Top FDA Official Says Regulators Should Consider Potential Benefits Of E-Cigarettes

By Dr Deepu

The Congressional Quarterly (10/22, Siddons, Subscription Publication) reports that Mitch Zeller, head of the Food and Drug Administration’s Center for Tobacco Products, said Wednesday that regulators have to consider the possible health benefits for smokers who transition to e-cigarettes. “If there is an opportunity to shift those unable or unwilling to quit from the most harmful form of nicotine delivery, to the least harmful form,” Zeller said, “then I think that we as regulators have an opportunity to explore what those options are. “

Fauci Optimistic About The Development Of A Universal Flu Vaccine Within Next 5 To 10 Years

By Dr Deepu

In a 1,500-word article, NBC News (10/20) reports on its website on this year’s flu vaccine, the market environment, and the push for vaccination. The piece also reports on the “holy grail for flu: A universal vaccine,” which is currently being pursued at the National Institutes of Health. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci “said he’s optimistic a universal vaccine is five to 10 years away.” In an interview, Fauci said, “I think that we are making extraordinary progress and we can sort of see that light at the end of the tunnel.” He added, “If we can successfully induce a response against that stem part of that protein, we’re going to be very close to developing a universal flu vaccine.” In the meantime, public health researchers “emphasized the best thing the public can do to avoid spread of the flu is to wash hands, cover coughs and sneezes…and get vaccinated.”

Sleep Apnea May Be More Dangerous For Women Than For Men

By Dr Deepu

The New York Times (10/20, D6, Bakalar) “Well” blog reports that research published in Circulation suggests that “sleep apnea may be even more dangerous for women than for men.” Investigators found that “obstructive sleep apnea was independently associated with increased troponin T, heart failure and death in women, but not in men.” The researchers also found that “in women, but not men, sleep apnea was associated with an enlarged heart, another risk factor for cardiovascular disease.”

Normal Vocal Cords

By Dr Deepu

CDC: Teen Smoking Rates Declining, Marijuana Use On The Rise

By Dr Deepu

HealthDay (10/16, Reinberg) reports that according to today’s MMWR, the CDC says that smoking among teenagers has dropped 64 percent in recent years, but marijuana use has more than doubled. Investigators “tracked teen smoking rates from 1997 to 2013.” The researchers found that “overall, the number of teens who smoked cigarettes or cigars dropped from 20.5 percent to slightly more than 7 percent, while marijuana use went from 4 percent to 10 percent.”

EV-D68 No More Deadly Than Common Cold Germs, Study Finds

By Dr Deepu

HealthDay (10/16, Thompson) reports that a new study conducted at McMaster University in Ontario, Canada suggests that enterovirus D68, which made headlines in 2014 after sickening children across North America, is “no more deadly than other common cold germs.” For the study, the researchers compared “87 kids treated for EV-D68 at McMaster Children’s Hospital with 87 kids who caught a rhinovirus or some other enterovirus at the same time.” The findings were published in the Canadian Medical Association Journal. Medscape (10/16) also covers the story.

Sleep Apnea May Increase A Woman’s Risk For Heart Problems

By Dr Deepu

HealthDay (10/15, Preidt) reports that research indicated that “sleep apnea can boost a woman’s risk for heart problems and even death, but there was no such effect for men.” The study also indicated that, “compared to women without sleep apnea, women with the disorder had higher blood levels of troponin, a chemical signal of early heart damage.” The study was published in Circulation.

Kartageners Syndrome

By Dr Deepu

See the question

The answer is b."Kartagener syndrome"

Kartagener syndrome is the inheritable disorder of dextrocardia, chronic sinusitis (with the formation of nasal polyps), and bronchiectasis. Patients may also present with situs inversus.The disorder is due to a defect that causes the cilia within the respiratory tract epithelium to become immotile. Cilia of the sperm are also affected

Chest Challenge MCQ - Give your diagnosis

By Dr Deepu

A teenage boy presents with a history of chronic sinusitis and frequent pneumonias. On physical examination, the patient has normal vital signs and is afebrile. He has mild frontal and maxillary sinus tenderness with palpation. Transillumination of the sinuses is normal. Heart sounds are best heard on the right side of the chest. The boy is coughing copious amounts of yellowish sputum. The chest X ray is shown.

Which of the following is the most likely diagnosis?

a.Cystic fibrosis

b.Kartagener syndrome

c.Pulmonary dysplasia

d.Tuberculosis

e.Pulmonary hypertension

see Answer Here.

Experts question the evidence underpinning e-cigarette recommendations

By Dr Deepu

Concern over Public Health England's recent support for e-cigarettes

Public Health England (PHE) recently endorsed the use of electronic cigarettes as an aid to quitting smoking. But in The BMJ this week, experts question the evidence on safety and effectiveness underpinning the recommendations.

Professor Martin McKee at the London School of Hygiene The BMJ Tropical Medicine and Professor Simon Capewell at the University of Liverpool, argue that the available evidence about e-cigarettes "suggests that the debate is far from over and questions remain about their benefits and harms."

The PHE report concludes that e-cigarettes are much safer than conventional cigarettes. It also says there is no evidence that e-cigarettes give children a "gateway" into smoking.

Some of the findings have been welcomed by Action on Smoking and Health (ASH) and the Royal College of Physicians of London. But other leading health bodies - including the British Medical Association, the US Centers for Disease Control and Prevention, and the World Health Organization - have expressed caution.

So does the available evidence show clearly that e-cigarettes are as effective as established quitting aids, ask McKee and Capewell.

Unfortunately not. For example, a recent Cochrane review, widely cited in the PHE report, concluded the available evidence was of "low or very low quality" by recognised standards.

And a recent systematic review, which the PHE report surprisingly fails to cite, also found serious methodological problems in many of the studies it reviewed, and noted that one third of the studies (34%) it reviewed were published by authors with conflicts of interest.

The headline message from the PHE report is that "best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes." Yet McKee and Capewell point out that this figure comes from a single meeting of 12 people, involving several known e-cigarette champions and sponsored by companies with links to the tobacco industry.

The PHE report also asserts that the available evidence suggests that e-cigarettes are not currently re-normalising smoking among children and young people in the UK. But McKee and Capewell point out that experimentation with e-cigarettes among young people in England is "worryingly high" and "this remains a major concern for health professionals and parents."

They describe the report's dismissal of the possibility that e-cigarettes may be a gateway to smoking as "premature." And they argue that the report has many other omissions, such as concerns about product safety, and the lack of evidence of risks from long term dual use with conventional cigarettes.

Finally, the PHE summary states, "The accuracy of nicotine content labelling currently raises no major concerns." Surely, England's leading public health agency cannot be indifferent to a situation in which consumer product information is known to be wildly inaccurate, they ask.

In 2017, the European Union Tobacco Products Directive will come into force, with substantial restrictions on e-cigarettes. "These restrictions will hopefully limit the negative effect of this flawed PHE report," say TheBMJ article's authors.

"Meanwhile, directors of public health and the wider community desperately need advice on e-cigarettes that is evidence based and free from any suspicion of influence by vested interests," they conclude.

Link to full article

Banning trans fats in England could prevent 7,000 heart deaths over next five years

By Dr Deepu

A total ban is technically feasible and decisive action is now needed, say experts

A total ban on trans fatty acids (trans fats) in processed foods in England could potentially prevent or postpone about 7,200 deaths from coronary heart disease over the next five years, suggest experts in TheBMJ this week.

They say a total ban in England is "technically feasible" and they call for "decisive action" to prioritise the most effective and cost effective policy options.

Industrial trans fatty acids are produced from plant oils (a process known as hydrogenation) and are commonly added to processed foods to cheaply improve shelf life and palatability.

Higher intake of these fats is associated with increased risk of coronary heart disease and death, and consumption is generally higher in lower socioeconomic groups. Their elimination from the UK diet is part of the Department of Health's responsibility deal.

So a team of researchers decided to evaluate three policy options to reduce consumption of trans fats in England: a total ban on trans fatty acids in processed foods; improved food labelling; and bans on trans fatty acids in restaurants and takeaway outlets.

They calculated health and equity benefits and cost effectiveness of each policy compared with consumption remaining at most recent levels. Influential factors such as age, sex, and socioeconomic status were taken into account.

Guidelines currently recommend that trans fats are limited to less than 1% of energy intake. The researchers calculated that average consumption of trans fatty acids among UK adults in 2001-09 to 2011-12 was around 0.7% of energy intake. For the most disadvantaged groups, consumption was higher, around 1.3%.

The researchers found that a total ban on industrial trans fatty acids in processed foods in England might potentially prevent or postpone about 7,200 deaths (2.6%) from coronary heart disease from 2015-20 and reduce inequality in mortality from coronary heart disease by about 3,000 deaths (15%).

This inequality stems from the fact that early death from coronary heart disease is substantially higher among the most disadvantaged socioeconomic groups compared with the most affluent.

Policies to improve labelling or simply remove trans fatty acids from restaurants and takeaways could save between 1,800 (0.7%) and 3,500 (1.3%) deaths from coronary heart disease and reduce inequalities by 600 (3%) to 1,500 (7%) deaths, thus making them at best half as effective.

A total ban would also have the greatest net cost savings of The BMJ264m excluding product reformulation costs, or The BMJ64m if substantial reformulation costs are incurred.

"Elimination of trans fatty acids from processed foods is an achievable target for public health policy," say the authors. Such a ban "would lead to health benefits at least twice as large as other policy options, both in terms of total population benefit and reduction in inequality."

They suggest that continuing to rely on industry cooperation via the responsibility deal "might be insufficient" and call for "decisive action" to prioritise the most effective and cost effective policy options.

There's nothing good about industrial trans fats and a total ban would be best for public health, argues Lennert Veerman from the University of Queensland's School of Public Health, in an accompanying editorial.

"Given the clear evidence on the health impact of trans fats and what we know about consumption patterns, rates of heart disease, and related economic costs in England, we can safely conclude that these actions to accelerate the removal of industrial trans fat from the food supply are good for health, cost saving, and equitable," he writes.

Link to full study

Link to editorial

Increasing calcium intake unlikely to boost bone health or prevent fractures, say experts

By Dr Deepu

Increasing intake through diet or supplements should not be recommended for fracture prevention

Increasing calcium intake through dietary sources or supplements is unlikely to improve bone health or prevent fractures in older people, conclude two studies published in The BMJ this week. Collectively, these results suggest that increasing calcium intake, through supplements or dietary sources, should not be recommended for fracture prevention.

Guidelines advise older men and women to take at least 1000-1200 mg/day of calcium to improve bone density and prevent fractures, and many people take calcium supplements to meet these recommendations. Recent concerns about the safety of calcium supplements have led experts to recommend increasing calcium intake through food rather than by taking supplements, but the effect on bone health is unknown.

So a team of researchers in New Zealand set out to examine the evidence underpinning recommendations to increase calcium intake from dietary sources or supplements to improve bone health and prevent fractures.

They analysed the available evidence from randomised controlled trials and observational studies of extra dietary or supplemental calcium in women and men aged over 50. Study design and quality were taken into account to minimise bias.

In the first study, they found that increasing calcium intake from dietary sources or by taking supplements produces small 1-2% increases in bone mineral density, which "are unlikely to lead to a clinically meaningful reduction in risk of fracture."

In the second study, they found that dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures.

It is time to revisit recommendations to increase calcium intake beyond a normal balanced diet, argues Professor Karl Michaëlsson from Uppsala University in Sweden, in an accompanying editorial.

He points out that ever increasing intakes of calcium and vitamin D recommended by some guidelines defines virtually the whole population aged over 50 at risk. Yet most will not benefit from increasing their intakes, he warns, and will be exposed instead to a higher risk of adverse events.

"The weight of evidence against such mass medication of older people is now compelling, and it is surely time to reconsider these controversial recommendations," he concludes.

Link to study 1

Link to study 2

Link to editorial

Calcium intake, bone mineral density, and risk of fracture

By Dr Deepu

Increasing calcium intake through supplementation or diet should not be recommended for preventing fractures, according to two studies from New Zealand. A systematic review found no association between dietary calcium intake and risk of fracture, and a meta-analysis showed that although dietary calcium led to small increases in bone mineral density, these were unlikely to reduce fracture risk to a clinically significant degree. The accompanying editorial cargues in favour of revisiting recommendations to increase intake beyond a normal balanced diet.