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Fetal alcohol spectrum disorder diagnosis often missed in foster children, youth
More than 86% of foster and adopted youth with fetal alcohol spectrum disorder were either not diagnosed or had been misdiagnosed, as the disorder is often mistaken for behavioral issues such as attention-deficit/hyperactivity disorder, a study showed.
According to Dr. Ira J. Chasnoff and his associates, 125 of 156 (80.1%) children and adolescents who met the criteria for a diagnosis within the fetal alcohol spectrum had never been diagnosed as affected by prenatal alcohol exposure. And of the 31 children who had been recognized before referral as affected by prenatal alcohol exposure, 10 had their fetal alcohol spectrum disorder (FASD) diagnoses changed within the spectrum, representing a misdiagnosis rate of 6.4% (Pediatrics 2014 [doi:10.1542/peds.2014-2171]).
Dr. Chasnoff and his colleagues at Children’s Research Triangle (CRT), Chicago, collected data from a sample of 547 children aged 4-18 years who were referred to a Chicago children’s mental health center for behavioral issues. All of the children in the sample were in foster or adoptive homes at the time of referral and evaluation, and the most common reason for referral of the 547 children to the CRT clinic was “behavioral problems.”
Neurodevelopmental deficits among children who have confirmed prenatal exposure to alcohol but who do not meet diagnostic criteria for FASD (growth retardation, central nervous system impairment, and facial dysmorphology) are common. The most common mental health diagnoses for the children at the time of referral were attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder, and conduct disorder.
The researchers cautioned that FASD can have far-reaching consequences for development and that properly diagnosing the disorder should happen as early as possible. Looking beyond the physical criteria (facial dysmorphology) and adhering to modern diagnostic criteria should help more doctors recognize the disorder, as well as increase public awareness of the signs and symptoms of FASD.
“The role of the pediatrician and other children’s health care providers is clear: early recognition of the child or adolescent with FASD, referral to a provider who can 1conduct a full evaluation, and participation in the development of a targeted treatment plan that incorporates mental health treatment, behavioral management strategies, and special education services,” the investigators wrote. “Learning disorders, communication disorders, and intellectual disability, objective signs of significant neurocognitive damage, had not been recognized in a large majority of the children with these disabilities.”
The study was supported in part by a grant from the Administration for Children and Families, Department of Health & Human Services. The investigators had no relevant financial disclosures.
More than 86% of foster and adopted youth with fetal alcohol spectrum disorder were either not diagnosed or had been misdiagnosed, as the disorder is often mistaken for behavioral issues such as attention-deficit/hyperactivity disorder, a study showed.
According to Dr. Ira J. Chasnoff and his associates, 125 of 156 (80.1%) children and adolescents who met the criteria for a diagnosis within the fetal alcohol spectrum had never been diagnosed as affected by prenatal alcohol exposure. And of the 31 children who had been recognized before referral as affected by prenatal alcohol exposure, 10 had their fetal alcohol spectrum disorder (FASD) diagnoses changed within the spectrum, representing a misdiagnosis rate of 6.4% (Pediatrics 2014 [doi:10.1542/peds.2014-2171]).
Dr. Chasnoff and his colleagues at Children’s Research Triangle (CRT), Chicago, collected data from a sample of 547 children aged 4-18 years who were referred to a Chicago children’s mental health center for behavioral issues. All of the children in the sample were in foster or adoptive homes at the time of referral and evaluation, and the most common reason for referral of the 547 children to the CRT clinic was “behavioral problems.”
Neurodevelopmental deficits among children who have confirmed prenatal exposure to alcohol but who do not meet diagnostic criteria for FASD (growth retardation, central nervous system impairment, and facial dysmorphology) are common. The most common mental health diagnoses for the children at the time of referral were attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder, and conduct disorder.
The researchers cautioned that FASD can have far-reaching consequences for development and that properly diagnosing the disorder should happen as early as possible. Looking beyond the physical criteria (facial dysmorphology) and adhering to modern diagnostic criteria should help more doctors recognize the disorder, as well as increase public awareness of the signs and symptoms of FASD.
“The role of the pediatrician and other children’s health care providers is clear: early recognition of the child or adolescent with FASD, referral to a provider who can 1conduct a full evaluation, and participation in the development of a targeted treatment plan that incorporates mental health treatment, behavioral management strategies, and special education services,” the investigators wrote. “Learning disorders, communication disorders, and intellectual disability, objective signs of significant neurocognitive damage, had not been recognized in a large majority of the children with these disabilities.”
The study was supported in part by a grant from the Administration for Children and Families, Department of Health & Human Services. The investigators had no relevant financial disclosures.
More than 86% of foster and adopted youth with fetal alcohol spectrum disorder were either not diagnosed or had been misdiagnosed, as the disorder is often mistaken for behavioral issues such as attention-deficit/hyperactivity disorder, a study showed.
According to Dr. Ira J. Chasnoff and his associates, 125 of 156 (80.1%) children and adolescents who met the criteria for a diagnosis within the fetal alcohol spectrum had never been diagnosed as affected by prenatal alcohol exposure. And of the 31 children who had been recognized before referral as affected by prenatal alcohol exposure, 10 had their fetal alcohol spectrum disorder (FASD) diagnoses changed within the spectrum, representing a misdiagnosis rate of 6.4% (Pediatrics 2014 [doi:10.1542/peds.2014-2171]).
Dr. Chasnoff and his colleagues at Children’s Research Triangle (CRT), Chicago, collected data from a sample of 547 children aged 4-18 years who were referred to a Chicago children’s mental health center for behavioral issues. All of the children in the sample were in foster or adoptive homes at the time of referral and evaluation, and the most common reason for referral of the 547 children to the CRT clinic was “behavioral problems.”
Neurodevelopmental deficits among children who have confirmed prenatal exposure to alcohol but who do not meet diagnostic criteria for FASD (growth retardation, central nervous system impairment, and facial dysmorphology) are common. The most common mental health diagnoses for the children at the time of referral were attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder, and conduct disorder.
The researchers cautioned that FASD can have far-reaching consequences for development and that properly diagnosing the disorder should happen as early as possible. Looking beyond the physical criteria (facial dysmorphology) and adhering to modern diagnostic criteria should help more doctors recognize the disorder, as well as increase public awareness of the signs and symptoms of FASD.
“The role of the pediatrician and other children’s health care providers is clear: early recognition of the child or adolescent with FASD, referral to a provider who can 1conduct a full evaluation, and participation in the development of a targeted treatment plan that incorporates mental health treatment, behavioral management strategies, and special education services,” the investigators wrote. “Learning disorders, communication disorders, and intellectual disability, objective signs of significant neurocognitive damage, had not been recognized in a large majority of the children with these disabilities.”
The study was supported in part by a grant from the Administration for Children and Families, Department of Health & Human Services. The investigators had no relevant financial disclosures.
FROM PEDIATRICS
Key clinical point: Children’s health care providers should screen children and youth in their practices for FASD more often.
Major finding: More than 80% of children sampled with fetal alcohol spectrum disorder had never been diagnosed.
Data source: A sample of 547 foster and adopted children 4-18 years of age.
Disclosures:The study was supported in part by a grant from the Administration for Children and Families, Department of Health & Human Services. The investigators had no relevant financial disclosures.
Aetna customers to receive discount on Gilead’s hepatitis C treatment
Gilead Sciences Inc. and Aetna Inc. have announced a partnership wherein the drug company will offer Aetna’s approximately 20 million health plan members a discounted rate on its hepatitis C drugs, Sovaldi (sofosbuvir) and Harvoni (ledipasvir and sofosbuvir).
The amount of the discount has not yet been announced, although it should be significantly less than the current rate: Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks.
For more information, go to www.reuters.com.
Gilead Sciences Inc. and Aetna Inc. have announced a partnership wherein the drug company will offer Aetna’s approximately 20 million health plan members a discounted rate on its hepatitis C drugs, Sovaldi (sofosbuvir) and Harvoni (ledipasvir and sofosbuvir).
The amount of the discount has not yet been announced, although it should be significantly less than the current rate: Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks.
For more information, go to www.reuters.com.
Gilead Sciences Inc. and Aetna Inc. have announced a partnership wherein the drug company will offer Aetna’s approximately 20 million health plan members a discounted rate on its hepatitis C drugs, Sovaldi (sofosbuvir) and Harvoni (ledipasvir and sofosbuvir).
The amount of the discount has not yet been announced, although it should be significantly less than the current rate: Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks.
For more information, go to www.reuters.com.
Gilead’s hepatitis C drugs to be sold exclusively at CVS
Gilead Sciences Inc. scored an exclusive deal with CVS Health Corp., as its two hepatitis C medicines, Harvoni and Sovaldi, will be available only for CVS customers.
Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks. The drugs will be available in health exchange marketplaces, Medicare Part D, and Medicaid formularies.
Viekira Pak – AbbVie Inc.’s rival combo drug to Harvoni and Sovaldi – will be excluded from CVS’s drug formulary of approved medications, except in cases when it is medically necessary. Viekira Pak received Food and Drug Administration approval in December of 2014.
For more information, go to www.bloomberg.com.
Gilead Sciences Inc. scored an exclusive deal with CVS Health Corp., as its two hepatitis C medicines, Harvoni and Sovaldi, will be available only for CVS customers.
Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks. The drugs will be available in health exchange marketplaces, Medicare Part D, and Medicaid formularies.
Viekira Pak – AbbVie Inc.’s rival combo drug to Harvoni and Sovaldi – will be excluded from CVS’s drug formulary of approved medications, except in cases when it is medically necessary. Viekira Pak received Food and Drug Administration approval in December of 2014.
For more information, go to www.bloomberg.com.
Gilead Sciences Inc. scored an exclusive deal with CVS Health Corp., as its two hepatitis C medicines, Harvoni and Sovaldi, will be available only for CVS customers.
Sovaldi costs $84,000 for a 12-week course of treatment, and Harvoni costs $94,500 for 12 weeks. The drugs will be available in health exchange marketplaces, Medicare Part D, and Medicaid formularies.
Viekira Pak – AbbVie Inc.’s rival combo drug to Harvoni and Sovaldi – will be excluded from CVS’s drug formulary of approved medications, except in cases when it is medically necessary. Viekira Pak received Food and Drug Administration approval in December of 2014.
For more information, go to www.bloomberg.com.
ADT plus RT more effective in reducing prostate cancer mortality than ADT alone in geriatric men
Among older men with high-risk prostate cancer, receiving androgen-deprivation therapy in combination with radiotherapy reduced cause-specific and all-cause mortality by as much as 50% when compared with those who received androgen-deprivation therapy alone, results from a large-scale data review showed.
In fact, men over the age of 65 with locally advanced prostate cancer risk significantly higher mortality rates if they are treated with androgen-deprivation therapy (ADT) without accompanying radiotherapy (RT), according to the authors of a study published online Jan. 5 in the Journal of Clinical Oncology.
“Our findings raise a provocative hypothesis that in the United States, men age 75 years (or older) with locally advanced prostate cancer or men age 65 years (or older) with high-risk screen-detected prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival,” wrote Dr. Justin E. Bekelman and his associates (J. Clin. Oncol. 2015 Jan. 5 [doi:10.1200/JCO.2014.57.2743]).
The large-scale data review, led by Dr. Bekelman of the University of Pennsylvania, Philadelphia, examined 31,451 men who developed prostate cancer between the ages of 65 and 85 whose medical records were included in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men were diagnosed between 1995 and 2007 and observed through 2009.
The patients examined in the study were divided into three cohorts, including a primary cohort (which included men aged 65 to 75 years and was consistent with participants in randomized, controlled trials); an elderly cohort (which included men from 75 to 85 years old with locally advanced prostate cancer); and a screen-detected cohort (which included men over 65 years old with screen-detected high-risk prostate cancer).
Among men aged 76-85, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 5.0% of patients, compared with ADT alone at 7 years follow-up. Among men aged 65-75, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% compared with ADT alone at 7 years follow-up.
Though a number of studies have examined the effects of combination therapy for prostate cancer, the authors noted that geriatric patients are underrepresented in efficacy trials for prostate cancer therapy. In addition, androgen-deprivation therapy by itself is particularly common among patients older than 75, with 40% of patients in that age group receiving ADT without accompanying RT.
“The lack of evidence to guide prostate cancer treatment decisions among older men and those with screen-detected high-risk tumors stands as a special priority among the many evidence gaps in the treatment of prostate cancer,” the authors wrote.
In addition to confirming findings from the randomized, controlled trials, the study by Bekelman et al. has important implications, given that it highlights the prevalent age bias against the use of radiotherapy in elderly men with high-risk prostate cancer. Much of the public discourse relating to prostate cancer emphasizes the overtreatment of low-risk prostate cancer in men who are least likely to die as a result of prostate cancer. Nevertheless, given the weight of evidence favoring the addition of RT to androgen-deprivation therapy for high-risk disease, one must question why, in the population analyzed by Dr. Bekelman and his associates, 49% of men older than age 65 years with locally advanced or high-risk prostate cancer were treated with ADT monotherapy, a rate that increased to 61% in those aged 75 years or older.
In elderly men who are sufficiently healthy to tolerate ADT, careful consideration should be given to also treating with RT, which is associated with substantial improvements in disease-specific and overall survival and can be delivered with minimal morbidity using modern treatment techniques.
Dr. Dean A. Shumway and Dr. Daniel A. Hamstra are radiologists with the University of Michigan, Ann Arbor. These remarks were part of an editorial accompanying the report (J. Clin. Onc. 2015 Jan 5. [doi:10.1200/JCO.2014.59.4093]). Dr. Shumway had no disclosures to report. Dr. Hamstra received research funding from Novartis and has advisory roles with Myriad Genetics and Teva.
In addition to confirming findings from the randomized, controlled trials, the study by Bekelman et al. has important implications, given that it highlights the prevalent age bias against the use of radiotherapy in elderly men with high-risk prostate cancer. Much of the public discourse relating to prostate cancer emphasizes the overtreatment of low-risk prostate cancer in men who are least likely to die as a result of prostate cancer. Nevertheless, given the weight of evidence favoring the addition of RT to androgen-deprivation therapy for high-risk disease, one must question why, in the population analyzed by Dr. Bekelman and his associates, 49% of men older than age 65 years with locally advanced or high-risk prostate cancer were treated with ADT monotherapy, a rate that increased to 61% in those aged 75 years or older.
In elderly men who are sufficiently healthy to tolerate ADT, careful consideration should be given to also treating with RT, which is associated with substantial improvements in disease-specific and overall survival and can be delivered with minimal morbidity using modern treatment techniques.
Dr. Dean A. Shumway and Dr. Daniel A. Hamstra are radiologists with the University of Michigan, Ann Arbor. These remarks were part of an editorial accompanying the report (J. Clin. Onc. 2015 Jan 5. [doi:10.1200/JCO.2014.59.4093]). Dr. Shumway had no disclosures to report. Dr. Hamstra received research funding from Novartis and has advisory roles with Myriad Genetics and Teva.
In addition to confirming findings from the randomized, controlled trials, the study by Bekelman et al. has important implications, given that it highlights the prevalent age bias against the use of radiotherapy in elderly men with high-risk prostate cancer. Much of the public discourse relating to prostate cancer emphasizes the overtreatment of low-risk prostate cancer in men who are least likely to die as a result of prostate cancer. Nevertheless, given the weight of evidence favoring the addition of RT to androgen-deprivation therapy for high-risk disease, one must question why, in the population analyzed by Dr. Bekelman and his associates, 49% of men older than age 65 years with locally advanced or high-risk prostate cancer were treated with ADT monotherapy, a rate that increased to 61% in those aged 75 years or older.
In elderly men who are sufficiently healthy to tolerate ADT, careful consideration should be given to also treating with RT, which is associated with substantial improvements in disease-specific and overall survival and can be delivered with minimal morbidity using modern treatment techniques.
Dr. Dean A. Shumway and Dr. Daniel A. Hamstra are radiologists with the University of Michigan, Ann Arbor. These remarks were part of an editorial accompanying the report (J. Clin. Onc. 2015 Jan 5. [doi:10.1200/JCO.2014.59.4093]). Dr. Shumway had no disclosures to report. Dr. Hamstra received research funding from Novartis and has advisory roles with Myriad Genetics and Teva.
Among older men with high-risk prostate cancer, receiving androgen-deprivation therapy in combination with radiotherapy reduced cause-specific and all-cause mortality by as much as 50% when compared with those who received androgen-deprivation therapy alone, results from a large-scale data review showed.
In fact, men over the age of 65 with locally advanced prostate cancer risk significantly higher mortality rates if they are treated with androgen-deprivation therapy (ADT) without accompanying radiotherapy (RT), according to the authors of a study published online Jan. 5 in the Journal of Clinical Oncology.
“Our findings raise a provocative hypothesis that in the United States, men age 75 years (or older) with locally advanced prostate cancer or men age 65 years (or older) with high-risk screen-detected prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival,” wrote Dr. Justin E. Bekelman and his associates (J. Clin. Oncol. 2015 Jan. 5 [doi:10.1200/JCO.2014.57.2743]).
The large-scale data review, led by Dr. Bekelman of the University of Pennsylvania, Philadelphia, examined 31,451 men who developed prostate cancer between the ages of 65 and 85 whose medical records were included in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men were diagnosed between 1995 and 2007 and observed through 2009.
The patients examined in the study were divided into three cohorts, including a primary cohort (which included men aged 65 to 75 years and was consistent with participants in randomized, controlled trials); an elderly cohort (which included men from 75 to 85 years old with locally advanced prostate cancer); and a screen-detected cohort (which included men over 65 years old with screen-detected high-risk prostate cancer).
Among men aged 76-85, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 5.0% of patients, compared with ADT alone at 7 years follow-up. Among men aged 65-75, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% compared with ADT alone at 7 years follow-up.
Though a number of studies have examined the effects of combination therapy for prostate cancer, the authors noted that geriatric patients are underrepresented in efficacy trials for prostate cancer therapy. In addition, androgen-deprivation therapy by itself is particularly common among patients older than 75, with 40% of patients in that age group receiving ADT without accompanying RT.
“The lack of evidence to guide prostate cancer treatment decisions among older men and those with screen-detected high-risk tumors stands as a special priority among the many evidence gaps in the treatment of prostate cancer,” the authors wrote.
Among older men with high-risk prostate cancer, receiving androgen-deprivation therapy in combination with radiotherapy reduced cause-specific and all-cause mortality by as much as 50% when compared with those who received androgen-deprivation therapy alone, results from a large-scale data review showed.
In fact, men over the age of 65 with locally advanced prostate cancer risk significantly higher mortality rates if they are treated with androgen-deprivation therapy (ADT) without accompanying radiotherapy (RT), according to the authors of a study published online Jan. 5 in the Journal of Clinical Oncology.
“Our findings raise a provocative hypothesis that in the United States, men age 75 years (or older) with locally advanced prostate cancer or men age 65 years (or older) with high-risk screen-detected prostate cancer who receive ADT alone risk decrements in cause-specific and overall survival,” wrote Dr. Justin E. Bekelman and his associates (J. Clin. Oncol. 2015 Jan. 5 [doi:10.1200/JCO.2014.57.2743]).
The large-scale data review, led by Dr. Bekelman of the University of Pennsylvania, Philadelphia, examined 31,451 men who developed prostate cancer between the ages of 65 and 85 whose medical records were included in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. The men were diagnosed between 1995 and 2007 and observed through 2009.
The patients examined in the study were divided into three cohorts, including a primary cohort (which included men aged 65 to 75 years and was consistent with participants in randomized, controlled trials); an elderly cohort (which included men from 75 to 85 years old with locally advanced prostate cancer); and a screen-detected cohort (which included men over 65 years old with screen-detected high-risk prostate cancer).
Among men aged 76-85, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 5.0% of patients, compared with ADT alone at 7 years follow-up. Among men aged 65-75, ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% compared with ADT alone at 7 years follow-up.
Though a number of studies have examined the effects of combination therapy for prostate cancer, the authors noted that geriatric patients are underrepresented in efficacy trials for prostate cancer therapy. In addition, androgen-deprivation therapy by itself is particularly common among patients older than 75, with 40% of patients in that age group receiving ADT without accompanying RT.
“The lack of evidence to guide prostate cancer treatment decisions among older men and those with screen-detected high-risk tumors stands as a special priority among the many evidence gaps in the treatment of prostate cancer,” the authors wrote.
FROM THE JOURNAL OF CLINICAL ONCOLOGY
Key clinical point: Androgen-deprivation therapy in combination with radiotherapy is superior to androgen-deprivation therapy alone in geriatric cancer patients.
Major finding: ADT plus RT reduced cause-specific and all-cause mortality from 9.8% to 4.4% among men aged 65-75, compared with ADT alone at 7 years follow-up.
Data source: A large-scale data review of 31, 541 prostate cancer patients ranging in age from 65 years to 85 years using the SEER Medicare database.
Disclosures: Dr. Bekelman had no disclosures to report.
Topical androgen use by sexual partner linked to high testosterone in prostate cancer patient
Patients with prostate cancer who have elevated levels of testosterone should be investigated for use of topical androgens taken either by themselves or by their sexual partners, investigators suggested in reporting an unusual case history.
They found increasing levels of testosterone above the normal range, consistent with exogenous receipt of androgens, in a 68-year-old patient with prostate cancer who denied the use of androgens. Prostate-specific antigen at baseline was 4.8 ng/mL. After treatment with radical prostatectomy, the PSA never became undetectable, but it declined to a nadir of 0.05, reported Dr. Mhd Yaser Al-Marrawi and his colleagues. The results were published online in the Journal of Clinical Oncology (J. Clin. Oncol. 2015 Jan 5. [doi: 10.1200/JCO.2014.59.7773]).
A year later, PSA increased to 0.18 and the patient underwent salvage external beam radiotherapy. However, his PSA continued to increase, and 2 months later it was 0.53, consistent with failure of local therapy, noted Dr. Al-Marrawi of Penn State University and the Hershey Cancer Institute in Hershey, Pa., and associates.
They eventually discovered that the persistently high testosterone levels were caused by the spouse’s use of topical testosterone cream vaginally as a lubricant before intercourse, to relieve dryness, unbeknownst to the patient.
“Topically applied testosterone gels are absorbed rather slowly, and they presumably form a reservoir in the stratum corneum of the skin. This reservoir of testosterone is then leached into the capillary circulation. Theoretically, more testosterone absorption will occur in the presence of a profuse vasculature. This situation is present in both male and female genitals during sexual intercourse,” the authors speculated.
The patient’s PSA continued to rise after his wife ceased using the testosterone cream, and he ultimately began androgen-deprivation therapy.
Patients with prostate cancer who have elevated levels of testosterone should be investigated for use of topical androgens taken either by themselves or by their sexual partners, investigators suggested in reporting an unusual case history.
They found increasing levels of testosterone above the normal range, consistent with exogenous receipt of androgens, in a 68-year-old patient with prostate cancer who denied the use of androgens. Prostate-specific antigen at baseline was 4.8 ng/mL. After treatment with radical prostatectomy, the PSA never became undetectable, but it declined to a nadir of 0.05, reported Dr. Mhd Yaser Al-Marrawi and his colleagues. The results were published online in the Journal of Clinical Oncology (J. Clin. Oncol. 2015 Jan 5. [doi: 10.1200/JCO.2014.59.7773]).
A year later, PSA increased to 0.18 and the patient underwent salvage external beam radiotherapy. However, his PSA continued to increase, and 2 months later it was 0.53, consistent with failure of local therapy, noted Dr. Al-Marrawi of Penn State University and the Hershey Cancer Institute in Hershey, Pa., and associates.
They eventually discovered that the persistently high testosterone levels were caused by the spouse’s use of topical testosterone cream vaginally as a lubricant before intercourse, to relieve dryness, unbeknownst to the patient.
“Topically applied testosterone gels are absorbed rather slowly, and they presumably form a reservoir in the stratum corneum of the skin. This reservoir of testosterone is then leached into the capillary circulation. Theoretically, more testosterone absorption will occur in the presence of a profuse vasculature. This situation is present in both male and female genitals during sexual intercourse,” the authors speculated.
The patient’s PSA continued to rise after his wife ceased using the testosterone cream, and he ultimately began androgen-deprivation therapy.
Patients with prostate cancer who have elevated levels of testosterone should be investigated for use of topical androgens taken either by themselves or by their sexual partners, investigators suggested in reporting an unusual case history.
They found increasing levels of testosterone above the normal range, consistent with exogenous receipt of androgens, in a 68-year-old patient with prostate cancer who denied the use of androgens. Prostate-specific antigen at baseline was 4.8 ng/mL. After treatment with radical prostatectomy, the PSA never became undetectable, but it declined to a nadir of 0.05, reported Dr. Mhd Yaser Al-Marrawi and his colleagues. The results were published online in the Journal of Clinical Oncology (J. Clin. Oncol. 2015 Jan 5. [doi: 10.1200/JCO.2014.59.7773]).
A year later, PSA increased to 0.18 and the patient underwent salvage external beam radiotherapy. However, his PSA continued to increase, and 2 months later it was 0.53, consistent with failure of local therapy, noted Dr. Al-Marrawi of Penn State University and the Hershey Cancer Institute in Hershey, Pa., and associates.
They eventually discovered that the persistently high testosterone levels were caused by the spouse’s use of topical testosterone cream vaginally as a lubricant before intercourse, to relieve dryness, unbeknownst to the patient.
“Topically applied testosterone gels are absorbed rather slowly, and they presumably form a reservoir in the stratum corneum of the skin. This reservoir of testosterone is then leached into the capillary circulation. Theoretically, more testosterone absorption will occur in the presence of a profuse vasculature. This situation is present in both male and female genitals during sexual intercourse,” the authors speculated.
The patient’s PSA continued to rise after his wife ceased using the testosterone cream, and he ultimately began androgen-deprivation therapy.
FROM THE JOURNAL OF CLINICAL ONCOLOGY
The Healthy Obese Don’t Stay Healthy for Long, Study Suggests
The phenomenon of “healthy obesity”– having a body mass index over 30 kg/m2 but without significant metabolic risk factors – is most often a transitive phase toward unhealthiness, and not a stable physiological stage, a new report suggests.
“Healthy obese” adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than were healthy nonobese adults. After 20 years, roughly 50% of healthy obese adults were unhealthy obese, and 10% were healthy nonobese, lead author Joshua A. Bell wrote in a research letter published Jan. 5 in the Journal of the American College of Cardiology (doi: /10.1016/j.jacc.2014.09.077).
Mr. Bell and his colleagues from the department of epidemiology and public health at University College London examined data from 2,521 British government workers between the ages of 39 and 62 years. Each participant’s body mass index, cholesterol, blood pressure, fasting plasma glucose and insulin resistance was measured over 5 years, 10 years, and 20 years. Three-quarters of the participants were male.
The sample included 66 “healthy obese” adults at baseline, or about a third of all obese participants. Of these subjects, 21 (32%) were unhealthy obese after 5 years, and 27 (41%), 23 (35%), and 34 (52%) were unhealthy obese after 10, 15, and 20 years, respectively.
“Our results, which were obtained with a longer, more detailed follow-up than any previous study, suggest that long-term stability is the exception, not the norm. The natural course of healthy obesity is progression to metabolic deterioration,” the authors wrote.
There were no relevant disclosures to report.
The phenomenon of “healthy obesity”– having a body mass index over 30 kg/m2 but without significant metabolic risk factors – is most often a transitive phase toward unhealthiness, and not a stable physiological stage, a new report suggests.
“Healthy obese” adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than were healthy nonobese adults. After 20 years, roughly 50% of healthy obese adults were unhealthy obese, and 10% were healthy nonobese, lead author Joshua A. Bell wrote in a research letter published Jan. 5 in the Journal of the American College of Cardiology (doi: /10.1016/j.jacc.2014.09.077).
Mr. Bell and his colleagues from the department of epidemiology and public health at University College London examined data from 2,521 British government workers between the ages of 39 and 62 years. Each participant’s body mass index, cholesterol, blood pressure, fasting plasma glucose and insulin resistance was measured over 5 years, 10 years, and 20 years. Three-quarters of the participants were male.
The sample included 66 “healthy obese” adults at baseline, or about a third of all obese participants. Of these subjects, 21 (32%) were unhealthy obese after 5 years, and 27 (41%), 23 (35%), and 34 (52%) were unhealthy obese after 10, 15, and 20 years, respectively.
“Our results, which were obtained with a longer, more detailed follow-up than any previous study, suggest that long-term stability is the exception, not the norm. The natural course of healthy obesity is progression to metabolic deterioration,” the authors wrote.
There were no relevant disclosures to report.
The phenomenon of “healthy obesity”– having a body mass index over 30 kg/m2 but without significant metabolic risk factors – is most often a transitive phase toward unhealthiness, and not a stable physiological stage, a new report suggests.
“Healthy obese” adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than were healthy nonobese adults. After 20 years, roughly 50% of healthy obese adults were unhealthy obese, and 10% were healthy nonobese, lead author Joshua A. Bell wrote in a research letter published Jan. 5 in the Journal of the American College of Cardiology (doi: /10.1016/j.jacc.2014.09.077).
Mr. Bell and his colleagues from the department of epidemiology and public health at University College London examined data from 2,521 British government workers between the ages of 39 and 62 years. Each participant’s body mass index, cholesterol, blood pressure, fasting plasma glucose and insulin resistance was measured over 5 years, 10 years, and 20 years. Three-quarters of the participants were male.
The sample included 66 “healthy obese” adults at baseline, or about a third of all obese participants. Of these subjects, 21 (32%) were unhealthy obese after 5 years, and 27 (41%), 23 (35%), and 34 (52%) were unhealthy obese after 10, 15, and 20 years, respectively.
“Our results, which were obtained with a longer, more detailed follow-up than any previous study, suggest that long-term stability is the exception, not the norm. The natural course of healthy obesity is progression to metabolic deterioration,” the authors wrote.
There were no relevant disclosures to report.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
The healthy obese don’t stay healthy for long, study suggests
The phenomenon of “healthy obesity”– having a body mass index over 30 kg/m2 but without significant metabolic risk factors – is most often a transitive phase toward unhealthiness, and not a stable physiological stage, a new report suggests.
“Healthy obese” adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than were healthy nonobese adults. After 20 years, roughly 50% of healthy obese adults were unhealthy obese, and 10% were healthy nonobese, lead author Joshua A. Bell wrote in a research letter published Jan. 5 in the Journal of the American College of Cardiology (doi: /10.1016/j.jacc.2014.09.077).
Mr. Bell and his colleagues from the department of epidemiology and public health at University College London examined data from 2,521 British government workers between the ages of 39 and 62 years. Each participant’s body mass index, cholesterol, blood pressure, fasting plasma glucose and insulin resistance was measured over 5 years, 10 years, and 20 years. Three-quarters of the participants were male.
The sample included 66 “healthy obese” adults at baseline, or about a third of all obese participants. Of these subjects, 21 (32%) were unhealthy obese after 5 years, and 27 (41%), 23 (35%), and 34 (52%) were unhealthy obese after 10, 15, and 20 years, respectively.
“Our results, which were obtained with a longer, more detailed follow-up than any previous study, suggest that long-term stability is the exception, not the norm. The natural course of healthy obesity is progression to metabolic deterioration,” the authors wrote.
There were no relevant disclosures to report.
The phenomenon of “healthy obesity”– having a body mass index over 30 kg/m2 but without significant metabolic risk factors – is most often a transitive phase toward unhealthiness, and not a stable physiological stage, a new report suggests.
“Healthy obese” adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than were healthy nonobese adults. After 20 years, roughly 50% of healthy obese adults were unhealthy obese, and 10% were healthy nonobese, lead author Joshua A. Bell wrote in a research letter published Jan. 5 in the Journal of the American College of Cardiology (doi: /10.1016/j.jacc.2014.09.077).
Mr. Bell and his colleagues from the department of epidemiology and public health at University College London examined data from 2,521 British government workers between the ages of 39 and 62 years. Each participant’s body mass index, cholesterol, blood pressure, fasting plasma glucose and insulin resistance was measured over 5 years, 10 years, and 20 years. Three-quarters of the participants were male.
The sample included 66 “healthy obese” adults at baseline, or about a third of all obese participants. Of these subjects, 21 (32%) were unhealthy obese after 5 years, and 27 (41%), 23 (35%), and 34 (52%) were unhealthy obese after 10, 15, and 20 years, respectively.
“Our results, which were obtained with a longer, more detailed follow-up than any previous study, suggest that long-term stability is the exception, not the norm. The natural course of healthy obesity is progression to metabolic deterioration,” the authors wrote.
There were no relevant disclosures to report.
The phenomenon of “healthy obesity”– having a body mass index over 30 kg/m2 but without significant metabolic risk factors – is most often a transitive phase toward unhealthiness, and not a stable physiological stage, a new report suggests.
“Healthy obese” adults were nearly eight times more likely to progress to an unhealthy obese state after 20 years than were healthy nonobese adults. After 20 years, roughly 50% of healthy obese adults were unhealthy obese, and 10% were healthy nonobese, lead author Joshua A. Bell wrote in a research letter published Jan. 5 in the Journal of the American College of Cardiology (doi: /10.1016/j.jacc.2014.09.077).
Mr. Bell and his colleagues from the department of epidemiology and public health at University College London examined data from 2,521 British government workers between the ages of 39 and 62 years. Each participant’s body mass index, cholesterol, blood pressure, fasting plasma glucose and insulin resistance was measured over 5 years, 10 years, and 20 years. Three-quarters of the participants were male.
The sample included 66 “healthy obese” adults at baseline, or about a third of all obese participants. Of these subjects, 21 (32%) were unhealthy obese after 5 years, and 27 (41%), 23 (35%), and 34 (52%) were unhealthy obese after 10, 15, and 20 years, respectively.
“Our results, which were obtained with a longer, more detailed follow-up than any previous study, suggest that long-term stability is the exception, not the norm. The natural course of healthy obesity is progression to metabolic deterioration,” the authors wrote.
There were no relevant disclosures to report.
FROM THE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Key clinical point: Obese patients without metabolic risk factors will likely develop complications over time.
Major finding: Of “healthy obese” participants, 51% became “unhealthy obese” over 20 years, while 11% lost weight and became healthy.
Data source: An analysis of 5,521 men and women from the Whitehall II cohort study of British government workers.
Disclosures: There were no relevant disclosures to report.
Text messages prompt parents to vaccinate their kids
For children who need two doses of influenza vaccine in a season, text messages containing health literacy information are more effective at reminding parents to bring their children in for a second vaccination than are text messages or written messages alone, according to a study published in Pediatrics.
A team of investigators led by Dr. Melissa S. Stockwell of Columbia University Medical Center, New York, found that nearly 73% of children in the educational text message group received a second dose of influenza vaccine by April 30, whereas 67% of those in the conventional text message group received a second dose, and 57% of the written reminder–only group received a second dose (Pediatrics 2015 January [doi/10.1542/peds.2014-2475].
The randomized, controlled trial included 660 families and was conducted during the 2012-2013 influenza season in three community-based pediatric clinics in New York. The majority of the population was categorized as low income, urban, and predominantly Hispanic. Text messages were sent in English or Spanish based on the participants’ preferences.
“The inclusion of health literacy–promoting information in a text message second-dose reminder could potentially increase its efficacy by providing specific information that may compel a family to act overall and in a more timely fashion,” wrote Dr. Stockwell and her associates.
For children who need two doses of influenza vaccine in a season, text messages containing health literacy information are more effective at reminding parents to bring their children in for a second vaccination than are text messages or written messages alone, according to a study published in Pediatrics.
A team of investigators led by Dr. Melissa S. Stockwell of Columbia University Medical Center, New York, found that nearly 73% of children in the educational text message group received a second dose of influenza vaccine by April 30, whereas 67% of those in the conventional text message group received a second dose, and 57% of the written reminder–only group received a second dose (Pediatrics 2015 January [doi/10.1542/peds.2014-2475].
The randomized, controlled trial included 660 families and was conducted during the 2012-2013 influenza season in three community-based pediatric clinics in New York. The majority of the population was categorized as low income, urban, and predominantly Hispanic. Text messages were sent in English or Spanish based on the participants’ preferences.
“The inclusion of health literacy–promoting information in a text message second-dose reminder could potentially increase its efficacy by providing specific information that may compel a family to act overall and in a more timely fashion,” wrote Dr. Stockwell and her associates.
For children who need two doses of influenza vaccine in a season, text messages containing health literacy information are more effective at reminding parents to bring their children in for a second vaccination than are text messages or written messages alone, according to a study published in Pediatrics.
A team of investigators led by Dr. Melissa S. Stockwell of Columbia University Medical Center, New York, found that nearly 73% of children in the educational text message group received a second dose of influenza vaccine by April 30, whereas 67% of those in the conventional text message group received a second dose, and 57% of the written reminder–only group received a second dose (Pediatrics 2015 January [doi/10.1542/peds.2014-2475].
The randomized, controlled trial included 660 families and was conducted during the 2012-2013 influenza season in three community-based pediatric clinics in New York. The majority of the population was categorized as low income, urban, and predominantly Hispanic. Text messages were sent in English or Spanish based on the participants’ preferences.
“The inclusion of health literacy–promoting information in a text message second-dose reminder could potentially increase its efficacy by providing specific information that may compel a family to act overall and in a more timely fashion,” wrote Dr. Stockwell and her associates.
FROM PEDIATRICS
Text Messages Prompt Parents to Vaccinate Their Kids
For children who need two doses of influenza vaccine in a season, text messages containing health literacy information are more effective at reminding parents to bring their children in for a second vaccination than are text messages or written messages alone, according to a study published in Pediatrics.
A team of investigators led by Dr. Melissa S. Stockwell of Columbia University Medical Center, New York, found that nearly 73% of children in the educational text message group received a second dose of influenza vaccine by April 30, whereas 67% of those in the conventional text message group received a second dose, and 57% of the written reminder–only group received a second dose (Pediatrics 2015 January [doi/10.1542/peds.2014-2475].
The randomized, controlled trial included 660 families and was conducted during the 2012-2013 influenza season in three community-based pediatric clinics in New York. The majority of the population was categorized as low income, urban, and predominantly Hispanic. Text messages were sent in English or Spanish based on the participants’ preferences.
“The inclusion of health literacy–promoting information in a text message second-dose reminder could potentially increase its efficacy by providing specific information that may compel a family to act overall and in a more timely fashion,” wrote Dr. Stockwell and her associates.
For children who need two doses of influenza vaccine in a season, text messages containing health literacy information are more effective at reminding parents to bring their children in for a second vaccination than are text messages or written messages alone, according to a study published in Pediatrics.
A team of investigators led by Dr. Melissa S. Stockwell of Columbia University Medical Center, New York, found that nearly 73% of children in the educational text message group received a second dose of influenza vaccine by April 30, whereas 67% of those in the conventional text message group received a second dose, and 57% of the written reminder–only group received a second dose (Pediatrics 2015 January [doi/10.1542/peds.2014-2475].
The randomized, controlled trial included 660 families and was conducted during the 2012-2013 influenza season in three community-based pediatric clinics in New York. The majority of the population was categorized as low income, urban, and predominantly Hispanic. Text messages were sent in English or Spanish based on the participants’ preferences.
“The inclusion of health literacy–promoting information in a text message second-dose reminder could potentially increase its efficacy by providing specific information that may compel a family to act overall and in a more timely fashion,” wrote Dr. Stockwell and her associates.
For children who need two doses of influenza vaccine in a season, text messages containing health literacy information are more effective at reminding parents to bring their children in for a second vaccination than are text messages or written messages alone, according to a study published in Pediatrics.
A team of investigators led by Dr. Melissa S. Stockwell of Columbia University Medical Center, New York, found that nearly 73% of children in the educational text message group received a second dose of influenza vaccine by April 30, whereas 67% of those in the conventional text message group received a second dose, and 57% of the written reminder–only group received a second dose (Pediatrics 2015 January [doi/10.1542/peds.2014-2475].
The randomized, controlled trial included 660 families and was conducted during the 2012-2013 influenza season in three community-based pediatric clinics in New York. The majority of the population was categorized as low income, urban, and predominantly Hispanic. Text messages were sent in English or Spanish based on the participants’ preferences.
“The inclusion of health literacy–promoting information in a text message second-dose reminder could potentially increase its efficacy by providing specific information that may compel a family to act overall and in a more timely fashion,” wrote Dr. Stockwell and her associates.
FROM PEDIATRICS
Experimental drug for vascular leak syndrome used to treat Ebola
A doctor who contracted Ebola at a field hospital in Sierra Leone made a complete recovery due in part to a 3-day treatment course with an experimental drug called FX06, a fibrin-derived peptide used to slow vascular leakage.
The patient, a 38-year old physician from Uganda, was flown into University Hospital Frankfurt, Germany. Within 72 hours of admission he developed signs of vascular leakage and severe multiorgan failure, The patient then began the experimental treatment in the hospital’s intensive care isolation unit. In addition to being administered FX06, the patient was placed on a ventilator and received renal replacement therapy until virologic remission, Dr. Timo Wolf of the hospital and associates wrote in the Lancet (2014 Dec. 19 [doi:10.1016/S0140-6736(14)62384-9]).
FX06 has never been used to treat a patient with Ebola virus disease, although it was shown to reduce hemorrhaging from dengue virus in mice. Use of the experimental drug was approved by the hospital ethical board due to the patient’s deteriorating health, and it was used until the patient’s own immune response could effectively control the infection.
The patient was released to his family after viral remission and a 30-day isolation period.
“The efficacy of FX06 should soon be assessed in clinical trials or at least by standardized collection of data from patients with Ebola virus disease who received it in a compassionate use setting,” the investigators wrote.
The investigators reported that they had no conflicts of interest.
A doctor who contracted Ebola at a field hospital in Sierra Leone made a complete recovery due in part to a 3-day treatment course with an experimental drug called FX06, a fibrin-derived peptide used to slow vascular leakage.
The patient, a 38-year old physician from Uganda, was flown into University Hospital Frankfurt, Germany. Within 72 hours of admission he developed signs of vascular leakage and severe multiorgan failure, The patient then began the experimental treatment in the hospital’s intensive care isolation unit. In addition to being administered FX06, the patient was placed on a ventilator and received renal replacement therapy until virologic remission, Dr. Timo Wolf of the hospital and associates wrote in the Lancet (2014 Dec. 19 [doi:10.1016/S0140-6736(14)62384-9]).
FX06 has never been used to treat a patient with Ebola virus disease, although it was shown to reduce hemorrhaging from dengue virus in mice. Use of the experimental drug was approved by the hospital ethical board due to the patient’s deteriorating health, and it was used until the patient’s own immune response could effectively control the infection.
The patient was released to his family after viral remission and a 30-day isolation period.
“The efficacy of FX06 should soon be assessed in clinical trials or at least by standardized collection of data from patients with Ebola virus disease who received it in a compassionate use setting,” the investigators wrote.
The investigators reported that they had no conflicts of interest.
A doctor who contracted Ebola at a field hospital in Sierra Leone made a complete recovery due in part to a 3-day treatment course with an experimental drug called FX06, a fibrin-derived peptide used to slow vascular leakage.
The patient, a 38-year old physician from Uganda, was flown into University Hospital Frankfurt, Germany. Within 72 hours of admission he developed signs of vascular leakage and severe multiorgan failure, The patient then began the experimental treatment in the hospital’s intensive care isolation unit. In addition to being administered FX06, the patient was placed on a ventilator and received renal replacement therapy until virologic remission, Dr. Timo Wolf of the hospital and associates wrote in the Lancet (2014 Dec. 19 [doi:10.1016/S0140-6736(14)62384-9]).
FX06 has never been used to treat a patient with Ebola virus disease, although it was shown to reduce hemorrhaging from dengue virus in mice. Use of the experimental drug was approved by the hospital ethical board due to the patient’s deteriorating health, and it was used until the patient’s own immune response could effectively control the infection.
The patient was released to his family after viral remission and a 30-day isolation period.
“The efficacy of FX06 should soon be assessed in clinical trials or at least by standardized collection of data from patients with Ebola virus disease who received it in a compassionate use setting,” the investigators wrote.
The investigators reported that they had no conflicts of interest.
FROM THE LANCET