Friday, November 30, 2007

CT scans raise cancer risk

A research article published in this week's NEJM raised serious concerns about the cancer risks associated with CT scans due to its widespread use in America.

CT sacns are increasingly used in America to diagnose medical problems in children as well as adults, they are needlessly exposed to dangerous radiation that raises the risk of cancer.

The authors said that "too many CT studies are being performed in US" and suggested ways to reduce overall radiation dose from CT including reducing dose in individual patients, using other options and reducing the number of prescribed CT studies.

Source : "Computed Tomography — An Increasing Source of Radiation Exposure" NEJM, Volume 357(22):2277-2284 ( free full text)

Wednesday, November 28, 2007

Prostate cancer patients often receive mismatched therapy

A study conducted at 4 Massachusetts hospitals using questionnaires to survey more than 400 patients found that prostate cancer patients often receive treatment that is contraindicated by pre-existing conditions such as urinary or bowel dysfunction. It also found mismatched treatments were more common than expected.

The authors raised concerns about poor patient-doctor communication that can lead to poor clinical outcomes.

Source: "Treatment 'Mismatch' In Early Prostate Cancer: Do Treatment Choices Take Patient Quality of Life Into Account?" CANCER; Published Online: November 26, 2007 (DOI: 10.1002/cncr.23138); Print Issue Date: January 1, 2008

Tuesday, November 27, 2007

Can insoles prevent back pain?

There had been a theory that insoles might reduce the impact on spinal discs therefore protecting the back.

According to a new review of 6 studies published in the Cochrane Database of Systematic Reviews 2007, Issue 4, the use of insoles does not prevent back pain. The researchers concluded that "there is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities".

Source: "Insoles for prevention and treatment of back pain" Cochrane Database of Systematic Reviews 2007, Issue 4.

Lung transplants may bring more harm than good to children with CF

According to a new study that looked at lung transplants in children with cystic fibrosis (CF) in US, children rarely benefited from such transplants and there were significant risk of harm associated with the transplant. The lead author said it is important to develop criteria to identify the children who would benefit most from transpalnts.

An editorial in the same issue of the NEJM commented that the report's conclusion was shocking, the transplant rules in the US have chanaged since the study was done and the researchers put together data of children and adult patients who have a different success rate.

Source: "Lung Transplantation and Survival in Children with Cystic Fibrosis". NEJM 2007 357(21): 2143-2152 (abstract only)

Prostate cancer may be missed in obese men

A new study found dcotors may be missing a large number of cancer in obese men because the test for prostate-specific antigen (PSA) is unreliable. It may explain why obese men tend to have more aggressive cancer.

Researchers said doctors must take body weight into account when reading test results for prostate cancer because higher body mass index (BMI) is linked to higher plama volume that can lead to dilution of PSA.

Source: "Obesity-Related Plasma Hemodilution and PSA Concentration Among Men With Prostate Cancer" JAMA. 2007;298(19):2275-2280

Thursday, November 22, 2007

Rapid response team reduces death

A children’s hospital in California added a rapid response team (RRT) with experts available 24x7 for hospitalised patients who were not in the intensive care unit. After the implementation of the intervention, there was significant decrease in death and cardiopulmonary arrest rates, according to a new study published in the November 21 issue of JAMA.

However, in an accompanying editorial, the authors said that rigorous and comparable data will need to be collected to determine the best approach for RRTs in pediatrics.


Source: "Effect of a Rapid Response Team on Hospital-wide Mortality and Code Rates Outside the ICU in a Children’s Hospital" JAMA. 2007;298(19):2267-2274 (free full text article)

Arthritis drug withdrawn from market

Prexige, an arthritis drug called COX2 inhibitors, made by Novartis, has been ordered to be withdrawn from the market by drug regulators in Britan after growing international evidence that it has caused severe liver damage - according to the Guardian.

Another drug in the group, Vioxx made by Merk was withdrawn from the market in 2004 after reports of heart problems.

Wednesday, November 21, 2007

Modest results from obesity drugs

A study that reviewed the results of 30 placebo-controlled trials involving participants with mean BMI 35-36 and took anti-obesity drugs for at least 12 months, found that 3 commonly prescribed drugs - orlistat, sibutramine and rimonabant only achieve modest results in terms of weight loss - under 5% of total body weight.

The researchers said the three drugs had various health benefits but all had adverse effects, in rimonabant is associated with an increase in depression and anxiety.

A separate study in The Lancet found patients who took rimonabant were at increased risk of severe psychiatric events.

Sanofi-Aventis, the French drug maker, has issued press release in response to the BMJ & The Lancet article.

Source : "Long term pharmacotherapy for obesity and overweight: updated meta-analysis" BMJ, doi:10.1136/bmj.39385.413113.25 (published 15 November 2007)

Monday, November 19, 2007

ADHD drugs have no long term benefits

A research referred to in the BBC programme Panorama : What Next for Craig? raised questions about the long -term benefit of the drugs used to treat children with ADHD.

The 3 year Multimodal Treatment study of children with ADHD (MTA) found that ADHD drugs may work well in the short term. By 36 months, there was no apparent improvement in children's behaviour. The study also found the drugs could stunt children's growth.

Source: "3-Year Follow-up of the NIMH MTA Study". Journal of the American Academy of Child & Adolescent Psychiatry. 46(8):989-1002, August 2007.

Tuesday, November 13, 2007

Healthy diet may cut dementia risk

A study that looked at the diets of more than 8,000 healthy men and women aged over 65 over 4 year period, found that diets rich in fish, omega-3 oils and eating fruit and vegetables daily may decrease the risk of dementia and Alzheimer disease. The study, published in the Journal of Neurology.


Source : "Dietary patterns and risk of dementia -The Three-City cohort study" Neurology 2007;69:1921-1930 (Abstract only)

Long-term Beta Carotene Supplement use may preserve memory

According to a new study that looked at the effects of beta-carotene supplements on the cognitive abilities in nearly 6000 men over an average of 18 years, long term use of beta-carotene supplements may preserve memory and other thinking skills.


However, it was stressed in an accompanying editorial, that other studies into beta-carotene supplements had shown contrasting results. One study has suggested potential harm from taking beta-carotene in pill form.


Source : "A Randomized Trial of Beta Carotene Supplementation and Cognitive Function in Men: The Physicians' Health Study II" Arch Intern Med. 2007;167(20):2184-2190.

Overweight men with prostate cancer have higher risk of dying

A new study that tracked 788 men with prostate cancer also looked at their BMI at the start of the trial and followed up for 8 years. The researchers found that men who are overweight when diagnosed with prostate cancer are twice as likely to die from it. The finding was published in the journal Cancer.


Source : "Obesity and Mortality In Men With Locally Advanced Prostate Cancer: Analysis of RTOG 85-31," Cancer; Published Online: November 12, 2007 (DOI: 10.1002/cncr. 23093); Print Issue Date: December 15, 2007

This is the 3rd post this month about overweight and cancer risk.

Friday, November 09, 2007

Paracetamol as the first line of care for acute low back pain

Australian researchers warn in a study published in The Lancet that diclofenac and/or spinal manipulative therapy do not work for acute lower back pain patients, but paracetamol and keeping active are the best cures.

Source : "Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial" The Lancet, Volume 370, Issue 9599, p 1638-1643.

Pills linked to cervical cancer risk

A Belgian study found that use of oral contraceptives increased the risk of cervical cancer - but the risk fell 10 years after the women stopped taking the pills.

Some experts feared that this study may mislead the public that there is a direct link between cervical cancer and oral contraceptives. They said that the women on the pill may have more sexual activities and therefore more likely to be infected with HPV, but cervical cancer is only caused by HPV. Many doctors said that women should not stop taking them.


Source: "Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16 573 women with cervical cancer and 35 509 women without cervical cancer from 24 epidemiological studies - International Collaboration of Epidemiological Studies of Cervical Cancer" The Lancet, vol 370; 9599, pp 1609-1621

Being overweight does not increase death risk from cancer or heart disease

A new American federal report found that overweight increase the risks of dying from diabetes and kidney disease but not cancer or heart disease. The findings are based on decades of cause-of-death data collected by federal scientists. They also found a protective effect against all other causes of death.

Some dismissed the findings as fundamentally flawed while others saw that the dangers of being fat have been exaggerated. The author said the findings does not mean being overweight is good, but is associated with less mortality than expected.

Source : "Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity" JAMA. 2007;298(17):2028-2037

Wednesday, November 07, 2007

Tourette syndrome can be treated with deep brain stimulation

A small randomised and double-blinded study of 5 adults with Tourette syndrome (TS) suggests that the tic frequency and severity of some TS patients can be reduced by a technique called deep brain stimulation ( DBS) that has shown success for Parkinson’s and dystonia - sending electric impulses to specific parts of the brain.


Source: "Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome" Journal of Neurosurgery
November 2007 Volume 107, Number 5 DOI: 10.3171/jns.2007.107.5.1004

Cancer fears for overweight women

According to an article published in the BMJ, researchers matched body mass index (BMI) against cancer incidence to identify the risk of being overweight among UK women and found that obesity and overweight raised the risk of developing and dying from a range of cancer.

The study also found that the cancer risk was dependent on a woman's stage in life.


Source: "Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study" BMJ, doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)

Breast milk and higher IQ - it is in the gene

Two studies of more than 3,000 children in Britain and New Zealand found that breastfeeding raised IQ if the children also had a variant of a gene, called FADS2, found in 90% of people, which helps metabolize the fatty acid efficiently.


Source: "Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism" Proc. Natl. Acad. Sci. (PNAS) November 5, 2007 (subscription required)

Non-prescription painkillers may reduce risk of Parkinson's Disease

A study of 293 patients with Parkinson's Disease found that regular use of some non-prescription drugs known as NSAIDs reduced the risk of developing the disease. The protection persisted for 2 years after the patients stopped taking the drugs.

However, researchers warned that regular use of high dose aspirin and non-aspirin NSAIDs may cause gastrointestinal bleeding and other risks.

Source: "Nonsteroidal anti-inflammatory drugs may protect against Parkinson disease" Neurology 2007; 69: 1836-1842. (Subscription required for f/t)