the January 31 issue of the New England J of Medicine reported a large observational study on endovascular vs. open repair of Abdominal Aortic Aneurysms (AAA).
Endovascular repair is a minimally invasive technique involving placing a stent via a catheter while open repair involves placing a graft through a large incision. However there have been concerns about the long term benefits of endovascular repair.
The study, including more than 45,000 patients on the US Medicare, found those who had endoscopic repairs had a higher survival rate 30 days after the procedure, the benefit is greater the older the patient. By 4 years, rupture and minor reintervention were more likely in the endovascular repair group than the open repair group. The author said these were balanced by an increase in laparotomy-related reinterventions and hospital admission after open surgery, however, not everyone is suitable for endoscopic stenting.
Source: "Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population" , NEJM Volume 358(5):464-474 ( subscription required)
Thursday, January 31, 2008
Deep-brain stimulation could improve memory
While a team of Canadian doctors was using the technique of deep-brain stimulation to suppress an obese man's appetite, the man suddenly recalled in details a scene decades earlier instead of losing his appetite. Further tests showed his ability to learn was dramatically improved.
The lead author said the discovery was totally unexpected and the team is now applying the technique to treat patients with Alzheimer's disease in a trial. The findings, reported in the Annals of Neurology, might provide benefit to patients with memory disorders.
The lead author said the discovery was totally unexpected and the team is now applying the technique to treat patients with Alzheimer's disease in a trial. The findings, reported in the Annals of Neurology, might provide benefit to patients with memory disorders.
Tuesday, January 29, 2008
Exercise can make you younger
A new study based on the analysis of questionnaires of more than 2400 twins found that physically active adults are biologically younger than inactive ones - they have longer telomeres that are the caps at the end of the chromosomes. Telomeres tend to get shorter as people age and are used as an indicator of a peson's biological age.
The research team said the "differences in telomere length between active and inactive individuals cannot be explained by variations in genes, smoking, BMI and socioeconomic status", and the findings "could be used by clinicians to promote the potentially anti-aging effect of regular exercise". The study is published in the Archives of Internal Medicine, 28th issue.
In an editorial in the same issue, an expert said there could be other factors responsible for the biological differences between active and sedentary people, but the findings provide the evidence that telomere length might be targeted in studying ageing outcomes.
Source: "The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length."Arch Intern Med. 2008;168(2):154-158. ( full text via Athens)
The research team said the "differences in telomere length between active and inactive individuals cannot be explained by variations in genes, smoking, BMI and socioeconomic status", and the findings "could be used by clinicians to promote the potentially anti-aging effect of regular exercise". The study is published in the Archives of Internal Medicine, 28th issue.
In an editorial in the same issue, an expert said there could be other factors responsible for the biological differences between active and sedentary people, but the findings provide the evidence that telomere length might be targeted in studying ageing outcomes.
Source: "The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length."Arch Intern Med. 2008;168(2):154-158. ( full text via Athens)
Monday, January 28, 2008
Coffee is bad for diabetics
A small study of 10 patients with type 2 diabetes and who drank at least two cups of coffee daily found that daily consumption of caffeine increases their sugar levels by 8% and can exaggerate the rise in glucose after each meal. Higher sugar levels are bad for diabetics, complications may develop if the sugar levels are not controlled.
Source:"Caffeine Increases Ambulatory Glucose and Postprandial Responses in Coffee Drinkers With Type 2 Diabetes" Diabetes Care 31:221-222, 2008
Source:"Caffeine Increases Ambulatory Glucose and Postprandial Responses in Coffee Drinkers With Type 2 Diabetes" Diabetes Care 31:221-222, 2008
Contraceptive pill has prevented 100,000 deaths
A large review based on 45 studies including 23,257 women with ovarian cancer and 87,303 controls found that the contraceptive pill substantially reduces women's risk of ovarian cancer for 30 years after they stop taking it, indicating a real protective effect against the cancer. Writing in the Lancet, the author said at least 100,000 deaths from ovarian cancer have been prevented worldwide by the contraceptive pill over 50 years.
It has been known that the pill increases women's risk of breast and cervical cancer, but the author said that these effects disappear after a woman stops taking it while the ovarian protection lasts for decades.
In the editorial, the author said "this study is impressive and compelling" and called for the pill to be available over-the-counter. A scientist writing in The Lancet opposed the over-the-counter access of the pill sayingthat women and their doctors must perform a balancing act between the risk and benefits.
Source: "Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls"
The Lancet 2008; 371:303-314
It has been known that the pill increases women's risk of breast and cervical cancer, but the author said that these effects disappear after a woman stops taking it while the ovarian protection lasts for decades.
In the editorial, the author said "this study is impressive and compelling" and called for the pill to be available over-the-counter. A scientist writing in The Lancet opposed the over-the-counter access of the pill sayingthat women and their doctors must perform a balancing act between the risk and benefits.
Source: "Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls"
The Lancet 2008; 371:303-314
Work stress raises heart risk
A new study involving 10,000 civil servants aged between 35 and 55 over 12 years found that chronic work stress raised the risk of coronary heart disease (CHD) and this association was stronger among the under 50.
Stress appeared to undermine the autonomic nervous system that controls the heart and the variability of the heart rate. Researchers also found higher levels of the stress hormone in workers who reported stressful job.
Source: "Work stress and coronary heart disease: what are the mechanisms?" European Heart Journal, published online on January 23, 2008 (free f/t)Thursday, January 24, 2008
Aspirin resistant may increase heart attack risk
Aspirin is widely used to prevent heart attacks, strokes and blood clot, but the Telegraph reported that a review of 20 studies involving 3000 patients has found 28% do not respond to aspirin and there is no standard test to establish who are resistant to the drug.
The author concluded that "patients who are resistant to aspirin are at a greater risk of clinically important cardiovascular morbidity long term than patients who are sensitive to aspirin" and called for further research. The report was published in the BMJ.
Source: Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis BMJ, doi:10.1136/bmj.39430.529549.BE (published 17 January 2008)
The author concluded that "patients who are resistant to aspirin are at a greater risk of clinically important cardiovascular morbidity long term than patients who are sensitive to aspirin" and called for further research. The report was published in the BMJ.
Source: Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis BMJ, doi:10.1136/bmj.39430.529549.BE (published 17 January 2008)
Arthritis drug could reduce psoriasis in children
The Telegraph reported that an arthritis drug, Etanercept (Enbrel), could significantly improve the signs and symptoms of psoriasis in children.
The report is based on a double-blind randomised controlled trial published in New England Journal of Medicine, involving 211 children with psoriasis. The patients received weekly injections of etanercept or placebo for 12 weeks, followed by a 24-week period when all patients received etanercept and a 12-week period when patients were randomised to etanercept or placebo. The author concluded that Etanercept significantly reduced disease severity in children and adolescents with moderate to severe plaque psoriasis
Source: "Etanercept Treatment for Children and Adolescents with Plaque Psoriasis" NEJM 2008 358(3):241-251
The report is based on a double-blind randomised controlled trial published in New England Journal of Medicine, involving 211 children with psoriasis. The patients received weekly injections of etanercept or placebo for 12 weeks, followed by a 24-week period when all patients received etanercept and a 12-week period when patients were randomised to etanercept or placebo. The author concluded that Etanercept significantly reduced disease severity in children and adolescents with moderate to severe plaque psoriasis
Source: "Etanercept Treatment for Children and Adolescents with Plaque Psoriasis" NEJM 2008 358(3):241-251
Calcium supplements may increase heart attack risk
The Telegraph reported researchers in New Zealand found that calcium supplements may increase the risk of heart attack in healthy postmenopausal women.
1,471 postmenopausal women of average age 74 were randomly assigned to receive calcium supplement or placebo, followed for 5 years, researchers found heart attacks were more common in the women taking the calcium supplements. The report was published in the BMJ Online, the authors said the results are not conclusive but suggest that high calcium intakes might have an adverse effect on vascular health. Some experts in the field found the conclusion surprising and urged patients not to stop taking the supplements.
Source: "Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial." BMJ 2008:394405257 published online, 15 January 2008 ( full text via Athens)
1,471 postmenopausal women of average age 74 were randomly assigned to receive calcium supplement or placebo, followed for 5 years, researchers found heart attacks were more common in the women taking the calcium supplements. The report was published in the BMJ Online, the authors said the results are not conclusive but suggest that high calcium intakes might have an adverse effect on vascular health. Some experts in the field found the conclusion surprising and urged patients not to stop taking the supplements.
Source: "Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial." BMJ 2008:394405257 published online, 15 January 2008 ( full text via Athens)
Wednesday, January 09, 2008
New medical training body needed in England
After the chaos of MTAS last year, Professor John Tooke, Dean of the Peninsula School of Medicine, was asked by the DH to lead an independent inquiry into Modernising Medical Careers. His interim report was published last October and was backed by doctors.
The Tooke final report was out yesterday with recommendations that a new body - NHS Medical Education England to be set up to manage postgraduate medical training and the training budget should be ring-fenced to prevent the NHS from using it to plug deficits.
The report also warns that junior doctors training could suffer when the European Working Time Directive comes into force next year, so measures need to be taken to ensure doctors have enough training time.
Junior doctors across the UK are being warned that they will face tough competition this year for specialist training jobs in the NHS after the government failed in a legal bid to give UK medical graduates priority. The report says that the Government failed to resolve its two policies that have caused the severe competition for training posts in the UK - British medical schools increasing the intake of students and the "open door" policy toward overseas doctors who want specialist training in the UK. Read more at TimesOnline .
The Tooke final report was out yesterday with recommendations that a new body - NHS Medical Education England to be set up to manage postgraduate medical training and the training budget should be ring-fenced to prevent the NHS from using it to plug deficits.
The report also warns that junior doctors training could suffer when the European Working Time Directive comes into force next year, so measures need to be taken to ensure doctors have enough training time.
Junior doctors across the UK are being warned that they will face tough competition this year for specialist training jobs in the NHS after the government failed in a legal bid to give UK medical graduates priority. The report says that the Government failed to resolve its two policies that have caused the severe competition for training posts in the UK - British medical schools increasing the intake of students and the "open door" policy toward overseas doctors who want specialist training in the UK. Read more at TimesOnline .
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