Archive | December, 2012

Right Combination of Immunosuppressive Drugs May Lead to Less Organ Rejection and Long-term Benefits

Preventing organ rejection for kidney transplants without compromising other aspects of health requires a delicate balance of medications.  Finding this balance and the correct dosage of drugs has been difficult for physicians.  For example, immunosuppressive drugs that protect transplanted organs can also cause serious side effects, including compromising patients’ immunity to infection, cancer, and other threats.

A new multi-year study, conducted by Giselle Guerra, MD, and colleagues at the University of Miami has shown that using tacrolimus (TAC) and mycophenolate mofetil (MMF) in combination provided the vest long-term benefits and the least amount of side effects after a kidney transplant.  This was the longest randomized study to date that has analyzed transplant drugs.  The results provide valuable guidance to physicians who treat kidney transplant patients.  The study appears in an upcoming issue of the Journal of the American Society Nephrology (JASN), a publication of the American Society of Nephrology.

Guerra studied 150 kidney transplant recipients who received one of three common immunosuppressive treatment regimens: tacrolimus + MMF, tacrolimus + sirolimus, or cydosporine + sirolimus.  Tacrolimus and cydosporine are in a class of drugs called calcineurin inhibitors; they can prevent early organ reject but can be toxic to the kidneys.  Sirolimus and MMF do not damage the kidneys.  Often, patients receive low doses of calcineurin inhibitors plus sirolimus or MMF in order to gain the most benefit without serious risk to their kidneys.  The patients in the study also received another immunosuppressive drug, dadizumab, shortly after transplantation, and long term steroids.  All patients were followed for an average of eight years after transplantation.

The research team found that survival of transplanted organs was similar in all groups of patients.  Significantly fewer patients treated with tacrolimus + MMF (12%) experienced acute rejection, compared to those given tracrolimus + sirolimus (30%) or cyclosporine + sirolimus (28%).  Patients taking tacrolimus + MMF also had better kidney function during the first three years.  Patients given tacrolimus + MMf or cyclosporine + sirolimus were less likely to die with a functioning transplant (12% and 4% respectively), compared to those treated with tacrolimus + sirolimus (26%).  Patients who were given sirolimus were more likely to develop viral infections, discontinue treatment, and need cholesterol-lowering medications, compared to patients not taking sirolimus.  In conclusion, the results suggest that transplant patients do better long term with tacrolimus + MMG than with either tacrolimus + sirolimus or cyclosporine + sirolimus.

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How to Care for Urinary Incontinence

Urinary incontinence is a condition that results in the involuntary loss of urine.  It is a condition that affects millions of American men and women.  As we age, our body undergoes many changes.  Some of these changes involve the urinary tract and may lead to incontinence as men and women get older.

Both men and women may develop urinary incontinence, but several actions exist that women, specifically, can take to decrease or even limit involuntary release of urine.

The skin around the outside of the vagina in women is called the vulva.  This area includes the skin around the urethra and the vaginal lips, or labia.  Frequently, in incontinent women, this area is red, raw, and sore from urine irritating the skin.  These tips may help make women more comfortable and avoid irritation of the bladder, urethra, and surrounding skin.

Women who are incontinent should avoid synthetic or nylon underwear or synthetic pantyhose.  Instead, use full underwear made of cotton, also avoiding thongs and g-strings.  In addition, women may find that washing underwear in pure soap or soap flakes, instead of harsh detergents, may reduce irritation to the vulva.  Also, women should not wash the vulvar area no more than twice a day, using only plain water or mild soap.

Although bath oils, bubble baths, and bath salts feel nice, women with incontinence should avoid them.  The ingredients in relaxation baths can be very irritating to the already sensitive skin of the vulva.  Vaginal deodorants or douches should be avoided.  And tampons should not be used as they may irritate the bladder and urethra.

After bathing, gently dry the vulvar area with a towel.  Women may use a hair dryer on cool or low setting to dry the area completely.  If a powder is necessary, use corn starch and not talcum powder.

Finally, drink plenty of pure water.  Avoid caffeinated beverages such as coffee, tea, and cola.  Alcohol should also be avoided, especially excessive amounts of alcohol, as it also irritates the bladder and urethra.

Urinary incontinence can be helped and in many cases may be cured with proper treatment.  If you are experiencing any of the symptoms of urinary incontinence, contact your physician to discuss treatment options.

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