On November 18, 2008 the NY Times published the report of a health scorecard entitled “The Wrong Place to Be Chronically Ill” which follows. It once again documents, as does every survey of international health and health cost, that the US reliance on prescription medication rather than on healthy food, healthy life style, exercise and supplements, is a national disaster of the first water.
Only clean food, high potency natural supplements and nutrients and a huge pile of sceptical salt about what the FDA and the pharmaceutical industry, through its gullable spokespeople, uninformed doctors, will change that along with one more ingredient: common sense!
Eating GMO food is disastrous for your health. Organic food and supplements are essential. Go to www.Organics4U.org to stop using nutrients from GMO sources! Get hold of some high quality nano silver and stop using antibiotics. Check out http://www.Nutronix.com/naturalsolutions and go to the Products tab, then the Silver solutions button. Your health will thank you! Growing whatever you can and making contact with local growers to make sure you know what is in your food.
It’s your choice. Act now to make your life a healthy one! And act now to donate (http://drrimatruthreports.com/index.php?page_id=189) to the Health Freedom organization that is there for you, the Natural Solutions Foundation, www.HealthFreedomUSA.org.
Yours in health and freedom,
Dr. Rima
Rima E. Laibow, MD
Medical Director
Natural Solutions Foundation
www.HealthFreedomUSA.org
www.GlobalHealthFreedom.org
www.NaturalSolutionsFoundation.org
www.Organics4U.org
www.NaturalSolutionsMarketPlace.org
www.NaturalSolutionsMedia.tv
The Wrong Place to Be Chronically Ill
Tuesday 18 November 2008
The New York Times | Editorial
Chronically ill Americans suffer far worse care than their counterparts in seven other industrial nations, according to a new study by the Commonwealth Fund, a New York-based foundation that has pioneered in international comparisons. It is the latest telling evidence that the dysfunctional American health care system badly needs reform.
The results of the study, published by the respected journal Health Affairs, belie the notion held by many American politicians that health care in this country is the best in the world. That may be true at a handful of pre-eminent medical centers, but it is hardly true for the care provided to a huge portion of the population.
The Commonwealth Fund’s survey of 7,500 patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, Britain and the United States focused on patients who suffered from at least one of seven chronic conditions: hypertension, heart disease, diabetes, arthritis, lung problems, cancer or depression.
The care they received in this country – or more often did not receive – ought to be a cause for shame. More than half of the American patients went without care because of high out-of-pocket costs. They did not visit a doctor when sick, skipped a recommended test or treatment or failed to fill a prescription. The uninsured suffered most, but even 43 percent of those who had insurance all year skipped care because of costs.
Americans also were most likely to report wasting time because their care was so poorly organized. About a third reported that medical records and test results were not available when needed or that tests were duplicated unnecessarily. A third experienced a medical error, such as being given the wrong medication or test results. Some 40 percent found it very difficult to get after-hours care without going to an emergency room.
The United States did comparatively well in some areas, such as providing relatively prompt access to specialists and clear instructions to patients leaving the hospital. But the nation’s overall performance was abysmal.
By contrast, Dutch patients reported far more favorable experiences with their health care system, largely because the Netherlands provides universal coverage (through individual mandates and private health insurance), a strong primary care system and widespread use of electronic medical records. It should be possible to achieve the same level of performance here.
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There is a great deal of misinformation about silver solutions. While there are several kinds (ionic, colloidal, nano technology, protein silver), the safety of silver is extraordinary, despite the fear of turning blue (argyria) which has been promulgated over the years.
The truth is that virtually no one has ever turned blue because of a deposition of silver particles in the skin. In the documented case where this has happened, the person drank huge and irrational amounts of silver daily for decades. In the recent well-publicized case of a politician who was supposed to have turned blue from drinking silver, it turned out to be a hoax perpetrated by his political opponents in the campaign for office he was participating in.
The smaller the particle size, the more effective the silver is at disrupting the biological function of disease causing bacteria, mycoplasma and viruses. The smaller the particle size, the more efficiently the body can get rid of the silver.
The silver we recommend, ASAP silver sol solution is exceedingly small in size, has never been shown to provide any medical or health problems and has been used for people from infancy to people in their 90s.
Here are the facts as I see them, after extensive experience using silver for infections of all types:
1. Silver in nano sized particles does not cause argyria because the particles are small enough to pass easily out of the urine, rather than being deposited in tissues. No case of argyria has ever been reported with nano particle silver
2. As you said, the amounts you would have to consume border on the insane.
3. Nano silver is effective, without any known side effects, against every pathogen it has been tested against
4. Through its applications in Africa, we know that pregnant women, tiny babies, fragile elderly, people with diabetes, cancer, auto immune disease, etc., do not develop side effects when they take silver as directed.
5. No ulcers have ever been reported with nano silver
6. The silver we recommend has been shown NOT to kill beneficial bacteria, thus protecting the integrity of the gut and the immune system.
ASAP silver sol solution has been tested against more than 650 pathogenic organisms and has been effective in vitro (in the lab) against every one. It has also been tested against the normal bacteria (which we refer to collectively as “pro biotics”) and found, rather amazingly, to spare these beneficial bacteria.
I personally never travel without ASAP silver sol solution. I have used it for common ailments like a cold and uncommon ones like malaria. It can be taken via sub lingual administration directly under the tongue to speed absorption and prevent it from reaching the GI tract or it can be mixed in a small amount of water and taken by mouth. It has no flavor or taste so even babies can take it without distress.
We have concluded a special arrangement with Nutronix.com to allow us to offer you this silver sol solution. Please do yourself a favor and lay in a good supply of this outstanding health aid.
Click here, http://www.Nutronix.com/naturalsolutions, to get your supply. Click on the “Products” tab, then go to the left hand column and click on “Silver Solutions”.
It is not clear how long the FDA will allow this exceptional product to remain on the market. I suggest you stockpile it for pandemics, general disease use and immune system boosting.
Yours in health and freedom,
Dr. Rima
Medical Director
Natural Solutions Foundation
www.HealthFreedomUSA.org
www.GlobalHealthFreedom.org
www.NaturalSolutionsFoundation.org
www.Organics4U.org
www.NaturalSolutionsMarketPlace.org
www.NaturalSolutionsMedia.tv
Effect of Prophylactic Treatment with ASAP-AGX-32 and ASAP Solutions on an Avian Influenza A (H5N1) Virus Infection in Mice
Gordon Pedersen,American Biotech Labs
Sidwell, Robert W., The Institute for Antiviral Research of Utah State University Animal, Dairy and Veterinary Sciences Dept
Alan Moloff, D.O., M.P.H., Colonel, MC, U.S. Army (RET)
Robert W. Saum Ph.D., IDHA, Medical Science and Technology, American Biotech Labs
Introduction
Avian Influenza (H5N1, or Bird Flu) can be a fatal disease in humans and a serious threat to become a pandemic event. Since there is no pharmaceutical remedy for the Bird Flu it is essential that preventive treatments be tested and developed in order to enhance survivor rates in the human population.
Since 1973, Silver has been shown to have topical activity against 22 bacterial species (643 isolates) including gram positive and gram negative bacteria1. As an antimicrobial agent, Silver has been shown to be beneficial in the treatment and prevention of burn infections, post surgical wound infections, and gynecological infections2, 3. In addition, Silver has been shown to be active against black mold4, Anthrax5, Bubonic plague6, Malaria7, and numerous viruses such as Hepatitis 8.
Recently it was reported that the American Biotech Labs product, Silver Sol, demonstrated additive and synergistic effects when combined in individual trials with 19 different antibiotics9. The Silver
from ABL was shown to improve the effectiveness of the antibiotics even against
antibiotic resistant infections 9.
The Merck Index identifies the following medicinal uses of silver: Antiseptic particularly for mucous membranes and infectious sinusitis10. The Merck Manual and Centers for Disease Control, recommend that Silver nitrate drops should be placed in each infant eye as soon as possible or at least in the first half hour of life to prevent gonorrheal ophthalmia 11.
The safe use of Silver as an orally consumed preventive agent has been demonstrated and supported by reports from the EPA and the United States Department of Health and Human Services in a 76 week long study12,13. Dogs that inhaled Silver showed activity in the lung in one hour with 90% of the silver carried to the liver by the blood within 6 hours14.
Due to the increased risk from methicillin resistant bacteria, black mold, plasmodium and especially bird flu, the need for orally consumed, safe, daily prophylactic prevention exists. In this study, Silver Sol from American Biotech Labs demonstrates safe beneficial and preventive activity against H5N1 Bird Flu, when taken orally in mice.
The American Biotech Labs product, ASAP- AGX-32, as well as their product designated ASAP, to be virucidal against the avian influenza A/Vietnam/1203/2004 (H5N1) x A/Ann Arbor/6/60 hybrid virus, with an up to 2 log10 virus titer reduction occurring after a 6 h incubation of the product and the virus
(USU report dated March 28, 2006). In that same report, similar incubation with the avian influenza A/Duck/MN/1525/81 (H5N1) virus reduced the virus titer by approximately one-half log10 in the same
time period. This material is reportedly very well tolerated in human subjects when ingested orally, Dr Gordon Pedersen of American Biotech Labs designed a study with the Centers for Antiviral Research to
evaluate the potential for ASAP-AGX-32 and ASAP, to inhibit an avian influenza A (H5N1) virus infection of mice when administered orally to the animals beginning 1 week prior to virus exposure. This report describes the results of this experiment.
Materials and Methods
Animals: Female specific pathogen-free 18- 21 g BALB/c mice were obtained from Charles River Laboratories (Wilmington, MA). They were quarantined 5 days prior to use. They were housed in polycarbonate cages with stainless steel tops and provided tap water and mouse chow ad libitum.
Virus: Influenza A/Duck/MN/1525/81 (H5N1) virus was originally provided by Dr Robert Webster of the St. Jude Hospital (Memphis, TN). The virus was adapted to mice by passage twice through weanling animals and a large pool prepared in MDCK cells for use in this study. The virus was titrated in young
adult mice prior to use in the present experiment.
Compounds: ASAP and ASAP-AGX-32 were provided by Dr Pedersen. They were in blue bottles, so all studies run with each were performed using the materials in injection bottles covered with aluminum foil to avoid light exposure. All were stored at room temperature until used. It is understood that the ASAP solution contained a colloidal silver at a concentration of 10 ppm, and the ASAP-AGX-32 contained the same colloidal silver at a concentration of 32 ppm. Ribavirin, included as a known positive
control, was provided by ICN Pharmaceuticals, Inc. (Costa Mesa, CA); it was dissolved in sterile saline and stored at 4o C until used.
Arterial Oxygen Saturation (SaO2) Determinations: SaO2 was determined using the Ohmeda Biox 3800 pulse oximeter (Ohmeda, Louisville, OH). The ear probe attachment was used, the probe paced on the thigh of the animal. Readings were made after a 30 sec stabilization time on each animal. Use of an earlier Ohmeda Model (3740) for measuring effects of influenza virus on SaO2 in mice has been previously described by Dr.s Sidwell and Pedersen15.
Lung Score Determinations: Each mouse lung removed and placed in a petri dish which, using a permanent black marker, had been divided into sections which were pre- numbered from 1 through 3 or, for placebo controls, 1 through 5. Each lung was assigned a score ranging from 0 (normal appearing lung) to 4 (maximal plum coloration in 100% of lung). These scores were assigned blindly, with the individual doing the scoring not being aware of what group was being examined. An arithmetic mean was determined for each group.
Lung Virus Titer Determinations: Each mouse lung was homogenized and varying dilutions assayed in triplicate for infectious virus in MDCK cells as described previously16. Each lung homogenate was
centrifuged at 2000 g for 5 min and the supernatents used in these assays.
Experimental Design: Groups of 19 mice were treated by oral gavage (p.o.) with either ASAP-AGX-32 or ASAP twice daily (every 12 h) for 7 days, then infected intranasally (i.n.) with an LD70 dose of
influenza virus, then treated an additional 10 days. A similar group of mice were treated p.o. with ribavirin at a dosage of 75 mg/kg/day twice daily for 5 days beginning 4h pre-virus exposure. The infection was achieved by anesthetizing the mice with an intraperitoneal injection of Ketamine at a dosage of 100 mg/kg and instilling 90 µl of suspended virus in minimum essential medium on the nares of the animals. As controls, 35 mice were treated with water using the identical schedule as used for the
ASAP materials and infected as above. Ten infected, test substance-treated mice and 20 water-treated controls were observed daily for deaths for 21 days after virus exposure, and SaO2 levels ascertained on days 3-11, which were the times when this parameter usually declines. From the remaining infected, treated animals, 3 test substance-treated and 5 water-treated control mice were killed on days 1, 3 and 6, and their lungs removed, assigned a consolidation score, weighed, and assayed for virus titer.
As toxicity controls, 3 uninfected mice were treated in parallel with each test material and observed for signs of adverse effects for 21 days. The weights of these mice as well as 5 normal controls were determined prior to initial treatment and again 18 h after final treatment to determine if the treatments
affected host weight gain. Three normal controls were also sacrificed on days 3 and 6 to provide background lung data.
Statistical Analysis
Increases in total survivors were evaluated by chi square analysis with Yates’ correction. Increases in
mean day to death, differences in mean SaO2 values, mean lung weight, and mean virus titers were analyzed by t-test. Only animals dying up to day 21 were considered for mean day to death calculations. The Wilcoxon ranked sum analysis was used for mean lung score comparisons. Each
statistical test was run using Excel software on a MacIntosh computer.
Results and Discussion
The results of this experiment are summarized in Table 1 and in Figures 1-4. As seen in Table 1, the virus challenge in this experiment was lethal to 14 of the 20 placebo-treated mice, with the mean day to
death being 8.4 days. Such a pattern of death is considered ideal for evaluation of potential antiviral agents. This optimal condition was verified by the observation that Ribavirin was fully protective to the
mice, preventing any deaths from occurring (Table 1), significantly lessening SaO2 declines (Figure 1), inhibiting lung score development (Figure 2), lung weight increase (Figure 3), and lung virus titer
increases (Figure 4).
Treatment with ASAP-AGX-32 appeared to not affect the numbers of animals dying of influenza, although a half-day delay in mean day to death was seen (Table 1). SaO2 declines in this group of treated mice were almost at the same rate as those in the placebo controls, although it was interesting
that on the first day this parameter was assayed, a highly significant (P<0.001) difference was seen (Figure 1). SaO2 declines are a manifestation of declining lung function, suggesting that the lung consolidation in the lungs did not progress as rapidly as seen in the placebo controls. The treatment appeared to moderately lessen lung consolidation as seen by lower lung scores on each time evaluated, the day 6 mean lung score being significantly (P<0.05) less than the placebo treated controls (Figure 2). Lung weights, another indication of fluid developing in the lungs to cause pneumonia in the animal, were also less at each time point than seen in the placebos (Figure 3). The mean lung virus titers in the
mice treated with ASAP-AGX-32 were lower than the placebo controls on days 3 and 6 of the infection (Figure 4).
Treatment with ASAP, which we understand is a less-concentrated version of ASAP-AGV- 32, also provided some intriguing results. Especially of interest was the observation that 60% of the infected mice treated with this compound survived compared to the 30% in the placebo-treated controls. Although not statistically significant because of the number which survived in the latter controls, this effect is strongly suggestive a disease-inhibitory effect may have occurred. At two time points during the SaO2 assays, days 3 and 6, the declines normally seen were significantly lessened (P<0.01), and
there was a general lessening of decline throughout the times of assay (Figure 1). Modest inhibition in lung scores were seen in this treated group as well, especially on day 6 (Figure 2); the lung weight data did not correlate too well with the lung scores, however (Figure 3). Again, slight inhibition of lung virus titers were seen in the ASAP- treated, infected mice (Figure 4).
Both the ASAP formulations were well tolerated by the toxicity control mice as seen by no deaths occurring in them and host weight increases observed during time of therapy. Ribavirin, while not lethal to the mice, did result in a 0.4 g host weight loss (Table 1); this was an expected effect for the latter material, since the maximum tolerated dose is approximately 100 mg/kg/day.
It is difficult to attribute the effects seen in this experiment wholly to viral inactivation, since both test materials were administered orally to animals infected by direct nasal inhalation, although the treatments began one week before virus exposure, so it is possible that a portion of the Silver Sol may
have been able to be in the vicinity of the virus-exposed lung tissue. It is also possible that this material is exerting a mild immunomodulatory effect in the animals, which would provide modest protection
against the infection. If such a mechanism is indeed associated with the potential activity seen, then a different treatment schedule, perhaps limiting the number of treatments to one per day or once every other day, may enhance any immune modulatory effects, since it is recognized that too-frequent dosing may overtax the immune system. The greater protection seen by the lower- dosed ASAP material could be explained by immunomodulation, since the greatest immunologic effect is not necessarily at the
highest dose used.
Another mechanism whereby the ASAP materials may have inhibited the influenza virus infection in these studies may simply be one of coating the virion with Silver Sol to prevent attachment and penetration. Again, the material would need to be in the vicinity of the exposed lung tissues at the time
infection was initiated. The Silver material could also play a role in limiting apoptosis of the epithelial lining of the lung induced during acute lung inflammation. Apoptosis plays a causative role in acute lung injury in part due to epithelial cell loss.
Further studies would have to be conducted to more fully delineate the actions of this material.
It is acknowledged that the effects seen in the present study, while of considerable interest, would need to be repeated to confirm that the observations were not due to mere chance. Consideration of combined use of oral administration of the ASAP materials and intranasal instillation at near
the time of virus exposure would determine
whether the effects seen were indeed
associated with virucidal effects of these
materials.
Summary
Mice infected with avian influenza A/Duck/MN/1525/81 (H5N1) virus were treated with the Silver Sol-containing formulations ASAP-AGX-32 and ASAP provided by American Biotech Labs. Oral gavage treatment began 7 days prior to virus exposure and continued twice daily for a total of 17 days. Treatments with both formulations provided a suggested inhibitory and preventive effect on this virus infection as seen by either less animals dying in the treated groups than in the placebo-treated
controls, delay in mean day to death, lessened SaO2 decline, modest inhibition of lung consolidation, and/or lessened virus titers in the lungs. Ribavirin was included as a positive control drug, used orally at a dose of 75 mg/kg/day twice daily for 5 days beginning 4 h pre-virus exposure, and this treatment was markedly inhibitory to the infection as expected.
References
1. Carr, H., Wlodowski, T., 1973. Department of Microbiology, College of Physicians and Surgeons, Columbia University, New York. Antimicrobial Agents and Chemotherapy. 10:585-587.
2. Fox, C. J. Jr., 1968. Silver sulfadiazine, a new topical therapy for Pseudomonas burns. Arch. Surg. 96:184-188.
3. Fox, C. J., 1969. Control of Pseudomonas infection in burns by Silver Sulfadiazine. Surg.Gynecol. Obstet. 128:1021-1026.
4. U.S. House International Relations Committee, 2005. Written testimony on Black Mold.
5. Illinois Institute of Technology. 2001. Anthrax.
6. Robinson, R., 2003. Bactericidal activity of ASAP Silver Solution on Yersinia Pestis, the etiological agent of plague. Department of Microbiology, Brigham Young University.
7. U.S. House Relations Committee. 2005. Written testimony on Malaria.
8. Hafkine, A., 2003. ASAP antiviral activity in Hepatitis B; DNA Polymerase Inhibition, Reverse Transcriptase Inhibition. Hafkine Institute for Training, Research and Testing.
9. DeSousa, A., Mehta, D., Leavitt, R. W., 2006. Bactericidal activity of combinations of silver-water dispersion with 19 antibiotics against seven microbial strains. Current Science. 91:7- 11.
10. Merck Index, 2006. Silver 1:645.
11. Merck Index, 2006. Silver 1:2082.
12. EPA Research and Development, 1988. Drinking water criteria document for Silver. Office of Health and Environmental Assessment.
13. U.S. Department of Health and Human Services, Public Health Service and Agency for Toxic Substances and Disease Registry, 1990. Toxicological profile on Silver.
14. Phalen, R.F. and Morrow P.E., 1973. Experimental Inhalation of Metallic Silver, Health Physics 24: 509-518.
15. Sidwell, R.W., Huffman, J. H., Gilbert, J., Moscon, B. Pederson, G., Burger, R. and Warren, R.W. 1992. Utilization of pulse oximetry for the study of the inhibitory effects of antiviral agents on influenza
virus in mice. Antimicro Agents Chemother 36:473-6.
16. Sidwell, R.W., Huffman, J. H., Call, E.W., Alaghamandan, H., Cook, P.D, and Robins, R.K. 1985. Effect of Selenazofurin on influenza A and B virus infections in mice. Antiviral Res. 6:343-353.
Another theoretical “impossibility†becomes real by experiment. Water burning? Yes, it can!
Materials Research Innovations, March 2008, Vol 12, 3-5.
Table 1. Expt. ABLA-1. Effect of Oral Gavage Prophylactic Treatment with ASAP-AGX-32 and ASAP on an Influenza A (H5N1) Virus Infection in Mice.
Animals: Female 18-21 g BALB/c mice Virus: Influenza A/Duck/MN/1525/81 (H5N1) Drug diluent: Company diluent Treatment schedule: bid x 17 beg -7 days (Ribavirin: bid x 5 beg -4 h) Treatment route: p.o. Experiment. duration: 28 days Tax Controls Infected, Treated Mice Tax Controls Dosage
Surv/Total Mean Host Weight Change (g) Surv/Total Mean Day to Death ± SD Mean Day 11
SaO2 (% =± SD) ASAP- AGX- 32 32ppm 3/3 1.8 2/10 8.9 ± 1.4 75.4 ± 1.0
ASAP 10ppm 3/3 1.4 6/10 7.3 ± 1.0 76.7 ± 2.1 Ribavirin 75 mg/kg /day 3/3 -0.4 10/10*** >21.0 ± 0.0*** 86.6 ± 2.5** * H2O — — — 6/20 8.4 ± 1.8 76.0 ± 1.9 Norma l Contro ls — 5/5 2.3 — — 88.8 ± 3.0
Difference between initial weight and weight 18 h after final treatment.
Difference between initial weight and weight 18 h after final treatment.
*P<0.05; **P<0.01; ***P<0.001 compared to H2O -treated controls.
There is good news making its way slowly, slowly into the medical world: little by little allopathic medicine is finally noticing how effective nutrients are in diseases and clinical conditions. Too slowly for most of us, but, still, there are creeping changes.
Instead of antibiotics, for example, pediatricians have noticed that pediatric diarrhea responds to zinc. Why? Because immune systems need zinc to do their job. So give the child zinc and it can fix the problem by itself without dangerous, expensive drugs. Well, well!
And even better, infection yields to silver. Well, of course it does. Burn centers have know that for decades and so has every natural doctor and naturopath for the last how many decades? But the derision and scorn heaped on us when we tried to talk about these and a thousand other ways of treating people when they come to us for cheap, simple, effective and safe means of getting well or staying that way is profound.
It is, however, the derision and anger born of fear.
Laibow’s First Law of Human Psychology is “Anger Drives Out Fear, Or At Least It’s Supposed To!” And conventional medicine is very, very afraid of the natural competitors to its expensive, dangerous and very limited drugs.
Oh, yes, one more thing: Codex Alimentarius makes the international trade of supplements very difficult since supplements may only be sold at doses so low that they have no clinical impact. Codex copmpliance in Europe through the European Food Supplements Directive is, in fact, stripping the shelves of stores of the nutrients previously avaialbe which might have allowed people to use the information in this article. Just ask any one you know, for example, in the UK, what is happening to their supplements: they are vanishing like the morning mist. Poof! Just like that.
If you don’t want the same thing to happen to you, it is imperative that you take action now, join the Natural Solutions Foundation’s distribution list for the free and secure Health Freedom eAlerts and take the action steps therein. I can assure you that legislators are not going to protect your health freedom without an effective outcry from us, the consumers who make our own choices about our own health paths.
Yours in health and freedom,
Dr. Rima
Rima E. Laibow, MD
Medical Director
Natural Solutions Foundation
www.HealthFreedomUSA.org
www.GlobalHealthFreedom.org
www.NaturalSolutionsFoundation.org
www.Organics4U.org
www.NaturalSolutionsMedia.tv
www.NaturalSolutionsMarketPlace.org
Changes in Folate and Homocysteine Linked to Incident Dementia
http://www.medscape.com/viewarticle/579216?sssdmh=dm1.378114&src=nldne
NEW YORK (Reuters Health) Aug 18 – Onset of dementia is associated with decreasing folate and increasing vitamin B12 and homocysteine, results of a study published in the August issue of the Journal of Neurology, Neurosurgery, and Psychiatry indicate.
“Several cross-sectional studies have found significant associations of lower folate and hyperhomocysteinemia with dementia or cognitive impairment, but the direction of cause and effect is not known,” Dr. Jin-Sang Yoon, of University Medical School, Kwangiu, Republic of Korea, and colleagues write. “Results from prospective studies have been controversial.”
In their study, the researchers examined both baseline levels and changes in folate, vitamin B12, and homocysteine as predictors of incident dementia in 625 elderly patients free of dementia at baseline; 518 (83%) were followed over 2.4 years.
Incident dementia occurred in 45 of the 518 (8.7%). The only baseline factor that predicted incident dementia was lower folate concentrations
However, “The onset of dementia was significantly associated with an exaggerated decline in folate, a weaker increase in vitamin B12 concentrations and an exaggerated increase in homocysteine concentrations over the follow-up period,” the team reports.
After adjustment for weight change, these associations were reduced.
“Further research is required to clarify these complex longitudinal interrelationships,” Dr. Yoon and colleagues conclude. “In the meantime, attention needs to be paid to the nutritional status of people with dementia from the time of diagnosis onwards, regardless of whether this is a cause or effect of their condition.”
J Neurol Neurosurg Psychiatry 2008;79:864-868.Silver-Coated Endotracheal Tube Reduces Risk for Ventilator-Associated Pneumonia CME
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
Disclosures
Release Date: August 19, 2008; Valid for credit through August 19, 2009
Credits Available
Physicians – maximum of 0.25 AMA PRA Category 1 Credit(s)â„¢ for physicians;
Family Physicians – up to 0.25 AAFP Prescribed credit(s) for physicians
To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Compare the incidence of ventilator-associated pneumonia in patients intubated for at least 24 hours with a silver-coated endotracheal tube vs an uncoated endotracheal tube.
2. Report whether use of a silver-coated endotracheal tube affects duration of intubation, length of stay in the intensive care unit or hospital, mortality rates, and adverse events.
Authors and Disclosures
Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Penny Murata, MD
Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
August 19, 2008 — Use of a silver-coated endotracheal tube significantly reduces the incidence of microbiologically confirmed ventilator-associated pneumonia (VAP), according to the results of a large, randomized, multicenter study reported in the August 20 issue of the Journal of the American Medical Association.
“VAP causes substantial morbidity,” write Marin H. Kollef, MD, from the Washington University School of Medicine in St. Louis, Missouri, and colleagues from the North American Silver-Coated Endotracheal Tube Investigation Group. “A silver-coated endotracheal tube has been designed to reduce VAP incidence by preventing bacterial colonization and biofilm formation.”
The goal of this prospective, single-blind study conducted in 54 centers in North America was to evaluate whether use of a silver-coated endotracheal tube would reduce the incidence of microbiologically confirmed VAP.
Of 9417 adult patients aged 18 years or older who were screened between 2002 and 2006, a total of 2003 patients who were expected to need mechanical ventilation for at least 24 hours were randomly assigned to undergo intubation with 1 of 2 high-volume, low-pressure endotracheal tubes. These tubes were similar except that the experimental tube had a silver coating.
The main endpoint was incidence of VAP, diagnosed from quantitative bronchoalveolar lavage fluid culture with at least 104 colony-forming units/mL in patients intubated for at least 24 hours. Secondary endpoints were VAP incidence in all intubated patients, time to VAP onset, length of intubation and duration of intensive care unit and hospital stay, mortality rates, and adverse events.
Rates of microbiologically confirmed VAP in patients intubated for at least 24 hours were 4.8% (37/766 patients; 95% confidence interval [CI], 3.4% – 6.6%) in the group receiving the silver-coated tube and 7.5% (56/743; 95% CI, 5.7% – 9.7%; P = .03) in the group receiving the uncoated tube (relative risk reduction, 35.9%; 95% CI, 3.6% – 69.0%).
Rates of microbiologically confirmed VAP in all intubated patients were 3.8% (37/968; 95% CI, 2.7% – 5.2%) in the experimental group and 5.8% (56/964; 95% CI, 4.4% – 7.5%; P = .04) in the control group (relative risk reduction, 34.2%; 95% CI, 1.2% – 67.9%).
Use of the silver-coated endotracheal tube was associated with delayed occurrence of VAP (P = .005), but there were no statistically significant between-group differences in durations of intubation, intensive care unit stay, and hospital stay. Mortality rates and frequency and severity of adverse events were also similar in both groups.
“Patients receiving a silver-coated endotracheal tube had a statistically significant reduction in the incidence of VAP and delayed time to VAP occurrence compared with those receiving a similar, uncoated tube,” the study authors write. “The silver-coated endotracheal tube appears to offer a unique approach because it is the first intervention that becomes user-independent after intubation, requiring no further action by the clinician.”
Limitations of this study include single blinding rather than double blinding; use of a small, fixed block size stratified by center; other factors possibly contributing to between-group differences in VAP rates; study protocol not standardizing prevention strategies; and a protective effect of higher severity-of-illness scores against development of VAP.
In an accompanying editorial, Jean Chastre, MD, from Institut de Cardiologie, Groupe Hospitalier Pitié-Salpê trière in Paris, France, discusses the study limitations.
“Important uncertainties exist regarding the exact benefit of silver-coated endotracheal tubes,” Dr. Chastre writes. “Consequently, silver coated tubes should not be viewed as the definitive answer for VAP prevention, and, until additional data confirm the clinical effectiveness and cost benefit of these devices, their use should be restricted to high-risk patients treated in ICUs [intensive care units] with benchmark value-based infection rates that remain above institutional goals despite implementation of a comprehensive strategy of usual preventive measures to prevent VAP.”
CR Bard Inc supported this study and provided grant support to all of the study authors. Some of the study authors have disclosed various financial relationships with Kimberly Clark, Elan, Merck, Pfizer, Bayer, GlaxoSmithKline, Boehringer Ingelheim, KCI, sanofi-aventis, Johnson & Johnson, Easi, Hospira, Nomir Medical Technologies, Arpida, Cubist, Elan, Ortho-McNeil, Sanofi Pasteur, Wyeth, Bayer-Nektar, Nestle Clinical Nutrition, Lilly, Corbett Accel Healthcare, National Institutes of Health, Novartis, and/or Maquet. Dr. Chastre has received consulting and lecture fees from Pfizer, Brahms, Wyeth, Johnson & Johnson, Bayer-Nektar, and Arpida.
JAMA. 2008.300:805-813, 842-844.
Clinical Context
Rello and colleagues reported in the December 2002 issue of Chest that VAP is linked with increased morbidity rates and generally occurs in the first 10 days after endotracheal intubation. Probable causes of VAP include colonization with pathogenic bacteria and aspiration, as noted by Kollef in the June 2005 issue of Respiratory Care. In the November 2006 issue of Critical Care Medicine, Rello and colleagues found that a silver-coated endotracheal tube decreased bacterial colonization of the airway. The silver ions in a polymer on the inner and outer lumen migrate to the surface of the tube to potentially reduce bacterial adhesion, impede biofilm formation, and promote antimicrobial activity.
This prospective, randomized, controlled, multicenter, single-blind study assesses the efficacy of a silver-coated endotracheal tube in reducing the incidence of VAP in patients needing mechanical ventilation for at least 24 hours.
Study Highlights
* 2003 adults aged at least 18 years and expected to need at least 24 hours of mechanical ventilation were randomly assigned to use of a silver-coated endotracheal tube vs an uncoated endotracheal tube.
* Exclusion criteria were enrollment in a conflicting study, bronchiectasis, severe hemoptysis, cystic fibrosis, pregnancy, silver sensitivity, and more than 12 hours of endotracheal intubation in the previous 30 days.
* 1932 subjects were intubated: 968 in the silver-coated tube group and 964 in the uncoated tube group.
* 1509 subjects were intubated for at least 24 hours: 766 in the silver-coated tube group and 743 in the uncoated tube group.
* Baseline characteristics for both groups were similar for age (mean age, 60.9 – 62.2 years; range, 18 – 102 years), sex, Acute Physiology and Chronic Health Evaluation II score, immunocompetency, enteral nutrition use, and endotracheal tube size.
* Both groups had similar VAP risk factors, except chronic obstructive pulmonary disease was less common in the silver-coated tube group vs the uncoated tube group (24-hour intubation subjects, 11.6% vs 16.4%; P = .007; all intubated subjects, 9.2% vs 12.7%; P = .02).
* The primary outcome measure was VAP incidence, defined by at least 104 colony-forming units/mL in bronchoalveolar lavage fluid culture, in patients intubated for at least 24 hours.
* VAP incidence in patients intubated for at least 24 hours was lower in the silver-coated tube group vs the uncoated tube group (4.8% [37/766 patients] vs 7.5% [56/743 patients]; P = .03; relative risk reduction, 35.9%).
* VAP incidence in all intubated patients was lower in the silver-coated tube group vs the uncoated tube group (3.8% vs 5.8%; P = .04; relative risk reduction, 34.2%).
* Bronchoalveolar lavage fluid culture was also obtained in those with suspected VAP or with new radiographic infiltrate and at least 2 qualifying signs (fever or hypothermia, leukocytosis or leukopenia, or purulent tracheal aspirate).
* Of 220 patients who underwent bronchoalveolar lavage for suspected VAP, the most common pathogens for the silver-coated tube group vs the uncoated tube group were Staphylococcus aureus (9 vs 16), Pseudomonas aeruginosa (8 vs 11), Enterobacteriaceae (10 vs 5), and polymicrobial infections (7 vs 13).
* VAP incidence within 10 days of intubation in patients intubated for at least 24 hours was less common in the silver-coated tube group (relative risk reduction, 47.6%; 95% CI, 14.6% – 81.9%; P = .005).
* Delayed occurrence of VAP was linked to silver-coated tube use (P = .005).
* There was no difference between groups in median duration of intubation, intensive care unit stay, hospital stay, and mortality rates.
* Regression analysis showed that silver-coated tube use was associated with decreased risk for VAP at any time, VAP within 10 days of intubation, and delayed time to occurrence.
* Adverse events occurred with similar frequency and severity for both groups.
* 59 endotracheal tube–related adverse events occurred: 21 in the silver-coated tube group vs 38 in the uncoated tube group.
* 74 intubation procedure–related adverse events occurred: 39 in the silver-coated tube group vs 35 in the uncoated tube group.
* Post hoc analysis showed that VAP in patients intubated for at least 24 hours was linked with longer duration of intubation and longer length of stay in the intensive care unit or hospital but not with mortality rate.
* Limitations of the study included lower than expected VAP incidence in the uncoated tube group, more subjects with chronic obstructive pulmonary disease in the uncoated tube group, and lack of blinding of investigators.
Pearls for Practice
* The incidence of VAP in patients intubated for at least 24 hours is reduced and delayed with use of a silver-coated endotracheal tube vs an uncoated endotracheal tube.
* Use of a silver-coated endotracheal tube does not affect duration of intubation, length of stay in the intensive care unit or hospital, mortality rates, or adverse events.
http://www.medscape.com/viewarticle/579239?sssdmh=dm1.378114&src=nldne
Oral zinc for treating diarrhoea in children.
Cochrane Database Syst Rev. 2008; (3):CD005436 (ISSN: 1469-493X)
Lazzerini M; Ronfani L
Unit of Research on Health Services and International Health, WHO Collaborating Centre for Maternal and Child Health, Via dei Burlo 1,34123, Trieste, Italy.
BACKGROUND: Diarrhoea causes around two million child deaths annually. Zinc supplementation could help reduce the duration and severity of diarrhoea, and is recommended by the World Health Organization and UNICEF. OBJECTIVES: To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. SEARCH STRATEGY: In November 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 4), MEDLINE, EMBASE, LILACS, CINAHL, mRCT, and reference lists. We also contacted researchers. SELECTION CRITERIA: Randomized controlled trials comparing oral zinc supplementation (>/= 5 mg/day for any duration) with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery. DATA COLLECTION AND ANALYSIS: Both authors assessed trial eligibility and methodological quality, extracted and analysed data, and drafted the review. Diarrhoea duration and severity were the primary outcomes. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses (using the fixed- or random-effects model) and assessed heterogeneity. MAIN RESULTS: Eighteen trials enrolling 6165 participants met our inclusion criteria. In acute diarrhoea, zinc resulted in a shorter diarrhoea duration (MD -12.27 h, 95% CI -23.02 to -1.52 h; 2741 children, 9 trials), and less diarrhoea at day three (RR 0.69, 95% CI 0.59 to 0.81; 1073 children, 2 trials), day five (RR 0.55, 95% CI 0.32 to 0.95; 346 children, 2 trials), and day seven (RR 0.71, 95% CI 0.52 to 0.98; 4087 children, 7 trials). The four trials (1458 children) that reported on diarrhoea severity used different units and time points, and the effect of zinc was less clear. Subgroup analyses by age (trials with only children aged less than six months) showed no benefit with zinc. Subgroup analyses by nutritional status, geographical region, background zinc deficiency, zinc type, and study setting did not affect the results’ significance. Zinc also reduced the duration of persistent diarrhoea (MD -15.84 h, 95% CI -25.43 to -6.24 h; 529 children, 5 trials). Few trials reported on severity, and results were inconsistent. No trial reported serious adverse events, but vomiting was more common in zinc-treated children with acute diarrhoea (RR 1.71, 95% 1.27 to 2.30; 4727 children, 8 trials). AUTHORS’ CONCLUSIONS: In areas where diarrhoea is an important cause of child mortality, research evidence shows zinc is clearly of benefit in children aged six months or more.
Subject Headings
Major Subject Heading(s) Minor Subject Heading(s)
* PreMedline Identifier: 18646129