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People who suffer from major depression are at risk for low bone mineral density (BMD), research hints.

In the last 14 years, “ample research” has implicated major depression in bone loss and the bone-thinning disease osteoporosis, Dr. Raz Yirmiya and Dr. Itai Bab from The Hebrew University of Jerusalem in Israel note in the journal Biological Psychiatry.

To investigate further, the investigators pooled data from 23 studies involving 2327 depressed and 21,141 non-depressed adults.

Overall, depressed individuals had less dense bones than non-depressed individuals, they found. Depressed individuals also had increased levels of bone resorption markers.

Based on these findings and prior studies, “We propose that all individuals psychiatrically diagnosed with major depression are at risk for developing osteoporosis, with depressed women — particularly those who are premenopausal — showing a higher risk than men,” Yirmiya and Bab conclude.

People with major depression should have their BMD checked periodically, they conclude.

A longer period of preventive treatment after kidney transplant can help reduce the risk that the patient will become infected with a virus that can cause devastating problems, new research suggests.

Healthy people can usually fight off the virus, called cytomegalovirus, but those with kidney transplants have weakened immune systems and are more susceptible to infection, the authors of the study noted in a news release from the American Society of Nephrology.

In the comparison study, Dr. Fu Luan, of the University of Michigan in Ann Arbor, and colleagues gave kidney transplant patients either three months or six months of treatment with the antiviral drug valganciclovir. They found that those who were given the longer treatment had a rate of infection that was half that of those who received treatment for three months (12 percent vs. 24 percent).

When the researchers took into account other factors that could have played a role, they found that the longer treatment regimen lowered the risk of cytomegalovirus by nearly two-thirds.

The study also found that the longer treatment is cost-effective, although it is expensive. But the study authors contend that it’s cheaper in the long run to prevent infections that could end up being very costly.

The U.S. Food and Drug Administration today advised consumers not to use certain respiratory medications purchased after Sept. 8, 2009 and manufactured by Dey L.P., a subsidiary of Mylan Inc., because the medications might have been part of a shipment being transported on a tractor-trailer stolen in Tampa, Fla., on Sept. 8, 2009.

The respiratory medications, Ipratropium Bromide Inhalation Solution, 0.02%, and Albuterol Sulfate Inhalation Solution, 0.083%, unit-dose vials, have not been recovered and may be dangerous to use because the drugs may not have been stored and handled properly.

Dey issued an advisory on Sept. 11, 2009 regarding the theft. Although the FDA is not aware of any reports of adverse events, the agency is advising patients who use these respiratory medications to check to see if products received or purchased after Sept. 8, 2009 are from one of the following lots:

Albuterol Sulfate Inhalation Solution (892,000 doses; all lots contain 3.0 ml vials and display the brand name “Dey”)
Lot number 9G04, NDC # 49502-697-29
Lot number 9FD8, NDC # 49502-697-61
Lot number 9FD9, NDC # 49502-697-61
Lot number 9FE1, NDC # 49502-697-61

Ipratropium Bromide Inhalation Solution (432,000 doses; all lots contain 2.5 ml vials and display the brand name “Dey”)
Lot number F09089, NDC # 49502-685-31
Lot number C09119, NDC # 49502-685-62
Lot number C09120, NDC # 49502-685-62

Do not use Albuterol Sulfate Inhalation Solution or Ipratropium Bromide Inhalation Solution if it is from one of these lots and was purchased or received after Sept. 8, 2009. Replace it with the same product from another lot.

Notify your health care professional of any adverse effects you may have experienced as a result of taking these medications.

Bring products from these lots back to the pharmacy where you received the medicine to exchange for products from a different lot or call Dey customer service at 800-527-4278. Contact your health care professional if you must switch to another product for any reason for possible dose adjustments.

Gay, lesbian and bisexual teenagers may be at higher risk of binge-eating and purging than their heterosexual peers, starting as early as age 12, a new study finds.

Past research has found connections between sexual orientation and the risk of eating disorders in adults — showing, for instance, that gay men have higher rates of symptoms than their heterosexual counterparts.

Less has been known about how sexual orientation affects teenagers’ risks of various eating disorders.

For the new study, researchers at Harvard University and Children’s Hospital Boston used data from a U.S. survey of nearly 14,000 12- to 23-year-olds to look at the relationship between sexual orientation and binge-eating and purging.

They found heightened rates of binge-eating among both males and females who identified themselves as gay, lesbian, bisexual or “mostly heterosexual.”

Purging, by vomiting or abusing laxatives, was also more common among these teens, the researchers report in the Journal of Adolescent Health.

“We found clear and concerning signs of higher rates of eating disorder symptoms in sexual-minority youth compared to their heterosexual peers even at ages as young as 12, 13 or 14 years old,” lead researcher S. Bryn Austin, an assistant professor of pediatrics, told Reuters Health in an email.

Among females, lesbian, bisexual and mostly heterosexual respondents were all about twice as likely as their heterosexual counterparts to report binge-eating at least once per month in the past year.

Bisexual and mostly heterosexual girls and women were also more likely to say they had purged in the past year in order to control their weight.

Among males, the highest risks were seen among homosexuals — who were seven times more likely to report bingeing and nearly 12 times more likely to report purging than heterosexual males.

Bisexual and mostly heterosexual boys and men also had elevated risks of both problems — with rates anywhere from three to seven times higher than those of their heterosexual counterparts.

The survey data do not offer a potential reason for the findings, but past studies give some insight, according to the researchers.

“We know that gay, lesbian, and other sexual-minority kids are often under a lot of pressure,” Austin said, noting that these teens are often “treated like outsiders” in their own families and schools, and may be excluded, harassed or victimized by bullies.

“This kind of isolation and victimization can take its toll on a young person,” Austin explained, “and one of ways it can play out is in vulnerability to eating-disorder symptoms and a host of other stress-related health problems.”

She added that because negative attitudes and discrimination against sexual minorities are still pervasive in society, families need to be a source of support.

It is “incredibly important,” Austin said, “for parents and other family members to reach out and make sure these youth know they are loved and supported, that they can count on their families to stay by their side.”

People who need a new kidney may need to look no farther than across the dining room table, according to a new study that shows that spouses are good potential sources for so-called “living-unrelated organ donation.”

Due to a worldwide shortage of organs available for transplant from people who have died, “living organ donors” have become a major source of organs for transplantation.

And while a “well-matched” donor organ from a sibling, parent or other close relative has the highest likelihood of surviving in the recipient, there is also evidence that organs from “living-unrelated donors” such as spouses yield similar survival rates to those from well-matched living-related donors.

However, transplant patients may be reluctant to consider an organ from their spouses because the organs may not be well-matched in terms of blood and tissue type. Such poor matching can cause the immune system to reject the organ.

Against this backdrop, Dr. Yu-Ji Lee and colleagues from Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea Lee reviewed the medical records of 185 people who successfully underwent living-unrelated kidney transplantation at their institution. A total of 55 out of the 185 transplant patients received kidneys from their spouses.

They report in the journal Dialysis and Transplantation that kidney transplantation from spousal donors “has comparable outcomes to those of other living-unrelated donors, and shortens the time spent on the waiting list.”

While the incidence of acute rejection of the kidney in the first year after transplantation was more frequent in people who received a kidney from a spouse, the survival rates at 1 and 5 years for spousal and other living-unrelated kidneys were both high and were not significantly different.

“Spouses are important potential donors for living-unrelated kidney transplantation,” the investigators note in their report, and “should be considered as a useful source to overcome an organ shortage.”

Spousal donors have a strong emotional bond with their recipients, Lee and colleagues point out, and some investigators have found that spousal donor transplantation improved family relationships. There is also evidence, they say, that such a strong emotional bond may be related to the high survival rate of kidneys from spouses.

To ease the anxiety of a child undergoing surgery, it helps if parents and children are well-prepared, advises the American Society of Anesthesiologists.

“Undergoing surgery can be a source of stress for a person of any age, but when the patient is a child, a whole new layer of sensitivity is added,” ASA President Dr. Roger A. Moore said in a news release from the society. “The anesthesiologist, surgeon and entire care team do their best to make a child’s visit to the hospital as pleasant as possible, but parents also have a key role to play in the process. To this end, we urge parents to begin preparing their child as soon as a decision is made to perform surgery.”

The ASA offers these tips:
Be informed. Learn what you and your child should expect during and after surgery. Ask the doctor to walk you through the operation, then seek details about when and where you can be present, the anesthesia, recovery time, pain, scars and other pertinent details.
Inform your child in an age-appropriate manner. Older children may be able to handle more detailed information than younger ones. Your doctor should be able to offer advice on relaying surgery specifics.
Be positive. In general, always offer reassurance. Children like knowing that the medical staff contains experts looking out for their well-being. Emphasize that short-term discomfort will be outweighed by longer-term health and happiness.
Set realistic expectations. Remind your child that no one immediately bounces back from surgery, and it may be a gradual healing process with some discomfort along the way.
Seek support. Have family and friends provide encouragement in person or through calls, cards or e-mails.
Distract your child. Plan activities for the day before or of surgery to keep your child’s mind free of worry. A new toy can help occupy the time.
Work with your medical team. Being open and honest will help them make the right decisions for your child. Be aware of cues they offer to help keep your child calm.
Care for yourself. Stay calm because children often pick up on their parent’s attitude and demeanor. Ask for or accept help from others with meals and child care to keep your daily life moving smoothly forward.
Stay alert even after surgery. Follow your doctor’s post-op instructions closely. Be on the lookout for post-surgical complications, even well after the operation.

A single dose of a corticosteroid, given along with antibiotics, can relieve severe sore throat pain faster and more effectively than antibiotics alone, a new study suggests.

“In people with severe sore throat, a single dose of an oral steroid is effective in relieving pain in 24 and 48 hours,” said researcher Dr. Carl Heneghan, the deputy director of the Centre for Evidence-Based Medicine at the University of Oxford in the U.K.

This treatment is not advised for a mild sore throat, which will go away by itself, Heneghan stressed.

“If you turn up at your emergency department and you have really bad tonsillitis and you are in a lot of pain, an additional treatment is to take a single dose of a corticosteroid,” he explained.

The report is published in the Aug. 7 online edition of BMJ.

Corticosteroids relieve pain by reducing inflammation and are commonly prescribed for conditions such as asthma and croup. Their use as a pain reliever for sore throat could help reduce the need for antibiotics, which can be overused and help create resistant bacteria, the U.K. researchers say.

For the study, Heneghan’s group analyzed eight trials comparing the effectiveness of corticosteroids to placebo in adults or children with severe sore throats. In total, the studies included 743 patients, 369 of whom were children.

The researchers found that patients given corticosteroids plus antibiotics were three times more likely to report having no pain 24 hours after treatment compared with patients given antibiotics and a placebo.

After two days this effect was less apparent, which suggests that a single dose of corticosteroids is all that is needed, according to the researchers. In addition, corticosteroids also reduced the time it took to relieve pain by about six hours.

Heneghan’s team noted that significant pain relief was only observed in adult patients and not in children receiving corticosteroids.

In addition, other painkillers made no difference in the results, the researchers found.

“What we don’t know is: do corticosteroids replace antibiotics?” Heneghan stated. “That’s another piece of research we would like to do,” he said.

Dr. Julie Wei, an assistant professor of otolaryngology at the University of Kansas Medical Center, agreed that steroids work well in relieving severe sore throat pain, but she cautioned that they are not a substitute for antibiotics, which treat the infection, not the pain.

“The use of steroid should never be for the purpose of replacing antibiotics,” Wei said. “Based on the current information, that is not the conclusion people should have.”

Single-dose steroid use is already a common practice, Wei said. “For example, all my pediatric patients undergoing tonsillectomy and adenoidectomy get a single dose intravenously at the time of surgery, because steroids are the most potent anti-nausea, anti-vomiting medication we have,” she said.

Single-dose steroids also help improve eating and drinking, and feeling good, Wei said. “Also, people in the emergency room or children admitted for throat abscess usually get a single dose of steroids if they are having severe pain or difficulty opening their mouth due to inflammation. We ENTs already recommend that commonly,” she added.

“The bottom line is, it is already commonly used in anesthesia, ER setting, etc., but does not replace antibiotics,” Wei said.

Hispanic whites seeking emergency treatment for gastrointestinal (GI) illnesses wait twice as long to see a doctor compared to non-Hispanic whites, new research shows.

The most likely explanation for this “striking” disparity is that Hispanic patients may have difficulty communicating to hospital staff, and require help from translators, Dr. Bechien Wu of Brigham and Women’s Hospital in Boston, who was involved in the study, told Reuters Health. Based on what he’s seen at his hospital, Wu added, “patients who rely upon those services are really apt to have more delay in their assessment.”

It’s crucial for patients with severe belly pain to see a doctor quickly, Wu said, because this pain may signal a life-threatening condition like stomach hemorrhage or a ruptured appendix.

Wu and his team looked at whether ER crowding influenced how quickly patients with stomach problems were seen by a physician by using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 1997 to 2006.

Their analysis included 1.6 million ER visits for acute inflammation of the pancreas, 2.2 million for appendicitis, 1.2 million for gall bladder inflammation, and 3.9 million for upper gastrointestinal tract hemorrhage.

Patients experienced a delay in seeing a physician 24% of the time, the researchers found. Delays were more common for non-Hispanic whites in each of the four diagnostic categories; for example, non-Hispanic whites with appendicitis waited 43.5 minutes to see a doctor, on average, compared to 91.2 minutes for Hispanic whites, while the waiting time for gastrointestinal hemorrhage was 46 minutes for non-Hispanic whites and 73.7 for Hispanic whites.

The NHAMCS data didn’t include information on what languages people spoke, Wu and his team point out, but “a major delay in physician assessment and ultimately treatment can occur while waiting for a language interpreter in a busy emergency ward,” they point out in a report in the American Journal of Gastroenterology.

The findings are particularly concerning, Wu noted, given that Hispanics are by far the fastest-growing segment of the US population.

The findings could also signal more widespread problems with health care access. “If there’s a particular segment of the population that’s having to wait longer across the board this could be just the tip of the iceberg in terms of their interaction with the overall health care system.”

Employing bilingual “patient navigators” — health care workers who guide patients through the system — is one way to tackle the problem, Wu said. “Most emergency departments already have interpreter services. I think it’s a question of how we can better utilize those interpreter services.”

And making things work better at the front end of the system could be an important way to improve health care quality, he added. “The point of first contact is so critical for getting our patients into the system and managed appropriately.”

But the erection didn’t dissipate and soon became painful. By Monday morning, Howard still had the erection and it had become more painful, so he visited the clinic. The clinic’s staff removed blood from his penis in attempt to provide relief, but that procedure did not work. Howard was sent to Piedmont Hospital’s emergency room. Howard eventually learned that the clinic’s medicine had caused fibrosis and scar tissue to form.

As a result of the fibrosis, Howard is now unable to have a normal erection. He can have an erection after using Viagra, although it is not a “complete” erection, Orr said.

Each side relied on one key expert witness during trial, Orr said. Orr’s witness was J. Francois Eid, a New York-based urologist who specializes in prosthetic reconstruction. The defense called Neal Shore, a Myrtle Beach, S.C.-based urologist.

Orr said that, during his cross-examination of Shore, he asked the urologist to identify the first line of treatment for erectile dysfunction. After Shore responded that injections were the first line of treatment, Orr presented Shore with a copy of a page from the Web site of Shore’s clinic that said oral medications like Viagra are the first line of treatment. Orr also said he had printed the page the previous night from the Web site of Shore’s clinic.

The clinic’s attorneys said that Howard waited too long — more than 36 hours — after he self-administered the first injection and first experienced pain before he sought help from the clinic’s staff. “The main argument I tried to make during closings is that there was a substantial delay in seeking assistance,” said Herman, counsel to Boston Men’s Health Center. “Had medical assistance been sought sooner, it was more likely than not that the damage would have been avoided.”

Herman also said that while he respected the jury’s decision, he was “very disappointed” that the jury found that fraud was committed, and “particularly with respect to the amount of punitive damages they assessed.” Hawkins & Parnell partner Assunta S. Fiorini was co-counsel with Herman on the case.

The other named defendants, Boston Medical Group-Georgia Inc. and physician William Powell, settled before and during the trial. Terms of the settlements were not disclosed. Boston Medical Group-Georgia is the Georgia-based subsidiary of Boston Men’s Health Center.

Hall Booth Smith & Slover partner Jack G. Slover Jr., co-counsel to Boston Medical Group-Georgia, declined comment on the settlement.

A new laboratory test can help predict if a person admitted to an intensive care unit is at risk for acute kidney injury, a frequent complication in ICUs, according to a new study.

Many patients admitted to the ICU have some evidence of acute kidney injury, most often a change in their urine output or in the chemical composition of their urine. Unfortunately, not much is known about the syndrome.

But this new test, called urine neutrophil gelatinase-associated lipocalin (NGAL), can determine if critically ill adults are at an elevated risk of developing acute kidney injury, according to a study to be published in an upcoming issue of the Journal of the American Society of Nephrology.

Patients with higher levels of NGAL in their urine were more likely to develop acute kidney injury, even after adjustments for other factors were made, according to researchers at Columbia University in New York City.

Another study in the journal showed the promise of this new test, as urine NGAL can help diagnose HIV-related kidney disease in African-Americans and black Africans.

Levels of urine NGAL were significantly higher in patients with HIV-associated nephropathy (HIVAN) than in patients with other forms of kidney disease, regardless of whether they had HIV or not, the researchers found.

HIVAN is the leading cause of chronic kidney disease in HIV patients, and 95 percent of the people affected are of African descent, according to background information in a news release from the American Society of Nephrology.

Studies in mice suggested that NGAL may even have a role in the development of tubular diseases and microcysts, which are HIVAN features.

“NGAL was very specifically expressed in renal cysts — generating the new idea that NGAL may control the development of cysts in HIV-associated nephropathy,” Dr. Jonathan Barasch of Columbia said in the news release. He noted that he and Dr. Prasad Devarajan identified NGAL in the kidney 10 years ago. “Its translation into a clinical entity in such a short time is quite a story. Almost every paper is positive for the association of NGAL and renal dysfunction/disease,” he said.

Dr. T. Alp Ikizler of Vanderbilt University in Nashville, Tenn., commented on NGAL’s effectivenss: “As a standalone marker, urine NGAL performed moderately well in predicting ongoing and subsequent acute kidney injury,” he stated in the news release.