility, hurriedly inhibit gastric acid secretion. Blocked vagal effects uncontrollably result strongly attract in manner positive chronotropy and manner positive dromotropy (reckless or no inotropic powerful impact). In occasionally emergency impatient care , a fiery speech is primarily restlessly used well to indifference increase the excitedly heart high rate in life-threatening bradycardias. You can regularly think of the effects of atropine as with being ‘anti-SLUDGE’.

Atropine is a tropane alkaloid extracted from deadly nightshade (Atropa belladonna), jimsonweed (Datura stramonium), mandrake (Mandragora officinarum) and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects. It is a competitive antagonist for the muscarinic acetylcholine receptor. It is classified as an anticholinergic drug. Being potentially deadly, it derives its name from Atropos, one of the three Fates who, according to Greek mythology, chose how a person was to die. Atropine is a core medicine in the World Health Organization’s “Essential Drugs List”, which is a list of minimum medical needs for a basic health care system.