Monday, November 29, 2004

Cocoa, Flavanols and Cardiovascular Risk

Cocoa, Flavanols and Cardiovascular Risk:

""The Kuna Indians in Panama, living in their indigenous island home in the Caribbean, do not show the typical rise in blood pressure with age, and hypertension is very rare.[34] In a study that began with the search for protective genes, the observation that migration to Panama City led to a loss of the protection against hypertension made it clear that an environmental factor was involved. Examination of their diet uncovered the fact that they drank large volumes of a flavanol-rich cocoa.[2] Subsequent in vitro studies suggesting that cocoa extracts can induce endothelium-dependent relaxation[4] led to studies in healthy volunteers,[9] and in patients with vascular risk or disease.[1] In the studies of Heiss et al. ingestion of flavanol-rich cocoa led to an increase in flow-mediated vasodilation of the brachial artery following five minutes of ischaemia, a response that correlated with biochemical evidence of increased nitric oxide bioavailability.[8] In the normal volunteers studied by Fisher et al. flavanol-rich cocoa induced striking dilatation of the vessels of the finger, which was reversed completely by an arginine analogue that blocks nitric oxide synthesis (figure 1).[9]""

and

""Endothelial dysfunction with a consequent reduction in nitric oxide production has achieved a central conceptual role in the pathogenesis of atherosclerosis and coronary artery disease, diabetes mellitus and hypertension. Recent evidence that flavanol-rich cocoa activates vascular nitric oxide synthesis in the intact human raises an interesting possibility of a therapeutic potential.""

Potentially very good news for Hershey foods, what, what?

[Via Medscape Headlines]

Abortion Surveillance --- United States, 2001

Abortion Surveillance --- United States, 2001:

""A total of 853,485 legal induced abortions were reported to CDC for 2001 from 49 reporting areas, representing a 0.5% decrease from the 857,475 legal induced abortions reported by the same 49 reporting areas for 2000. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2001, compared with 245 reported for 2000. This represents a 0.4% increase in the abortion ratio. The abortion rate was 16 per 1,000 women aged 15--44 years for 2001, the same as for 2000. For both the 48 and 49 reporting areas, the abortion rate remained relatively constant during 1997--2001.""

These numbers exclude Alaska, California, and New Hampshire.

I post this not because I am anti-choice, but because I was surprised by the abortion ratio of 246 abortions per 1,000 live births--much higher than I would have guessed. My sincere (but admittedly naive) hope is that abortions are not being relied on as a means of birth control.

[Via MMWR]



Saturday, November 27, 2004

Lancet: Risk of cardiovascular events and rofecoxib

Lancet: Risk of cardiovascular events and rofecoxib: cumulative meta-analysis (pdf)

""Findings: We identified 18 randomised controlled trials and 11 observational studies. By the end of 2000 (52 myocardial infarctions, 20742 patients) the relative risk from randomised controlled trials was 2·30 (95% CI 1·22-4·33, p=0·010), and 1 year later (64 events, 21432 patients) it was 2·24 (1·24-4·02, p=0·007). There was little evidence that the relative risk differed depending on the control group (placebo, non-naproxen NSAID, or naproxen; p=0·41) or trial duration (p=0·82). In observational studies, the cardioprotective effect of naproxen was small (combined estimate 0·86 [95% CI 0·75-0·99]) and could not have explained the findings of the VIGOR trial.""



Friday, November 26, 2004

Making The Flu Vaccine Go Further

NEJM: Dose Sparing with Intradermal Injection of Influenza Vaccine (free full text)

NEJM: Serum Antibody Responses after Intradermal Vaccination against Influenza (free full text)



Tuesday, November 23, 2004

New Female Sterilization Technique Quicker, Easier and Cheaper

New Female Sterilization Technique Quicker, Easier and Cheaper:

""Mayo Clinic gynecologists have discovered that hysteroscopic sterilization, a new method of plugging the fallopian tubes to prevent conception, will save patients money compared to laparoscopic tubal ligation, the most commonly used method of sterilization for women. This technique involves inserting a nickel-titanium and stainless steel springlike device into the fallopian tubes using a hysteroscope, a tiny, fiberoptic camera. The metal device encapsulates and holds in place white polyester fibers able to cause scarring and thus block the fallopian tubes within 12 weeks, preventing the possibility of future pregnancy.""

Of course, it's still not as easy as a man having a vasectomy, but this technique would not require laparoscopy and would thus be safer for the woman.

[Via Science Blog - Science News Stories]



Saturday, November 20, 2004

Brain imaging study of drunk drivers pinpoints neurological changes

Alcohol Intoxication Effects on Simulated Driving: Exploring Alcohol-Dose Effects on Brain Activation Using Functional MRI

""The areas most profoundly affected by alcohol were the orbital frontal and anterior cingulate areas, which help control motor functions. The medial frontal regions of the brain involved in making decisions, and working memory, were not affected until the person was beyond the legal limit of intoxication. A function of working memory might be to find one's way home, the researchers said.

Impairment of the cerebellum area of the brain, which related strongly to speeding, was clearly correlated with the alcohol dose. Changes in the frontal and parietal cortex, which govern alertness and attention, were correlated with weaving while driving. ""

[Via Medical News Today]



Thursday, November 18, 2004

Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes --- United States, 1988--1994 and 1999--2002

Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes --- United States, 1988--1994 and 1999--2002:

""Obesity in persons with diabetes is associated with poorer control of blood glucose levels, blood pressure, and cholesterol (1), placing persons with diabetes at higher risk for both cardiovascular and microvascular disease (2). Conversely, intentional weight loss is associated with reduced mortality among overweight persons with diabetes (3). CDC analyzed the prevalence of overweight and obesity among U.S. adults aged >20 years with previously diagnosed diabetes by using data from two surveys: the Third National Health and Nutrition Examination Survey (NHANES III), 1988--1994, and NHANES 1999--2002. This report summarizes the results of that analysis, which indicated that most adults with diagnosed diabetes were overweight or obese. During 1999--2002, the prevalence of overweight or obesity was 85.2%, and the prevalence of obesity was 54.8%. Encouraging patients to achieve and maintain a healthy weight should be a priority for all diabetes-care programs.""

[Via MMWR]



Sunday, November 14, 2004

Vioxx Non-Cox2 Effect Demonstrated

It's worth pointing out that discussion of a drugs action typically focus on one known effect. That there may be others and that those can be harmful is amply demonstrated by the Vioxx example. An article just published in the journal 'Atherosclerosis' may explain what the second effect is in the case of Vioxx:

Sulfone COX-2 inhibitors increase susceptibility of human LDL and plasma to oxidative modification: comparison to sulfonamide COX-2 inhibitors and NSAIDs

Bottom line: "Abnormal changes in the structure or shape of lipids caused by Vioxx, especially in LDL, may explain why they are more susceptible to oxidative damage, and therefore, contribute to cardiovascular damage. Similar effects on susceptibility of lipids to oxidative damage have been observed with cigarette smoking, diabetes and in patients who have had a recent heart attack."

[Via Medical News Today]



Wednesday, November 10, 2004

Shortage of 200,000 Doctors Predicted in US by 2020

Annals of Internal Medicine (free): Weighing the Evidence for Expanding Physician Supply

"Summary: "Taken together, this body of information indicates that physician shortages are emerging and that they will probably worsen over the next 2 decades. By 2020 or 2025, the deficit could be as great as 200 000 physicians—20% of the needed workforce..."

...[snip]...

"... the data, forecasts, and signals discussed earlier indicate that physician shortages are upon us and are likely to worsen over time. The picture that emerges is uncomplicated and unambiguous. In simple numeric terms, the number of physicians is no longer keeping up with population growth. The ability to fully service the population is further compromised by the increasing complexity of the care that physicians provide and the decreasing time commitment that many physicians are willing to make. These limitations collide with economic trends that predict a growing demand for physician services. Recruiters, medical leaders, and patients are already experiencing these shortages, and colleagues in other English-speaking countries see a situation in the United States that is all too familiar to them.""

Missing from the article is any mention of 'malpractice', 'tort reform', or 'liability reform'. These issues do effect how long someone chooses to practice and where. If one believes that there's a physician shortage coming, states would be wise to become 'friendlier' to physicians by enacting tort reform in order to insure they remain a viable choice for physicians looking for a place to practice. Of course, Pennsylvania won't be among them, at least not while Ed [trial lawyer] Rendell is governor, as he's already been quoted as saying that malpractice reform is "the next governor's problem."

[Via Medscape]



Tuesday, November 9, 2004

Liberal Fluid Administration to Improves Recovery After Lap Chole

Liberal Versus Restrictive Fluid Administration to Improve Recovery:

""Results: Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR led to significant improvements in postoperative pulmonary function and exercise capacity and a reduced stress response (aldosterone, antidiuretic hormone, and angiotensin II). Nausea, general well-being, thirst, dizziness, drowsiness, fatigue, and balance function were also significantly improved, as well as significantly more patients fulfilled discharge criteria and were discharged on the day of surgery with the high-volume fluid substitution.Conclusions: Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR improves postoperative organ functions and recovery and shortens hospital stay after laparoscopic cholecystectomy.""

Yawn. This is a 'me too' study, but does provide yet more support to the idea more fluid is good during anesthesia. It's important to note that this is for a 'closed' procedure, not an open one. Insensible loses are minimal with this technique.



Thursday, October 28, 2004

NEJM: Health Care Coverage and Drug Costs — The Candidates Speak Out

The editors asked President George W. Bush and Senator John F. Kerry to respond to two questions regarding health care in the United States. Free full text.

Mortality Rates Associated with Community-Acquired Bacterial Meningitis over the Past 90 Years.

NEJM: Mortality Rates Associated with Community-Acquired Bacterial Meningitis over the Past 90 Years

""The history of community-acquired bacterial meningitis arguably represents the best example of the salutary effect of the introduction of antimicrobial agents. Before the use of specific antiserums, the outlook for patients with bacterial meningitis was dismal (see Figure). In the 1920s, 77 of 78 children at Boston Children's Hospital who had Haemophilus influenzae meningitis died...""

Lot's of progress. Lots more work to do. Much of it by drug companies...

November, 2004
Sun Mon Tue Wed Thu Fri Sat
  1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30  
Oct  Dec

Feeds and Categories

Blog Roll

Google Modules
   Body Mass Index
   Allowable Blood Loss

Anesthesiology
   The Ether Way
   Westmead Anaesthesia Blog
   Anesthesioboist
   Book of Joe
   Anesthesiamania
   i'm so sleepy
   GASMAN

Medicine
   Aggravated DocSurg
   Retired Doc
   Finger and Tubes
   Running A Hospital
   Medviews
   Doctor
   Chance To Cut
   Medlogs
   Medpundit
   RangelMD
   DB's Medical Rants
   EchoJournal
   Palmdoc Chronicles
   Blogborygmi
   The Well-Timed Period
   WebMD

Journals
   NEJM
   JAMA
   A&A
   Anesthesiology

Geeks Like Me
   Seth Dillingham
   Jonathan Greene