BlogMed

Cardiovascular Disease Much More Common In Patients With Restless Leg Syndrome

Restless Leg Syndrome is a disease characterized by a strong urge to move your legs, typically being a movement that cannot be resisted.  It is typically worse at rest, improves during periods of movement or activity and typically is worse in the evening.  It occurs frequently during sleep, resulting in periods of awakening which prevent the brain from reaching deeper levels of sleep that are necessary to feel well rested.

This multi-center study looked at the relationship between Restless Leg Syndrome(RLS) and the prevalence of Cardiovascular disease.  1,559 men and 1,874 women were enrolled in this study, and had symptoms of RLS at least 5 times per month.  After adjustment for other cardiovascular risk factors such as age, smoking, diabetes, hypertension, and elevated cholesterol with special statistical formulas, the risk of heart disease in patients with RLS was evaluated in comparison to those without this sleep disorder.

The prevalence of cardiovascular disease was 2.07 times more likely in those with RLS compared to patients without this disorder.  The risk was even stronger in those with more severe symptoms of RLS.

Reference: Windelman JW et al, Neurology 2008;70:35-42.

Tags: cardiovascular disease, restless leg syndrome, sleep

Posted in Heart Attack, sleep, stroke | No Comments »

The Use of Statins To Lower Cholesterol Help Lung Function In Emphysema Patients

Smoking is responsible for causing a significant amount of lung disease, noteably emphysema and chronic bronchitis.  This study investigated whether Statin drugs(cholesterol lowering medication in the class HMG coA reductase inhibitors) which appear to have anti-inflammatory properties, also have the ability to preserve lung function in current and former smokers.

A group of patients that included smokers and ex-smokers at the Oklahoma City VA hospital who had lung function testing done 6 months apart were analyzed.  Approximately half of the patients, 215 of 418, were receiving a statin drug.  Statin users had a significantly lower decline in lung function compared to the group not receiving this drug.  This benefit held true irrespective of whether the patients were present smokers or ex-smokers.  Additionally, a lower incidence of respiratory related medical care was needed for the group taking statin drugs.

This study highlights the need for additional studies to be done looking at the anti-inflammatory properties and alternative protective effects of cholesterol lowering medications such as lipitor, zocor, crestor, mevacor, pravachol and others.

Reference: Keddissi JI et al, Chest 2007; 132:1764-1771.

Tags: bronchitis, emphysema, Smoking, Statins

Posted in Lung Disease, Pharmacology, Smoking | No Comments »

Mammogram Accuracy Varies By Radiologist

Previous investigation has revealed variation in the quality of screening mammograms performed, which affects the accuracy of detecting breast cancer.  This study performed by a researcher at the Group Health Center for Health Studies in Seattle found a significant disparity in the interpretation of mammograms even when a lump was present on exam prior to these studies.  This study evaluated 123 radiologists who looked at 36,000 diagnostic mammograms from 1996-2003 at 72 U.S. facilities.  They found that the sensitivity(the ability to accurately detect cancer) ranged from 27% to 100% among the centers evaluated.  They also found that the range of false positives(when a test is called abnormal but no cancer is present) was 0-16%.  On average, 21% of breast cancers were missed and 4.3% of woman underwent biopsies despite not having breast cancer.

Many of the centers in this study were from rural areas which may not necessarily handle a high volume of diagnostic mammograms.  The conclusion of this study is that woman should consider having their mammograms performed at high volume centers that have breast imaging experts.

Reference: Reuters Health Information (2007-12-11)

Tags: Breast Cancer, mammogram, radiology

Posted in Breast Cancer, Preventative Medicine | 5 Comments »

Mouth-to-Mouth Not Necessary for Effective CPR

CPR, also known as cardiopulmonary resuscitation, is well recognized as being a potentially life saving technique when performed quickly on somebody who has a sudden cardiac arrest(stopping of the heart).  A simpler version of CPR where one administers only chest compressions without mouth-to-mouth resuscitation may be just as effective as standard CPR with mouth-to-mouth respiration given.

Two studies published this month in Circulation: the Journal of the American Heart Association, compared both of these methods for individuals who suffered out-of-hospital cardiac arrest.  The first study out of the Karolinska Institute in Stockholm reported on 11,275 patients.  73% received standard CPR, 10% received chest compression only CPR, and 17% received only mouth-to-mouth resuscitation.  20% of patients receiving compression only CPR survived versus 19.6% of patients receiving standard CPR survived until hospital arrival.  Both of these methods were superior to mouth-to-mouth resuscitation only.  After 1 month the survival of these 2 groups remained similar as well.

The second study from the Kyoto University Health Service in Japan found similar results when they analyzed 4900 witnessed cardiac arrests.  Additionally, they found that 1 year survival with favorable neurological outcome(adequate brain function) was superior with either of these forms of CPR when compared to no CPR given. 

Both of these studies comment on the low rate of bystander CPR being performed, and mention such factors as fear of contracting contagious illnesses, or the inability to perform a complicated task in the setting of extreme emotional anxiety.  Since chest compression only CPR is much simpler to perform, if adopted as the standard it could potentially contribute to a substantially higher percentage of bystanders performing it, and hence saving many lives.

Reference: Reuters Health 2007-12-13.

Tags: Arrhythmia, cardiac arrest, CPR

Posted in Cardiology, Cognitive Dysfunction, Emergencies, Medical Training | 139 Comments »

A Promising Start to a New, Wearable, Artificial Kidney

A newly developled articial kidney (which performs haemodialysis) which can be worn by patients with end stage kidney disease shows promise according to a recent study published in the journal, Lancet.  The device, developed by a physician in California, was tested in 8 patients in the UK for a brief period of 4-8 hours.  The patients received anticoagulation as they would in normal dialysis.  The machines performed well in terms of saftey and in measures of dialysis efficiency.  The investigators professed the study successful, opening the door to larger studies.   Such devices could help dialysis patients in two ways. First, they would afford them more freedom of movement and second, it is known now that shorter, more frequent dialysis treatments are better for maintaining health - these devices could allow patients to do such treatments.

Reference: The Lancet 2007; 370:2005-2010

Posted in Diabetes, Nephrology, News, Renal Failure | 748 Comments »

Virtual Colonoscopy - Still Limited Compared to Conventional Colonoscopy

Virtual Colonoscopy, also known as computed tomography colonography (CTC), is a newer diagnostic test used in the detection of colorectal tumors and polyps.   The test involves a CT scan of the abdomen and pelvis performed by radiologists at an imaging center and relies on sophisticated computer modelling to render a three dimensional reconstruction of the inside of the colon.     Compared to conventional colonoscopy (CC), the test does not require sedation and carries minimal risk of perforation of the colon.      But the sensitivity and cost effectiveness of CTC as a screening test for colonic pathology is still being determined.  When CC was compared to CTC in a recent study, CTC was found to be less sensitive in detecting polyps and lesions under < 10 mm in size.  Flat lesions also could be missed by this screening test.   For detection of lesions >/=10 mm the two tests were equivalent.   

CTC is limited in that it is only a diagnostic test and any discovered polyps or lesions would require a follow-up colonoscopy with biopsy or polypectomy.   As with all CT scans,  the patient is also exposed to radiation when undergoing CTC.   Despite it’s limitations CTC is a cost effective and useful screening test and  may eventually evolve into a complementary colorectal screening test. 

Reference:  Arnesan RB, et al.  Acta Radiol.  2007 Oct; 48(8):831-7.

Tags: Colon Cancer, Colon Polyps, Colonoscopy, Virtual Colonoscopy

Posted in Cancer, Gastroenterology | No Comments »

Steriods no Help in Meningitis

A recent series of two studies was conducted to hopefully lend further support for the use of steroids (dexamethasone - not anabolic steroids illegally used by athletes) along with antibiotics in the treatment of bacterial meningitis.  Researchers unfortunately found that the steroids were of no benefit - contradicting more positive studies done over the last few years.  Some speculate that these trials, performed on patients in Vietnam and in Malawi (Sub-Saharan Africa) present a situation where different patient populations respond differently to the same treatment.  They feel that patients in Asia and Africa have different co-morbidities (such as HIV) and strains of infection and may need to be treated differently than those in Europe and North America.   Current recommendations are that steroids be used as adjunctive treatment - these studies raise questions and beg for larger trials.

References: NJEM Dec 13th, Part 1, Part 2

Posted in Emergencies, Infectious Disease, Neurology, Pharmacology, Public Health, Race | No Comments »

Combining Doxycycline and Beta-Interferon May Slow MS Progression

A recent small study is the latest in a series of investigations looking at the efficacy of combining the well known generic antibiotic, doxycycline with B-interferon (brand name Avonex) in slowing the progression of Multiple Sclerosis (MS).  The study described at a recent European MS society meeting and to be soon published, showed that patients taking the combination of the drugs for four months experienced an average reduction of greater than 25% of brain lesions (an indicator of MS disease activity).  This was a very small study (15 patients),was funded by the drug manufacturer of Avonex (Biogen, Inc), and had some other flaws, however several other small studies over the last two years have showed promise in this combination therapy. The authors state that the time is right to perform larger-scale studies with this drug combination.

Reference: Clinical Trials

Posted in Multiple Sclerosis, Neurology, Pharmacology | 1 Comment »

U.S. FDA Finds No Heart Impact of Prilosec, Nexium

Recent studies done on the popular anti-acid medications such as Prilosec and Nexium raised a concern about a possible association between these drugs and the development of heart related problems such as heart attack.  The Food and Drug Administration in early August released information about a formal drug review that was initiated, after two studies they reviewed suggested a greater risk of heart attacks, heart failure and heart related sudden death from these drugs compared to a surgical remedy for severe acid reflux disease.

U.S. regulators have released their findings where they found no evidence of increased risk of heart related problems from these popular heartburn or anti-acid medications.  The FDA based its opinion in part on 14 studies of Prilosec, the oldest drug of this class of Proton Pump Inhibitors.  Four of these studies were placebo-controlled studies(studies where half the participants get dummy pills).  Placebo controlled studies are viewed as the “gold standard” for clinical trials.

Reference: Reuters Health Information (2007-12-10)

Tags: Heart Attack, proton pump inhibitor, reflux

Posted in Cardiology, GERD, Gastroenterology, Heart Attack, Pharmacology | 675 Comments »

Excessive Abdominal Obesity Is a Strong Predictor of Heart Disease and Diabetes

There is a worldwide increase in the incidence of diabetes and this is largely related to the growing epidemic of obesity.  Overall increases in body weight  increase the liklihood of developing many disease states such as high blood pressure, elevated cholesterol and tryiglycerides, increased tendency for the blood to clot, elevated inflammatory markers(such as cRP levels) and heart disease. 

A specific type of body fat distribution known as visceral adipose tissue accumulation(fat cells within the abdominal cavity that surround vital organs there) has been found to be an even stronger predictor of developing heart disease and heart attacks.  The risk of heart disease seems to be substantially increased in the presence of an elevated waist circumference and elevated triglyceride levels, largely because it correlates strongly with this visceral adipose tissue accumulation.  Therefore, from a risk assessment standpoint, the simple measurement of waist size and triglyceride levels is a reasonable first step approach to identify a high risk group of individuals at risk of this metabolic syndrome.  Moreover, moderate weight loss in individuals with the largely abdominal obesity pattern results in selective mobilization of significant amounts of this visceral adipose tissue accumulation, leading to marked improvements in one’s risk of heart disease and diabetes.

Reference: Lemieux I et al., Canadian Journal of Cardiology 2007 Oct;23 Suppl B;23B-31B.

Tags: heart disease, Obesity, triglycerides, visceral fat

Posted in Heart Attack, Obesity, hypertension | 1 Comment »