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21-10-2012 | Article

Global medical news in review: October 14-20, 2012

medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.

But can they take out the trash?

The possibility of reducing the risk for hepatocellular carcinoma (HCC) could be added to the alleged wonders of statins, show the results of a meta-analysis.

The authors found the effect to be strongest in East Asian men with hepatitis B virus (HBV)-related cirrhosis, indicating that the drugs could be used as chemoprevention in this population.

The meta-analysis, published in Gastroenterology, included seven observational studies and three studies of pooled data from randomized trials. Overall, there were 4298 cases of HCC in 1,459,417 patients.

William Sanchez (Mayo Clinic, Rochester, Minnesota, USA) and colleagues found that the risk for developing HCC was 41% lower among patients who took statins compared with those who did not. When they analyzed the results by location, the reduction was 48% among Asian patients compared with 33% in Western patients.

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VTE risk after knee surgery not weight related

Being morbidly obese does not increase the risk for developing venous thromboembolism (VTE) after total knee arthroplasty (TKA) surgery, report Banafsheh Sadeghi (University of California Davis, Sacramento) and co-workers in the Journal of Hospital Medicine.

They say that being ambulatory 2 days after the procedure and receiving US Food and Drug Administration (FDA)-approved pharmacologic prophylaxis - rather than mechanical prophylaxis alone - reduced the risk for VTE in TKA patients.

Conversely, undergoing bilateral as opposed to unilateral TKA, and not walking until 3 days after surgery were both significant risk factors for VTE in this patient population.

Multivariate analysis, adjusted for factors including age, gender, body mass index (BMI), receipt of FDA-approved prophylaxis, and type of TKA, showed that neither age, gender, nor obesity (BMI >30) significantly predicted VTE.

By contrast, patients who underwent bilateral TKA (n=64) were 4.2-times more likely to develop VTE than their peers who underwent unilateral TKA (n=525).

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Eye docs worry about ratting out older drivers

Two-thirds of vision care providers (VCPs; optometrists and ophthalmologists) routinely inquire about their older patients' driving, but almost half believe that reporting patients negatively to government agencies affects the physician-patient relationship, show US study results.

The researchers suggest that "further attention should be given to addressing barriers, providing resources, and devising communication strategies between VCPs and other members of the health care team."

Writing in the Archives of Ophthalmology, Rebecca Leinberger (University of Michigan, Ann Arbor) and colleagues add that improving such lines of communication "could increase the likelihood that older adults receive the assistance required to remain safe drivers and that potentially unsafe drivers are identified more often."

The recommendations emerge from a survey of 404 VCPs working in Michigan, USA, in practices containing at least some patients aged 65 years and older.

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Soccer training 'a hat trick' for middle-aged men

Soccer training can significantly reduce blood pressure (BP) and improve aerobic fitness in hypertensive middle-aged men, researchers say.

Peter Kustrup (University of Exeter, UK) and colleagues report that 6 months of soccer training prevents cardiovascular disease in middle-aged men (31-54 years) with hypertension and is more effective than advice given by general practitioners on how to maintain a healthy lifestyle.

Kustrup and team found that during training, the average heart rate of men randomly assigned to the soccer training group rose to 155 beats per minute. Their systolic and diastolic BP decreased over 6 months of two hour-long soccer training sessions per week, from 151 to 139 mmHg, and from 92 to 84 mmHg, respectively.

There were smaller decreases in systolic and diastolic BP among men who were randomly assigned to receive healthy lifestyle advice from a doctor, from 153 to 145 mmHg and 96 to 93 mmHg, respectively. These men received traditional physician-guided recommendations on how to modify their cardiovascular risk, the researchers reported in Medicine and Science in Sports and Exercise.

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Study sours on cranberry juice for UTIs

Results from an updated systematic review suggest that the value of cranberry juice or capsule consumption for prevention of urinary tract infections (UTIs) is likely to be limited.

In their update, published in the Cochrane Database of Systematic Reviews, Ruth Jepson (University of Stirling, UK) and colleagues found some evidence to suggest that while there were small benefits for women with recurrent infections, they would have to consume large amounts of juice for long periods to prevent one infection.

The previous systematic review, published in 2008, suggested that consumption of cranberry juice or associated products moderately reduced the number of UTIs over a 12-month period, but the addition of 14 new studies in the current review indicates that the beneficial effects of cranberry juice are smaller than previously estimated.

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SSRIs increase brain hemorrhage risk

Use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk for brain hemorrhage, particularly intracerebral bleeding, suggest meta-analysis findings published in Neurology.

In the analysis of 16 observational studies, involving over 500,000 participants, SSRI exposure was linked to a 51% increased relative risk for intracranial hemorrhage, and a 42% increased relative risk for intracerebral hemorrhage.

Daniel Hackam, of Western University in London, Ontario, Canada, and colleagues estimate that in light of a global incidence of 24.6 per 100,000 person-years, SSRI use could be expected to cause one additional intracerebral bleeding episode per 10,000 persons treated for 1 year.

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Dust protein may exacerbate asthma

A bacterial protein found in common house dust may worsen a person's asthmatic response to other indoor allergens, say researchers.

The team screened house dust extracts to assess which microbial components were the most allergenic. The bacterial protein flagellin stimulated strong allergic responses to inhaled egg white (ovalbumin) protein in a mouse model of airway inflammation.

Mice challenged with ovalbumin alone or flagellin alone did not become sensitized to ovalbumin and did not exhibit an allergic airway response to subsequent repeat challenges.

The researchers also found that the flagellin receptor, toll-like receptor 5, was required for strong allergic responses to be initiated to common indoor allergens such as dust mites, cockroaches, and animal dander in house dust.

In the study, published in Nature Medicine, Donald Cook (National Institutes of Health, North Carolina) and colleagues compared serum samples from people with and without asthma and found significantly higher levels of flagellin-specific antibodies in asthmatic compared with nonasthmatic individuals.

Bacterial products are known to act as adjuvants and are thought to promote asthma by initiating allergic sensitization to inhaled allergens, write the authors, and their results support this theory.

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By Neil Osterweil, medwireNews Reporter