Author Archives: Heidi Splete

FDA Takes the Measure of Nanotechnology

The  Food and Drug Administration is paying attention to the little things—the very little things. The FDA recently released guidelines for industry on the use of nanotechnology in food and cosmetics. The draft guidelines have been issued for public comment, according to the FDA website.

Courtesy Wikimedia Commons/KoS/Creative Commons License

The Nanodermatology Society issued a statement in response to the guidance for nanotechnology use in cosmetics—an issue that will continue to interest dermatologists as the technology evolves. The NDS stated its belief that the FDA has a responsibility to ensure the evaluation of nanomaterial use in cosmetics, including both over-the-counter and prescription products.

The guidelines must measure up to the science, however. “The NDS believes that the guidelines should not be based on controversial evidence, weak evidence, or pure conjecture,” according to the NDS statement. To that end, the NDS pointed out a few areas of the guidelines where scientific evidence could be more complete. For example, with respect to titanium dioxide, the NDS notes that “TiO2 can accumulate in tissues such as kidneys, but can also be eliminated, for example, in the liver in some animal models.” In addition, the NDS notes that a guideline proposing that penetration studies should be conducted on both intact and impaired skin might not be appropriate in cases where products are recommended for use on intact skin only.

In addition, the NDS recommended an expiration period for the final guidelines, due to the swift evolution of nanotechnology.

Check out the draft guidance on the use of nanotechnology in cosmetic products at the FDA’s website:

What’s your take? Should the FDA monitor nanomaterials in cosmetic products?

–Heidi Splete (@hsplete on twitter)

1 Comment

Filed under Dermatology, Drug And Device Safety, IMNG

Will Expanded Use of EMRs Fuel Keyboard Contamination?

As more and more doctors adopt electronic medical records in advance of the federally mandated switch to this form of record-keeping in 2014, an unanticipated side effect could be the emergence of more resistant pathogens in the office, spread unwittingly by increased use of communal keyboards to access and update these records.

Courtesy of MichaelMaggs, via Creative Commons Attribution-Share Alike 3.0

The evidence is there. Previous research has shown that computer keyboards are about as dirty as it gets.

So what’s a modern, EMR-based clinician to do?

Ross Goldberg, a high school student and son of dermatologist Neil Goldberg, decided to test whether alcohol-based hand sanitizer helped prevent keyboard contamination in his father’s dermatology practice.

Ross found that use of hand sanitizer before every keyboard touch did notably decrease the number and variety of bacteria that were gleaned from these keyboards, compared to control keyboards that were touched by people not using hand sanitizer. He even surmised that the use of hand sanitizer before each keyboard touch could reduce the spread of the flu virus, were it to take hold in the office setting.

But how likely is it that all office employees will be consistent about such frequent use of hand sanitizer? For doctors who aren’t confident that hand sanitizer could be used consistently in their practices, Ross offered some creative alternatives for reducing the spread of keyboard contaminants, including using voice-recognition software, washable keyboards, and virtual keyboard images. With the transition to EMRs looming, clinicians might do well to give his ideas some thought.  

–Heidi Splete

(on twitter @hsplete)

Leave a comment

Filed under Family Medicine, IMNG, Internal Medicine, Pediatrics, Primary care, Uncategorized

Dickensian DX: Tiny Tim Had TB and Rickets

In Charles Dickens’ tale, A Christmas Carol, miserly Ebenezer Scrooge has a change of heart after visits from three very persuasive spirits. Among his charitable endeavors was to improve the health of Tiny Tim Cratchit, the crippled youngest son of Scrooge’s long-suffering clerk, Bob Cratchit.

Reproduced from a c.1870s photographer frontispiece to Charles Dicken's A Christmas Carol, courtesy of wikimedia commons

Tiny Tim’s condition is not fully described in the story, and has been the subject of speculation, since it was considered fatal (according to the Ghost of Christmas Present).

In the current issue of the Archives of Pediatrics and Adolescent Medicine, Dr. Russell W. Chesney of the University of Tennessee Health Science Center in Memphis offers a diagnosis, based in part on what we know about environmental factors during the time when the story was set (London, 1820-1843).

Dr. Chesney suggests that Tiny Tim had both rickets and tuberculosis. His odds of having rickets were fairly high, given the lack of sun exposure (due to coal-blackened skies and a tendency at the time for children of low-income families to work indoors in factories during daylight hours) and poor nutrition (due to Bob Cratchit’s meager salary). In addition, Dr. Chesney points out, pneumonia, upper respiratory infections, and TB are more common in those with vitamin D deficiency and rickets. Improving vitamin D status with better food (achieved when Bob Cratchit gets a long overdue raise in salary from Scrooge) would cure rickets and improve the TB, Dr. Chesney writes, so Scrooge’s generosity actually could make a difference in whether Tiny Tim lived or died.

“We are not told whether he was fully cured, but he definitely survived,” Dr. Chesney notes.

The moral of the story? Another victory for Vitamin D, and also, perhaps, for a good attitude. As Dickens said, “It is a fair, even-handed, noble adjustment of things, that while there is infection in disease and sorrow, there is nothing in the world so irresistibly contagious as laughter and good-humour.”

–Heidi Splete (on twitter @hsplete)

Leave a comment

Filed under Family Medicine, IMNG, Infectious Diseases, Internal Medicine, Internal Medicine News, Pediatrics, Primary care, Uncategorized

When Bats Attack: New Design Should Improve Safety


Collegiate ballplayers like this athlete from the U.S. Air Force Academy started using the redesigned bats in 2011. Image courtesy Wikimedia Commons/Danny Meyer, USAF/Public Domain

Doctors  know about concussions from football, lacrosse, hockey, and similar contact sports, but what about baseball? Apparently, aluminum baseball bats have been implicated in severe injuries and even deaths in school-aged children.

How? It comes down to physics. According to researchers at Washington University in St. Louis, the aluminum bats currently in use can cause the baseball to rebound so quickly, and with so much force, that even an attentive pitcher can’t always get out of the way in time.  In a tragic example, they cited the 2010 death of a 13-year-old pitcher in Vermont — killed by a line drive off an aluminum bat — and noted there have been other reports of similar fatalities.

To cut down on the risk of serious injuries and deaths from hard-hit line drives, the National Collegiate Athletic Association last season started mandating the use of a new style of aluminum bat. The new bat is engineered to put less energy behind the ball once it’s hit, so it is less likely to cause serious harm.

Here’s one of the researchers explaining of the features of the new bat:

This year, the new bats will be used by high school players as well. The National Federation of State High School Associations will enforce the use of the new bats, so ideally the hazards of school baseball will be limited to bug bites and sore jaws from hours of gum-chewing in the outfield.

–Heidi Splete (@hsplete on Twitter)

Leave a comment

Filed under Family Medicine, Pediatrics, Sports Medicine, Video

A Little Respect Goes a Long Way

There’s often truth in humor, as was the case in a slightly tongue-in-cheek talk by Dr. Eric “Billy” Baum of the University of Alabama at this year’s Caribbean Dermatology Symposium in Puerto Rico.

Dr. Baum’s talk, ostensibly on practice and financial pearls, was peppered with funny sports quotes and pearls about saving money by combining family vacations with CME meetings.

Read more in The Mole blog on …

Image courtesy of The Tango! Desktop Project via wikimedia commons

—Heidi Splete (on Twitter @hsplete)

Leave a comment

Filed under Allergy and Immunology, Dermatology, IMNG

Early Look: Caffeine for Cancer Prevention

Dr. Paul Lizzul and Dr. Allan Conney, along with their colleagues, are in the early stages of research that hints at broad implications for preventing squamous cell and basal cell skin cancer. After starting in the lab and progressing with animal models, they took a hypothesis about the effect of caffeine on actinic keratoses and applied it to humans in a recent phase I study. They shared some thoughts on this research with the Skin & Allergy News blog, the Mole:

The Mole: What prompted you to conduct this study?

Dr. Lizzul: Skin cancer of the nonmelanoma type (i.e., squamous cell and basal cell carcinoma) is the most common skin cancer and is most often a result of sunlight exposure. Ultraviolet B light is believed to be mostly responsible for these cancers. Many squamous cell skin cancers are curable if detected early. However, many people still suffer from these cancers and some also die from them. Actinic keratoses are precancerous skin tumors that mainly result from long-term sun exposure in susceptible persons. They have the potential to progress to squamous cell carcinoma. Finding effective methods of preventing UV-induced cancers and precancerous lesions would have a major impact on the total amount of human cancer.

Chemistry of caffeine image courtesty of Icey, ClockworkSoul via wikimediacommons

The Mole: Could you briefly explain your hypothesis?

Dr. Conney: In studying the effect of tea on UVB carcinogenesisis in an animal model, we found that caffeine was the major active constituent, and that pure caffeine inhibited carcinogenesis in this animal model. Topical caffeine was also active. Topical caffeine inhibited carcinogenesis in mice pretreated with UVB with a high risk of skin cancer in the absence of further UVB. Mechanistic studies showed that caffeine enhanced apoptosis (programmed cell death) in UVB-treated epidermis and in tumors. We hypothesize that topical caffeine will inhibit proliferation and stimulate apoptosis in the actinic keratoses.

Dr. Lizzul: The hypothesis to be tested in this study is that treatment of actinic keratoses with caffeine for 2 weeks will enhance apoptosis and inhibit the growth of these skin lesions in humans. The purpose of this study is to determine the effects of topical applications of caffeine on apoptosis (programmed cell death), proliferation, and the ATR/Chk1 pathway in actinic keratoses in human skin in vivo.

Our collaborators at Rutgers University found that treatment of UVB-pretreated high-risk mice with caffeine topically once a day, 5 days a week for 18 weeks inhibited the formation of keratoacanthomas and squamous cell carcinomas, decreased the size of the tumors, and enhanced apoptosis in the tumor. 

At Rutgers University, Drs. Yaoping Lu, Yourong Lu, and Allan Conney are participating in the study.

(Read more at “The Mole” blog on 

 —Heidi Splete (on Twitter @hsplete)

Leave a comment

Filed under Dermatology, IMNG, Oncology

Getting Under the Skin to Treat Infections

New research in the emerging field of nanodermatology is setting the stage for the more efficient use of nitric oxide to treat infections. Nitric oxide (NO) is known for its antimicrobial activity, but it is difficult to channel this highly reactive gas into a convenient tool for clinical use.

Nanotechnology to the rescue! Nanotechnology allows researchers to create a vehicle for the controlled release of NO, study co-author Dr. Adam Friedman of Montefiore Medical Center in Bronx, NY, explained in an interview.


Image of nanoparticles courtesy of Dr. Adam Friedman

Tiny NO nanoparticles can penetrate the skin’s surface and deliver the goods to deep tissue infections, overcoming the biological barriers that block the use of other therapeutic agents, he said.

“In this study [in rats], we demonstrated that both topical and intralesional injection of the nitric oxide nanoparticles were more effective in clearing MRSA muscle abscesses than vancomycin, a common first line systemic antibiotic for deep skin and soft tissue infections,” said Dr. Friedman. “When the infected muscle tissue was examined under the microscope, samples from the nanoparticle-treated groups showed both decreased inflammation and destruction to normal tissue, likely owing to the swift and potent antibacterial impact of nitric oxide.”

So, nanotechnology with NO is effective, but can it really be used in clinical practice? Dr. Friedman says yes.

“To date, most of the practical NO delivery systems have been based on NO donor molecules, which all suffer from various drawbacks ranging from tissue toxicity, instability (especially in the presence of light), and even carcinogenicity from related breakdown products,” he said.

“The ease with which the nanoparticles can release NO, as well as that with which we can alter the rate of release by simply manipulating the production process, makes this technology a frontrunner for translation to the bedside,” Dr. Friedman noted.

“That we were able to treat MRSA muscle infections by applying the nanoparticles to the skin, and that this approach was more effective then vancomycin, suggests that this technology may be a potent addition to our armament of treatments for skin and soft tissue infections,” he said.

What’s next? Filing an Investigation New Drug (IND) with the FDA in hopes of beginning clinical trials, said Dr. Friedman.

“All in vitro and animal studies (including topical, subcutaneous injection, and intravenous) to date suggest that the nitric oxide-releasing nanoparticles are both safe (as in they do not cause damage to cells or tissues or negatively impact biological processes) and more importantly effective,” he said. “We will continue to characterize the physical, chemical, and biological properties of this technology in the lab to help optimize its potential in the clinical setting.”

Lead author Dr. David Shairer of Montefiore Medical Center; Bronx, NY, Dr. Friedman, and colleagues published their findings in the Jan./Feb. 2012 issue of Virulence (“Nitric oxide nanoparticles: Pre-clinical utility as a therapeutic for intramuscular abscesses”).

Check out the website of the Nanodermatology Society for more about the intersection of these two fields.

–Heidi Splete (on twitter @hsplete)


Filed under Dermatology, IMNG, Infectious Diseases

Epilepsy Patients Take Control

Epilepsy, like other chronic medical conditions, leaves affected individuals feeling out of control and isolated, says Shelly Stoll, MPH, of the University of Michigan.

Ms. Stoll, along with colleagues at the university and the Epilepsy Foundation of Michigan, developed a program for individuals with epilepsy (IWE) to improve their self-care.

The researchers conducted a pilot study of their intervention and presented the results at the annual meeting of the American Epilepsy Society in Baltimore, Md.

The 21 study participants were epilepsy patients aged 21 years and older. They completed telephone interviews at baseline and four months after completing the 6-week intervention.

The FOCUS intervention includes five elements:

-Figure out the problem or issue.

-Observe your routine.

-Choose a change goal.

-Undertake a change strategy.

-Study the results and select a reward.

The intervention included a day-long workshop followed by weekly telephone calls with a coach, some of which were conference calls with other patients.

Although this intervention didn’t reduce the frequency of seizures, the patients showed significant improvement from baseline in terms of quality of life and positive well-being.

The researchers admitted that the study is small and the findings preliminary, but the results merit a larger study with a longer time frame. Ideally, patients who participated in this study will continue to benefit. The researchers quoted one satisfied patient, who said, “I plan to keep moving forward, empowering and taking my life into my hands regardless of how epilepsy has tried to conquer me.”

The study was supported by the Centers for Disease Control and Prevention and the Managing Epilepsy Well network.

(Photo courtesy of Lidingo via wikimedia commons (creative commons attribution share-alike license)

–Heidi Splete (On Twitter @hsplete)

1 Comment

Filed under Family Medicine, IMNG, Neurology and Neurological Surgery, Uncategorized

How Vitamin D Supplements May Help Lupus Patients

It seems like every week brings a new study about the benefits of vitamin D: It builds bones, tames psychotic symptoms in bipolar teens, and strengthens the immune system. It is the immune system benefit that attracted the interest of Dr. Benjamin Terrier and colleagues at the Pitié-Salpêtrière Hospital in Paris, France.

Courtesy of Mikael Häggström, via Wikimedia Commons

The researchers studied 24 people with lupus to determine the possible benefit of vitamin D supplementation on their immune systems. They presented their findings at this year’s annual meeting of the American College of Rheumatology.

So, did it help? Yes, to some extent. The patients received 100,000 IU of vitamin D weekly for 4 weeks, and then the same amount monthly for 6 months. Serum 25(OH)D levels, which had been below normal in all patients at baseline, were normal when measured after 2 months and 6 months.

Most importantly, the number of regulatory T cells increased and the number of T helper lymphocytes decreased after 2 months and also after 6 months of vitamin D supplementation. In addition, antibody-producing memory B cells decreased after 2 months, and activated CD8+ T cells (thought to be associated with lupus in particular) decreased after 6 months.

An added bonus: None of the patients reported adverse events associated with vitamin D, including hypercalcemia or lithiasis.

The findings are preliminary, Dr. Terrier said, and large, randomized controlled trials are needed to confirm the results.

Currently, no one is advocating that lupus patients increase their vitamin D with heavy supplementation, said Dr. Sam Lim of Emory University in Atlanta, Georgia. Dr. Lim served as moderator at the press conference in which the findings were presented.

However, “the study is very important because it is a link to take [the research] to the next step,” Dr. Lim said.

–Heidi Splete (On Twitter @hsplete)

Image courtesy of Mikael Häggström, via Wikimedia Commons

1 Comment

Filed under IMNG, Rheumatology

Docs Who Groove Improve Their Polyp Perception

Some doctors play music in the waiting room to help patients relax, others tune in during surgery to help them focus.

courtesy of wikimedia commons user Denelson83 (creative commons attribution-share alike 3.0 unreported)

 And a new study presented at the annual meeting of the American College of Gastroenterology showed that endoscopists who listened to music while performing screening colonoscopies found significantly more adenomatous polyps than those who did the job in silence.

And not just any music:  Mozart.

Dr. Catherine O’Shea and Dr. David Wolf of the University of Texas Health Sciences Center in Houston randomized two endoscopists with similar skill and experience to perform screening colonoscopies while listening to a selection of music by Mozart and then perform the same number of procedures without music. One was blinded to the outcome and one was unblinded. A total of 118 procedures were reviewed.

One endoscopist was blinded to the outcome and the other was not, but both found significantly more adenomas while listening to Mozart than in silence. The adenoma detection rate for endoscopist 1, who was blinded as to outcome, was 30% without music and 67% while listening to Mozart. The rate for endoscopist 2, who was unblinded as to outcome, was 37% while listening to Mozart and 41% without music. The detection rates for both endoscopists improved over their baseline rates (21% and 27%, respectively).

A large body of research shows that detecting and removing colon polyps significantly reduces the risk of death from colon cancer, the researchers said. Therefore, adenoma detection rate is an important quality indicator for colonoscopy. “Anything we can do to get those rates up has the potential to save lives,” Dr. O’Shea said in a statement.

The study was limited by the use of only music by Mozart. Who knows what the polyp detection rate would be with Guns N’ Roses? Or a selection of show tunes? Further research is needed.

–Heidi Splete (on twitter @hsplete)

1 Comment

Filed under Blognosis, Family Medicine, Gastroenterology, IMNG, Internal Medicine, Oncology