Friday, 30 October 2009

Woman beats invasive aspergillosis to get married


Trish Dunlop was hit with the devastating news that she suffered from the same leukemia that killed her mother some years before. Fearing the worst she attended hospital for treatment. During chemotherapy her long term partner Will proposed and they resolved to marry soon.

Trish was diagnosed with Acute Myeloid Leukemia (AML). Long term recovery from AML varies according to a number of factors and can be as high as 50-70% for some groups of patients but overall a recovery rate of 20-30% is currently achieved. Trish had her work cut out to survive this cancer.

Unfortunately the worst was yet to come. Some types of leukemia cause a severe weakening of the patients ability to fight off infections. After 3 rounds of chemotherapy her body was weak and her immune system weaker still. She fell victim to an aspergillosis infection in her lungs. Aspergillosis is tough to treat at the best of times but if the patient has a weak immune system they are particularly up against it in the fight for survival. Things looked bleak when her doctors could do no more and early in December 2008 gave her 2 hours to live.

2 days later Trish woke up on the anniversary of her mother's death. From that point on she gradually improved, beating back both AML and aspergillosis. She left hospital a month later and was married six months later in the summer of  2009.

This is a good news story but it was a close run thing. Presumably Trish's body recovered enough of its immune system just in time to beat back the fungus. The message is that there is always hope even in the direst of circumstances, never give up hope.

Friday, 23 October 2009

Itraconazole: how much is too much?


Itraconazole is an antifungal that is known to cause a range of adverse 'side effects'. It is also an important weapon in the clinicians armoury against aspergillosis and other fungal infections, so how do we find out how much to use without causing excessive side effects?

Dose of itraconazole is often difficult to judge accurately as there are several variables which effect blood levels of the drug (e.g. variable absorption from patient to patient) so it is important to base dosage studies on actual levels on the blood. A paper by Lestner et.al. goes one step further  to ensure accuracy by using a sophisticated bioassay to measure levels of active itraconazole rather than simply measuring levels of the chemical present in the blood. The chemical is often only partly active so measurement of active itraconazole is a more reliable measurement of real dose.

Using this assay Lestner et.al. demonstrated that a level of 17.1mg/L of itraconazole and above was the point at which side effects started to become excessive.

Wednesday, 14 October 2009

Over 90% drugs sold online are fake or illegal


This report by EAASM looks at the widespread trade in prescription drugs over the internet. In many countries supply of these drugs are strictly controlled, partly because they can be very dangerous when not taken with the advice of a medical doctor but also partly because it is important to control quality - if a particular batch of a drug is found to be causing unexpected problems it can be withdrawn from public consumption.

Unfortunately these drugs can be very expensive when purchased via normal routes, or not available at all if the health authority budget cannot pay for them. Websites offering what are apparently the same drugs at much lower prices then become a tempting proposition for some and many might for example supplement drugs they have been prescribed with a much cheaper supply purchased over the internet.

Why are these drugs cheaper when purchased over the internet? The group who published this report purchased 30 different drugs from over 100 of the websites who supply prescription drugs, ignoring those that were obviously fraudulent. Quoting the article:
  • 62% of medicines purchased online are fake or substandard

  • 95.6% of online pharmacies researched are operating illegally.

  • 94% of websites do not have a named, verifiable pharmacist.

  • Over 90% of websites supply prescription-only medicines without a prescription.

So legality apart, over six out of ten of the purchased drugs were fake or of poor quality. At best they would do nothing but considering many of these were vital for life threatening conditions doing nothing could be lethal. The substances used to make the fakes were also found to be toxic in some cases.
Equally dangerous is that very few of these companies asked any questions about the health of the person ordering the drugs or what else they were taking - again with potentially lethal consequences. Most drugs supplied did not arrive with so much as an information leaflet for the patient to read - though many of these are also available online it isn't easy be sure to find the right one.

One of the comments I have read on this issue was that these drug suppliers are providing a valuable service to the lower paid. Drug companies are also said to be profiteering when a drug can be purchased in an adjacent country at far lower prices. The answer to this is clear, these drugs are cheaper because they aren't what you think they are, they come with little or no medical advice and if they are the drug you purchased they are most often out of date and/or stored under poor conditions leading to important dosages lacking consistancy.

If you value your health at all this isn't the way to save money.

Wednesday, 7 October 2009

Hurricane Katrina Victims are Contaminated by Mycotoxins

Hurricane Katrina devastated large numbers of homes that lay in its path when it made landfall in 2005. It was the sixth largest hurricane on record in the Atlantic and the most costly and deadly in the history of the United States with over 1800 people losing their lives.
Tens of thousands of homes were severely effected by extensive flooding and as a result of the warmth and moisture moulds grew rapidly inside houses. In these conditions moulds can start producing mycotoxins within a few days of the initial flooding.

Over the next few months people fell ill with a variety of symtoms that could be consistent with exposure to moulds e.g. asthma, memory loss, fatigue, headache, muscle pains or weakness etc. These are not universally agreed to be related to mould exposure as they tend to be considered to be a collection of rather vague symptoms for which there is no tool to measure.

Mycotoxins are known to be highly toxic when present in sufficient amounts (there is a lot of data on animals fed with contaminated food) so there is a movement to consider whether or not mycotoxins could be causing those symptoms thought to be related to mould exposure.

This paper published recently examined the levels of mycotoxins in people exposed to moulds after Katrina. There had been no easily available tool to measure the levels of mycotoxins in the bodily fluids and tissue samples from people thought to have been exposed to moulds but this paper addressed that shortcoming and demonstrates the usefullness of several methods not only to detect the presence of mycotoxins but also to detect the levels of several different types of mycotoxin in several different tissue types.

Levels exceeding 2 parts per billion (up to 18ppb) of several different mycotoxins were detected in people suffering 'mould exposure symptoms' and these were compared with no detectable mycotoxins in control unexposed individuals.
Mycotoxins are therefore proved to be detectable in the Katrina victims in this study - so have they made these people sick?

Unfortunately we still do not know the answer to that question.

2-18ppb is well below mycotoxin levels known to cause acute or cumulative mycotoxin poisoning in animal models. We cannot yet rule out toxicity caused by long term exposure to these levels of mycotoxins, or exposure to a cocktail of different toxins, both of which may well have effected this group of people but evidence is not yet ready to confirm or dismiss the possibilities.

At least as a result of this work we now have some of the important tools with which we can start to answer these questions.

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