PDSA E-News: June 27, 2017

 


 


ITP & PLATELET DISORDERS RESEARCH & TREATMENTS


H. Pylori Eradication in Chronic ITP Patients Improved Platelet Counts

H Pylori drawingA recent study found about 40% of ITP cases are caused by infection with the gram-negative bacteria Helicobacter pylori. Infection with H. pylori bacteria has been associated with many autoimmune diseases, including ITP. Eradicating H. pylori infection has been found effective in treating some other diseases but there are conflicting reports about how effective it is in raising platelet counts in ITP patients. In the study, researchers analyzed bone marrow and stool samples of 85 ITP patients (32 male, 53 female) for evidence of H. pylori infection. They also investigated how effective eradicating the infection was in raising patients’ platelet levels. Patients with H. pylori infection took two antibiotics (amoxicillin and clarithromycin) and a proton pump inhibitor, twice daily for two weeks.

Results showed that in ITP patients infected with H. pylori platelet counts nearly doubled (from 48.56 million/µL to 94.2 million/µL). Among 34 infected patients, 19 (55.8%) had a complete response and 10 (29.9%) achieved a partial response. Only 5 (14.7%) showed no response. The researchers concluded that “40% of the local chronic ITP patients are H. pylori infected.” They said eradication of the infection in these patients significantly improved platelet levels. To gain more insight into the prevalence of H. pylori and duration of remission after treatment the researchers called for larger studies with longer follow up time.

Sheema K, Ikrumdin U, Arshi N, et al. “Role of Helicobacter pylori eradication therapy on platelet recovery in chronic immune thrombocytopenic purpura.” [published online January 17, 2017] Gastroenterol Res Pract. Doi: 10.1155/2017/9529752.
http://bit.ly/2tbziYW

 


Interleukin-11 Combined with Steroids is Effective New ITP Therapy

Drawing of platelets in bloodRecombinant human interleukin 11 (IL-11) administered to adult ITP patients with steroids has been proven to be a safe, effective treatment according to researchers in Shandong, China. IL-11 is a protein that triggers activation of CD34+ cells into megakaryocytes, which produce and promote platelet growth. Glucocorticoids, or steroids such as prednisone, dexamethasone, and prednisolone, are a common first-line therapy for ITP that work to minimize rate of platelet destruction by suppressing antibody production and reducing immune function.

The researchers of the study, which was published in the journal Experimental and Therapeutic Medicine, enrolled 80 adult ITP patients. Half of the participants received standard doses of steroids only; the other half were administered steroids and recombinant human IL-11. Patients who received the combination therapy took less time to elevate their platelet counts after initial treatment, increased platelet recovery, and decreased the amount of circulating platelet antibody, which attacks platelets in the immune system. These patients also required a shorter treatment course, had a lower rate of relapse, and were observed to have a decreased percentage of regulatory immune T cells in comparison to the group that received steroids only. Further observation is required to determine the effects of long-term combination therapy; however, short-term use of IL-11 with steroids has for now been proven to be safe and effective, providing a new treatment option for adult ITP patients.

Garbutt, T. “IL-11 Plus Glucocorticoids Safe, Effective for ITP in Adults.” Oncology Nurse Advisor. 5/25/2017.
http://bit.ly/2rnquNC

Wu X, Wang L, Sun L, et al. “Analysis of clinical effects and mechanism of recombinant human interleukin-11 with glucocorticoids for treatment of idiopathic thrombocytopenic purpura.” Experimental and Therapeutic Medicine. Feb. 2017.
http://bit.ly/2su28Gv

 


HOSPITALS, INSURANCE & HEALTH CARE


Be an Informed Patient: Two Cleveland Clinic Doctors Share Tips

Doctor with patientRegardless of physician specialty, doctors often treat patients with a variety of different medications and enroll them in a number of clinical trials. Physicians almost always explain potential side effects of the therapies and are obligated to give you an “informed consent” form to affix your signature, but do all patients always understand all of the risks associated with each new treatment? Of course, you trust your doctor, knowing he or she will do what is best for your health, and will do the worrying for you. And of course, that is what they will do. However, it’s important to recognize the role you as a patient can play in your own health journey in order to be fully informed while receiving treatment or participating in clinical trials.

Dr. Mikkael Sekeres, director of the Cleveland Clinic leukemia program, and Dr. Timothy Gilligan, director of coaching, Center of Excellence in Healthcare Communication at the Cleveland Clinic, share what you can do to help your doctors better inform you about your healthcare:

  1. Use common words and terms. Ask, “Can you explain what that means?” if you don’t know the meaning of a complex medical term.
  2. Summarize what your doctor explained; that way if you misunderstood something your doctor can re-explain.
  3. Request hard copies of written materials, or videos and pictures to take home with you.
  4. Ask for best-case and worst-case scenarios, along with the likelihood that they both occur.
  5. Ask to talk to another patient who has undergone the treatment to ask for their perspective.
  6. Explore other treatment options and come to your consults knowing the advantages and disadvantages for each.
  7. Take notes and bring a family member or friend with you to your appointments to advocate for your health.

Sekeres, Mikkael and Gilligan, Timothy. “Informed Patient? Don’t Bet On It.” The New York Times. 3/1/2017.
http://nyti.ms/2niNH1V

 

GENERAL HEALTH & MEDICINE


Staying Calm with Relaxation Techniques is Key to Coping with Stress

Woman relaxing in a poolAs ITP patients know stress is definitely not all in your head. When the stresses of life related to money, work, family responsibilities and health concerns begin to get to you your body releases excess stress hormones—cortisol, epinephrine and norepinephrine. It puts your body into a ‘threats’ reaction nearly 24/7. With chronic stress the person’s immune system becomes desensitized to the hormone cortisol. Inflammation plays a role in regulating this hormone so decreased sensitivity increases inflammatory response, which allows inflammation to get out of control. Chronic inflammation is a factor of many chronic diseases. As a result of this unrelenting stress response and inflammation a person may have sleep problems, come down with colds and flu easily, and see flare-ups of asthma or skin disorders.

The relaxation response can help a person counter their stress response. It is a calming physical state of deep rest that changes the body’s physical and emotional responses to stress and could help lessen its harmful effects. According to research one important positive effect of relaxation is it boosts immunity, including increasing natural killer cells that help the body resist viruses and tumors. People who meditated to relax saw reductions in psychological distress, depression, and anxiety. Many different techniques can help invoke the body’s relaxation response. Some of these include: breathing exercises, guided imagery, meditation, massage therapy, yoga, and tai chi. Deep breathing induces the relaxation response but even 10 minutes of sitting quietly and shutting out any chaos around you can trigger the response as well.

“How to Stay Calm among Chaos.” Dr. Mercola online health newsletter, June 16, 2017.
http://bit.ly/2s9hVcQ

 


 

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