Drug will save lives of accident victims, says study
Up to 100,000 lives could be saved every year if a known drug were given to seriously bleeding trauma patients, says a report from a global trial.
The research reported in The Lancet shows that tranexamic acid (TXA), which helps blood to clot, could lower the risk of dying by 15%.
Developing countries would benefit most from this treatment, say researchers after studying 20,000 patients.
Each year 600,000 injured patients bleed to death worldwide.
World Health Organisation figures show that nearly six million people die each year from injuries, which accounts for 10% of the world’s deaths.
Most of those injury deaths occur in developing countries, where deaths from road traffic crashes and homicide have been steadily increasing. Almost half of those deaths are caused by bleeding.
Although previous smaller trials had shown that TXA reduced bleeding in patients undergoing major surgery, this was the first trial to test its effect on injured patients with severe bleeding.
Early treatment with TXA could combat the effects of serious bleeding
These included victims of traffic accidents, shootings, stabbings or land mine injuries.
The patients were injected with 1g of TXA within a few hours of being injured, followed by another 1g in a drip over the next eight hours, or a matching placebo.
After studying the numbers of deaths in hospital within four weeks of injury, researchers found that TXA reduced the chances of death, due to massive blood loss, by one sixth.
Ian Roberts, professor of epidemiology from the London School of Hygiene and Tropical Medicine, led the CRASH-2 international trial. He said it showed a “highly significant reduction in risk of dying”.
“The large number of patients treated in very different healthcare settings around the world means we can be sure that prompt use of TXA will be of benefit to trauma patients in all kinds of facilities,” he said.
The trial also showed no evidence of complications or unwanted clotting, which doctors had feared.
Researchers estimate that TXA could prevent up to 100,000 deaths every year across the world. In countries like India and China it could save about 12,000 lives each year, they predict.
Two thousand deaths a year could be saved in the United States and more in Europe. In the UK, where about 1,800 people die from bleeding after injury each year, researchers say TXA could cut this figure by about 280.
Addressing the practicalities of making the drug available worldwide, Professor Roberts said: “TXA is one of the cheapest ways to save a life there is”.
The poverty problemTXA costs about £3 per gram; it is easily administered and does not need to be refrigerated, he says. It can also be manufactured by a number of different companies.
The authors of the trial report recommend that tranexamic acid, should be available to doctors treating trauma patients in all countries, and should be considered for inclusion on the WHO List of Essential Medicines.
Dr Etienne Krug, director of violence and injury prevention and disability at the World Health Organisation, said that doctors needed to be aware of the trial results.
“We want to avoid injuries happening in the first place but we also need to strengthen the trauma response. Death and serious injury throw families into poverty, so the problem affects hundreds of millions every year worldwide.”
The trial was jointly funded by the National Institute for Health Research, part of the Department of Health, the drug company Pfizer, the BUPA Foundation and the JP Moulton Charitable Foundation.
UK health minister Earl Howe said: “This is a great example of how important research can help the NHS save more lives and spread best practice around the world.”
Reference Link: http://news.bbc.co.uk/2/hi/health/10311371.stm
Courtesy : BBC News
Teen brain wired to take risks
Teenagers do crazy things, and the chemistry of their brains might explain why, say researchers.
The adolescent brain is extra sensitive to reward signals when pay-off for a risk is higher than expected, say cognitive neuroscientist Dr Russell Poldrack, from the University of Texas, Austin and colleagues.
They say the discovery might help explain why teens take risks that don’t seem worth it to adults – from driving too fast to experimenting with drugs.
“Teenagers seek out these sorts of rewarding experiences, and this provides a little explanation for that,” says Poldrack, whose research is published in this week’s Nature Neurosciece.
“In the long run, it may help us understand how addictions start and develop.”
Prediction error
To zero in on the neuroscience behind risk-taking behaviour in adolescents, Poldrack and colleagues focused on a concept called prediction error, which describes the difference between what a person expects to happen and what actually happens.
If you anticipate a rich sip of full-bodied espresso, for example, but you end up gulping weak, watery, and burnt coffee, that’s a negative prediction error.
If you expect nothing from a friend for your birthday but he gives you $20, that’s a positive error – far better than expected.
To test the brain’s reaction to positive prediction errors at different stages of life, the scientists enlisted 45 people, ranging in age from 8 to 30.
Each participant was shown a series of abstract kaleidoscopic images and challenged to categorise the figures as logos belonging to one of two fictional colleges.
When they got an answer right, participants earned a small amount of money and they all gradually learned which logos went with which colleges and which ones were worth more than others.
There were a few twists, though: Sometimes, an answer that should’ve been correct was judged as wrong.
Sometimes, a wrong answer was rewarded as a correct one. And sometimes, the reward was larger or smaller than the exercise indicated it should be.
With a mathematical model, the researchers were able to determine how much money each person expected to get with each answer and compare that with what they actually received. At the same time, fMRI’s showed what was happening in the brain.
Dopamine release
Previous research has shown a surge of activity in a brain region called the ventral striatum when reality exceeds a person’s expectations.
In the new study, the region’s response was highest in participants between 14 and 19 years old when they received more money than anticipated.
Brain activity in the ventral striatum is related to the release of dopamine, a nerve-signalling molecule that helps the brain process rewards and can be involved in addictions.
With more dopamine flowing, a teenager is likely to feel that a risky behaviour – when it ends well – is so much more rewarding than it might seem to a child or adult.
So, for example, the social rewards of staying out past curfew might outweigh the likelihood of getting in trouble for an adolescent.
And the physical pleasure of getting drunk might outweigh the dangers, including the next day’s hangover.
Besides providing insight into how addictions might begin in adolescence, the new study might help parents channel their teens into more positive risk-taking activities, like playing sports or acting in school plays, suggests Dr Adriana Galvan, a developmental cognitive neuroscientist at the University of California, Los Angeles.
“Adolescents are uniquely sensitive to the uncertainty in the world,” says Galvan. “Perhaps their willingness to engage in uncertainty is driven by the potential rewards that might result from that uncertainty. For them, the rewards loom so much bigger than the potential negatives.”
Reference Link
http://www.abc.net.au/science/articles/2010/05/18/2902619.htm?site=science&topic=latest
Courtesy
ABC
Donating a kidney doesn’t boost risk of premature death
Live kidney donation is a safe, effective procedure that poses little risk for the premature death of the donor, reports a new study in the Journal of the American Medical Association. That’s welcome news to the more than 106,000 people on the United Network for Organ Sharing (UNOS) transplant list who are waiting on potential donors as of this writing.
The JAMA study is the first of its kind to review the health of live kidney donors over an extended period of time. Researchers looked through more than 80,000 records of people who had donated a kidney between 1994 and 2001. They found that for every 10,000 donors, there were only 3.1 deaths within 90 days of the transplant. Being over age 50 or obese at the time of the transplant did not increase a donor’s risk of dying prematurely.
“Kidney donation surgery is an extraordinarily safe operation in terms of…risk of death, the most serious surgical complication,” explains Dr. Martin Zand, medical director of the Kidney and Pancreas Transplant Programs at the University of Rochester Medical Center.
Zand says that recipients worrying about potential kidney donors’ health has become major point of concern during the transplant process, even though the number of live kidney transplants performed annually has nearly doubled over the past 15 years. Today nearly 6,000 live kidney transplants happen every year.
“By donating a kidney, they’re concerned their donor will put themselves at risk for everything from minor surgery to development of kidney disease to death,” says Zand. “These donors are family members or partners but also people that come forward from the community.”
The hope within the transplant community is that this information will ease some of the concerns expressed by both potential donors and their recipients, particularly because no other research has followed so many live kidney donors for so long.
Generally donors must complete an education process that outlines the risks associated with transplants, before they can donate a kidney. The goal is to make sure each donor is as informed as possible about the surgery they’ve elected to have.
“There’s an enormous value to this, in terms of public health, in terms of medical practice, ” says Zand.
Reference Link
http://pagingdrgupta.blogs.cnn.com/2010/03/09/study-donating-a-kidney-doesn%E2%80%99t-boost-risk-of-premature-death/?hpt=Sbin
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