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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


What Your Doctor Is Reading What Your Doctor Is Reading
 

Update From the Medical Journals: April 2014


April 30, 2014

By Mary Pickett M.D.

Harvard Medical School

What's the latest news in the medical journals this month? Find out what your doctor is reading.

FDA Plans To Regulate E-Cigarettes

The U.S. Food and Drug Administration (FDA) regulates cigarettes. It can require health warnings on cigarette packages, ban sales to children and require manufacturers to list added ingredients. But the FDA does not currently regulate e-cigarettes. Nor does it regulate cigars, pipe tobacco, hookahs or water pipes.

Now the FDA is proposing to regulate all of these products. The agency announced this proposal on April 24 in an online news release.

The FDA will accept comments from the public and from e-cigarette makers for the next 75 days. Then the FDA plans to make its oversight of e-cigarettes official. It is possible that e-cigarette makers will challenge the FDA in court. It may be several years before we see regulations enforced.

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Organ Transplant Drug May Add to HIV Treatment Success

Specialized antiviral drugs have helped to suppress the human immunodeficiency virus (HIV) to either low or undetectable levels on blood tests. But these drugs don't cure HIV, because some virus can survive inside immune system cells. The virus can safely wait inside these cells, which are sometimes called a "reservoir" for HIV. Because HIV survives in the reservoir, patients must keep taking antiviral drugs to keep their blood HIV levels under control. So doctors began to wonder if medicines that suppress the immune system would reduce the amount of HIV in a patient's reservoir. Or would blocking the immune system only allow the HIV virus to multiply out of control?

Now we have some answers in new research published online April 3 in the American Journal of Transplantation. Drugs that suppress the immune system are commonly used in patients who have received organ transplants, in order to prevent rejection. Researchers observed 91 kidney transplant patients who happened to have HIV for more than 3 years. During this time they took immune suppression medicines after their transplants. Blood samples showed that HIV remained remarkably well controlled. This was especially true for patients who took an immune suppressing drug called sirolimus.

Because of this study, the National Institutes of Health is already sponsoring a study that will focus on sirolimus treatment in HIV. If HIV can be eliminated in the bloodstream (by antiviral medicines) and in the immune reservoir (by sirolimus), these drugs might be highly effective against HIV when they are used together. This research may bring us one step closer to curing HIV.

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More News In Brief

  • People with Diabetes Have Fewer Health Problems Today. Americans with diabetes are avoiding some of the health problems that have traditionally affected diabetics. This comes from a new study published April 16 in the New England Journal of Medicine. The study noted that the actual number of people with diabetes has more than tripled over the past two decades. But rates of kidney disease, amputation of toes or feet and other health problems that come with long-term diabetes have dropped dramatically since 1990. Heart attack rates declined nearly 70%. Stroke risk declined about 50%. Deaths from extremely high blood sugar dropped 65%. Rates of amputation (leg or foot) and stroke fell about 50%. The risk of end-stage kidney disease  declined by 28%. Better treatments and education have made a big difference in preventing these other health problems. Doctors, patients and diabetes researchers have all contributed to the improved health of people living with diabetes.
     
  • PET Scans Can Predict  Recovery  For Some Coma Patients. The Lancet published a study April 15 that will change coma care. A brain scan called a positron emission tomography (PET) scan can tell whether a person in a deep coma (not speaking or responding) has a likelihood of regaining consciousness. The study included 126 patients with severe brain injury. Using the PET scan, doctors were roughly 74% accurate in predicting which patients would come out of a coma within the next year. By contrast, they were only 56% right when they used a standard magnetic resonance imaging (MRI) scan. It can be very difficult for doctors and family members to make decisions about continued life support for patients who have been in a prolonged coma. Better tools that can predict recovery can only help in this dire situation.
     
  • Study Offers New Hope to Paraplegics. "Paraplegia"  is paralysis in both legs due to spinal cord injury. During a 5-year trial, 4 paraplegic patients were implanted with a stimulator that sent fine electric shocks to the spinal cord through 16 electrodes. They also "walked" on a treadmill while in a harness that supported them. The sensation of "walking" may have helped by sending sensory signals to the spinal cord while the spinal nerves "rediscovered" nerve-to-nerve connections. After varying amounts of time, the patients have been able to voluntarily move their legs, feet and toes. They also have more strength to stand. The study was published online April 8 in the journal Brain.
     
  • Surgery to Remove Fibroids Has Unexpected Danger. Many women have surgery to remove benign fibroid tumors in the uterus. One popular surgical technique is to remove the tumors through very small surgical incisions. It uses a tool called a "morcellator." This electronic tool causes the tumor to fragment into small pieces; the pieces are then removed through the surgical incision. Unfortunately, this technique has a serious risk. The U.S. Food and Drug Administration (FDA) issued a safety alert on its website on April 17. If the tumor being removed has cancer cells, morcellation can cause these cells to spread into the abdomen and pelvis during the procedure. The evidence shows that 1 out of 352 women who are told they have fibroids actually have a cancer called uterine sarcoma. And 1 in 498 women who are told they have fibroids have a type of cancer called uterine leiomyosarcoma. Women who have already had the procedure would know if there were cancer cells in their fibroid. That's because the tissue is examined by a pathologist. But the FDA is advising doctors to stop using this procedure in the future due to safety concerns. A larger incision is a better plan, since there is a serious risk involved in morcellation.
     
  • Marijuana Increases the Risk for Heart Attack. Research presented at the International Stroke Conference 2013 strongly suggested that marijuana use can trigger stroke in young adults. A new study, published online April 23 in the Journal of the American Heart Association, finds that marijuana can also cause heart attacks. The study evaluated 1,979 marijuana-related complications among French patients between 2006 to 2010. During this time, there were about 1.2 million regular marijuana users in France. Most of the marijuana users were male.Their average age was 34.5 years. There were 20 heart attacks among the complications and three strokes. One out of four of these heart attacks and strokes were fatal. The number of heart attacks in this large group of marijuana users was small. Still, it is a very serious concern. Many people have a false impression that marijuana is a safe drug. In addition to the small risk for heart attack or stroke, marijuana can increase the risk for depression and psychotic symptoms, cause memory and learning problems, and cause lung irritation and injury.

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Mary Pickett, M.D., is an associate professor at Oregon Health Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a lecturer for Harvard Medical School and a senior medical editor for Harvard Health Publications.

 

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