Saturday, December 14, 2013
A study of 1721 Japanese cancer patients treated with cisplatin as a first-line chemotherapy between 2006 and 2012 found that cisplatin dosages/m² or diagnosis of stage 4 cancer were risk factors of moderate cisplatin-induced acute kidney injury (AKI). Patients with a history of diabetes, a history of cardiovascular disease, or a diagnosis of stage 4 cancer were risk factors for severe cisplatin-induced AKI. The Oncology study investigators note that because severe cisplatin-induced AKI can shorten survival, physicians should carefully consider whether the use of cisplatin will benefit patients with these risk factors.
Study finds CPAP may lead to reduced blood pressure in patients with sleep apnea and high blood pressure.
HealthDay (12/11, Reinberg) reports on a study published in the Journal of the American Medical Association finding that the treating of sleep apnea with the standard treatment of continuous positive airway pressure for 12 weeks led to reduced diastolic blood pressure and improved “overall nighttime blood pressure” among patients with sleep apnea who were “taking three or more drugs to lower their blood pressure.” Researchers recommended that patients with hard-to-control high blood pressure be tested for sleep apnea. The study covered 194 patients randomly assigned to CPAP or no CPAP. Those assigned to CPAP “lowered their 24-hour average blood pressure 3.1 mm Hg more than those not receiving CPAP,” and also had “a 3.2 mm Hg greater reduction in 24-hour average diastolic blood pressure.”
Medscape (12/11, O'Riordan) reports the study found “significant improvements in their 24-hour mean and diastolic blood pressures, but no change in their systolic blood pressure.”
The New York Times (12/10, Saint Louis) reports on a study published in the Journal of the American Medical Association and conducted by researchers at Kaiser Permanente finding that proton-pump inhibitors and histamine 2 receptor antagonists “increase the risk of vitamin B12 deficiency.” That applies particularly to those patients who use the medications for two years or more. The study’s senior author Dr. Douglas A. Corley commented, “This raises the question of whether people taking these medications for long periods should be screened for vitamin B12 deficiency.” The study was based on the medical records of 25,956 adults diagnosed with vitamin B12 deficiency and 184,199 patients who did not have B12 deficiency during the period 1997-2011. Specifically, those “who took P.P.I’s for more than two years were 65 percent more likely to have a vitamin B12 deficiency” as 12 percent of those with B12 deficiency “had used P.P.I.’s for two years or more,” compared to “7.2 percent of control patients,” while 4.2 percent were “long-term” users of H2RA’s compared to “3.2 percent of nonusers.”
The San Francisco Chronicle (12/11, Colliver) explains that B-12 deficiency is associated with greater “risk of dementia, nerve damage, anemia and other potentially serious medical problems.” Dr. Corley also pointed out that PPIs have been connected to “increased risk in food-borne infections and bone fractures” in earlier research “because these drugs make it difficult to absorb certain nutrients.” In response to the study, Dr. Keith Obstein, a gastroenterologist at Vanderbilt University Medical Center in Nashville and a committee member of the American College of Gastroenterology, said that “the study gives physicians another potential side effect to discuss with their patients.”
Reuters (12/11, Seaman) reports that Dr. Corley said that those taking the medications should not simply stop, but that they “should have their B12 levels checked.” He also said that patients should take the smallest effective dose and for as little duration as possible. Reuters lists a number of PPIs omeprazole, esomeprazole, and lansoprazole, and H2RAs cimetidine, famotidine, and ranitidine.
BBC News (12/11) reports that Prof Mark Pritchard of the British Society of Gastroenterology pointed out that “only a minority of patients” who were long-term users of the medications were also B12 deficient. The report found that higher doses led to greater likelihood of deficiency, and the link “was stronger in women and younger age groups,” but it also found that “the overall risk was still low.”
HealthDay (12/11, Gordon) reports that last year, there were over “150 million prescriptions” for PPIs, while lower doses are available over the counter.
MedPage Today (12/11, Petrochko) reports the population of those with B12 deficiency was “mostly female (57.4%), 60 or older (67.2%), and were white (68.4%).”
NPR (12/11, Shute) also covered the study in its “Shots” blog.
No Link between Diastolic Dysfunction and Mortality in Patients with Heart Failure and Kidney Disease
A new study has found that severe diastolic dysfunction does not appear to contribute to the increased mortality risk observed in heart failure patients with renal dysfunction. Researchers analyzed data pertaining to 669 patients in the EchoCardiography and Heart Outcome Study (ECHOS), evaluating whether eGFR was associated with mortality risk before and after adjustment for severe diastolic dysfunction. During a 7-year follow-up period, eGFR was associated with similar mortality risk before and after adjustment for severe diastolic dysfunction according to the BMC Nephrology article.
On its website, CBS News (12/3) reports that research presented at the Radiological Society of North America annual meeting suggests that “energy drinks may cause serious increases in heart contraction rates within an hour of” consuming them.
The Huffington Post (12/3) reports that investigators “recruited 18 healthy people – 15 men and three women – with an average age of 27.5 to undergo cardiac magnetic resonance imaging before drinking an energy drink containing 32 milligrams/100 milliliters of caffeine and 400 milligrams/100 milliliters of taurine.” One “hour after consuming the drinks, all the participants underwent cardiac MRI to see if energy drink consumption had any effect on heart function.” The investigators “found that the participants’ hearts had increased contraction rates – indicated by increased peak systolic strain in the heart’s left ventricle – after drinking the energy drinks.”
The Los Angeles Times (12/3, Kaplan) “Science Now” blog reports that the investigators “also looked for changes in heart rate and blood pressure before and after volunteers consumed the energy drink, but the readings in both cases were essentially the same.”
On its website, FOX News (12/3) reports that researcher Dr. Jonas Dörner, said, “There are concerns about the products’ potential adverse side effects on heart function, especially in adolescents and young adults, but there is little or no regulation of energy drink sales.”
HealthDay (12/3, Thompson) reports that this “study raises concerns that energy drinks might be bad for the heart, particularly for people who already have heart disease, said Dr. Kim Williams, vice president of the American College of Cardiology.” According to Dr. Williams, “We know there are drugs that can improve the function of the heart, but in the long term they have a detrimental effect on the heart.”
ABC World News reported on “outrageous hospital costs” and “expensive and wildly confusing bills.” The segment focuses on one women who had the same tests performed at two different facilities and then received bills asking her to pay very different amounts. ABC’s Rebecca Jarvis said, “With so many hospitals, doctors, labs and insurance companies negotiating rates confidentially among themselves, patients are at their wits end.”
In a 3,500-word story front-page story titled, “As Hospital Prices Soar, A Single Stitch Tops $500,” the New York Times (12/3, Rosenthal, Subscription Publication) also reports on high hospital costs and hospitals’ often confusing billing patterns. The “prices for any item or service are set by each hospital and move up and down yearly, and show extraordinary variability, health economists say.” The primary cause of “high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.” The article points out that “hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.” The Times also discusses how emergency departments have, in many cases, become “profit centers.”
Reuters (12/3, Jegtvig) reports that patients often have no idea how much a medical procedure costs until they have been discharged from the hospital, and a study published online in JAMA Internal Medicine indicates that it would be difficult to find out beforehand. Investigators attempting to obtain price quotes for an electrocardiogram from hospitals in the Philadelphia area. The researchers found that just three of the 20 hospitals provided a quote on how much the test would cost.
NBC Nightly News reported that new research suggests that individuals cannot be simultaneously be overweight and physically fit. NBC’s Chief Medical Editor Dr. Nancy Snyderman said that the research indicates that “there is no such thing as healthy obesity.”
Reuters (12/3, Pittman) reports that investigators analyzed data from studies that included a total of more than 61,000 participants.
The Los Angeles Times (12/3, Healy) “Science Now” blog reports that the investigators “found that, as BMI rose, so rose blood pressure, waist circumference and insulin resistance.” Meanwhile, “as BMI increased, levels of HDL cholesterol, thought to protect against heart attack and stroke, decreased.” While participants who were either overweight or obese “may not yet have reached the points that define metabolic illness, they appeared to be on that road as their weight” increased. The research was published online in the Annals of Internal Medicine.
On its website, Time (12/3, Sifferlin) reports that “since obesity has different effects on the body for different people, researchers are still investigating how weight gain and its health effects may vary among people whose obesity is due primarily to things such as genetics and environmental exposures as opposed to unhealthy diets and lack of physical activity.” The article points out that some of the studies used “in the current meta-analysis” had no “follow-up with the participants, so the final mortality and heart disease rates may be slightly higher or lower than they should be.”
On its website, NBC News (12/3, Carroll) reports that the findings appear “to contradict a study published earlier this year, which had concluded that overweight individuals might actually be healthier than those with normal weights,” although “the differing results may simply be due to the fact that the new report looked at different data and at long-term outcomes, experts said.” Also covering the story are HealthDay (12/3, Reinberg), MedPage Today (12/3, Boyles), and Medscape (12/3, Laidman).