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Breaking News Archives
- Febuary 12, 2007: Stroke
Patients Improve with Movement Therapy:
A research study showed that a 2 week program of constraint induced
movement therapy (CIMT) improved upper extremity function even after
one year in stroke patients with some residual hand and wrist
movement. By restraining the good hand with a mitten and requiring
use of the affected hand, significant improvements in movement were
seen.
Wolf SL et al, JAMA. 2006; 296:2095-2104
- February 26, 2007: Long Term
Exposure to Air Pollution Increases Cardiovascular Disease and
Death in Women:
Long term exposure to the fine particulate matter in air
pollution increases the incidence of cardiovascular disease and
death in postmenopausal women. The increased risk applied to
both fatal and nonfatal coronary artery disease and stroke. Each
10µg per cubic meter increase in fine particulate matter caused
a 24% increase of a cardiovascular event and a 76% increase in
death from cardiovascular disease. Miller KA et al, N Engl J Med
2007; 356:447-58.
- March 5, 2007: Medical Errors Common
in Stroke Care:
A study of stroke patients admitted to a large teaching hospital
showed that medical errors and adverse events occurred
frequently. 46% of the injuries were determined to be
preventable. Of the preventable injuries, 37% were due to
transcription/documentation errors, 23% were due to a failure to
perform a clinical task, 10% were due to communication errors,
and 10% were due to incorrect calculations. Of the 1,000,000
annual hospital admissions for stroke, 50,000 to 100,000
patients may experience injury caused by medical error.
Neurology 2007; 68:550-555, 500-501.
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March 19, 2007: Maternal Diet in Late Pregnancy
Affects Children’s Risk for Eczema:
A recent study showed that a maternal diet high in margarine,
vegetable oils and citrus fruits during the last 4 weeks of
pregnancy is linked with eczema in children by 2 years of age.
The mother’s diet during pregnancy may be a factor that
influences the fetal immune responses that cause childhood
allergy. The study suggests that mothers eating allergenic foods
and foods rich in n-6 polyunsaturated fatty acids (e.g.
margarine, vegetable oils, celery and citrus fruit) during
pregnancy increase the risk of allergic diseases in their
children, while eating foods rich in n-3 polyunsaturated fatty
acids such as fish may decrease this risk. Am Jrnl Clin Nutr.
2007; 85:530-537.
-
March 26, 2007:
Safety Concerns Persist About Aprotinin:
Aprotinin (Trasylol) is used during coronary artery bypass
grafting (CABG) to reduce bleeding risk. Compared with a lysine
analogue (another anti-bleeding agent to reduce bleeding risk)
or no antifibrinolytic therapy, aprotinin was associated with an
increased mortality risk at 5 years. Pending further FDA
evaluation, aprotinin must be used with caution given the
availability of lysine analogue as an alternative treatment that
was not associated with an increased mortality risk. Mangano DT
et al. Mortality associated with aprotinin during 5 years
following coronary artery bypass graft surgery. JAMA 2007 Feb 7;
297:4719.
-
April
2, 2007: RotaTeq and Intussusception:
A Reminder of This Complication: On February 13, 2007, the TDA
issued a public health notification that 28 cases of intussusception
had been reported after administration of a vaccine against
Rotavirus (RotaTeq) since its licensure in February 2006.
Intussusception is a form of partial or complete intestinal
obstruction usually in children. Cases occurred up to 73 days after
administration of the vaccine and half occurred within 21 days. The
number of reported intussusceptions is less than the government’s
estimated background rate. The FDA is not recommending changes in
current vaccination practices, but it wants to encourage reporting
of future cases linked to RotaTeq and to remind people of this
potential complication of the Rotavirus vaccine. FDA Public Health
Notification. Information on RotaTeq and Intussusception
(Click
Here)
-
April 16, 2007: Predicting Early Stroke After
TIA:
Two
research groups have developed a unified scoring system to
assess patients at high risk for a stroke after experiencing a
Transient Ischemic Attach (TIA). Using 7- point scoring tool
based on 5 clinical factors (Age, Blood Pressure, Clinical
Features, Duration of Symptoms in minutes, and Diabetes),
patients can be managed based on the level of risk for early
stroke after their TIA. The scoring system identifies patients
who require immediate attention, including brain imaging,
neurovascular and cardiac evaluation, and hospitalization to
allow prompt treatment with clot dissolving medications if a
stroke develops. Johnson SC et al. Validation and refinement of
scores to predict very early stroke risk after transient
ischaemic attack. Lancet 2007 Jan 27; 369:283-92
-
April 30, 2007:
HPV Prevalence in U.S. Women:
27% of U.S. women test positive for infection with human
papillomavirus (HPG). The highest incidence was in women aged
20-24 with a 45% positive rate and declined to 20% in women aged
50 to 59 years of age. The incidence of HPV in women who
reported never having sex was 5%. Unfortunately, only 3.4% of
HPV types were covered by the new vaccine, which is lower than
expected, and this low efficacy rate may change the
cost-effectiveness calculation for using the new HPV vaccine.
Dunne EF et al.. Prevalence of HPV infection among females in
the United Staes. JAMA 2007 Feb 28; 297:813-9.
-
May 14, 2007:
Fibrinolysis for Acute Ischemic Stroke: Standard of Care?
\
Despite fibrinolysis being recommended as a first line
treatment, many physicians are reluctant to use it because of
intracerebral hemorrhage. A recent study using intravenous
Alteplase was conducted on ischemic stroke patients aged 18 to
80 who presented within 3 hours of symptoms. The complication of
intracerebral hemorrhage occurred in 1.7% and 7.3% of patients
at 24 hours and 7 days after therapy respectively. An accurate
diagnosis of acute nonhemorrhagic stroke with rapid CT scanning
to confirm the absence of bleeding supports the use of a
fibrinolytic agent. Though fibrinolysis is not without risk, its
benefits in acute stroke are well documented, and emergency room
physicians need to work with neurologists and radiologists to
establish optimal stroke treatment. WQahlgren N et al.
Thrombolysis with alteplase for acute ischemic stroke in the
Safe Implementation of Thrombolysis in Stroke-Monitoring
(SITS-MOST): An observational study. Lancet 2007 Jan 27;
369:275-82.
-
May 28,2007: Outcomes of
Myocardial Infarction in Hospitals With Percutaneous Coronary
Intervention Facilities:
Patients with heart attacks who are admitted to hospital that
can perform Percutaneous Coronary Intervention (PCI) have better
survival than those that go to no-PCI hospitals. PCI includes
coronary angiography and treatment with angioplasty and arterial
stenting of blocked coronary arteries. Patients admitted to PCI
hospitals had lower in-hospital death rates (7% vs. 12%) and
lower mortality at one year (13% vs. 20%). Labarere J. et al.
Arch Intern Med. 2007;167:913-920.
-
June 11, 2007: Prehospital and Hospital Delays After Stroke Onset --- United
States, 2005-2006:
Each year approximately 700,000 persons in the United States
have a new or recurrent stroke with 15-30% becoming permanently
disabled. The severity of ischemic stroke related disability can
be reduced if appropriate treatment is received with intravenous
thrombolytic therapy within 3 hours of symptom onset. The study
showed that fewer than half of stroke patients arrived at the ER
within 2 hours of symptom onset, but that nearly two-thirds of
those who arrived at the ER within 2 hours received brain
imaging within 1 hour. There is a need for heightened awareness
by the public of the importance of recognizing stroke symptoms
and to call for an ambulance to get the patient to an ER as
quickly as possible. There is also a need for hospitals to
streamline procedures for rapid brain imaging of possible
ischemic stroke patients. MMMR Weekly. 56(19);474-478 (May 18,
2007).
-
July 2, 2007: HPV
Vaccine Prevents High Grade Vulval and Vaginal Lesions:
A study
of 18,000 young women showed that, among women without previous
exposure to HPV-16 and HPV-18, the quadrilvalent HPV vaccine was
100% effective in preventing high-grade lesions associated with
these viryus types. The maximum effect of vaccination is
expected in girls who are vaccinated in early adolescence before
exposure. HPV-16 and 18 are associated with the development of
high-grade vulval and vaginal intraepithelial neoplasia in
women. Jura EA et al., Efficacy of a quadrivalent prophylactic
human papillomavirus (types 6, 11, 16, and 18) L1
virus-like-particle vaccine against high-grade vulval and
vaginal lesions: a combined analysis of three randomised
clinical trials. The Lancet 2007; 369:1693-1702.
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July 23, 2007: Studies Find
Some Advantage of Back Surgery Over Conservative Treatment:
Two studies in the New England Journal of Medicine reported that
back problems improve more rapidly after surgery than with
conservative treatment. In one study of 283 patients, the early
surgery group experienced pain relief more quickly, but at one
year follow-up there were no differences in the amount of pain,
disability or recovery scores. The other study of some 600
patients showed that surgical treatment provided an advantage in
both pain relief and functional improvement, and this difference
persisted for 2 years after initial injury. In conclusion, it
appears that in the absence of major neurological deficits,
patients with herniated disks, degenerative spondylolisthesis,
or spinal stenosis do not need surgery. However, appropriate
surgical procedures may provide earlier and valuable pain
relief. Paul WC et al., Surgery versus prolonged conservative
treatment for sciatica. N Engl J Med 2007 356;22:2245-56..
Weinstein JN et al. Surgical versus nonsurgical treatment of
lumbar degenerative spondylolisthesis. N Engl J Med 2007
356;22:2257-70
-
August
13,2007:
Quadrivalent Vaccine
against Human Papillomavirus to Prevent Anogenital Diseases:
A study in
the New England Journal of Medicine reported on the efficacy of
the quadrivalent HPV vaccine to prevent anogenital disease
caused by the virus. Women were followed for vulvar, vaginal,
perianal and/or cervical disease for an average of 3 years after
the vaccination. Regardless of the HPV, vaccination reduced the
rate of any vulvar, vaginal or perianal lesions by 34% and
reduced the rate of cervical lesions type by 20%. The
quadrivalent vaccine significantly reduced the incidence of
HPV-associated anogenital diseases in young women. Garland SM et
al. Quadrivalent vaccine against human papillomavirus to prevent
anogenital disease, N Engl J Med 2007; 356:1928-43.
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August 27,
2007: Over The Counter Medications Can be Dangerous:
The New York City Medical
Examiner has determined that the sudden death of an adolescent
cross-country runner was caused by the excess use of
over-the-counter (OTC) sports creams, such as Ben-Gay and Icy
Hot, which she used to relieve sore muscles and joints. The
anti-inflammatory agent, salicylic acid, is in the form of oil
of wintergreen or batula oil. Exercise and heat, as well as
patches, accentuate absorption of the drug into the body.
Nausea, vomiting, fatigue, dizziness, convulsions and agitation
are symptoms of salicylate poisoning. Extremely high levels of
methyl salicylate were found in the teen’s body and caused a
fatal seizure. Associated Press. Muscle-pain reliever is blamed
for Staten Island runner’s death. New York Times 2007 Jun 10;
1,39.
-
September 10,
2007:
Middle Age Not
Too Late To Lower Cardiac Risk:
The American Journal of Medicine
reports that a healthy lifestyle after age 45 provides
cardiovascular benefits and decreases the death rate for individuals
at risk of a cardiac event even just after 4 years of life style
change. Individuals who ate at least five fruits and vegetables
daily, exercised at least 2.5 hours weekly, maintained weight
between 18.5 and 30 BMI and stopped smoking had a 40% reduction in
all causes of death and a 35% reduction in cardiovascular events,
compared with individuals who did not implement all of the studied
life style changes. Living a healthy life style is extremely
worthwhile and even middle-aged people can benefit from implementing
these changes. King DE et al. Turning Back the Clock: Adopting a
Healthy Lifestyle in Middle Age. Am. Journ. Medicine. Volume 120:7;
598-603 (2007).
-
September 24,
2007: Risk of Blood Clots on Long Planes Rides in 1 in 6000:
The risk for venous thromboembolism approximately doubles after
a plane flight lasting at least 4 hours, but is still only about
1 in 6000, according to the World Health Organization based upon
three epidemiological studies and two pathophysiology studies.
This risk remains elevated for 2 months after the trip, and the
risk of venous thromboembolism is also increased with other
forms of travel by car, bus or train, when riders sit immobile
for long periods of time. The risk is further increased by
obesity, use of oral contraceptives, the presence of factor V
Leiden mutation and extremes of height (either above 6’3” or
below 5’3”). WHO Research Into Global Hazards of Travel (Wright)
Project. June 29, 2007.
-
October
8, 2007: Prostate Cancer Recurrence
Declines with Increasing Experience of Surgeon:
Prostatectomies performed by
highly experienced surgeons result in significantly less cancer
recurrence than those done by less seasoned doctors, according to a
study in the Journal of the National Cancer Institute. There was a
steep learning curve that did not begin to plateau until surgeons
had done about 250 operations. Recurrence after 5 years was 18% for
surgeons who had only done 10 prior operations, compared with 11%
fro those surgeons who had done 250 operations. This study provides
support for regionalized cancer care, for choosing high-volume
surgeons and for basing payments on performance outcomes. Vickers AJ
et al, The surgical learning curve for prostate cancer control after
radical prostatectomy. JNCI 2007 99(15):1171-1177.
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October 22,
2007: Hip Protectors Don’t Prevent Fractures Among Nursing Home
Residents:
A study designed to show the efficacy of hip protectors
on nursing home patients to prevent hip fractures failed to show
any benefit. Hip protectors as currently designed are not
effective for preventing hip fractures, and there was no
difference in the incidence of hip fractures in residents
wearing such protective devices and those who did not. Kiel DP
et al. Efficacy of a hip protector to prevent hip fracture in
nursing home residents. JAMA. 2007;298:413-422.
-
November 18,
2007: AHA Guidelines for Screening Student Athletes:
The American Heart Association recently updated its guidelines
for screening student athletes. Routine use of 12-lead ECG is
not recommended for mass screening, because it is considered
impractical and costly, unlike Europe where ECG screening is
used. A complete history and physical exam, including specific
attention to the cardiovascular system, should be performed.
Athlete examinations should be performed every 2 years. Maron BJ
et al., Recommendations and considerations related to
preparticipation screening for cardiovascular abnormalities in
competitive athletes: 2007 Update. Circulation
2007;115:11643-1655.
December 3, 2007:
Cosmetic Eyelash-Lengthener Seized:
The FDA seized more than 12,000 applicator tubes of Age
Intervention Eyelash, a cosmetic designed to increase eyelash
growth, because of concerns it may cause eye damage. The product
contains bimatoprost (Lumigan) which is used to treat elevated
intraocular pressure. Side effects may include optic nerve
damage, macular edema and uveitis. No cases of damage have been
reported to the manufacturer, but consumers need to be aware of
the potential risk. FDA News. Approximately $2 million of
potentially harmful “cosmetic” eye product seized. November 16,
2007.
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