Month: April 2011

Could Working Long Hours Be Bad for Your Heart?

Posted by

0


In a low-risk cohort, adding working hours to standard Framingham risk factors improved prediction of coronary heart disease.

Working long hours is associated with an increase in risk for coronary heart disease (CHD). Investigators used data on civil service workers in London to study how the incorporation of information on work hours into the Framingham risk score (FRS) affects prediction of 10-year risk for CHD. They excluded individuals who already had CHD, worked part time, or lacked data on working hours at baseline. Baseline mean levels of coronary risk factors were low or moderately elevated in the 7095 participants included in the analysis. Fifty-four percent of participants worked 7 to 8 hours per day, and 10% worked 11 hours per day.

During a median follow-up of 12.3 years, 192 incident CHD events occurred. Compared with participants working 7 to 8 hours per day, the FRS-adjusted hazard ratio for a CHD event was 0.90 in participants working 9 hours per day, 1.45 in those working 10 hours per day, and a statistically significant 1.67 in those working 11 hours per day. The association of FRS with incident CHD was strengthened after adjustment for long working hours, but only by 2.6%.

Comment: Information about working hours modestly improves the accuracy of risk prediction for coronary disease, particularly in individuals who work 11 or more hours per day. Whether working long hours is causal or a risk marker for CHD remains to be determined. Nonetheless, in these difficult economic times, patients should be made aware of the association and of the potential deleterious effects of long working hours.

Source: Journal Watch Cardiology

NIH Study Finds Avastin And Lucentis Are Equally Effective In Treating AMD

Posted by

0


Researchers are reporting results from the first year of a two-year clinical trial that Avastin, a drug approved to treat some cancers and that is commonly used off-label to treat age-related macular degeneration (AMD), is as effective as the Food and Drug Administration-approved drug Lucentis for the treatment of AMD.

The report, from the Comparison of AMD Treatments Trials (CATT), was published online in the New England Journal of Medicine on Sunday, May 1, 2011. CATT is funded by the National Eye Institute (NEI), a part of the National Institutes of Health.

“Over 250,000 patients are treated each year for AMD, and a substantial number of them receive Avastin. Given the lack of efficacy data regarding Avastin for AMD treatment, the NEI had an obligation to patients and clinicians to conduct this study,” said Paul A. Sieving, M.D., Ph.D., director of the NEI.

AMD is the leading cause of vision loss and blindness in older Americans. In its advanced stages, the wet form of AMD spurs the growth of abnormal blood vessels, which leak fluid and blood into the macula and obscure vision. The macula is the central portion of the retina that allows us to look straight ahead and to perceive fine visual detail. Accumulation of fluid and blood damages the macula, causing loss of central vision. AMD can severely impede mobility and independence. Many patients are unable to drive, read, recognize faces or perform tasks that require hand-eye coordination.

Genentech, the maker of both drugs, originally developed Avastin to prevent blood vessel growth that enables cancerous tumors to develop and spread. In 2004, the FDA approved Avastin for the systemic treatment of metastatic colon cancer. Genentech later developed Lucentis, derived from a protein similar to Avastin, specifically for injection in the eye to block blood vessel growth in AMD.

In 2005, two Genentech-sponsored clinical trials established Lucentis as highly effective for the treatment of wet AMD. During the year between the announcement of the trial results and the release of Lucentis, ophthalmologists began injecting AMD patients with low doses of Avastin, due to its similarity to Lucentis and its availability. The FDA has not licensed Avastin for the treatment of AMD.

Numerous physicians noted a beneficial treatment effect and Avastin’s use grew rapidly despite the lack of data on safety, efficacy and dosing from randomized clinical trials to support its use. Ophthalmologists used Avastin primarily as needed, or pro re nata (PRN), when there was evidence of active disease. The FDA approved Lucentis in 2006. However, most clinicians adopted PRN dosing for Lucentis, which was a departure from FDA-approved labeling and the monthly dosing schedule evaluated in the Genentech-sponsored clinical trials. It was not known if PRN dosing would produce the same long term vision benefits that were achieved with monthly administration.

NEI launched CATT in 2008 to compare Lucentis and Avastin for treatment of wet AMD. The study has now reported results for 1,185 patients treated at 43 clinical centers in the United States. Patients were randomly assigned and treated with one of four regimens for a year. They received Lucentis monthly or PRN, or Avastin monthly or PRN. Enrollment criteria required that study participants had active disease.

Patients in the monthly dosing groups received an initial treatment and then had an injection every 28 days. Patients in the PRN groups received an initial treatment and were then examined every 28 days to determine medical need for additional treatment. PRN groups received subsequent treatment when there were signs of disease activity, such as fluid in the retina. Ophthalmologists involved in patient care did not know which study drug a patient was getting, to make sure that the data was not affected by how anyone felt about the treatment.

Change in visual acuity served as the primary outcome measure for CATT. Thus far, visual acuity improvement was virtually identical (within one letter difference on an eye chart) for either drug when given monthly. In addition, no difference was found in the percentage of patients who had an important gain or loss in visual function. Also, when each drug was given on a PRN schedule, there also was no difference (within one letter) between drugs. PRN dosing required four to five fewer injections per year than monthly treatment. Visual gains were about two letters less with PRN than with monthly treatment but overall visual results were still excellent.

“In addition to the primary finding of equivalence between Lucentis and Avastin for visual acuity, CATT also demonstrates that PRN dosing is a viable treatment option for either of these drugs,” said Daniel F. Martin M.D., study chair for CATT and chairman of the Cole Eye Institute at the Cleveland Clinic. “Substantial visual acuity gains may be accomplished with a lower treatment burden.”

Adverse events indicate development or worsening of a medical condition. They may or may not be causally associated with the clinical trial treatment, but they are always monitored and reported in any clinical trial. The median age of patients in CATT was over 80 years, and a high rate of hospitalizations might be anticipated as a result of chronic or acute medical conditions more common to older populations.

Serious adverse events (primarily hospitalizations) occurred at a 24 percent rate for patients receiving Avastin and a 19 percent rate for patients receiving Lucentis. These events were distributed across many different conditions, most of which were not associated with Avastin in cancer clinical trials where the drug was administered at 500 times the dose used for AMD. The number of deaths, heart attacks, and strokes were low and similar for both drugs during the study. CATT was not capable of determining whether there is an association between a particular adverse event and treatment. Differences in serious adverse event rates require further study.

Investigators in the CATT study will continue to follow patients through a second year of treatment. These additional data will provide information on longer-term effects of the drugs on vision and safety.

source: the NIH/National Eye Institute

Vegan Diet Reduces Breast Cancer Risk

Posted by

0


Insulin-like growth factor I (IGF-I) is a specific type of hormone that has been linked to a potential increased risk of breast cancer. Similar to measuring cholesterol in the blood to check for heart disease risk, IGF-I is measured over time and depending on the level (i.e., more IGF-I refers to higher cancer risk) can determine cancer risk.

One study looked at women with a genetic susceptibility to cancer risk, and those with a mutation of the BRCA1 and/or BRCA2 gene (tumor suppressor genes). Apparently, those who inherit a mutation of the BRCA1/BRCA2 gene are up to 80 percent more likely to develop breast cancer within their lifetime. Researchers were trying to determine if IGF-I had a connection to breast cancer risk in women genetically susceptible, which could give insight to controlling breast cancer risk by modifying blood levels of IGF-I. Researchers observed 308 women (209 cases and 99 controls) at high genetic risk for breast cancer, and some were carriers of the altered BRCA1or BRCA2 gene. The women already diagnosed with breast cancer (referred to as “cases”) were matched to those unaffected (referred to as “controls”). By observing IGF-I levels from both groups researchers found that those with the highest levels of IGF-I had a 3.5-fold increased breast cancer risk, compared to those with the lowest. When excluding for women on hormone altering medications, like Tamoxifen, the risk was even greater, with a 3.7-fold increased risk. Women with the altered BCRA1/BCRA2 gene who had the highest levels of IGF-I were seven times more likely to develop breast cancer than those with low IGF-I levels. Researchers conclude that if larger studies can confirm these findings, women with genetic susceptibility for breast cancer will have other methods for decreasing risk, such as focusing on lowering IGF-I.

Recent studies suggest a plant-based diet can do just that. Vegetarian and vegan diets tend to be low in circulating levels of IGF-I. Diets high in a variety of fruits and vegetables can significantly reduce breast cancer development in women with BRCA mutations. Since the BRCA gene is responsible for repairing DNA, it is thought that antioxidants in fruits and vegetables can assist the DNA repair system. However, foods most know to increase IGF-I stem from animal protein animal proteins, milk, and dairy protein.

source: the cancer project

May is Skin Cancer Awareness Month

Posted by

0


Skin cancer is the most common form of cancer in the United States. Each year, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon, according to the Skin Cancer Foundation.

Since May is right around the corner, The Cancer Project would like to highlight the importance of skin care. Many sun-goers are looking for that “perfect” tan this summer, but there are a few considerations regarding time in the sun.

Sunshine provides natural vitamin D, which helps control calcium absorption and can also help fight many types of cancer. But too much of it can increase skin cancer risk.

Ten to 15 minutes of direct sunlight typically generates a day’s worth of vitamin D. After that, it is important to cover your skin with sun block and wear clothing for protection. About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun. But even melanoma, considered the most serious form of skin cancer, is also largely due to sun exposure, and if someone has had a severe sunburn (blistering) in childhood their risk for acquiring melanoma doubles.

Of course preventing skin cancer is the best bet. However, if diagnosed with skin cancer nutrition can still play its role.

Studies show that foods fortified with vitamin D and foods high in carotenoids (like lycopene) can decrease the risk of skin cancer.1 Plant-sources of vitamin D include fortified cereals, plant-milks, and juices. It is also becoming more common for doctors to prescribe a vitamin D supplement, as many Americans are deficient. Good sources of carotenoids come from brightly colored fruits and veggies. Choose all colors, especially orange and red, to boost up on carotenoids this summer.

It is important to catch skin cancer early in order to have a successful treatment. Look for warning signs of odd skin development and see a dermatologist and your doctor immediately. Possible signs include:

  • A new development/growth on the skin
  • Changes in an existing mole
  • If a new mole forms
  • A sore that refuses to heal
  • Reddish patches (or growing bump) on skin that may appear flat, scaly, and rough

source: the cancer project

Long-Term Proton-Pump Inhibitor Therapy in Children

Posted by

0


A high percentage of children developed low-grade enterochromaffin cell-like hyperplasia.

The hypergastrinemia associated with long-term proton-pump inhibitor (PPI) therapy is suspected of causing enterochromaffin cell-like (ECL) hyperplasia or even carcinoid tumors in the developing stomachs of children.

To address this issue, investigators in Canada retrospectively reviewed sequential gastric biopsies from 65 children who received PPI therapy for >9 months (median, 2.29 years). The median age of patients at the time of first biopsy was 8.2 years (range, <1–17 years). Biopsy tissue was stained to identify ECL cells and was read by a pathologist who was blinded to the timing of the biopsies.

ECL hyperplasia was found in 40 of 65 patients (9 patients had ECL hyperplasia prior to PPI therapy) and in 82 of 458 biopsies (67 biopsies had grade 1 hyperplasia, and 15 had grade 2 hyperplasia). The median duration of PPI use was nonsignificantly longer in patients with ECL hyperplasia than in those without (3.17 years and 2.20 years). No patients developed chronic atrophic gastritis or carcinoid tumors. The authors concluded that a high percentage of children who receive chronic PPI therapy develop ECL hyperplasia, but that it is low grade and has no known clinical implications.

Comment: This small study suggests that the hypergastrinemia produced by PPI therapy has similar effects in children similar to those in adults. The absence of high-grade hyperplasia, neoplasia, or carcinoid tumors is reassuring, but larger long-term studies are required to verify these results.

Source: Journal Watch Gastroenterology

Symptoms Persist After Minor Head Injury and Concussion

Posted by

0


Postconcussive symptoms persist for at least 1 month in most patients.

The prevalence and management of concussion in patients with head injury have received much attention in the medical literature and lay press. Researchers prospectively assessed the prevalence and patterns of concussive symptoms at 1 month in a convenience sample of 94 patients who presented to two Canadian emergency departments (EDs) after minor head injury (defined as any acute traumatic head injury in a patient with a transient loss of brain function and Glasgow Coma Scale score of 15 at presentation).

Overall, 68 patients (72%) reported concussive symptoms at presentation, and 59 (63%) reported persistent concussive symptoms at 1-month follow-up. The most persistent symptoms were headache (42%), dizziness (29%), fatigue (28%), and cognitive impairment (28%).

Comment: Patients who present with minor head injury and concussive symptoms should be informed that symptoms likely will persist for 1 month or longer. Athletes should be advised to avoid both exertion and contact until all symptoms have resolved and they have been cleared to return to playing sports by a physician knowledgeable about sports-related concussion.

Source: Journal Watch Emergency Medicine

Levothyroxine Dosing Associated with Increased Fracture Risk in the Elderly

Posted by

0


Elderly patients receiving levothyroxine show a dose-related increased risk for fracture, according to a BMJ study. An accompanying editorial says that the risk is small and the main concern is defining the proper “normal” thyroid-stimulating hormone (TSH) level in this age group.

Using Ontario’s prescription-benefit database, researchers conducted a case-control study among more than 200,000 adults (mean age, 82) who were using thyroxine any time over a 5-year period. Current and recent thyroxine use (within the past 6 months) were both associated with an increased risk for fracture, compared with remote use (discontinued more than 6 months previously). Both high and medium cumulative doses showed increased fracture risk over low doses.

Editorialists criticize the lack of TSH data — a limitation the authors acknowledge — and point out that “elderly people need relatively low thyroxine doses, so serum TSH should be regularly monitored and a suppressed TSH should be avoided in such patients.”

Source: BMJ

Gastric Bypass May Improve Diabetes Quickly

Posted by

0


Researchers Say Changes in Amino Acid Levels Explains Improvements in Bypass Patients
Obese woman talking with doctor

April 27, 2011 — Gastric bypass weight loss surgery often improves type 2 diabetes long before patients lose much weight. Now a new study from Duke University Medical Center and Columbia University may help explain why.

When researchers compared patients who had gastric bypass surgery to those who lost the same amount of weight by dieting, they found that the surgery patients had lower levels of amino acids that have been linked to insulin resistance.

The study was small, including just 10 patients who had the surgery and 11 patients who followed severely calorie-restricted diets. And the patients in both groups had lost just a fraction of the weight they needed to lose at the time of the analysis.

But researchers say the preliminary findings could one day lead to diabetes treatments.

“Certainly weight loss by any means improves type 2 diabetes, but there is something else going on with gastric bypass surgery,” study researcher Blandine Laferrere, MD, of Columbia University’s St. Luke’s and Roosevelt Hospital Center, tells WebMD.

“Surgery puts the diabetes into remission. Most of the research has focused on changes in gut hormones, but we have shown that a decline in specific circulating amino acids also occurs.”

Surgery Improves Blood Sugar

The study included obese people with type 2 diabetes who had a BMI (body mass index) greater than 35. Patients who did not have gastric bypass surgery were placed on strictly monitored 1,000-calorie a day meal-replacement diets.

All the participants had lost an average of about 20 pounds at the time of the study. The surgery group did this in one month, while the dieters took about two months to lose the weight.

The analysis revealed that the surgery patients had much lower levels of several types of circulating branched-chain amino acids (BCAA) and the aromatic amino acids phenylalanine (Phe) and tyrosine (Tyr).

They also had greater improvements in blood sugar control. One month after surgery, all of the gastric bypass patients were off all diabetes drugs. About half the dieters still needed treatment after losing the same amount of weight.

In earlier research, study co-researcher Christopher Newgard, PhD, and colleagues from the nutrition and metabolism center at Duke University showed that these amino acids were associated with insulin resistance and cardiovascular disease.

In a news release, Newgard noted that studies are needed to better understand how BCAA and the related metabolites influence diabetes risk.

Laferrere says this understanding could lead to new diabetes treatments that are as effective as gastric bypass surgery.

“It would not be possible to offer this surgery to everyone with type 2 diabetes,” she says. “About 28 million American adults have type 2 diabetes, and about 200,000 of these surgeries are done each year.”

The American Diabetes Association (ADA) considers gastric bypass surgery an option for severely overweight people with type 2 diabetes who have BMIs of 35 or more, but less than half of patients with the disease are that heavy.

Late last month, the International Diabetes Federation, which represents more than 200 diabetes groups across the globe, called for weight loss surgery to be considered a treatment for type 2 diabetes in certain patients with BMIs as low as 30.

ADA Vice President for Clinical Affairs Sue Kirkman, MD, says while benefits of surgery appear to clearly outweigh the risks for patients who are morbidly obese and are not helped by other treatments, this is not so clear for other patients.

“Like all surgeries there are risks,” she tells WebMD. “The risks are the same no matter what the BMI, but the benefits of surgery may not be as great for patients with lower BMIs.”

She says side effects of surgery can include chronic diarrhea and abdominal cramping, which occurs in about one in five patients, and frequent bouts of low blood sugar. There are also concerns about the surgery’s long-term impact on bone health.

The study, which appears in the journal Science Translational Medicine, was funded by the ADA, the National Institutes of Health, and the drugmaker GlaxoSmithKline.

source: webMD

Some Women Who’ve Had High-Grade Cervical Intraepithelial Neoplasia Can Resume Regular Screening

Posted by

0


Women with a history of high-grade cervical intraepithelial neoplasia (CIN) can return to regular screening schedules in some circumstances, according to a Lancet Oncology report.

Researchers followed 435 women who’d been treated for grade 2 or 3 CIN up to 21 years earlier. All had undergone cytologic testing as well as testing for high-risk human papillomavirus at 6, 12, and 24 months after treatment and then were screened cytologically every 5 years thereafter.

During follow-up, the 5-year risk for grade 2 or higher CIN among women with three consecutive negative cytologic exams was less than 3% — a rate comparable to that among women with normal results on population-based screening.

Source:Lancet Oncology

Cardiac sarcoidosis

Posted by

0


Cardiac sarcoidosis can have a variety of manifestations including conduction disease, congestive heart failure, valvular heart disease, pericardial effusions, tamponade, ventricular arrhythmias and sudden cardiac death. In patients with sarcoidosis, the reported incidence of cardiac involvement ranges from 20% in US autopsy studies to nearly 60% in Japan, where it accounts for the majority of deaths as a result of sarcoidosis. Despite this, the diagnosis of cardiac sarcoidosis remains difficult and no single diagnostic test has emerged that combines a high degree of sensitivity and specificity. Recent evidence suggests that gadolinium-enhanced magnetic resonance imaging can potentially offer high sensitivity and specificity for both disease presence and activity. It may also be possible to track response to treatment of cardiac sarcoidosis with cardiac magnetic resonance imaging. Corticosteroids are the mainstay of treatment for cardiac sarcoidosis as with systemic sarcoid but at present no prospective trial has shown a survival benefit. Pharmacological treatment of heart failure should follow standard heart failure guidelines, whereas anti-arrhythmic treatment is problematic. The role of implantable cardiac defibrillators in sarcoid has not been well defined, although the risk of ventricular arrhythmias and sudden cardiac death are high. Cardiac transplantation remains an option for younger patients, although overall cardiac involvement in sarcoidosis carries a relatively poor prognosis.

source: journal of internal medicine