Masala [PDF] 275
Teriparatide—a recombinant human
parathyroid hormone—is the new addition to the list of drugs
being introduced for osteoporosis. In a study, 428 patients
with glucocorticoid-induced osteoporosis were randomized to
either oral alendro-nate or injectable teriparatide. Starting
at 6 months onwards, by the 18-month mark, total hip density
and lumbar spine density were significantly higher in the teriparatide group relative to alendronate recipients. In
addition, teriparatide recipients had significantly fewer new
vertebral fractures (N Engl J Med 2007;357:2028–39).
Urinary retention is not just a simple
failure to void. Men admitted with urinary retention have an
increased mortality risk. In a database analysis, researchers
examined data on about 175 000 British men >45 years of
age, admitted for the first episode of acute urinary
retention. Overall, 7% of men with spontaneous urinary
retention and 15% of those with an underlying cause for
retention died within 90 days; 15% and 25%, respectively, died
within a year. Compared with the general population, the
highest relative increase in mortality was in men 45–54 years
of age (standardized mortality ratio 10.0 for spontaneous and
23.6 for precipitated acute urinary retention). The authors
concluded that men with acute urinary retention should undergo
comprehensive investigations for co-morbid diseases (BMJ
2007 Nov 8; Epub ahead of print).
Obesity is carcinogenic! According to a
study, a higher body mass index (BMI) is linked to increased
risk for cancer. Data from the Million Women Study on women
50–64 years of age suggest that there is a significant
increase in cancer risk per 10-unit increase in BMI for
several cancers. For example, the relative risk for
endometrial cancer is 2.89, for oesophageal adenocarcinoma
2.38, for kidney cancer 1.53, for leukaemia 1.5 and for
post-menopausal breast cancer 1.4. For endometrial and
oesophageal cancers, the authors estimated that half the cases
in postmenopausal women were due to overweight or obesity (BMJ
2007 Nov 6; Epub ahead of print).
The World Cancer Research Fund and the
American Institute for Cancer Research have released a
comprehensive, 500-page report detailing ways for people to
reduce their risk for cancer through diet and exercise (WCRF/AICR
Expert Report, Food, Nutrition, Physical Activity and the
Prevention of Cancer: a Global Perspective; http://www.dietandcancerreport.org).
The report selected 7000 studies from a worldwide pool of
500 000 written since records began in the 1960s and the key
recommendations include: To prevent cancer achieve and
maintain a BMI within the normal range, exercise 30–60 minutes
a day, eat no more than 18 ounces of red meat per week with
little processed meat, limit alcoholic drinks to one a day for
women and two a day for men, consume less than 6 g of sodium
daily and do not use dietary supplements.
Time to change from povidone–iodone to
chlorhexidine-based solutions for preventing central venous
catheter infections. A study of nearly 500 patients compared
skin preparation and continuing care of jugular or subclavian
vein sites with either chlorhexidine-based or povidone–iodine
solutions. Patients randomized to chlorhexidine had a 50%
decrease in catheter colonization and blood-borne infections (Arch
Intern Med 2007;167:2066–72).
Keep children off food additives. Common
food additives may cause hyperactivity in children in the
general population. In a randomized cross-over trial, 137
three-year-olds and 130 eight- or nine-year-olds consumed
daily drinks of placebo, mix A (sodium benzoate and artificial
food colouring) or mix B (similar to mix A but with additional
food colouring) for 6 weeks. Hyperactivity was evaluated using
teacher and parent ratings, direct observation and a
computerized test. Mix A was associated with elevated
hyperactivity scores among 3-year-olds, while mix B was
associated with elevated scores among 8–9-year-olds (Lancet
2007;370:1560–7).
This may alarm doctors and hospitals. In
the USA, Medicare announced that it will stop paying hospitals
for treatment of 8 conditions that result from preventable
errors (are all of these entirely preventable?). The
conditions are catheter-associated urinary tract and vascular
infections, pressure ulcers, objects left during surgery, air
embolism, blood incompatibility, mediastinitis and falls. The
agency said it is also considering adding other conditions
such as Staphylococcus aureus septicaemia,
ventilator-associated pneumonia and Clostridium difficile-associated
disease to the list. The rules state that ‘The hospital cannot
bill the beneficiary for any charges associated with the
hospital-acquired complication’ (http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1533-FC.pdf;
Department of Health and Human Services, USA).
Subcutaneously applied histamine may
represent a novel and effective therapeutic alternative in
patients with resistant migraine. Histamine has a selective
affinity for H3-receptors and may specifically inhibit the
neurogenic oedema response involved in migraine
pathophysiology. In a study, patients
with migraine were randomized to subcutaneous administration
of histamine twice a week or oral administration of sodium
valproate (Eur J Neurol 2007;14:1079–84).
Histamine caused a significantly greater reduction in
intensity and duration of migraine attacks as well as in
analgesic intake.
Another risk factor for disease created by
human activities—air pollution. In a double-blind, randomized,
cross-over study, 20 men with prior myocardial infarction were
exposed, in 2 separate sessions, to dilute diesel exhaust or
filtered air for 1 hour during periods of rest and moderate
exercise in a controlled-exposure facility. During the
exposure, myocardial ischaemia was quantified by ST-segment
analysis and after 6 hours of exposure, vasomotor and
fibrinolytic function were assessed by means of intra-arterial
agonist infusions (N Engl J Med 2007;357:1075–82).
During both exposure sessions, exercise-induced ST-segment
depression was present in all patients, but there was a
significantly greater increase in the ischaemic burden during
exposure to diesel exhaust. Exposure to diesel exhaust also
reduced the acute release of endothelial tissue plasminogen
activator.
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