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HEALTH & SCIENCE

News in brief - May 12, 2008

Heart tests urged for kids with ADHD - FDA OKs new drug for Crohn's - Number of pregnant women with preexisting diabetes increases - C. diff among hospitalized patients becomes more common - Hirsute women should have androgen levels measured

Heart tests urged for kids with ADHD

Children with attention-deficit/hyperactivity disorder should receive a careful cardiac evaluation and monitoring -- including an electrocardiogram -- before starting treatment with stimulant drugs, according to a new recommendation from the American Heart Assn.

The scientific statement on "Cardiovascular Monitoring of Children and Adolescents with Heart Disease Receiving Stimulant Drugs" was published online April 21 in Circulation: Journal of the American Heart Assn. Warnings from the Food and Drug Administration about stimulant medications and public concern for their safe use prompted the statement, the heart association said.

Studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure. Although these side effects are insignificant for most children with ADHD, they are an important consideration for those who have a heart condition, according to the new statement.

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FDA OKs new drug for Crohn's

The Food and Drug Administration April 22 approved a new drug to treat adults with moderate to severe Crohn's disease who have not responded to conventional therapy.

Patients treated with the new drug, Cimzia, will receive one injection every two weeks for the first three injections. Once benefit has been established, Cimzia should then be given once every four weeks, according to the FDA. The drug, which will be accompanied by a medication guide, can affect the immune system and place patients at risk for serious infections.

Crohn's disease, a chronic, inflammatory bowel disease, affects more than 1 million men and women worldwide. It has no cure and its cause is unknown.

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Number of pregnant women with preexisting diabetes increases

The rate of diabetes before pregnancy has more than doubled, but numbers for the gestational form of this disease are stable, according to a paper published online in this month's Diabetes Care.

Researchers analyzed data on 175,249 women ages 13-58 who gave birth at a Kaiser Permanente hospital in Southern California from 1999 to 2005. The rate of preexisting diabetes increased from 0.81 per hundred pregnancies in 1999 to 1.82 per hundred in 2005. Increases were noted in all age groups and racial or ethnic categories, but gestational diabetes hovered around 7.5 per hundred.

The authors are concerned about this phenomenon because diabetes increases the risks associated with pregnancy. "More young women are entering their reproductive years with diabetes, in part due to the fact that our society has become more overweight and obese," said Jean M. Lawrence, ScD, MPH, lead author and a research scientist with Kaiser Permanente's Dept. of Research and Evaluation in Pasadena, Calif. "While we currently don't know how to prevent type 1 diabetes, the steps to reducing risk of type 2 diabetes must start before childbearing years."

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C. diff among hospitalized patients becomes more common

The number of patients in hospital with a diagnosis of Clostridium difficile increased dramatically from 2001 to 2005, according to a report issued by the Agency for Healthcare Research and Quality in April.

The authors culled data from the Nationwide Inpatient Sample, finding that the number of hospitalized patients with this infection increased by 102% from 2001 to 2005 but only 74% from 1993 to 2001. The infection was associated with a tripling of the length of a hospital stay and raising the death rate 4.5 times.

It's unclear whether the infections were acquired in or out of the hospital setting, but the authors note that this is an important public health problem.

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Hirsute women should have androgen levels measured

Women with male pattern hair growth should have their androgen assessed, and oral contraceptives are appropriate treatment for the majority. If a patient is not satisfied with the results of that strategy, an antiandrogen can be added after six months, and lasers are recommended for hair removal, according to an Endocrine Society clinical practice guideline published last month in the Journal of Clinical Endocrinology & Metabolism.

"Hirsutism is a potential indication of an underlying medical disorder that may require specific treatment, and such a disorder may have implications for menstrual function, fertility and metabolic risks," said Kathryn Martin, MD, lead author and co-director of the reproductive endocrine unit at Massachusetts General Hospital in Boston.

The guidelines recommended against using an antiandrogen alone because of risks to male fetuses if the patient becomes pregnant. Evidence also is lacking to support the use of insulin-lowering drugs, which can have significant side effects.

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Copyright 2008 American Medical Association. All rights reserved.