Opposition To Larger Health Warnings Grows In India

By Dr Deepu

The Deccan (IND) Herald (7/30) reports that opposition to health warnings covering 85% of tobacco packages in India has expanded from the tobacco industry to include 13 petitions from groups such as the CII (Confederation of Indian Industry) and ASSOCHAM (Associated Chambers of Commerce Of India) while no major hospitals have supported the measure. The piece notes that 26 petitions support larger warnings, however, as the Lok Sabha Committee on Subordinate Legislation prepares to issue a report on the matter to the House.

Lung Cancer Risk May Be Higher In People With Long Telomeres

By Dr Deepu

HealthDay (7/30, Preidt) reports that research published in Human Molecular Genetics suggests that individuals “with long telomeres are at increased risk for lung cancer but not other types of cancer.” Investigators “analyzed genetic data from more than 50,000 cancer patients and 60,000 people without cancer to learn more about the links between telomere length and the risk of five types of cancer: breast, lung, colon, ovarian and prostate.” While the researchers “found an association between long telomeres and increased risk of lung cancer,” they did not find any “significant association between telomere length and any of the other types of cancer.”

Ex-Smokers May Have Less Severe Hot Flashes Than Smokers

By Dr Deepu

Reuters (7/24, Rapaport) reported that a small study found that women who quit smoking appeared to have fewer and less severe hot flashes during menopause than those who continued smoking. The findings were published in online June 22 in Maturitas.

Low-Nicotine Cigarettes Don’t Help Smokers Quit In The Long-Term

By Dr Deepu

HealthDay (7/25, Preidt) reported that a new study by researchers at the University of California San Francisco found that “low-nicotine cigarettes alone don’t help smokers quit over the long term.” The study “included 135 smokers who had no immediate plans to quit,” 80 of which were given “cigarettes with progressively lower levels of nicotine, eventually reaching just 5 percent of the level used in regular cigarettes,” while the rest continued to use their regular cigarettes. Researchers concluded that “while smokers who used low-nicotine cigarettes lowered their nicotine intake, they were unable to reduce their smoking in the long term.”

Sleep Apnea May Lead To Development, Attention Problems In Kids

By Dr Deepu

The New York Times (7/27) “Well” blog reports that “experts say that between 1 percent and 3 percent of children have sleep apnea that, if untreated, can disrupt far more than a family’s restful nights.” Children with the condition “simply do not get enough restorative sleep to assure normal development.” Sleep apnea, “if not corrected...can result in hyperactivity and attention problems in school that are often mistaken for attention deficit hyperactivity disorder.”

Patients With Advanced HIV May Not Benefit From Empiric Tuberculosis Treatment

By Dr Deepu

Medscape (7/28, Harrison) reports that a study suggests that “whether patients with advanced HIV receive empiric treatment for tuberculosis (TB), which they frequently die from, or isoniazid preventive therapy, there is no difference in mortality rates.” The findings were presented during the 8th International AIDS Society Conference.

CT Scans May Cause Cellular Damage.

By Dr Deepu

Fox News (7/23, Kwan) reports that research published in the Journal of the American College of Cardiology: Cardiovascular Imaging suggests that “computerized tomography (CT) scans may cause cellular damage.” Investigators “examined the blood of 67 patients undergoing cardiac CT angiograms (CTA), and measured biomarkers of DNA damage before and after undergoing the procedure.” The investigators “found an increase in DNA damage and cell death after a single CT scan, but most of the cells were repaired or eliminated.” Medscape (7/23) reports that “in addition to DNA damage, the group also observed a significant increase in cellular apoptosis in 15 of 25 patients with measured levels oif apoptotic cell death before and after cardiac CT angiography.” HealthDay (7/23, Preidt) points out that “in 2007, the U.S. National Cancer Institute predicted that 29,000 future cancer cases could be linked to the 72 million CT scans performed in the country that year alone.”

End-Stage Cancer Patients May Not Benefit From Chemotherapy.

By Dr Deepu

The New York Times (7/24, Belluck, Subscription Publication) reports that research published in JAMA Oncology suggests that patients with end-stage cancer “may not benefit from...chemotherapy — and that for many, their quality of life may worsen in their final weeks compared with patients who forgo last-ditch treatment.” Investigators “followed 312 adult patients with a prognosis of six months or less to live.”

        On its website, CBS News (7/24, Welch) reports that the investigators found that “giving chemotherapy to end-stage cancer patients near death was associated with worse quality of life among those who could still perform many daily life functions.” The researchers “also found that chemotherapy had no effect on the quality of life on less-functional patients close to death.”

        The Washington Post (7/24, Johnson) “Wonkblog” reports that “In an accompanyingeditorial, two physicians from the Oregon Health and Science University wrote that there are only two reasons to give a patient chemotherapy, which can be time-consuming, expensive, and have side effects: it should either extend their lives or make their lives better.”

        TIME (7/24, Park) points out that some “groups like the” American Society of Clinical Oncology “recently advised” physicians “to be more judicious with their chemotherapy use in terminal patients.” Also covering the story are USA Today (7/24, Szabo), NPR (7/24, Harris), AFP(7/24), HealthDay (7/24, Preidt), and Medscape(7/24).

Recent 2015 IPF Guidelines Update Adds New Agents.

By Dr Deepu

I have written this post giving an overview of  the latest IPF guidlines.The update to the 2011 guidelines appeared in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine. At the end I have provided download links for the article and supplements.

  Pirfenidone  and Nintedanib were recommended for use in idiopathic pulmonary fibrosis (IPF) with a moderate level of confidence, in a guideline update from ATS/ERS/JRS/ALAT
      It also mentions that the methods used by guideline panels to appraise the evidence are different than those used by regulatory agencies like FDA when they review applications seeking market approval for the use of pharmacologic agents for treatment of IPF.

Image Shows Comparison of 2015 and 2011 guidelines. Image published in AJRCCM

 
  The guidline doesnot provide recommendations for one treatment regimen over another.  The guideline does not provide suggestions for or against combination regimens or sequential therapies.
     
The updated guidline has given strong recommendation against using prednisone with azathioprine and N-acetylcysteine,The update also included strong recommendations against use of warfarin or other anticoagulants due to signals for harm in randomized trials in both cases. Both previously had been suggested as not appropriate for most patients but perhaps reasonable for some.
   
 Imatinib and ambrisentan, not previously addressed in the guidelines, got strong recommendations against use in IPF patients. Sildenafil is included in the guidelines, and got a conditional recommendation against use.

     The guidelines also updates on the dual endothelin receptor antagonists macitentan and bosentan , it has changed from a strong to a conditional recommendation against use.

   The Lung transplantation which was not addressed in 2011 was also included but formulation of recommendation for single vs bilateral lung transplantation was deffered.

   There is no change in the recommendation for anatacid therapy and N acetyl cysteine monotherapy which remains as conditional recommendation for use and conditional recommendation against use respectively.

     Adverse effects were common with nintedanib therapy, particularly diarrhea, although serious adverse events were not increased and relatively few patients discontinued the drug due to adverse effects. 
      Pooled results from the pirfenidone trials showed more risk of photosensitivity, fatigue, stomach discomfort, and anorexia with the drug.
 I have Provide the links to Download article from ATS.. Happy reading :)

1.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/executive_summary.pdf
2.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement.pdf
3.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement+2.pdf

Two Medications May Be Effective Against XDR-TB, New Research Reveals

By Dr Deepu

MedPage Today (7/16, Smith) reports that researchers found that “a drug being studied as a treatment for extensively drug-resistant tuberculosis (XDR-TB) had durable efficacy in a small trial.” One “year after the end of treatment with linezolid (Zyvox), combined with a background regimen, 27 of 38 patients had negative results on sputum culture, according to Clifton Barry III, PhD, of the National Institute of Allergy and Infectious Disease in Bethesda, Md., and colleagues.” Meanwhile, “in another brief report, investigators said post-hoc analysis of three trials of the investigational drug delamanid – a mycobacterial cell wall synthesis inhibitor – suggests it, too, is effective against XDR-TB.” The findings were published in the New England Journal of Medicine.

Here are the link to the published article.

1.http://www.nejm.org/doi/full/10.1056/NEJMc1415332

2.http://www.nejm.org/doi/full/10.1056/NEJMc1500286

FDA Issues New Warning About Risk Of Heart Attack, Stroke With NSAID Use

By Dr Deepu

The CBS Evening News (7/10, story 6, 1:35, Pelley) reported in continuing coverage on the FDA’s new “warning about common pain relievers.” According to the broadcast, “the FDA says everyone may be at risk, but the biggest concerns are for people with an underlying heart condition.”

        The Washington Post (7/11, Cha) reported that the warning updates will apply to “nonsteroidal anti-inflammatory drugs (NSAIDs), a group of medications used for temporary relief of pain and inflammation,” and that include ibuprofen and naproxen. The article added that “consumers should be careful not to take more than one product that contains an NSAID at a time” and to watch for symptoms such as “chest pain, breathing trouble, sudden weakness in one part or side of the body or slurred speech.”

        HealthDay (7/10, Thompson)and The Hill(7/10, Wheeler) also covered the story.

Taking Clopidogrel with Aspirin is a Deadly Combination.

By Dr Deepu

Taking Clopidogrel along with an aspirin a day to reduce your risk of a stroke or heart attack?

 

That Clopidogrel-aspirin combination almost doubled the mortality risks of patients who had diabetes and high blood pressure but had not suffered a heart attack, according to a study of some 15,000 patients.

Adding Clopidogrel is generally no more effective than taking an aspirin, a result that surprised researchers. No doubt, it shocked drug makers Bristol-Myers Squibb and Sanofi-Aventis too!

Researchers should have expected these kinds of health-harming results, considering Clopidogrel elevated a patient’s risk of developing ulcers by a factor of 12 versus aspirin and Nexium. Just remember, aspirin isn’t a safe, cure-all drug either and, according to one Harvard pharmacist, probably wouldn’t have been approved by the FDA for over-the-counter use had it debuted today.

Best alternatives to taking a drug to protect the heart are
Take a high quality fish or cod liver oil daily.
Get moving on an exercise program.

New England Journal of Medicine, March 12, 2006
USA Today, March 13, 2006.

FDA Strengthens Warning Of Heart Attack, Stroke Risk for NSAIDs.

By Dr Deepu

FDA Strengthens Warning Of Heart Attack, Stroke Risk for NSAIDs.

ABC World News (7/9, story 11, 1:15, Muir) reported that the Food and Drug Administration strengthened its warning about risks associated with popular pain medicines Advil (ibuprofen), Motrin (ibuprofen), and Aleve (naproxen).

        NBC Nightly News (7/9, story 3, 2:00, Holt) reported that FDA officials now believe that the evidence is “conclusive” that non-steroid anti-inflammatory drugs (NSAIDs) “can increase the chance of heart attack and stroke.”

        The CBS Evening News (7/9, story 10, 0:25, Pelley) reported that the risks are present even with short-term use of 10 days or less.

        According to New York Times (7/10, A20, Tavernise, Subscription Publication), current labels for these over-the-counter drugs indicate they “may cause” an increased risk of heart attack or stroke. However, the FDA believes that “new data from a recent analysis provided stronger evidence of the increased risk of heart failure from such drugs.”

        The Wall Street Journal (7/10, A4, Burton, Subscription Publication) reports that the agency will request the manufacturers change the safety labels on the drugs to indicate the drugs cause increased risk of heart failure within the coming months.

        The Los Angeles Times (7/10, Healy) reports in “Science Now” that the warnings will also point out that “the higher risk of stroke or heart attack is evident in the first weeks a patient starts taking such drugs, that the risk appears to escalate at higher doses and with longer use, and that even people with no other cardiovascular risk factors are more likely to suffer heart attack or stroke when taking the medications.”

        The AP (7/10, Perrone) reports that “the labeling change is the latest step in the FDA’s ongoing safety review of the drugs, which stretches back to 2004,” when “Merck & Co Inc. pulled its blockbuster pain reliever Vioxx [rofecoxib] off the market because of links to heart attack and stroke.”

        Also covering the story are the NBC News(7/10, Fox) website, HealthDay (7/10, Thompson),MedPage Today (7/10, Brown), and Medscape(7/10, Brown).

Survey: Majority Of Americans, Including Smokers, Say Age Limit For Tobacco Sales Should Be 21

By Dr Deepu

Survey: Majority Of Americans, Including Smokers, Say Age Limit For Tobacco Sales Should Be 21

The Washington Post (7/8, Dennis) “To Your Health” blog reports the findings of an online survey of over 4,000 US adults published Tuesday in the American Journal of Preventive Medicine found 75 percent of adults, including nearly 70 percent of smokers, favor putting the age limit for tobacco sales on par with those of alcohol. The poll was conducted by researchers at the Centers for Disease Control and Prevention. Scientists in the study said setting the legal minimum age at 21 instead of 19 would have a “substantially greater impact” because teenagers can pick up smoking from friends or relatives around the same age. Brian King, a co-author of the report and an acting deputy director for CDC’s Office on Smoking and Health, said in a statement about the findings: “Raising the minimum age of sale to 21 could benefit the health of Americans in several ways.”

        The Los Angeles Times (7/8, Kaplan) adds that that poll shows that 50 percent of US adults “strongly favor” increasing the age to 21, while 25 percent said they “somewhat favor” the increase. Only 11 percent said they “strongly oppose” the move, while 14 percent said they would “somewhat oppose” it. The poll also shows 77 percent of people who had never been smokers support raising the minimum age to 21.

        TIME (7/8) reports that Hawaii recently became the first state to increase its legal smoking age to 21. Alabama, Alaska, New Jersey and Utah have set the minimum age as 19.

        The Hill (7/8, Wheeler) reports American Heart Association (AHA) CEO Nancy Brown said in a statement, “If we can keep young Americans from buying tobacco until they turn 21, we could prevent 223,000 premature deaths among those born between 2000 and 2019,” citing numbers from the Institute of Medicine.

        The Winston-Salem (NC) Journal (7/8, Craver), HealthDay (7/8), and Washington Examiner (7/8, Cunningham) also report on this story.

Mouse Study: Just One Added Gene Needed To Turn Yersinia Pestis Bacterium Into A Killer

By Dr Deepu

Mouse Study: Just One Added Gene Needed To Turn Yersinia Pestis Bacterium Into A Killer

The New York Times (7/7, D3, McNeil, Subscription Publication) reports that a genetic study involving mice and published last week in Nature Communications suggests that the Yersinia pestis bacterium, which was “responsible for the Black Death, probably caused small outbreaks of lung disease for many years before it evolved its better-known bubonic form.” The study also found that just “one added gene was needed to turn the Yersinia pestis bacterium into a killer, and only one tiny mutation in that gene was needed to give it two ways of spreading – by cough or by flea bite.

Gene Therapy May Benefit Patients With Cystic Fibrosis

By Dr Deepu

Gene Therapy May Benefit Patients With Cystic Fibrosis

The AP (7/3, Cheng) reported that physicians “who gave children with cystic fibrosis a replacement copy of a defective gene say it appeared to slow the expected decline of some patients’ lungs.” However, they “called the results ‘modest’ and say there must be major improvements before offering the treatment more widely.” The findings (pdf) were published in Lancet Respiratory Medicine.

        Bloomberg News (7/3, Kitamura) reports that although “the therapy yielded a modest benefit in some patients, there was wide variability among the 136 people at least 12 years old who received monthly doses or a placebo for a year.” Investigators found that after one “year of treatment, in the 62 patients who received the gene therapy, lung function was an average of 3.7 percent greater than in” those given a placebo.

        Also covering the story were Reuters (7/3, Kelland), BBC News (7/4, Ghosh), HealthDay (7/3, Dallas), MedPage Today (7/3, Walker), theHuffington Post (UK) (7/3), the Telegraph (UK)(7/4, Knapton), and The Guardian (UK) (7/3)

Fireworks Temporarily Increase Levels Of Airborne Microscopic Particles

Pulmonary Medicine Blog By Dr Deepu

Fireworks Temporarily Increase Levels Of Airborne Microscopic Particles

The AP (7/1, Ritter) reports that “a study of 315 locations around the” US found that fireworks “temporarily boosted the levels of airborne microscopic particles that can pose a health risk.” The findings were published in Atmospheric Environment.

        The New York Daily News (7/1, Sblendorio) reports that investigators found that “air quality after America’s annual patriotic display is roughly 40% worse than on normal days.”

        USA Today (6/30, Rice) reports that Dian Seidel, National Oceanic and Atmospheric Administration scientist and study lead author, said, “These results will help improve air quality predictions, which currently don’t account for fireworks as a source of air pollution.” TheWashington Post (7/1, Samenow) “Capital Weather Gang” blog also covers the story.

FDA Approves New Oral Device To Treat Sleep Apnea

Pulmonary Medicine Blog By Dr Deepu

FDA Approves New Oral Device To Treat Sleep Apnea
Fierce Medical Devices (6/30, Lawrence) reports that “a new oral device to treat mild and moderate sleep apnea” which “incorporates a wireless microrecorder to track and transmit patient usage” has been approved by the FDA. The device, called SomnoDent, “is expected to help level the playing field for usage tracking between CPAP machines and oral devices.”

Consumption Of Sugar-Sweetened Drinks Tied To 180,000 Deaths Each Year

Pulmonary Medicine Blog By Dr Deepu

Consumption Of Sugar-Sweetened Drinks Tied To 180,000 Deaths Each Year
In “Science Now,” the Los Angeles Times (6/30, Healy) reports that “the consumption of sugar-sweetened drinks appears to claim the lives of about 25,000 American adults yearly and is linked worldwide to the deaths of 180,000 each year,” according to a study published June 29 in the journal Circulation. In particular, “low- and middle-income countries are bearing the brunt of the death toll attributed to overconsumption of sugar-sweetened sodas, sports drinks and fruit drinks.”
        The Washington Post (6/30, Gebelhoff) “To Your Health” blog points out that “overall...one in every 100 deaths from obesity-related diseases is [caused] by sugary beverages.” Tufts University researchers “found that the beverages would be responsible for 133,000 deaths from diabetes, 45,000 from cardiovascular disease and 6,450 from cancer.” Researchers arrived at these conclusions after gathering “data on deaths and disabilities from 2010,” then calculating “the direct effect that sugar-sweetened beverages had on public health based on dietary surveys reaching more than 600,000 people.”
        The NBC News (6/30, Carroll) website reports that Mexico “had the highest rate of deaths related to sugary beverages, with an estimated 405 deaths per million adults (24,000 total deaths) and the United States had the second highest.” The study authors theorized that “the high consumption of sugar sweetened beverages in Mexico and in Latin American countries could be due to problems finding safe drinking water.”
        Also covering the story are the Boston Business Journal (6/30, Bartlett, Subscription Publication) “Health Care Inc.” blog and Medical Daily (6/30, Olson).

For Cancer Survivors, Fear Of Recurrence May Affect Quality Of Sleep

Pulmonary Medicine Blog By Dr Deepu

For Cancer Survivors, Fear Of Recurrence May Affect Quality Of Sleep
Medscape (6/27, Nelson) reported that a survey published in the Journal of Psychosocial Oncology indicates that “cancer survivors often fear disease recurrence, and this can affect the quality of their sleep.” In the “survey of 67 cancer survivors, 52% reported poor sleep quality during the previous month.” Individuals “with some college education and those more afraid of a recurrence appeared to be at greater risk for poor sleep.”