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U.S. pre-term babies die despite medical care: study

in.reuters.com

U.S. pre-term babies die despite medical care: study

Very early pre-term babies kept alive with ventilators, chest tubes and drugs to support the heart may live a little longer than they did 10 years ago, but are just as likely to die before ever going home, U.S. researchers reported on Monday.

Their study suggests the emotionally taxing and expensive care given these tiny newborns, delivered at 22 to 24 weeks gestation, does not in the end save their lives. Babies born at 22 weeks included in the study all died as infants, regardless of care.

“This is a very difficult ethical dilemma for everyone involved,” Pamela Donohue of Johns Hopkins Childrens Center in Baltimore, who led the study, said in a telephone interview.

Most pregnancies last about 40 weeks, and babies born earlier than 37 weeks of pregnancy are considered premature.

Donohue’s team studied 160 women who gave birth at 22-24 weeks during separate two-year periods — 1993-1995 and 2001-2003.

Those who gave birth during the current decade were more likely to receive higher-level care around the time of delivery, including sonograms, antibiotics and steroids to help with fetal lung development.

After birth, their children were more likely to be put on ventilators, drugs to boost heart and blood pressure rates and to have chest tubes inserted.

Infants born in 2001-2003 lived longer on average — seven days, compared to two days in the 1990s.

But mortality rates did not fall, and the researchers urged greater discussion and further study both on intervention and the degree of suffering imposed on children, their families and healthcare providers.

Very early pre-term babies kept alive with ventilators, chest tubes and drugs to support the heart may live a little longer than they did 10 years ago, but are just as likely to die before ever going home, U.S. researchers reported on Monday.

Their study suggests the emotionally taxing and expensive care given these tiny newborns, delivered at 22 to 24 weeks gestation, does not in the end save their lives. Babies born at 22 weeks included in the study all died as infants, regardless of care.

“This is a very difficult ethical dilemma for everyone involved,” Pamela Donohue of Johns Hopkins Childrens Center in Baltimore, who led the study, said in a telephone interview.

Most pregnancies last about 40 weeks, and babies born earlier than 37 weeks of pregnancy are considered premature.

Donohue’s team studied 160 women who gave birth at 22-24 weeks during separate two-year periods — 1993-1995 and 2001-2003.

Those who gave birth during the current decade were more likely to receive higher-level care around the time of delivery, including sonograms, antibiotics and steroids to help with fetal lung development.

After birth, their children were more likely to be put on ventilators, drugs to boost heart and blood pressure rates and to have chest tubes inserted.

Infants born in 2001-2003 lived longer on average — seven days, compared to two days in the 1990s.

But mortality rates did not fall, and the researchers urged greater discussion and further study both on intervention and the degree of suffering imposed on children, their families and healthcare providers.

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Vaccine raises hope for cocaine addiction therapy

in.reuters.com

Vaccine raises hope for cocaine addiction therapy

A vaccine helped block the high felt by cocaine users in 38 percent of people who took it, U.S. researchers said on Monday, offering promise of a new approach to treating those addicted to the drug.

The aim is to prevent cocaine’s rewarding effects — the high — in order to reduce cravings that trigger drug relapses.

“The concept works,” Dr. Thomas Kosten of Baylor College of Medicine in Houston, Texas, whose study appears in the Archives of General Psychiatry, said in a statement.

Cocaine molecules on their own are too small to draw the attention of the immune system. To get the body to recognize cocaine, the researchers designed a vaccine that uses a harmless version of the cholera toxin with a few attached cocaine molecules.

When the immune system reacts to the toxin, it makes both cholera and cocaine antibodies.

“These antibodies bind to the cocaine, preventing it from leaving the bloodstream,” Kosten said. An enzyme called cholinesterase breaks down the cocaine and flushes it out of the body.

For the study, Kosten and colleagues studied 94 volunteers — mostly users of crack cocaine, which is a solid, smokable form of the drug — who were on methadone treatment at the Veterans Affairs Connecticut Healthcare System.

Over three months, the participants either got five shots of the vaccine or a placebo injection.

STUDY PLANS

Plans are under way to study the vaccine in many sites.

According to a 2007 National Survey on Drug Use and Health, 35.9 million Americans aged 12 and older reported having used cocaine, and 8.6 million reported having used crack. In 2006, cocaine accounted for about 14 percent of all admissions to drug abuse treatment programs.

Kosten said he plans to tinker with the vaccine to make it more effective. He has already tried a different carrier — a modified version of a meningitis bacterium — supplied by drug firm Merck & Co.

Animal studies showed it produced five times the antibody response as the cholera carrier.

He has used a similar approach on a nicotine vaccine called TA-NIC now being tested in Europe. Both the cocaine and nicotine vaccines are being developed through private equity firm Celtic Pharma.

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Scientists develop antidote for new class of drugs

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Scientists develop antidote for new class of drugs

A new compound can quickly counteract the action of an emerging class of drugs, offering a way to reverse the drugs’ actions if a patient develops serious side effects, U.S. researchers said on Sunday.

They designed the compound to work with a new blood-thinner being developed for heart patients undergoing angioplasty to clear out blocked arteries.

Such patients need to take blood thinners to prevent blood clots during surgery, but bleeding is a common side effect.

Having an antidote on hand would make the treatments safer, said Bruce Sullenger of Duke University Medical Center, whose study was published in the journal Nature Medicine.

But instead of just reversing the effects of the blood thinner, the antidote agent appears to work against a whole new class of drugs called aptamers.

“Most drugs target proteins. The type of drugs we’re talking about are ribonucleic acids (RNAs) that target proteins,” Sullenger said in a telephone interview.

“Normally in our body we don’t have these types of molecules outside of cells,” Sullenger said.

The antidote agent takes advantage of this, targeting only nucleic acid compounds circulating freely outside the cells.

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