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Drinking Milk in Pregnancy may Increase the Birth Weight

A recent study from Denmark looked at the effect of the consumption of cow’s milk on the foetus during pregnancy.  The investigators collected data on diet from women in mid-gestation and then follow up post partum data via interviews. In those women who drank >6 glasses per day, there was a strong association of larger infant birth weight than in women who drank no milk.  There was a increasing graded response to birth weight as well as abdominal circumference, placental weight, and birth length with greater intake of milk.  The weight gain is thought to be more related to the high protein intake than the intake of fat.

Reference: Am J Clin Nutr. 2007 Oct;86(4):1104-10

Posted in Diet, News, Pregnancy, Public Health | No Comments »

Esophageal Capsule Endoscopy - A Hard Pill to Swallow

Barrett’s esophagus and adenocarcinoma of the esophagus are complications related to chronic gastroesophageal acid reflux (GERD).   Though millions of people suffer from GERD and only a small percentage of people will develop these complications,  the incidence of esophageal cancer is rising and may be related to  underlying Barrett’s esophagus.  Barrett’s esophagus is considered a precursor lesion in the development of most types of esophageal cancer.   The gold standard diagnostic test relies on endoscopy under sedation to survey the esophagus and detect Barrett’s disease - a daunting task when one looks at the vast population of people who suffer from GERD and require screening.    

In recent years, new technology in the form of capsule endoscopy has emerged as a potential minimally invasive screening test.    Capsule endoscopy, first introduced by the GIVEN coorporation to visualize the small intestines, is now available to look at the esophagus.     A patient swallows a disposable mechanical pill containing a small battery, LED and transmitter.  The pill relays signals wirelessly to an attached sensor array which then is transferred to a computer and read as a movie file of the patient’s GI tract.   Though it is now a well established test for the small intestines it still remains to be seen if it will be an effective screening test for the esophagus.

A recent study published in The American Journal of Gastroenterology tested the effectiveness of this screening test.   When patients with Barrett’s esophagus (confirmed by traditional endoscopy and biopsy)  were examined by capsule endoscopy (in a blinded fashiobn) there was found to be high inter-observer variability and a low yield for detecting Barrett’s esophagus.   The type of Barrett’s being studied was very mild (often referred to as a ’short-segment Barrett’s) and may be more difficult to detect by capsule endoscopy.   

Traditional endoscopy still remains the most effective way to visualize and examine the esophagus.     

Reference:  Debakey M, et al,  Am J Gastroenterol.  2007 Nov 28

Tags: Barrett's esophagus, capsule endoscopy, GERD

Posted in Cancer, GERD, Gastroenterology | No Comments »

Top Three Drugs that Lead to a Visit to the ER

A large study recently published looked at Emergency Department vists for older adults caused by reactions or toxicity to certain medications.  Between 2004 and 2005, a total of 177,504 visits to the ER were caused by adverse reactions to drugs in patients over 65.  The top three offenders were Warfarin (Coumadin), Insulin, and Digoxin (Lanoxin).  All of these medications are very commonly used in elderly patients - warfarin is to thin the blood, insulin is for diabetes, and digoxin is for heart rhythm problems like atril fibrillation and for heart failure.  Unfortunately, all of them are difficult to dose - and frequent monitoring of levels needs to be done.  They all require the patient and doctor to communicate frequently to obtain a safe and effective level.  To complicate matters, other medications often interact with them and can dramatically change circulating blood levels. This can lead to toxicity like bleeding, arrhythmias, gastrointestinal problems, and low or high blood sugar (hypo and hyper glycaemia).  Antibiotics are a frequent culprit.  Of further interest, is that medications that are generally ill-advised in the elderly (a large list) account for a very small percent of visits (3%)  for adverse advents. The investigators go on to conclude in stating “a reminder that doctors and patients need to work on doing the best job we can managing these medicines.”

Reference: Annals of Internal Medicine, Dec 4, 2007

Posted in Emergencies, News, Pharmacology, Public Health, toxicology | 3 Comments »

Genetic discrimination in health insurance: current legal protections and industry practices.

There has recently been a tremendous increase in our understanding of human genetics(mapping of our chromosomes) and how it relates to causes of diseases.  Part of this growth of medical knowledge has been as a result of a significant number of subjects allowing the mapping of their genetic material and having scientists compare their medical histories’ to their genetic sequences of proteins.  However, there is increasing concern among scientists that patients concerns about discrimination based on this medical knowledge may discourage future patients from participating in clinical investigations.  Most states have enacted genetic nondiscrimination laws in health insurance and federal legislation is pending.

This paper studies underwriting practices in the private health insurance market related to genetic information.  Underwriters from 23 different companies were surveyed and given hypothetical situations to determine how they would respond.  What was seen was that some underwriters revealed that they would possibly deny coverage, charge a higher premium for coverage or possibly limit covered benefits based on an applicants genetic profiling.

This study underscores the importance of how we as a society are to handle this unique knowledge base on this new frontier.

Reference: Pollitz K et al, Inquiry, 2007 Fall;44(3):350-68.

Tags: chromosomes, diseases, Genetics, insurance

Posted in Genetics | 1 Comment »

Cholesterol and Stroke. A Confusing Relationship

The link between high cholesterol and heart disease is fairly well established and accepted in the medical community, however recent research has left investigators wondering about the relationship between cholesterol and stroke.  A study just published in The Lancet found that in middle to older age patients, elevated cholesterol was actually associated wtih a LOWER risk of stroke.   Even more baffling is that cholesterol lowering drugs like statins have been shown to lower the stroke risk as well as the cardiac risk.   Researchers speculate flaws in the study or other factors affecting the population of patients studied.  They are certainly not suggesting that if one is to be concerned with stroke prevention, that they need not worry about high cholesterol.  The state that more research is clearly needed, stroke seems to be much more complicated than heart attacks (myocardial infarctions).

Reference: Lewington et al, Lancet, Dec 1, 2007

Posted in Cardiology, Diet, Heart Attack, Preventative Medicine, stroke | No Comments »

Know the Risk, Make the Change

Researchers from McGill University in Montreal found that simply by having physicians discuss their patients’ risks for heart disease and educate them on how to reduce them, a measurable improvement was seen.  Patients were randomised to either receive “usual” care, or to have specific “ongoing feedback regarding their calculated coronary risk and the change in this risk after lifestyle changes, pharmacotherapy, or both to treat dislipidemia” (high cholesterol). 

Although the difference was small, the value of utilising risk assessment was significant in preventitive cardiac care. 

Reference: Arch Intern Med. 2007 Nov 26;167(21):2296-303

Posted in Cardiology, Diet, Heart Attack, Obesity, Pharmacology, Preventative Medicine, hypertension | No Comments »

Deadly Ebola Virus Strikes Again

An outbreak of Ebola has been reported by the World Health Organization (WHO) in the African nation of Uganda.   Ebola is a  virus causing hemorrhagic fever.   Afflicted patients develop high fever, red eyes, sore throat, severe abdominal pain and diarrhea and ultimately internal and external bleeding.   To date there is no known effective treatment or vaccine available to the public and infection carries a high mortality rate.    So far there have been 51 suspected cases in this latest outbreak with sixteen confirmed deaths already.  

What makes this latest outbreak unique is that a new strain of the virus has been discovered.   Though the nation of Uganda is remote and the latest outbreak deep in the nation’s jungle,   Ebola remains a potentially serious bioterrorism threat.  

 Reference:   WHO 

Tags: Bioterrorism, Ebola Virus, Hemorrhagic Fever, Virus

Posted in Infectious Disease, Viruses | No Comments »

Employees Must Wash Hands Before Returning to Work….

A recent study published in the British Medical Journal found that simple policies such as regular hand-washing and wearing masks, gloves and gowns, may be more effective than drugs to prevent the spread of respiratory viruses such as influenza and SARS.  This is of interest since in Britain, there is an effort underway to double the stockpile of antiviral medications , at great expense, as a possible defence against influenza.  This study showed that it is more effective and less costly to invest in these physical barrier methods than antivirals like oseltamivir (Tamiflu).  

Reference: BMJ. 2007 Nov 27

Posted in Hygiene, Infectious Disease, Influenza, Public Health, Viruses | No Comments »

Night Shift Work and the Risk of Cancer

Working the night shift may increase a person’s risk of developing cancer.  A possible link between the development of certain types of cancer and night time shift work was first proposed in the 1980’s but dismissed as ridiculous.   It wasn’t until the analysis of recent studies, to be reported in this month’s Lancet Oncology by the The International Agency for the Research on Cancer (IARC),  a division of the World Health Organization (WHO),  that the idea gained credibility again.   Studies have shown an increase in breast cancer rates in women who work night shift over many years.   Similar observations have also been made in men with the development of prostate cancer and in animal studies where day night reversal leads to the development of more tumors and quicker deaths.   The observations are still being greeted with skepticism by the scientific and medical community and lack evidence beyond a casual association.   

Theories to why night time shift work may lead to cancer revolve around the role of melatonin;   a hormone produced by the brain usually during night time hours when people sleep.   The hormone may have a protective role in suppressing tumors and people who work night shifts may have lower melatonin levels.   Sleep deprivation and altered immunity may also be factors associated with the development of cancer.  

The IARC  is likely to list night shift work as a carcinogen in the next month.   The American Cancer Society is likely to follow with a similar advisory.   

Reference:  Straif K  The Lancet Oncology.   Dec 2007;  Vol 8(12)

Tags: Breast Cancer, Cancer, Prostate Cancer, sleep

Posted in Breast Cancer, Cancer, Prostate Cancer, sleep | 1 Comment »

CAT Scans — An Increasing Source of Radiation Exposure

Since the advent of Computed Tomography Scanning(CAT scans or CT scans) in the 1970s, its use has increased tremendously.  It is estimated that 62 million scans are done per year in the US.  Its uses range from diagnosing cancer to evaluating for an infection or pneumonia, assessing amounts of trauma to ruling out things such as blood clots, and most recently imaging arteries to assess for blockages.

By the nature of this technology, it involves the delivery of much larger doses of radiation to the patient than conventional xrays.  The association between radiation exposure and the risk of developing cancer has been increasingly recognized.  This observation dates back to the followup of survivors of the atomic bombs dropped on Japan in 1945.  The risk of developing cancer from this radiation exposure increases with the number of scans a person has, the specific type of CT scanner used, the specific type of exam being done, and the age of the patient.  The younger the patient, the higher the risk because the relative radiation dose is higher in children and their life expectancy is so much longer, therefore there is more time for the radiation effects to become manifested.

The clinical information obtained from CT scanning remains vital to patient care.  However, it is important for physicians and patients to remain as informed as possible about the relative risks and benefits of each study being performed, in order to make reasonable treatment decisions.   Reducing the frequency of scanning as much as possible remains the safest tactic.

Reference: Brenner DJ et al, New England Journal of Medicine Vol. 357, No. 22, 2277-84.

Tags: Computed Tomography, CT scan, Radiation

Posted in Cancer, Radiation | 2 Comments »