What's the latest news in the medical journals this month? Find out what your doctor is reading.
This year, you will find several new options when you go to get your flu shot. (The flu shot is recommended for everyone except infants younger than 6 months.) A review of available options was released by the Centers for Disease Control (CDC) September 20 in the Morbidity and Mortality Weekly Report (MMWR). Here are some of the new developments for 2013:
All nasal flu vaccines will be quadrivalent vaccines this year. Some injectable flu shots will be quadrivalent vaccines. You are more likely to receive a quadrivalent flu vaccine if you get your flu shot early in the season. Most injectable flu shots this year will continue to protect against three strains, not four.
Studies to test whether the high dose vaccine truly lowers flu infection rates are not yet complete. We should know this information in the fall of 2014.
All of the high-dose flu shots this year are "trivalent. "There is no high-dose version of the quadrivalent form yet. The CDC's Advisory Committee on Immunization Practices (ACIP) says any one of the injectable vaccines (high or standard dose, quadrivalent or trivalent) are appropriate for people over age 65.
Even with all of these options, the best way to protect yourself against flu is probably to get whatever vaccine becomes available to you first. Flu shots give peak protection for 6 to 8 months after they are given.
Migraines Linked to Brain Changes on MRI
Migraine headaches are common. The cause is unknown. Fortunately, most people with migraines have no long-term problems related to them. The headache is temporary, and once it's over the brain and body function normally. Stroke and other complications have been reported, but they are very rare.
But a new study raises the possibility that migraines may permanently change the structure of a person's brain.
The journal Neurology published the study August 28. Researchers reviewed information that had been collected in 19 previous studies. They compared brain MRI scans of people with migraines to those of people without migraines.
They found that people with migraines were more likely to have abnormalities in the "white matter" of the brain. They were also more likely to have smaller brain volume than normal. These variations were more obvious in people who had migraine with aura. (An aura is a symptom that happens around the time of a headache. Sometimes an aura is a visual symptom, such as flashing lights or blank areas in vision). The risk for having an abnormal brain MRI was 34% higher for people with migraine than it was for people who had no migraines. With migraine and aura, the likelihood of having an abnormal MRI was 68% higher than for people with no migraine.
The importance of these findings is uncertain. We don't know if migraines can cause the changes, or if the changes may have caused migraines.
We also don't know whether the abnormal areas of the brain cause the brain to function abnormally. Abnormal findings on MRIs are very common, and healthy people can have minor abnormalities with no impact on their health or brain function.
Still, this is the sort of finding that could change the way we think about migraine headaches.
Statins are trusted medicines. They are the most widely prescribed drugs in the United States. Even if statins may contribute to cataracts, it is hard to argue with the proven benefits of these drugs. Statins are recommended for anyone who has had a prior heart attack or stroke. They are also recommended for people at very high risk of having a heart attack. Still, serious side effects deserve our respect. For people who are at average or low risk for heart disease and have acceptable cholesterol levels, statin drugs probably do more harm than good.
Researchers enrolled 657 smokers who were interested in quitting. Of these patients, 292 were given e-cigarettes with nicotine to use during their quit attempt. Another 292 patients were given nicotine patches, which have proven benefit as an aid to smoking cessation. A third group--the remaining patients--were given a placebo e-cigarette, which did not release any nicotine.
Over the next 13 weeks, 7.3% of people in the e-cigarettes group quit smoking. This was similar to the quit rates of people who used nicotine patches. People who got the placebo e-cigarettes had a quit rate of 4.1%. Fifty-seven percent of the e-cigarette group were able to cut down their (regular) cigarette smoking by at least half in the 6 months after starting e-cigarette use. It is remarkable in studies like this to see how hard it is for most people to quit smoking in one attempt. Usually, multiple attempts at quitting are needed. E-cigarettes may provide some help to people who are trying to quit smoking. However, until these devices are regulated and their safety can monitored, doctors are more likely to recommend other quitting aids.
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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