Template:WikiDoc News: Today in Medicine

January 26, 2009: Larry Husten, the former editor of TheHeart.Org, will serve as WikiDoc's first Director of Medical Journalism

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  The exact nature and scope of the position have yet to be fully defined, but Husten said that he hopes to "encourage and facilitate the development of high quality medical journalism in this new medium." Husten was the editor of TheHeart.Org from its inception in 1999 until December 2008. Before that he was a freelance medical journalist who wrote for The Lancet, The New York Times, Discover, and a large number of other medical and computer publications. In 1994-1995 he was a Knight Science Journalism Fellow at MIT. He received a PHD in English from the State University of New York at Buffalo and drove a taxicab in New York City before embarking on a career in medical journalism. Larry's blog, www.cardiobrief.com, is a one-stop source for information about new and interesting events in the cardiology universe. The content will also appear on clinicaltrialresults.com and wikidoc.org

January 26, 2009: FDA Announces Ongoing Safety Review of Clopidogrel

• In an “early communication” posted on its website, the FDA announced today that it was examining the safety of clopidogrel. The review is a response to recent studies showing widespread variability in the efficacy of clopidogrel, based on genetic differences in the metabolism of the drug, or when it is administered with other drugs, such as PPIs. Eric Topol told CardioBrief that “pending work that needs to be done,” he believes that “genotyping for CYP2C19 will be indicated if it is shown that increasing the dose of clopidogrel overrides the lack of anti-platelet action.” He was more skeptical about the PPI story, noting that “the same scare with some statins proved a non-issue,” but agreed that the issue required further study. The FDA told Dow Jones that it was working with Bristol-Myers to update the drug’s label and that it was in discussions with Bristol-Myers and its partner on the drug, Sanofi-Aventis, about new clinical trials concerning this issue. (CardioBrief

January 26, 2009: Danish Researchers Recommend Avoiding NSAIDs in HF

• NSAIDs are associated with significant increases in death and cardiovascular morbidity, according to a large, new registry study from Denmark in the Archives of Internal Medicine. Danish researchers found dose-dependent elevated risk levels for death and risk of hospitalization with use of rofecoxib, celecoxib, ibuprofen, diclofenac, naproxen, and other NSAIDs. They conclude that “patients with HF should, if possible, avoid using any NSAIDs at any dosage for most NSAIDS and at high dosages for ibuprofen and naproxen.” Dr. Steven Nissen agrees with the recommendation of the researchers but fully acknowledges the limitations of this type of research. He told CardioBrief: “Like all observational studies, this one has important weaknesses. There are many known and unknown confounders for which adjustment is not possible. All NSAIDs increase sodium retention and these drugs have long been associated with increased risk of heart failure. With regard to the effects on MI and mortality, the results suggest a class effect, but this can only be verified by a well-designed, prospective randomized trial. We are conducting such as study, the PRECISION trial in 20,000 patients using three of these drugs, naproxen, ibuprofen, and celecoxib. Until the results are available, prudent practitioners should use NSAIDs in high risk patients only when absolutely necessary and should always use the lowest effective dosage for the least duration possible.”(CardioBrief)

January 26, 2009: Innovative stent company seeks emergency intervention

• Xtent, a small company developing an innovative drug-eluting stent system featuring customized lengths and diameters, is being seriously threatened by the financial crisis. The company has announced that it will fire 112 of its 121 employees unless it can strike some sort of deal. Click to see the press release.(CardioBrief)

January 26, 2009: Evidence-Based Treatment for HF Sees Improvements

• Australian researchers have seen long-term improvement in heart attack patients undergoing evidence-based treatments. The study, printed in the British Medical Journal, did a 12-year follow-up on 4,500 Australians who survived 28 days after a myocardial infarction. The researchers noted improving trends for those treated with a progressive regime of evidence-based treatments and coronary revascularization in their initial admission to the hospital and over the following year. (British Medical Journal)

January 26, 2009: Follow-Up: Surgeons Adopting Strict Rules on Payments

• The North American Spine Society now requires its members to disclose all ties to medical device companies - including dollar amounts. Two weeks ago we told you about a University of Wisconsin researcher who raked in more than $19 million over five years from spinal device maker Medtronic. After coming under fire from lawmakers, the NASS made its disclosure policy dramatically stricter. The Wisconsin researcher had only been required to report earning "more than $20,000" in donations from medical companies. (Wall Street Journal)

January 26, 2009 By Michael W Tempelhof, MD [1]

Measuring Fractional Flow Reserve During PCI Improves 1-Year Outcomes.

Percutaneous coronary intervention (PCI) for treatment of NSTEMI and/or STEMI from ischemia has been associated with improvements in short-term and long-term clinical outcomes. However, in ischemic patients with multiple vessel disease, determination of which lesion is the culprit stentoic lesion requiring intervention is often difficult. -Fractional Flow Reserve (FFR): is the ratio of maximal blood flow in a stenotic vessel to normal maximal flow.

STUDY OBJECTIVE: To investigate whether FFR-guided PCI would be associated with better outcomes (rates of major adverse cardiac events (MACE) at 1 year, death, MI, or repeat revascularization at 1 year) vs. routine angiography-guided PCI in ischemic patients with multivessel disease.

STUDY DESIGN and METHODS: 1005 Patients with stenoses of >50% in at least two of the three major coronary arteries where randomized to either routine PCI, or FFR-guided PCI, where FFR was measured in all significant stenoses, with stenting in lesions with an FFR ≤0.8.

RESULTS: Rates of MACE at 1 year was significantly lower in the FFR arm compared with the routine-PCI arm (13.2% vs. 18.3%, p = 0.02). The incidence of death (1.8% vs. 3.0%, p = 0.19), myocardial infarction (MI) (5.7% vs. 8.7%, p = 0.07), and coronary artery bypass grafting or revascularization at year (6.5% vs. 9.5%, p = 0.08) was similar between both arms.

Mean procedure time was similar between the two study arms 70 minutes. Quantity of contrast dye utilized was significantly lower in the FFR arm, 272ml vs. 302 ml for standard PCI arm. The number of patients who were angina free at 1 year was also similar between the two arms (81% vs. 78%, p = 0.2). As measured by the EuroQOL-5D, the quality of life scores were similar between the two arms(p = 0.65).

CONCLUSIONS: The FAME trial results indicate that FFR-guided PCI is associated with a significantly lower incidence of MACE at year compared with routine angiography-guided PCI in ischemic patients with multivessel disease. FFR-guided PCI had a favorable cost-benefit ratio, similar procedural times to standard PCI and exposed patients to less contrast dye.

Tonino PA, De Bruyne B, Pijls NH, et al., on behalf of the FAME Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

Source

N Engl J Med. 2009 Jan 15;360(3):213-24.

January 23, 2009: Citing Costs, Younger Americans Skipping Meds

• One in seven Americans under the age of 65 passed on medication last year because it was too expensive. Not surprisingly, those with low incomes, chronic conditions and the uninsured were most likely to go without. But having insurance didn’t always help. According to the Center for Studying Health System Change, rising drug costs, more-frequent prescription-writing and expensive specialty meds all played a role. The researchers believe as the recession in America lengthens even more people will skip their meds, leading to more health-related complications. (Center for Studying Health System Change)

January 23, 2009: Women with Heart Problems Often Left Waiting

• Emergency medical personnel seem to delay women with signs of heart failure longer than men. Researchers at Tufts University examined nearly 6,000 emergency calls from Dallas County, Texas and found patients spent an average of 34 minutes with emergency personnel. But women were 52 percent more likely to be delayed by 45 minutes or more. Researchers weren’t able to say why that was the case but suggest heart problems in women aren’t as recognizable as those in men. (Circulation: Cardiovascular Quality and Outcomes)

January 23, 2009: 4,000-Person Drug Trial Scrapped After Sponsor Declares Bankruptcy

• In a clear sign of how the economic downturn is affecting research, phase 3 drug trial COGENT 1 has been scrapped after its sponsor declared bankruptcy. The trial would have tested a single-pill combination of clopidogrel and omeprazol to reduce gastrointestinal side effects in heart patients. Cogentus Pharmaceuticals, based in Palo Alto, CA, was the sponsor behind the trial. (TheHeart.org)

January 23, 2009: MA State Ethics Law Scuttles Plans for Medical Meeting

• A Massachusetts state law regulating medical industry marketing has wrecked plans for a medical group meeting to be held in Boston. The American Academy of Allergy, Asthma and Immunology was planning on holding its 2015 meeting in Boston but pulled out after deciding the new law would not allow it to offer Continuing Medical Education credit. Some presenters at the meeting work for drug and device companies, and as such would not meet the requirements for CME under the new law. (MedPage Today)

January 22, 2009: Gifts to Doctors Must Be Disclosed

• Any gifts made to doctors exceeding $100 per year would need to be disclosed under legislation introduced in the U.S. Senate Thursday. Companies that fail to disclose such gifts could see fines as high as $1 million, according to the Physician Payment Sunshine Act introduced by Senators Charles Grassley (R) and Herb Kohl (D). A similar bill failed in congress last year but Grassley says he feels this version has a good chance of passing the current Democrat-controlled houses. (Reuters)

January 22, 2009: Stroke Survivors with AF Have Greater Risk of Death

• Atrial fibrillation greatly increases stroke survivors’ chances of death, according to a study in the International Journal of Cardiology. Survivors with the arrhythmia showed a 50% greater chance of all-cause mortality versus those without it. The study showed patients older than 75 are at greatest risk, followed by those with congestive heart failure, prior stroke and diabetes. The researchers used patients’ CHADS2 scores to accurately determine how at risk they were for dying after ischemic stroke. (International Journal of Cardiology)

January 22, 2009: Women Make Better Heart Care Doctors?

• A European study demonstrates women are better at treating patients with chronic heart failure than their male counterparts. Female doctors are more likely to play by the book, following recommended guidelines for drug choice and dosage. Their male colleagues are less likely to prescribe drugs for CHF patients, and more likely to lower the dose if treating women. The researchers note, though, that women patients don’t necessarily have worse outcomes even though they get fewer drugs. Female CHF patients are also more likely to be misdiagnosed. (European Journal of Heart Failure)

January 22, 2009: American Journal of Clinical Nutrition

• Lowering salt intake improves endothelial function, according to researchers in the American Journal of Clinical Nutrition. They studied 29 overweight and obese patients with normal blood pressure and found those that cut salt in their diets had improved vessel dilation and blood flow. Scientists say further study is needed but it seems lowered blood pressure is not the only benefit of decreasing salt intake. (American Journal of Clinical Nutrition)

January 21, 2009: Pictures of a Bleeding Heart

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  Scientists in London have captured dramatic images of heart muscle bleeding immediately following heart attacks. The researchers used MRI machines to scan 15 people who had just suffered attacks. They found a direct correlation between the amount of heart damaged and the amount the heart bled. Recent research has shown some hearts bleed after blood restarts pumping through damaged tissue. The amount of bleeding that occurs after infarction may also indicate how well the patient recovers. (Radiology)

January 21, 2009: More Doctors E-Mailing It In

• The number of doctors prescribing medicine electronically has more than doubled in the past year thanks to a number of new incentives. Now about 70,000, or 12% of office-based doctors, have ditched pen and paper for software. Some studies have shown medicines are less likely to get mixed up if they’re e-prescribed, and starting this month Medicare’s going to give doctors a bonus if they make the digital switch. E-prescriptions may just be a start; the Obama administration wants to spend $50 billion in the next five years to adopt health-information technology. (Wall Street Journal)

January 21, 2009: Problems Pumping Iron? Maybe You’ve Got a Problem Pumping Blood

• Problems in the left ventricle are a good indicator of whether a person will have problems exercising. Researchers at the Mayo Clinic studied a group of people undergoing exercise echocardiography and found a strong inverse correlation between diastolic dysfunction and exercise capacity. They saw that those with mild and moderate/severe resting diastolic dysfunction had reduced exercise capacity. They also noted similar correlations with increased age, femaie sex and high body mass index. (JAMA)

January 21, 2009: Bill Gates, Others Pledge $630 Million to End Polio

• Should the U.S. start stockpiling antibiotics? Five years ago the last American plant to manufacture crucial ingredients for a number of drugs like penicillin closed its doors. On the heels of China's third reported case of human bird flu this year, some are asking whether President Obama’s administration should start storing more medicine at home. (Rotary International)

January 20, 2009: With a New President, a New Worry

• Retired Microsoft founder Bill Gates is teaming with a group of donors to give $630 million to eradicate polio. The Gates Foundation is teaming with Rotary International and the British and German governments. Polio remains a serious problems in parts of Africa, India and the Middle East. Despite the $630 million, the World Health Organization believes another $2 billion is needed to eliminate the disease by 2013, one of its goals.(New York Times by Gardiner Harris)

January 20, 2009: First Time Heart Attacks Not as Severe

• First time heart attacks aren’t as bad as they once were. Researchers in the current issue of Circulation think that may help explain why the heart attack death rate has declined by 1.5% over the past two decades. Since 1987, studies have shown those first attacks are doing less damage to the heart - though it’s unclear why. (HealthDay by Ed Edelson)

January 20, 2009: The “Sure Thing” Gene

• One percent of the world’s population carries a gene mutation nearly guaranteed to lead to heart problems. If those odds aren’t bad enough, they’re even worse for Indians. One in 25 people in India carry the gene, which means by next year India will have 60% of the world’s heart patients. It’s rare a common mutation has such a huge negative effect, according to scientists. (BBC News)

January 20, 2009: Men Better at Resisting Temptation

• Men’s brains may be better at resisting food cravings than women’s. A small study may shed some light on why greater numbers of women are obese. Twenty-three test subjects went without eating for 17 hours. Then researchers asked them to control their desire as they were taunted by plates of their favorite meals. Brain scans showed men fared better. (Time by Jeffrey Kluger)

January 20, 2009: Drug-Resistant Staph Infections Rising in Kids

• An “alarming” increase in children’s ear, nose and throat infections caused by drug-resistant staph, or MRSA, has a number of scientists worried. In the five year period between 2001 and 2006, the percentage of MRSA infections more than doubled, to 28 percent. These superbugs were once thought to only come from hospitals; now they’re being found in the community. (AP by Lindsey Tanner)

January 16, 2009: Brian Blank has joined WikiDoc as its inaugural Scholar in Medical Journalism

• Blank will be heading WikiDoc's international news bureau. Blank graduated from the University of Missouri-Columbia in 2003 with a degree in broadcast journalism. After working in local TV and radio, he moved to CNN in Atlanta as a researcher. There he assisted reporters and producers in CNN’s duPont award-winning coverage of the 2004 South Asia tsunami disaster and Peabody award-winning coverage of 2005’s Hurricane Katrina. He went on to do some reporting for CNN Radio in New York before moving to FOX in 2007. There he helped start the FOX Business Network as anchor Neil Cavuto’s producer. In 2008 he left that and moved to Cambridge, MA to complete a post-baccalaureate pre-med program at Harvard University in hopes of attending medical school in the future.

January 16, 2009: Popular Health Risk Tools Don’t Find Heart Disease

• Traditional risk assessment tools like the Framingham and National Cholesterol Education Program, NCEP, do not accurately predict coronary heart disease. In a Yale University School of Medicine study of 1,654 patients, some with no history of the disease and some taking statins, doctors used the tests to calculate the patients’ risk of heart disease. Researchers compared those results to the amount of plaque actually found in the patients’ arteries. The results: One in five patients thought to need statins before the test actually didn’t. And one in four taking statins had no plaque whatsoever.(ScienceDaily)

• Looking at cholesterol levels may not be any better. In another study, researchers found that nearly 75% of people hospitalized for heart attacks had normal levels of LDL cholesterol, the “bad” kind. The study’s author contends current cholesterol level guidelines should be changed, a topic the National Heart, Lung and Blood Institute is likely to look into soon.(HealthDay News by Ed Edelson)

January 16, 2009: Heparin-Induced Antibodies Point To Thrombosis Risk

• Cardiac patients with antibodies that resist heparin are more likely to develop thrombosis after surgery. Some of the patients studied developed the antibodies during surgery while others already had some resistance. But either way, researchers found the patients were more likely to develop deep vein thrombosis, a pulmonary embolism or myocardial infarction.(American Heart Journal by Anna Vittoria Mattioli, et al.)

January 16, 2009: Superbugs Vs. Cancer Drugs

• So-called “superbugs” that haunt some hospitals may have an enemy in cancer drugs. Some antibiotic-resistant bacteria “play dead,” or go dormant to avoid attack, then reawaken later. Scientists have discovered a protein called Hip A that enables the cells to go dormant is actually a protein kinase. Because several cancer drugs work by inhibiting protein kinases, it’s thought they might be able to treat some forms of antibiotic resistance.(NewScientist by Linda Geddes)

January 16, 2009: Senator: Schools Failing to Regulate Medical Conflicts of Interest

• Iowa Sen. Charles Grassley (R) says schools don’t go far enough to disclose researchers’ ties to industry. The senator recently informed the University of Wisconsin that one of its lead spinal surgeons/researchers under-reported payments received by spinal device maker Medtronic – by a factor of 100. While only required by the school to report receiving “more than $20,000,” Dr. Thomas Zdeblick actually received at least $2.6 million a year in royalty and consulting payments. In all, Dr. Zdeblick received $19 million from 2003 to 2007. Sen. Grassley blames the school’s disclosure requirements.(Wall Street Journal by David Armstrong and Thomas M. Burton)

January 16, 2009: Coffee Can Reduce Alzheimer’s, Cause Hallucinations

• Those daily coffee runs may help reduce the risk of Alzheimer’s. Middle-aged people who drink between three and five cups a day lowered their risk of developing dementia and Alzheimer’s by nearly two-thirds. Scientists aren’t sure why, exactly, but believe it may have something to do with the antioxidants found in coffee. Or it could be its ability to protect the nervous system.(Agence France-Presse)

• But that comes on the heels of another study that showed college students who drink more than seven cups of coffee a day sometimes hear voices that aren’t really there. The study’s researchers say they couldn’t prove a direct link between java and auditory hallucinations but more study is warranted.(Scientific American)

January 6, 2009: Cytochrome P450 2C19 polymorphism linked to poor outcomes for young MI patients treated with clopidogrel

• Patients who had CYP2C19*2 genetic variant in the CYP2C19 gene and were treated with clopidogrel after a myocardial infarction (MI) demonstrated worse cardiovascular outcomes than patients with a normal copy of the cytochrome P450 2C19 encoding gene, according to a study published in the Lancet. The study population was composed of 259 patients, all under the age of 45, who received clopidogrel treatments for at least one month (median exposure time was 1.07 years (IQR 0.28-3.0)). Patients who were carriers of the CYP2C19*2 genetic variant had 15 primary endpoint events, which was a composite of death, MI, and urgent revascularisation during treatment with clopidogrel, while non-carriers had only 11 primary endpoint events (HR 3.69 (95% CI 1.69-8.05), p=0.0005). Further, the study demonstrated that the CYP2C19*2 genetic variant "was the only independent predictor of cardiovascular events (HR 4.04 (1.81-9.02), p=0.0006)." The investigators noted that additional genetic variants, such as CYP2C19*17, may play a role in the reduced responsiveness to clopidogrel and that it remains unclear if a higher maintenance dose could overcome this reduced clopidogrel responsiveness.(Lancet by Jean-Philippe Collet, et al.)

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