Author Archives: Menon Medical Center

Do Women Over The Age of 65 Need Pap Smears?

Analysis that corrects for hysterectomy rates indicates risk in women
older than 65 is higher than previously thought.

Hysterectomy is common in the U.S., and the vast majority of these
surgeries involve removal of the cervix as well as the uterus. Because
total hysterectomy protects women from future invasive cervical cancer
(ICC), hysterectomy rates affect estimates of ICC incidence.

In contrast to the relative decline in uncorrected ICC rates with age,
rates corrected for hysterectomy continued to rise after age 39,
peaking among women aged 65 to 69. In addition, correction revealed
greater disparity in ICC incidence between white women and black
women, with the latter group having higher incidence than previously
thought.

Comment

Current guidance (NEJM JW Womens Health Apr 12 2012) states that, in
women older than 65 with adequate recent screening, further screening
can be discontinued (because of low rates of invasive cervical cancer
as well as high false-positive rates for cytologic changes reflecting
atrophy of the lower genital tract in this population). Given that
hysterectomy-corrected ICC rates in older women are substantially
higher than the uncorrected rates underlying these recommendations, I
agree with the authors of this analysis that the existing guidelines
should be reviewed.

Rositch AF et al., Cancer 2014 May 12

FDA Approves New Omega-3 Supplement

Leave a reply

The FDA has approved a new omega-3 supplement (brand name, Epanova) to
treat adults with severe hypertriglyceridemia, defined as triglyceride
levels 500 mg/dL or higher.

In its announcement, the manufacturer said that Epanova is the first
omega-3 formulation approved by the FDA in free fatty acid form. It
will be available in 1-g capsules and has been approved for 2-g and 4-
g dosages, which can be taken with or without food.

There are currently two other prescription formulations of omega-3
supplements on the market: Lovaza and Vascepa. All three are approved
only for the treatment of severe hypertriglyceridemia, though studies
of expanded indications are underway.

By Larry Husten

Triple Therapy For Ulcerative Colitis

Leave a reply

Response rates continue to be promising for amoxicillin, tetracycline,
and metronidazole.

Bacteria are widely suspected to be one of the inciting antigens in
ulcerative colitis (UC). As such, antibiotics, probiotics, and fecal
microbiota transplantation have all been established or proposed as
treatments for UC.

In the current open-label, multicenter trial, researchers assessed the
efficacy of a combination of amoxicillin (500 mg), tetracycline (500
mg), and metronidazole (250 mg) 3 times daily for 2 weeks to induce
and maintain remission in patients refractory to or dependent on
steroids. The same researchers had previously designed this regimen to
treat elevated levels of Fusobacterium varium observed in inflamed
colonic mucosa of patients with ulcerative colitis and serum
antibodies to F. varium. The regimen was effective for short-term
control of UC in a randomized, double-blind, placebo-controlled study
(NEJM JW Gastroenterol Aug 27 2010).

Kato K et al. Aliment Pharmacol Ther 2014 May

Syphilis on the Rise, Especially in Men Who Have Sex with Men

Leave a reply

Syphilis rates have nearly doubled in the past decade, with the
steepest rise among men who have sex with men (MSM), according to an
analysis of national data in MMWR.

From 2005 to 2013, annual rates of primary and secondary syphilis
increased from 2.9 to 5.3 cases per 100,000 population. Increases were
greatest among men, who accounted for 91% of cases in 2013, and were
seen in men of all ages, races/ethnicities, and geographic regions.
The rise was especially pronounced among MSM, who accounted for about
80% of cases in men. Among women, rates increased from 2005 to 2008
and dropped thereafter.

Notably, syphilis was at record low levels in 2000.

Calling the syphilis increase in MSM “a major public health concern,”
the researchers recommend promoting prevention measures, including
safer sex practices, syphilis screening, and partner notification.

MMWR article

Vitamin D2 or D3 as a supplement?

Leave a reply

Vitamin D3 seems like the better choice for supplementation.

Despite considerable research, the health benefits of vitamin D
supplementation in the general population remain controversial. In
this systematic review and meta-analysis, investigators determined
whether blood vitamin D levels and vitamin D supplementation were
associated with risk for death.

One analysis involved 73 observational studies (mean follow-up, 0.3–
29 years) that involved 850,000 participants (median age, 63; median
baseline blood 25-hydroxyvitamin D [25(OH)D] level, 20.7 ng/mL).
Overall, compared with participants whose blood 25(OH)D levels were in
the top third, those whose levels were in the bottom third had
significantly greater risks for cardiovascular (CV)-related death
(adjusted relative risk, 1.4), cancer-related death (ARR, 1.1), and
all-cause death (ARR, 1.4). For each 10 ng/mL lower increment of 25(OH)
D, risk for all-cause death increased by 16%.

Another analysis involved 22 randomized, placebo-controlled trials
(31,000 older participants; mean follow-up, 0.4–6.8 years) with data
on the effect of vitamin D supplementation on all-cause mortality; 8
trials provided vitamin D2 (dose range, 208–4500 IU/day), and 14
trials provided vitamin D3 (dose range, 10–6000 IU/day). Vitamin D3
supplementation significantly lowered mortality risk (relative risk,
0.9), but vitamin D2 supplementation did not.

Comment

In this analysis, the observational data showed an inverse association
between blood 25-hydroxyvitamin D levels and death, but reverse
causality is possible (i.e., ill people having low vitamin D levels
rather than low vitamin D levels causing illness). In randomized
trials, vitamin D3 supplementation modestly lowered all-cause
mortality risk; however, the optimal dose and duration of vitamin D3
supplementation are unknown. Thus, widespread vitamin D
supplementation should not be recommended.

Chowdhury R et al., BMJ 2014
Apr 1; 348:g1903

Aspirin Not Approved for Primary Prevention of Heart Attacks or Strokes

Leave a reply

Aspirin shouldn’t be marketed for primary prevention of heart attack
or stroke, the FDA has announced. The statement follows the agency’s
rejection on Friday of Bayer Healthcare’s decade-old petition
requesting approval of a primary prevention indication.

Aspirin is still widely used for primary prevention. The American
Heart Association currently supports its use for primary prevention
when recommended by a physician in high-risk patients. (There is
widespread agreement that for secondary prevention, aspirin’s benefits
outweigh the risks, and it should be used to prevent a second heart
attack or stroke after an earlier cardiovascular event.)

In its statement, the FDA said it had “reviewed the available data and
does not believe the evidence supports the general use of aspirin for
primary prevention of a heart attack or stroke. In fact, there are
serious risks associated with the use of aspirin, including increased
risk of bleeding in the stomach and brain.”

FDA consumer information

FDA Approves Implantable Device for Sleep Apnea

Leave a reply

The FDA has approved a new treatment — Inspire Upper Airway
Stimulation therapy — for patients with moderate-to-severe
obstructive sleep apnea who cannot use a continuous positive airway
pressure machine.

The device is implanted in the upper chest, senses breathing patterns,
and mildly stimulates the airway muscles, keeping the airway open. The
device is turned on and off using a handheld remote.

In a study published in the New England Journal of Medicine, some 125
patients (83% men, mean age: 55 years) had the device implanted. At 12
months, the number of apnea events per hour decreased by 68% and
oxygen desaturation events decreased by 70%.

The procedure to implant the device has a shorter recovery time than
surgery to alter airway or facial anatomy, according to the
manufacturer. It is expected to be available to patients by the end of
2014.

Global Threat of Antibiotic Resistance

Leave a reply

Global Threat of Antibiotic Resistance – The UN World Health
Organization has published a report which “… makes a clear case that
resistance to common bacteria has reached alarming levels in many
parts of the world and that in some settings, few, if any, of the
available treatments options remain effective for common
infections …” – The report focuses on “… antibiotic resistance in
seven different bacteria responsible for common, serious diseases such
as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary
tract infections and gonorrhoea. The results are cause for high
concern, documenting resistance to antibiotics, especially ‘last
resort’ antibiotics, in all regions of the world … The report
reveals that key tools to tackle antibiotic resistance – such as
basic systems to track and monitor the problem – show gaps or do not
exist in many countries … Other important actions include preventing
infections from happening in the first place – through better
hygiene, access to clean water, infection control in health-care
facilities, and vaccination – to reduce the need for antibiotics. WHO
is also calling attention to the need to develop new diagnostics,
antibiotics and other tools to allow healthcare professionals to stay
ahead of emerging resistance …”

For Adult Cancer Survivors

Leave a reply

The American Society of Clinical Oncology has released three
guidelines on treating problems commonly encountered by adult cancer
survivors: chemotherapy-induced peripheral neuropathy, anxiety and
depression, and fatigue. The guidelines are published in the Journal
of Clinical Oncology.

To treat chemotherapy-induced peripheral neuropathy, clinicians may
offer patients duloxetine. The group declined to make official
recommendations on tricyclic antidepressants, gabapentin, and a
topical gel (comprising baclofen, amitriptyline, and ketamine), but
said they may be reasonable options in certain patients.

Patients should be periodically evaluated for depression and anxiety,
and compliance with treatments should be assessed regularly. After 8
weeks, if symptoms have not improved, clinicians should try a new
approach.

Patients should be screened for fatigue at the time of cancer
diagnosis and routinely thereafter, at least annually. They should be
educated about ways to manage fatigue, such as through physical
activity (150 minutes of moderate aerobic weekly plus two to three
strength training sessions), cognitive behavioral therapy, and
mindfulness-based approaches like yoga and acupuncture.

Dietary Fiber After Heart Attack Linked to Improved Survival

Leave a reply

Consuming more dietary fiber after myocardial infarction is associated
with a reduced risk for death, a BMJ study finds.

Researchers analyzed long-term data about diet and other risk factors
from more than 4000 healthcare professionals who had an MI. Nine years
after the MI, people who were in the highest quintile of fiber
consumption had a 25% lower risk for death from any cause. Overall,
there was a 15% reduction in mortality risk associated with every 10-g/
day increase in fiber intake.

The strongest association was observed for fiber derived from cereals
and grains. A strong benefit was also found for people with the
largest increases in fiber consumption after their MI. The findings
remained significant after adjustment for other factors known to
influence survival after MI. However, the authors acknowledge that
they were unable to “fully adjust for all known or unknown healthy
lifestyle changes.”

The authors note that less than 5% of people in the U.S. consume the
minimum recommended amount of fiber (25 g/day for women and 38 g/day
for men).

BMJ article