Generic Amaryl (Glimepiride) Information

While nightmares mostly affect children, even adults have an occasional bad dream.

Why do nightmares happen? The U.S. National Library of Medicine offers this list of possible causes:
-Being stressed or anxious, often resulting from a significant life event.
-Withdrawing too quickly from alcohol use, or drinking too much alcohol.
-Having a sleep disorder, such as narcolepsy.
-Being sick with a fever.
-Having a side effect or reaction to a drug.
-Eating too close to bedtime, which raises your metabolism and increases brain activity.

Although acne traditionally has been considered a disease of teenagers, it is also extremely common in adult women. Studies show that acne affects more than 50 percent of women between the ages of 20-29 and more than 25 percent of women between the ages of 40-49¹. In fact, after age 20, women are far more likely to report having acne than men. While there is no cure for acne, dermatologists are finding that hormonal therapies can help some women fight bothersome acne that occurs in adulthood.At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist Bethanee J. Schlosser, MD, PhD, FAAD, assistant professor of dermatology and director of the Women’s Skin Health Program at Northwestern University Feinberg School of Medicine in Chicago, discussed the most widely used hormonal therapies available for women with acne and the best candidates for this type of treatment.

Factors that contribute to the formation of acne include excess oil gland production, skin inflammation, abnormal maturation of skin cells lining the hair follicle and an increased number of the acne-causing bacteria Propionibacterium acnes. However, hormones also influence both oil gland production and the maturation of skin cells thereby contributing to the formation of acne lesions. For example, when androgens (the male hormones present in both men and women) over-stimulate the oil glands and hair follicles in the skin, hormonal acne flares can occur.

“Women over the age of 20 may experience worsening of their acne or a change in the nature of their acne. This can include increased lesions on the lower one-third of the face (including the jaw line and upper neck), pre-menstrual flares, and resistance to oral antibiotics and other traditional acne therapies,” said Dr. Schlosser. “For these women, hormonal therapy in the form of combination oral contraceptives and/or anti-androgen medications, such as spironolactone, flutamide and dutasteride that work by reducing the activity of the male hormone testosterone, may provide significant benefit.”

Dr. Schlosser noted that the use of hormonal therapies for acne, including combination oral contraceptives, requires careful screening of patients. For example, there are numerous contraindications (or factors that increase the risks of a particular medication) that must be considered before hormonal therapy is prescribed for treating acne. Such contraindications for combination oral contraceptives include a personal history of breast cancer, heart attack or stroke, uncontrolled high blood pressure, migraines with neurological symptoms, or abnormal vaginal bleeding, to name a few.
Dermatologists will review these factors with patients to determine if hormonal acne therapy poses any potential risks for patients.

Based on a physical examination, a patient’s medical history and the success or failure of previously prescribed acne treatments, dermatologists may recommend hormonal therapy to enhance the results of acne treatment in women. Hormonal therapy in the form of combination oral contraceptive pills has been shown to help treat both inflammatory acne lesions (the papules, pustules and painful nodules under the skin), and non-inflammatory acne lesions (blackheads and whiteheads). Dr. Schlosser suggests that hormonal therapy should not be used in isolation but instead recommends that combination oral contraceptives or anti-androgen medications be used in conjunction with topical retinoids for optimal results.

While there are numerous types of oral contraceptives available that can be used to treat acne in women, three combination oral contraceptive pills have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of acne. All combination oral contraceptives contain an estrogen (ethinyl estradiol for most contraceptive pills) and a progestin. The estrogen component decreases the production of testosterone and other androgens by the ovaries and decreases the amount of active testosterone in the body.

Some progestins may actually mimic the activity of testosterone on the oil gland and thereby worsen acne. Therefore, Dr. Schlosser primarily recommends oral contraceptives that contain one of the following progestins: norgestimate, desogestrel, or drospirenone, all of which demonstrate low or no risk of increasing the activity of the testosterone receptor.

“Combination oral contraceptives can be very beneficial in the treatment of acne in appropriately selected women, and several different oral contraceptives have been shown to be effective in clinical studies,” said Dr. Schlosser. “But the treatment of acne with combination oral contraceptives needs to be targeted to each patient’s individual needs, and patients should be monitored regularly to ensure the safety and effectiveness of their particular therapy.”

Dr. Schlosser cautioned that improvement of acne with hormonal therapy does not occur overnight and requires at least three months of continuous use before a judgment about effectiveness should be made. In many cases, patients need to continue using oral contraceptives to sustain their results over time. However, some patients can stop hormonal therapy and maintain clear skin with the regular use of a topical retinoid.

“For many women with adult-onset acne, combination hormonal therapy can provide excellent results,” added Dr. Schlosser. “Women who think they might be good candidates should discuss their options with their dermatologist who can offer a customized treatment regimen and continual monitoring to ensure optimal results.”

To learn more about acne, visit the AcneNet section of www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

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Dr. Michael V. Rocco, almost a Prof. of private medicine-nephrology at almost a high rate of Wake Forest University Baptist Medical Center in Winston-Salem, N.C., says doctors may persistently know any more at almost a guess the effects of any more absolutely frequent dialysis in the sometimes next hardly declining years as with almost a uncontrollably result strongly attract of two National Institutes of Health-sponsored brilliantly clinical trials.

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Many infant deaths in the 19th century that were labeled as infanticide or neglect may actually have been sudden infant death syndrome (SIDS), a U.S. study suggests.

Historically, the sudden death of an apparently healthy baby would have been attributed to accidental smothering or overlaying by either bedding or a co-sleeper, according to background information. Smothering deaths were believed to be caused by parental neglect, while infant-adult bed sharing was regarded as proof of parental incompetence.

The analysis of data from the U.S. Federal Mortality Schedule from the years 1850 to 1880 revealed that, like SIDS, smothering and overlaying deaths occurred primarily during the second to fourth month of the baby’s life, were more common in the late winter months and among boys, and death rates were higher for black infants.

“The study strongly supports the hypothesis that these infant deaths represent empirical evidence of 19th-century SIDS mortality,” concluded Dr. Ariane Kemkes, an independent researcher in Scottsdale, Ariz.

Proteins in spinal fluid accurately detect early-stage Alzheimer’s disease in patients and could pave the way for better drug research, Swedish researchers said on Tuesday.

Several teams have been working on better ways to detect early-stage Alzheimer’s disease in hopes of developing drugs that can fight it before it causes too much damage.

“We confirmed in a large multi-center study that these (cerebrospinal fluid) biomarkers may identify early-stage Alzheimer’s disease, which has previously been suggested in earlier smaller studies,” Dr. Niklas Mattsson of the University of Gothenburg in Sweden, whose study appears in the Journal of the American Medical Association, wrote in an e-mail.

Mattsson said the current study in patients with mild cognitive impairment or MCI, a precursor to Alzheimer’s disease, strengthens the argument that proteins in spinal fluid can accurately show who has early-stage disease.

This may also be useful in structuring smaller clinical trials to test whether a drug is working. Current diagnostic measures, such as neurological and memory tests, are less accurate, forcing drug companies to run large, expensive clinical trials to show their drugs work.

“The drug industry certainly fears failure of these large scale studies and biomarkers may save millions of dollars in addition to allowing a more rapid development of efficient drugs,” Mattsson said.

FEW WEAPONS

Despite decades of research, doctors still have few effective weapons against Alzheimer’s, a mind-robbing form of dementia that affects more than 26 million people globally and is expected to reach 100 million by 2050.

The team studied three proteins — two types of tau, which forms toxic tangles in the brain and a form of amyloid, which forms sticky brain plaques in people with Alzheimer’s disease.

Although they affect the brain, bits of the proteins were also found in the cerebrospinal fluid, which bathes both the brain and the spinal cord.

“These biomarkers … reflect core elements of the disease process in the brain in Alzheimer’s disease,” Mattsson said.

His team studied 750 people with mild cognitive impairment, 529 with Alzheimer’s disease and 304 healthy people in 12 centers in Europe and the United States. People with cognitive impairment were followed for 2 years, or until their symptoms worsened.

The researchers found the three biomarkers accurately identified 62 percent of those who would develop Alzheimer’s disease, and were 88 percent accurate at ruling it out.

The team said the findings were a bit less accurate than results seen in smaller studies, and suggest standardized testing techniques might improve results.

Drs. Ronald Petersen of the Mayo Clinic in Rochester, Minnesota, and John Trojanowski of the University of Pennsylvania School of Medicine in Philadelphia, wrote in a commentary that the results were sufficient for screening patients, but not as a diagnostic test.

“Alzheimer disease has no treatment to prevent or alter the course of the disease, so making the diagnosis with good accuracy may aid in planning but also could be devastating news for some patients and families,” they wrote.

The drug vorinostat is able to cross the blood-brain barrier and reduce the development of large metastatic tumors in mice brains by 62 percent when compared to mice that did not receive the drug, according to a new study. In humans, the drug has been approved by the U.S. Food and Drug Administration for the treatment of a cancer called cutaneous T-cell lymphoma but can be used experimentally to study its effectiveness against other cancers. This research, by investigators at the National Cancer Institute (NCI), part of the National Institutes of Health, and their collaborators, appears online Sept. 29, 2009, in Clinical Cancer Research.

For people, while various therapies are improving the survival of breast cancer patients, the incidence of breast cancer spreading to the brain is increasing. Brain metastases of breast cancer have proven to be largely untreatable because the blood-brain barrier, which arises from the specialized structure of blood capillaries in the brain, severely limits drug access and many drugs are actively transported out of brain at this barrier. Consequently, the one-year survival estimate for breast cancer patients after a diagnosis of brain metastasis is only about 20 percent.

Vorinostat has been found to slow the growth of primary tumors of several different types of cancer in mice. Previous studies have suggested that the drug can be taken up by the brain, although little was known about its effects on metastatic tumors. Therefore, to study the effect of vorinostat on the formation of brain metastases, scientists used a mouse model of human breast cancer. Human breast cells were cultured in the laboratory and were injected into mice with compromised immune systems. The breast cancer cells then migrated to the brain, forming metastases.

“Drugs that can cross the blood-brain barrier and reduce the size and incidence of metastatic tumors are urgently needed,” said Patricia S. Steeg, Ph.D., study author, Center for Cancer Research, NCI. The researchers found that vorinostat was absorbed readily into normal mouse brains, and accumulation of the drug was up to three-fold higher in some metastases treated with this drug when compared to surrounding brain tissue. Vorinostat also reduced the development of tiny tumors (micrometastases) in mice by 28 percent when compared with mice that did not receive this therapy.

The ability of vorinostat to reduce metastatic lesions in the brain was linked to a novel double-barreled mechanism — the drug can cause breaks in both strands of a DNA helix and can also lower the activity of a DNA repair gene called Rad52. The researchers hypothesize that the inability of the cancer cells to repair DNA damage would then slow the rate of tumor cell metastasis.

In June of this year, several researchers affiliated with this study published a paper in Molecular Cancer Therapeutics showing that vorinostat could enhance the effect of radiation therapy in mice with brain cancer metastasis. Mice that received implants of human breast tumors in their brains lived the longest after treatment with both vorinostat and radiation, demonstrating that the drug enhances the sensitivity of cancer cells to radiation therapy. “Taken together with our current finding, researchers have now established a preclinical basis for testing this drug in clinical trials in humans,” said Steeg.

For more information on Dr. Steeg’s research, please go to http://ccr.cancer.gov/staff/staff.asp?profileid=5851

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

A national campaign to inoculate tens of millions of Americans against H1N1 influenza began Monday, with health care workers in Indiana and Tennessee targeted as the first recipients, federal health authorities said.

“I think the world has watched history unfold,” Dr. Judy Monroe, Indiana’s state health commissioner, told reporters at Wishard Hospital in Indianapolis.

Earlier Monday, the hospital received a shipment of 52 boxes — each containing 100 pre-filled sprayers.

“This first 5,200 doses that came to Marion County is really just the tip of the iceberg,” Monroe said.

Health Director Virginia Caine said the shipment will be split among the county’s hospitals.

A similar scene unfolded at LeBonheur Children’s Medical Center in Memphis, Tennessee, where three children have died from H1N1, sometimes referred to as swine flu.

Jennilyn Utkov, a spokeswoman for LeBonheur, said the hospital received about 100 doses. By noon, the supply had been depleted.

The vaccines shipped to both sites and to a few other places around the nation are the first of some 195 million doses the U.S. government has purchased from five vaccine manufacturers, the Centers for Disease Control and Prevention’s Dr. Jay Butler told reporters at the Indianapolis event. That number includes both spray and injectable forms.

Butler, who heads the agency’s 2009 H1N1 Vaccine Task Force, has promised there will be enough for anyone who wants it.

Butler said vaccine makers will ship 10 million to 20 million doses per week over the next couple of months.

“Is that fast enough?” he asked. “No, but it’s what’s feasible. It’s what can be done.”

Monroe predicted that an ample supply of the injectable form will be available by mid-October.

Last week, the CDC said it had received reports of 60 deaths of children related to H1N1 flu since April; 11 of those deaths were reported last week alone.

From August 30 until September 26, the agency tallied 16,174 hospitalizations nationwide and 1,379 deaths associated with influenza virus infection. iReport.com: How should H1N1 be handled?

The 27 states reporting widespread flu activity are Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, Texas, Tennessee, Virginia, Washington and Wyoming.

Nearly all of the viruses identified so far are H1N1, the agency said in a posting on its Web site.

“These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine” and remain susceptible to antiviral drugs “with rare exception,” it added.

Those who are at the highest risk of getting seriously ill — pregnant women, children, young adults and people with chronic lung disease, heart disease or diabetes — should be among the first to get vaccinated against the H1N1 flu virus, health officials have said.

According to a CNN/Opinion Corp. poll in late August, two-thirds of Americans said they plan to be vaccinated against H1N1 flu.

Health care workers may not necessarily be foremost among them. In the past, about 40 percent of health care workers have opted to be vaccinated against the flu, according to the CDC.

Health officials also have recommended people reduce their chances of getting sick by washing their hands frequently, sneezing into a tissue or sleeve rather than into one’s hand and staying home when sick.
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More than 340,000 laboratory-confirmed cases of H1N1 and more than 4,100 deaths have been reported to the World Health Organization.

Many countries — including the United States — have stopped counting cases, particularly of milder illness, meaning that the true number is likely much higher.