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Serum estradiol and testosterone together may be useful clues as to whether older men are at risk for hip fractures.

Researchers from Boston University, Boston Veterans Affairs Medical Center, and Harvard University observed 793 men from the Framingham Heart Study for up to 18 years. The men with both low estradiol generic and low testosterone levels had the greatest risk.

Of the 793 men in the study, 173 had low testosterone (below 3.85 ng/ml), 281 had mid-level testosterone (3.85-5.29 ng/ml), and 338 had high testosterone (5.30 ng/ml or more). During the follow-up period, 40 men experienced a hip fracture; 39 of these were atraumatic.

The higher risk was observed in men with serum estradiol below 20 ng/ml.

It is difficult to determine whether the major hormonal influence on hip fracture risk was testosterone or estradiol, but results suggest a synergistic effect.

When one selective serotonin re-uptake inhibitor (SSRI) does not seem effective for depression, substituting a different antidepressant has led to a remission of symptoms for almost 25% of patients.

In a multicenter study, 727 outpatients with a nonpsychotic major depressive disorder who were still symptomatic or who could not tolerate the SSRI citalopram (Celexa Generic, Forest) were switched to sustained-release bupropion (Wellbutrin tablet, GlaxoSmithKline), sertraline (Zoloft, Pfizer), or extended-release generic venlafaxine (Effexor XR, Wyeth) for up to 14 weeks.

At the end of the study, it seemed clear that any one of these three agents was a “reasonable second-step choice,” the researchers say. Remission rates ranged from 18% to 28%.

Contrary to the belief that intolerance of one SSRI predicts intolerance of another, sertraline was tolerated as well as sustained-release medication bupropion, even though 56% of patients could not tolerate citalopram drug. Thus, both within-class and out-of-class medication switches should be considered.

The recent rise in pertussis (whooping cough) cases in the U.S. poses a threat to hospital safety and resources. A single case of pertussis can easily spread to many health care workers, leaving the hospital responsible for containment costs.

The tetanus-diphtheria-acellular pertussis (Tdap) vaccine may be a cost-effective and responsible measure that hospitals should consider. A pertussis outbreak cost one hospital $74,870—2.38 times the dollar amount needed to vaccinate its health care workers.

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Two new higher-dose formulations are now available for patients with hypertension: generic valsartan/hydrochlorothiazide (Diovan HCT) 320/12.5 and 320/25 mg. The tablets are already available in combinations of 80/12.5, 160/12.5, and 160/25 mg. Diovan HCT contains the angiotensin receptor blocker valsartan and the diuretic hydrochlorothiazide (HCTZ).

Many patients need a combination of two therapies to achieve blood pressure (BP) goals.

The higher doses provided significantly greater reductions in BP compared with either agent alone. Giving the combination also reduced the incidence of low blood potassium, which is associated with HCTZ.

AstraZeneca has announced the FDA’s approval of generic esomeprazole magnesium (Nexium drug) delayed-release capsules in children 12 to 17 years of age with gastroesophageal reflux disease (GERD).

GERD affects approximately 8% of adolescents in the U.S. Children with GERD commonly experience vomiting or regurgitation as well as decreased appetite or refusal to eat. Asthma also may be a sign of the disease.

Families are encouraged to try lifestyle or dietary changes, such as smaller, more frequent meals. If these initial methods fail, physicians may recommend over-the-counter antacids or medications that suppress acid. Most erosions heal in four to eight weeks.

Merck has received approval for its Zostavax vaccine to prevent shingles, a varicella infection, in people 60 years of age or older.

Shingles is caused by the chickenpox virus. It usually affects older adults who contracted chickenpox earlier in their lives. It occurs when the virus lying dormant in the cells “wakes up” in older people and in others with health problems. The vaccine is a boosted dose of the chickenpox vaccine currently given to children.

In addition to triggering painful rashes, shingles can also cause painful nerve damage. About one million Americans become ill with shingles every year. antibiotics online pharmacy

Up to 10% of older patients won’t be candidates for the vaccine because of weakened immune systems caused by cancer therapy, AIDS, or organ transplantation.

If patients with human immunodeficiency virus (HIV) infection are already at risk for cardiovascular disease, clinicians are advised to double-check the antiretroviral medication. Researchers from the University of Washington in Seattle discovered a two-fold increase in the risk of elevated blood pressure (BP) among patients receiving lopinavir/ritonavir (Kaletra, Abbott), compared with efavirenz (Sustiva medication, Bristol-Myers Squibb).

Of 444 patients, 83 experienced elevated systolic BP, 33 had elevated dia-stolic BP, and 11 had newly diagnosed hypertension after starting highly active antiretroviral therapy (HAART). Patients taking atazanavir sulfate (Reyataz, Bristol-Myers Squibb), efavirenz, generic nelfinavir mesylate (Viracept tablet, Agouron) and indinavir sulfate (Generic Crixivan, Merck) had significantly lower risk of high BP compared with patients taking lopinavir/ritonavir drug.

Their results suggest that different protease inhibitors influence BP through different mechanisms. For instance, the increased risk associated with lopin-avir/ritonavir was related in part, the researchers say, to an increase in body mass index (BMI). Patients receiving atazanavir-based regimens were at a lower risk for elevated BP compared with those receiving generic efavirenz or lopinavir/ ritonavir even after the researchers adjusted for changes in BMI.

Patients taking tenofovir (Viread, Gilead) and lamivudine (Epivir generic, Glaxo-SmithKline) were more likely to experience high BP than patients using zido-vudine (Retrovir, GlaxoSmithKline) and lamivudine medication. Tenofovir has been associated with a decline in renal function, the researchers note; their results suggest that the increase in risk, again, was mediated by BMI changes.

Although BP did not increase in all patients receiving indinavir drug, a subset of those patients who did develop hypertension had the highest rise among the cohort (more than a 40-mm Hg rise in systolic BP while using HAART). The researchers say this might represent secondary hypertension via a renal pathway. They advise further studies of, among other things, the role of intermediate variables such as lipoatrophy and lipohypertrophy in HIV-infected patients.