Flu shots recommended for pregnant and postpartum women
Posted by on October 11, 2013 - 4:15pm

Because of the increased risk for serious illness and complications from influenza, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive the IIV vaccine. This vaccination can be administered at any time during pregnancy, before and during the influenza season.3

There are two types of flu vaccine:
  • IIV or Inactivated flu vaccine:  It does not contain any live influence virus and is given by needle injection (flu shot).
  • LAIV or Live attenuated (weakened) influenza vaccine:  This is given as a nasal spray.

LAIV is not recommended for pregnant women. Postpartum women can receive either LAIV or IIV. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV. Both live attenuated and inactivated vaccines are typically trivalent. That is, they contain material from three different influenza virus strains recommended by national and international public health agencies[3][4] as most likely to be protective against seasonal influenza in any given year.

HER2 Testing Guide Clarifies Rules
Posted by on October 9, 2013 - 1:31pm

A recent article in the Journal of Clinical Oncology recommends to oncologists that all patients with invasive breast cancer, including recurrent disease, should be tested for HER 2 status and these tests should adhere to specific criteria to define positive, equivocal, and negative results.

The American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) have released updated recommendations for HER2 testing in breast cancer. The new guideline endorses HER2 testing for every primary, recurrent, and metastatic tumor. Additionally, the report advocates retesting in patients who previously tested HER2-negative but demonstrate clinical behavior suggestive of HER2-positive or triple-negative disease at the time of recurrence.

HER2 is a protein involved in normal cell growth. It is  found on some types of cancer cells, including breast and ovarian. Cancer   cells removed from the body may be tested for the presence of HER2/neu to   help decide the best type of treatment. HER2/neu stands for human epidermal   growth factor receptor 2. The accurate identification of patients with  HER2-positive breast cancer remains an area of high interest, since   HER2-targeted therapies can substantially improve their survival.

The first test ideally should be performed on a core biopsy specimen from a patient with newly diagnosed breast cancer. If there is discordance, a section of the tumor from the excisional specimen should be tested. If this test is negative and concerns remain, the updated guideline recommends retesting in a different block from the patient’s tumor. If all three tests are negative, no additional testing is recommended

This is an update of guidelines previously published in 2007. The update does not represent a dramatic overhaul but instead clarifies test criteria, definitions, and processes, said Eric Weiner, MD, a breast cancer specialist in the Susan F Smith Center for Women’s Cancers at Dana Farber Cancer Institute.  “What this guideline states is that if more than 10% of the tumor meets the criteria for HER2 positivity, than it is called HER2 positive.”

Primary Source: Journal of Clinical Oncology

 

New Device Effective in Reducing HIV
Posted by on October 9, 2013 - 9:44am

It’s often said that the HIV/AIDS epidemic has a woman’s face. The proportion of women infected with HIV has been on the rise for a decade; in sub-Saharan Africa, women constitute 60 percent of people living with the disease. While preventative drugs exist, they have often proven ineffective, especially in light of financial and cultural barriers in developing nations.

A new intravaginal ring filled with an anti-retroviral drug could help. Developed with support from the National Institute of Allergy and Infectious Diseases by Northwestern University visiting associate professor Patrick Kiser, PhD, the ring is easy to use, long lasting and recently demonstrated a 100 percent success rate protecting primates from the simian human immunodeficiency virus (SHIV). The device will soon undergo its first test in humans.

“After 10 years of work, we have created an intravaginal ring that can prevent against multiple HIV exposures over an extended period of time, with consistent prevention levels throughout the menstrual cycle,” said Kiser, an expert in intravaginal drug delivery who joined Northwestern from the University of Utah, where the research was conducted.

The research was published Sept. 16 in the Proceedings of the National Academy of Sciences (PNAS).

Previous studies have demonstrated that antiviral drugs can prevent HIV infection, but existing methods for delivering the drug fall short. Pills must be taken daily and require high doses; vaginal gels that must be applied prior to each sex act are inconvenient, yielding poor usage rates. The new ring is easily inserted and stays in place for 30 days. And because the drug is delivered at the site of transmission, the ring -- known as a TDF-IVR (tenofovir disoproxil fumarate intravaginal ring) -- utilizes a smaller dose than pills.

The upcoming clinical trial, to be conducted in November at Albert Einstein College of Medicine in New York, will evaluate Kiser’s ring in 30 women over 14 days. The trial will assess the ring’s safety and measure how much of the drug is released and the properties of the ring after use.

The paper is titled “Intravaginal Ring Eluting Tenofovir Disoproxil Fumarate Completely Protects Macaques from Multiple Vaginal Simian-HIV Challenges.”

Source:  Megan Fellman on Oct 03, 2013

Northwestern University Feinberg School of Medicine

Yoga for Menopause
Posted by on October 6, 2013 - 2:14pm

Hormone replacement therapy is one of the most well-evidenced and regulatory-approved treatment options for menopause, but what about natural alternatives?

Many women turn to yoga to treat menopause symptoms, but new research has shown its benefits are limited. A randomized control study, published in the journal Menopause, assigned 107 healthy menopausal women to fulfill 12 weeks of 90-minute yoga classes, 106 women to do exercise, 142 women to go about their usual activity. The study also assigned 177 women to take omega-3 fatty acids, and 178 women formed the placebo group. All participants were asked to keep daily diaries and keep track of the menopausal symptoms of hot flashes and night sweats. At the end of the trial, researchers discovered no statistically significant difference in the frequency of menopausal symptoms; hot flashes and night sweats declined at similar amounts amongst women who did yoga and women went about their usual daily activity.

Yoga still has its benefits, however. Researchers did find that yoga was linked to a decrease in insomnia and better quality sleep, compared with usual activity. This suggests that yoga may be a possible intervention for the insomnia felt by many women undergoing menopause.

The study authors did not identify a link between the omega-3 fatty acids and improvements in menopausal symptoms, and exercise was linked with slight improvement, but not statistically significant, for insomnia and depression. To learn more about lifestyle and alternative treatments for menopause, visit our Northwestern menopause website here.

Low-Income Women and Children Feel Ramifications of Government Shutdown
Posted by on October 1, 2013 - 2:52pm

The news of the government shutdown has by now reached everyone’s ears and has sparked questions and concerns about the state of our nation. While several groups are directly affected in this stalemate, special attention must be drawn to the 9 million low-income women and children who may be adversely affected around the country.  These women and children rely on the government for food assistance through the “Special Supplemental Nutrition Program for Women, Infants, and Children,” known colloquially as the Women and Infant Children Program (WIC).  Douglas Greenaway, president and CEO of the National WIC Association, said that the state programs that serve this population may run out of money as early as next week, while others may be able to stay afloat until the end of the month.  The WIC clinics are funded by the U.S. Department of Agriculture, so when Congress fails to approve funding, it leaves WIC clinics, and the women and children they serve, in the lurch.  Since WIC programs are run by states through grants from the federal government, it is unclear which states will be hit harder than others.

Only women and young children who have acute nutritional deficits qualify for the WIC program.  They are given food benefits that average a meager $45 a month with benefits including vouchers to purchase whole grains, fruits and vegetables, fish, dairy and dairy substitutes, and infant formula.  The program also provides health care referrals and nutrition education for low-income pregnant women, new mothers, and children up to age five.  The WIC serves 53% of all infants born in the United States.  Every little bit helps these women and children who struggle to make ends meet in the lowest socio-economic quartile, and the uncertainties of the stability of the WIC program during the shutdown is an immense stress.

With Congress and the nation focused on larger, hot button issues, it’s easy for smaller programs like the WIC to fall through the cracks.  It’s equally important, however, to understand the ramifications of the government shutdown in order to truly grasp the magnitude of this event.

To learn about our local Chicago WIC clinic, click here.

Sources: CBS News and NPR

Treating Vulvavaginal Atrophy
Posted by on September 22, 2013 - 5:18pm

Menopause is known for its hot flashes, the sweats, weight gain, and mood changes. But what about vaginal dryness?

Vulvovaginal atrophy commonly occurs during menopause, and its symptoms include irritated tissue, lack of lubrication, pain with urination, and pain with intercourse. These symptoms of vulvovaginal atrophy occur in as many as 45% of post-menopausal women. And yet, the majority of post-menopausal women feel uncomfortable discussing their symptoms with their healthcare providers.

Vulvovaginal atrophy significantly affects many women, altering their relationships and quality of life. In recognition of this, the North

American Menopause Society issued an update to their position statement on vulvovaginal atrophy from 2007. The original statement was limited to just vaginal estrogen, but the recent update addresses the multitude of therapies currently available for vulvovaginal atrophy. The treatment available for vulvovaginal therapy ranges from over-the-counter products to prescriptions.

First-line therapy for vaginal dryness symptoms includes simple vaginal lubricants and moisturizers, along with regular intercourse.

When patients are refractory to this first-line treatment, locally applied estrogen or systemic therapy is recommended. Ospemifene, a selective estrogen receptor modulator, is recently approved for moderate to severe pain during intercourse. If a woman is a survivor of breast or endometrial cancer, her choice of treatment for vulvovaginal atrophy should depend on a consultation with her oncologist and understanding of her needs and potential risks.

Ultimately, vulvovaginal atrophy commonly occurs among post-menopausal women in varied presentation, and women should not be afraid to discuss their symptoms with their healthcare providers. Clinicians should understand their patients' preferences and needs, and they should be equipped to target these issues with one of the many therapies that currently exists.

Syrian health system in crisis
Posted by on September 17, 2013 - 9:04am

A group of more than 50 physicians and other healthcare professionals have signed an open letter calling on all parties involved in the Syrian conflict to stop targeting medical facilities and to permit medical care to continue without interference. In the letter, published online in the Lancet, the writers noted that 15,000 doctors have fled the country and 37% of the country's hospitals have been destroyed, and that many areas of the country are completely without any health care.

Source:  Medpage Today

Unintended pregnancy in the US higher than other developed countries
Posted by on September 17, 2013 - 8:53am

The Guttmacher Institute, a non-profit organization that works to advance reproductive health, released a report in September on the state of unintended pregnancy in the United States. The organization estimates that currently, around 49% of all pregnancies in the U.S. are unintended. This is higher than the rate of unintended pregnancy in many other developed countries. For this study, an unintended pregnancy is considered a pregnancy that is either mistimed or unwanted.

While the rate of unintended pregnancy has remained more or less stable in the U.S. between 2001 and 2006, it has increased substantially among poor and low-income women while decreasing in higher-income populations. Between 1994 and 2006, the rate of unintended pregnancy in women whose income fell below the federal poverty line increased by 50%, while decreasing for women whose income was at 200% or more above the poverty line by 29%.

The report points out that access to and use of contraception has a significant impact on unintended pregnancy. Two-thirds of women that are at risk for an unintended pregnancy use contraception correctly and consistently. These women make up only 5% of all unintended pregnancies. 19% of at-risk women use contraception incorrectly or inconsistently, and account for 43% of unintended pregnancies, while 52% of unintended pregnancies come from from the 16% of at-risk women who do not use contraception at all for at least a month during the year.

While unintended pregnancies can cause hardships for the women and families they affect, they are also a public health issue. Research shows that unintended and closely spaced pregnancies are associated with negative health outcomes for both mothers and babies. For this reason, the U.S. Department of Health and Human Services has incorporated unintended pregnancy into their Healthy People 2020 campaign, and will attempt to reduce the rate of unintended pregnancy to 44% by 2020.

For more information and statistics, click the source link below.

Source: "Facts on Unintended Pregnancy in the United States." Guttmacher Institute. September 2013.

The Science of Sequestration
Posted by on September 13, 2013 - 3:22pm

Last Tuesday’s New York Times article painted an unpleasant picture of the state of scientific research due to cutbacks with the sequestration. The $1 trillion in budget cuts have significantly slowed research momentum, which could lead to major setbacks in the health world. Dr. Francis Collins, director of the National Institutes of Health, described 2013 as the “darkest” year to date for the agency, whose budget is suffering and distributing smaller numbers of grants than ever. What is most dangerous about these grant cutbacks is that researchers are forced to “tread water” rather than focus their energies exploring new and bold ideas, and “science is very badly served by that tread-water message.”

Stagnation in the scientific world is essentially a death sentence for innovative breakthroughs, discoveries that could lead to the emergence of new cures. Director of the Center for Computational Biology at Johns Hopkins University, Steven Salzberg, laments the loss of science by arguing that shorter grant cycles force scientist to not only scramble to obtain results more quickly, but also compels them to spend more time bogged down with paperwork than actually engaging in laboratory work. Regrettably these significant changes to the research landscape discourage younger scientists from persisting in this field.

Dr. Teresa Woodruff shares similar viewpoints to her collegiate colleagues by stating that the sequestration is about “more than red tape and bureaucracy,” it’s about threatening the lives of patients counting on innovations made through research. In her published opinion letter responding to this article, Dr. Woodruff lists diabetes, cancer, infertility, osteoporosis, hypertension, and thyroid conditions as just a handful of the ailments whose research is being hindered by the government’s cutbacks. Dr. Woodruff stresses that, “when laboratories lose financing, they lose people, ideas, innovations, and patient treatments.” Until government leaders prioritize biomedical research, the potential for fresh ideas, innovations, and cures to come to fruition will continue to diminish.

Male and female cells can behave differently!
Posted by on September 11, 2013 - 3:39pm

Even at the most basic molecular level sex matters---and it's not just about hormones.   Did you know that muscle stem cells from female mice regenerate new muscle faster than cells from male mice?  And cells from male and female mice respond to stress differently.  Yet most researchers who use basic cell cultures in their work do not even identify the sex of the cells they use.

We already know that this lack of sex identification can have serious consequences when we study new therapeutics.   Most adverse drug effects reported occur in female humans!  Since most basic drug studies start with cell cultures, shouldn't we be comparing the two sets of cells at the start of the "experiment" before it reaches humans???  It certainly would be cheaper and may prevent serious consequences once the drug is used in humans!

At first, it is easy to blame hormones for the differences but researchers have found that hormones may not always  be the culprit.  The way a cell metabolizes its food (energy) may be different by sex and other biologic functions could be affected by sex.  A recent commentary by Elizabeth Pollitzer explores this issue and makes a plea for researchers to include the sex in their publications on all studies--cellular, animal and human.

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