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Childhood exposure to lead can cause permanent brain damage, a new study has found.

“What we have found is that no region of the brain is spared from lead exposure. Distinct areas of the brain are affected differently,” study author Kim Cecil, an imaging scientist at Cincinnati Children’s Hospital Medical Center and a professor of radiology, pediatrics and neuroscience at the University of Cincinnati College of Medicine, said in a news release.

The study included 33 adults, mean age 21, who were enrolled as infants in the long-term Cincinnati Lead Study, which looked at prenatal and early childhood exposure in 376 infants from high-risk areas of Cincinnati between 1979 and 1987.

The study participants had blood lead levels ranging from 5 micrograms to 37 micrograms per deciliter, with a mean of 14. They had IQ deficiencies and histories of juvenile delinquency and criminal arrests.

Functional MRI was used to monitor the participants’ brains while they did two tasks that assess attention, decision making and impulse control. The scans showed that in order to complete a task that required inhibition, participants with elevated blood lead levels required activation from additional regions within the brain’s frontal and parietal lobes.

“This tells us that the area of the brain responsible for inhibition is damaged by lead exposure and that other regions of the brain must compensate in order for an individual to perform. However, the compensation is not sufficient,” Cecil said.

According to Cecil, the brain’s white matter, which organizes and matures at an early age, adapts to lead exposure. But the frontal lobe, which is the last to develop, suffers permanent damage from lead exposure as it matures.

“Many people think that once lead blood levels decrease, the effects should be reversible, but, in fact, lead exposure has harmful and lasting effects,” Cecil said.

The study was scheduled to be presented Tuesday at the Radiological Society of North America annual meeting, in Chicago.

Medical care for osteoarthritis patients in the United States costs $185.5 billion a year, according to a new study.

Of that amount, insurers pay $149.4 billion while patients pay $36.1 billion in out-of-pocket costs. Annual insurer costs are $4,833 per female patient and $4,036 per male patient. Women also have higher out-of-pocket expenses than men — $1,379 versus $694. The total cost for female patients is $118 billion, compared with $67.5 billion for male patients. All figures are in 2007 dollars.

“Understanding the economic costs of OA [osteoarthritis] is important for payers, providers, patients and other stakeholders. Our study clearly reflects the significant impact of OA on U.S. health-care spending,” study author John Rizzo, of Stony Brook University in New York, said in a news release.

For the study, which is published in the December issue of the journal Arthritis & Rheumatism, Rizzo and his colleagues analyzed 1996-2005 data from the Medical Expenditure Panel Survey. The data sample included 84,647 women and 70,590 men aged 18 and older who had health insurance. The health-care costs included physician, hospital and outpatient services, as well as drugs, diagnostic tests and related medical services.

People with osteoarthritis suffer gradual loss of cartilage, primarily in the knees, hips, hands, feet and spine. About 27 million Americans have osteoarthritis, which affects more women than men, according to the U.S. Centers for Disease Control and Prevention. By 2030, it is projected that 25 percent of the U.S. population (nearly 67 million people) will have physician-diagnosed arthritis.

The study authors said increased awareness and better screening to identify patients with osteoarthritis may help delay disease progression and resulting disability, thus reducing medical costs.

“Our results suggest that patients with OA may benefit from greater efforts to promote exercise, proper medication use and appropriate surgical treatments for the disease,” Rizzo concluded.

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.