Inositol 6 g daily may be effective in depression but not in schizophrenia

Inositol is an important precursor for second messenger synthesis and has been reported to be reduced by lithium treatment in rat brain and in human CSF in depression. An open trial of 6 g/day in 11 depressed patients resistant to previous treatment led to major improvement in nine patients. The enzyme synthesizing inositol has been reported to be elevated in schizophrenia, suggesting an attempted compensation for possible inositol deficiency. A controlled double-blind crossover trial in 10 chronic schizophrenic patients of 6 g/day of inositol for 30 days did not reveal any benefit.     

A high sugar content, low caffeine drink does not alleviate sleepiness but may worsen it

Although the ingestion of high levels of glucose might have a short acting alerting effect, there is evidence of an ensuing enhancement of sleepiness in people already sleepy. Some 'energy drinks' contain large quantity of sugars. We compared 250 ml of a well known 'energy drink' (42 g sugars, containing a low [30 mg] level of caffeine for 'flavouring') with a nil sugar nil caffeine, similar tasting control. These were given a week apart, in a repeated measures, double blind, balanced design, to 10 participants sleep restricted to 5 h the prior night. They had a light lunch, consumed a drink at 13:50 h, and 10 min later underwent 3 x 30 min consecutive periods at a reaction time (RT) task (the Psychomotor Vigilance Test), separated by 3 min breaks when self-ratings of sleepiness were made. The energy drink did not counteract sleepiness, and led to slower RTs and more lapses during the final 30 min session, around 80 min after consumption.     

Long-term treatment of multiple sclerosis with interferon-beta may be cost effective

Multiple sclerosis (MS) is a devastating disease that can occur in early life, progressing to rapid disability and loss of physical, psychosocial and economic functioning, significantly affecting quality of life. The traditional treatment for MS has been symptomatic, treating acute relapses without affecting the underlying disease. The introduction of interferon-beta (IFN beta) has offered significant clinical benefits by reducing the frequency of relapses and slowing disease progression. Although the costs of this treatment are high, the costs to society of caring for a patient disabled by MS are greater, and if IFN beta can delay disease progression in the longer term, the economic impact would be substantial. Previous pharmacoeconomic studies of IFN beta have suggested that benefits can only be achieved at extremely high cost, with reported cost-effectiveness measures of up to 1 million pounds sterling (Pound) per quality-adjusted life year (QALY) [1995 values]. However, these studies have considered only the short term benefits of IFN beta treatment: over 2 to 3 years, the impact of treatment on patients' quality of life is relatively small, and cost-utility analyses that do not consider longer term benefits nor include societal costs may be misleading. The model reported here is based on the hypothesis that the delay in disease progression seen in short term clinical trials is likely to continue if treatment is continued. The model also assumes that the delay in disease progression, which represents a reduction in brain atrophy, will result in lasting clinical benefits even if treatment is stopped. These assumptions are strongly supported by clinical trial data and the treatment hypothesis itself. A delay in disease progression will result in a significant improvement in functioning and quality of life, and if the costs associated with increased disability can be postponed, even long term treatment of MS with IFN beta can be shown to be cost effective. Using resource utilisation costs derived from an economic evaluation of MS in the UK, it was possible to calculate the impact of delaying disease progression in terms of both health service and societal costs. An estimate of mean disease progression in patients with MS treated with IFN beta-1a compared with patients who did not receive disease-modifying agents suggested that significant cost savings would be realised after about 12 years' treatment with IFN beta-1a. The application of utility scores to the disease progression curves also facilitated estimates of cost effectiveness, with cost per QALY values ranging from 27,036 Pounds after 2 years' treatment with IFN beta-1a to 37,845 Pounds after 20 years' treatment (1995 values).     

Oral tetracyclines may not be effective in treating acne: dominance of the placebo effect

Oral tetracyclines (tetracycline, doxycycline, minocycline and lymecycline) have been commonly regarded as effective for treating both inflammatory and non-inflammatory acne. An excellent review of efficacy of 57 clinical trials by Simonart et al. in 2007 concluded that compared to the baseline before treatment, efficacies of all tetracyclines were similar (mean reduction in inflammatory lesions and non-inflammatory lesion being 54.3 ± 1.4% and 45 ± 2.6%, respectively) and were not affected by dosage amount (40 - 1,000 mg per day) and treatment period (4 - 24 weeks). These interesting findings may be pharmacodynamically rationalized by weak intrinsic anti-acne activity of tetracyclines and strong placebo effects. This hypothesis was supported by published data indicating that during weeks or months of daily administration, the placebo effect approached the effect of minocycline or doxycline in reducing acne lesions in three separate studies. The present work suggests the importance of considering placebo effects in the evaluation of anti-acne products. The treatability of acne was discussed in view of the slow and weak intrinsic anti-acne property of oral tetracyclines, and the reported fast (within days) elimination (curing) of severe acne by intralesional corticosteroids and antibiotics. The subantimicrobial or non-antimicrobial doses (e.g., only a small fraction) of various oral tetracyclines may be much lower than those commonly recognized.     

Acute hypokalemia may not be an effective way to sensitize the in situ canine heart for sparfloxacin-induced long QT syndrome

Extents of the sparfloxacin (3 - 10 mg/kg, i.v.)-induced QT interval prolongation under normokalemic and hypokalemic conditions were assessed in halothane-anesthetized beagle dogs (n = 5). The hypokalemic condition was induced by an oral administration of furosemide (200 mg/kg per day) for 3 days, which decreased the serum potassium concentration from 3.65 +/- 0.13 to 2.35 +/- 0.13 mM (P < 0.05). However, the decrease of potassium concentration by itself did not affect the extent of the sparfloxacin-induced QT interval prolongation. These results indicate that acute hypokalemia may not severely sensitize the in situ heart for drug-induced long QT syndrome as previously thought.