Every 72 seconds
someone in the US develops Alzheimer dementia (Alzheimer’s
disease: Facts and figures, 2007; Alzheimer’s
Association, US; www.alz.org). The report states
that more than 5 million people in the US have Alzheimer
disease and by the middle of this century, with the ageing
of the population, that number could reach 16 million.
Alzheimer disease was the seventh leading cause of death
in 2004 and in the face of decreasing mortality rates for
heart disease, stroke, and breast and prostate cancer, the
death rates from Alzheimer rose by 33%. The costs of care
have also been astronomical. In the US in 2005, Medicare
spent US$ 91 billion on beneficiaries with Alzheimer
disease or other dementias. That cost is projected to
increase to US$ 160 billion in 2010.
Firefighters save lives but their firefighting
duties pose substantial cardiovascular risk to them.
According to an 11-year study, the sudden stress of
firefighting poses a significant risk for cardio-vascular
death. Although fire suppression accounted for only
between 1% and 5% of firefighters’ professional time,
one-third of all deaths from coronary artery disease in
this population occurred during this activity—10–100 times
of the risk associated with non-emergency duties. The risk
was also increased during alarm response (2–14 times) and
physical training (3–6 times), which is a part of their
job (
N Engl J Med 2007;
356:1207–15).
Peel off the ‘Please Switch Off Your Mobile’ notice
from the hospitals and prepare for increased noise
pollution. So far, cellular telephone use is generally
restricted in hospitals because of concerns that these
could interfere with medical devices. However, in a study
cell phones from two different cellular carriers were used
in patient care rooms containing a total of 192 medical
devices, such as ECG monitors, ventilators and ultrasound
imaging machines for a total of 300 tests. There was no
instance of interference of any type in any of the tests.
Even the two Blackberries tested 40 times near 24 medical
devices caused no problems (
Mayo Clin Proc 2007;
82:282–5).
Screening for diseases is a bad idea. Yet
another failed screening strategy. Lung cancer is a fatal
illness and there has been a new trend to screen current
and former smokers for lung cancer with computed
tomography (CT). Is it effective in improving outcomes? A
4-year study combining annual CT scans with comprehensive
evaluation and treatment of detected nodules in 3200
asymptomatic current or former smokers found the screening
strategy may increase the rate of lung cancer diagnosis
and treatment, but may not meaningfully reduce the risk of
advanced lung cancer or death from lung cancer (
JAMA 2007;
297:953–61).
Wonder how much evidence is needed to junk
antioxidants? A recent study has finally dealt a lethal
blow to the ‘pro-antioxidant lobby’. In this systematic
review and meta-analysis, researchers examined randomized,
controlled trials of antioxidants used for primary or
secondary disease prevention. They included 47 trials that
used high-quality methodology comprising about 180 000
patients. It was seen that when used singly or in
combination with other supplements, beta-carotene, vitamin
A and vitamin E increased mortality. Only vitamin C did
not have a significant effect on mortality (
JAMA 2007;
297:842–57).
Even garlic does not achieve what is often attributed
to it—reduction in serum cholesterol levels. A study
evaluated the effect of raw garlic and 2 commonly used
garlic supplements on cholesterol concentrations in adults
with moderate hyper-cholesterolaemia. Nearly 200
participants were assigned to consume either raw garlic,
one of two commercial supplements, or placebo 6 days a
week for 6 months. None of the treatments showed either a
statistically detectable or a clinically relevant effect
on plasma lipid concentrations. However, the accompanying
editorial commented that garlic may still be useful in
preventing cardiovascular disease because it contains
several bioactive substances that have antithrombotic,
antiplatelet and other effects (
Arch Intern Med 2007;
167:346–53).
An unusual radiology procedure-related complication. A
report has linked MRI contrast agents to a skin disorder
in patients with renal disease. This culminated in a
Centers for Disease Control alert urging physicians to
avoid using gadolinium-containing MRI contrast agents in
patients with advanced renal failure. In this report,
gadolinium agents used as MRI contrast were linked to
nephrogenic fibrosing dermopathy (NFD). This disorder
causes thickening and hardening of the skin, often in the
extremities, and occurs in patients with underlying renal
disease. The skin lesions can progress rapidly, sometimes
leading to joint immobility and the inability to walk.
Patients receiving peritoneal dialysis appeared to be at
greater risk than those receiving haemodialysis (
MMWR
2007;
56:137–41).
Epilepsy is associated with increased risk of
mortality. However, not all the risk is due to epilepsy.
Suicide is common in epileptics. A meta-analysis reported
that the number of suicide deaths among persons with
epilepsy is actually the same as the number of deaths from
epilepsy. Almost a third of all deaths in persons with
epilepsy are due to suicide and at least 14% of all
registered suicides in the population are committed by
epileptics (
Epilepsy Behav 2006;
9:641–8).
Brain pill to contain folic acid for mental agility.
Low folate and raised homocysteine concentrations in blood
are associated with poor cognitive performance in the
general population. In a randomized, double-blind,
placebo-controlled study, participants were given 800
mg oral folic acid daily or
placebo for 3 years. The effect on cognitive performance
was measured as change in performance for memory,
sensorimotor speed, information processing speed and word
fluency (
Lancet 2007;
369:208–16). And folic
acid worked well.
Polypill for hypertension. Combined antihypertensive
agents are often used in clinical practice to enhance
hypertension control and improve compliance. To extend
this further, a study was conducted to determine whether a
capsule containing a quarter of the standard dose of 4
antihypertensive agents has greater efficacy than the
standard dose of each drug individually (
Hypertension
2007;
49:272–5). The low dose combination of 4
agents representing 4 classes of standard antihypertensive
agents was more efficacious than a standard single dose of
each agent individually, achieving a lower mean arterial
pressure at least 10 mmHg.
