Annals Internal Medicine, Author Interviews, Cost of Health Care, McGill / 18.11.2014

MedicalResearch.com Interview with: Todd Lee MD MPH FRCPC Consultant in Internal Medicine and Infectious Diseases Assistant Professor of Medicine, McGill University Director, General Internal Medicine Consultation Service, Chief of Service, 6 Medical Clinical Teaching Unit, McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs.  Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use.  Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy.  Sometimes this means that no antibiotics should be given. In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions. Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship".  This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist.  These audits were performed by our senior resident physicians in the context of providing their routine clinical care.  We also provided local antibiotic guidelines and regular educational sessions once a rotation. We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority.  We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested. Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. (more…)
Author Interviews, Heart Disease / 18.11.2014

Prof Simon Stewart PhD Mary MacKillop Institute for Health Research, Australian Catholic University, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, AustraliaMedicalResearch.com Interview with: Prof Simon Stewart PhD Mary MacKillop Institute for Health Research, Australian Catholic University, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia Medical Research: What is the background for this study? What are the main findings? Prof. Stewart: Atrial fibrillation (AF) is the most common irregular heart beat and a major cause of deadly and disabling stroke and chronic heart failure. Atrial fibrillation has become a major public health issue that is putting increasing pressure on health care systems worldwide. In an attempt to reduce re-hospitalisations and death due to Atrial fibrillation, we designed the randomised controlled trial the Standard versus Atrial Fibrillation-spEcific managemenT strategY (SAFETY); a home-based, nurse-led, AF-specific management programme delivered to patients who have been hospitalised with Atrial fibrillation and involved individualised AF management. Half of participants (n=168) were given this intervention and the other half (n=167) underwent standard post-hospital management. All participants were followed-up over 24 months with specific clinic visits scheduled at 12 months and 24 months. We found that patients in the intervention group had proportionately more days alive and out of hospital compared to patients who received standard management (reflecting a combination of less hospital stay and prolonged survival). Further, when intervention patients did go to hospital, the length-of-stay of their admission was shorter than for patients under standard management. (more…)
Cognitive Issues, Heart Disease / 17.11.2014

Dr. T. Jared Bunch, M.D Medical Director for Heart Rhythm Services Intermountain Healthcare network.MedicalResearch.com Interview with: Dr. T. Jared Bunch, M.D Medical Director for Heart Rhythm Services Intermountain Healthcare network. Medical Research: What is the background for this study? What are the main findings? Dr. Bunch: Approximately 5 years ago we found that atrial fibrillation was associated with all forms of dementia, including Alzheimer's disease.  At that time we did not know the mechanisms behind the association.  One hypothesis that we had was brain injury in patients with atrial fibrillation is in a spectrum, large injuries result in strokes and repetitive small injuries result in dementia.  In this regard, we anticipated that anticoagulation effectiveness and use may impact dementia risk.  Early this year we published in HeartRhythm Journal that atrial fibrillation patients with no history of dementia that have used warfarin, but had high percent times outside of the therapeutic range were much more likely to develop dementia.  We gained some insight from this trial in that we saw much higher risks of the patients were either over or under anticoagulated. Amongst our atrial fibrillation patients using warfarin nearly one third are also taking aspirin, typically due to the presence of coronary artery disease or a prior myocardial infarction. We hypothesized since these patients were using two agents that increase risk of bleed that over anticoagulation with warfarin may be an even great risk for dementia.  This is was we found.  The patients over anticoagulated greater than 30 percent of the time were nearly 2 and a half times more likely to develop dementia compared to those that were over anticoagulated less that 10 percent to the time. (more…)
Author Interviews, Heart Disease, Lancet / 17.11.2014

Prof Gavin D. Perkins MD Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research; Warwick Medical School and Heart of England NHS Foundation TrustMedicalResearch.com Interview with: Prof Gavin D. Perkins MD Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research; Warwick Medical School and Heart of England NHS Foundation Trust Medical Research: What is the background for this study? Prof. Perkins: Each year around 30,000 people in the United Kingdom suffer out of hospital cardiac arrests and less than one in twelve of those returns home alive. Early high quality Cardio- Pulmonary Resuscitation (CPR – ventilation and chest compressions) is critical to survival. However maintaining high quality chest compressions during resuscitation is difficult for crews of emergency vehicles, especially if they are on their own, because of fatigue and the need to perform other actions. Chest compression is particularly difficult in moving vehicles. A number of mechanical devices, suitable for out of hospital use, have been developed over the years to improve the quality of chest compressions and therefore attempt to improve patient outcomes. Some NHS organisations decided to purchase devices to use although there is limited evidence of their effectiveness. To equip all emergency vehicles in the NHS would cost tens of millions of pounds plus costs for on-going training and maintenance. This prompted the UK Joint Royal College Ambulance Liaison Committee to advise against the purchase of further mechanical chest compression devices until further research had been carried out. The aim of this trial was to compare the effects of the mechanical chest compressions (LUCAS-2) device versus standard manual chest compressions (crew using their hands) on survival. (more…)
Author Interviews, Heart Disease / 17.11.2014

Dr. Yacov Shacham MD Department of Cardiology Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel.MedicalResearch.com Interview with: Dr. Yacov Shacham MD Department of Cardiology Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel-Aviv University, Tel-Aviv, Israel. Medical Research: What is the background for this study? What are the main findings? Dr. Shacham: Acute kidney injury (AKI) is a common complication among ST elevation (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and it is associated with poor long-term clinical outcomes. No studies have yet evaluated the association between cardiac function and the risk of AKI in this patient population. We conducted a retrospective study of consecutive STEMI patients who underwent primary PCI and had a full echocardiography study performed within 72 hours of hospital admission. We evaluated the relation between systolic and diastolic parameters and AKI. We demonstrated that the occurrence of AKI following primary PCI was associated with worse left ventricular systolic and diastolic function, however only left ventricular EF emerged as an independent predictor of AKI. For every 1% reduction in EF, the risk of AKI increased (OR 1.1, 95% CI 0.86-0.96; p=0.001) (more…)
Heart Disease / 17.11.2014

Dr Guillaume Geri, MD Medical Intensive Care Unit Cochin Hospital Paris, FranceMedicalResearch.com Interview with: Dr Guillaume Geri, MD Medical Intensive Care Unit Cochin Hospital Paris, France   Medical Research: What is the background of the study? What are the main findings? Dr. Geri: Culprit coronary artery occlusion is the main cause of out-of-hospital cardiac arrest. This has been well demonstrated since pioneer study of Spaulding et al in the New England Journal of Medicine in 1997. Several studies highlighted the favorable prognostic impact of an immediate successful PCI in cardiac arrest patients but inclusion biases or the lack of data on in-hospital management limit the generalization of such findings. In this large French cohort of out-of-hospital cardiac arrest patients who were admitted after successful return of spontaneous circulation from 2000 to 2012, those who received immediate PCI had better short- and long-term survival than those who did not undergo the procedure, new data presented here concluded. The researchers examined the association between immediate PCI and survival at 30 days, 2 years and 10 years, and evaluated other potential predicting factors. Furthermore, they used a propensity score method to analyze the impact of PCI on 30-day and long-term survival in matched patients. Overall, 1,722 patients (71.5% male; median age, 59.9 years) were analyzed during a median 2 year follow-up. OHCA  (out-of-hospital cardiac arrest ) was witnessed in 86.7% of patients, and occurred in a public space in 32.2% of patients and with an initial shockable rhythm (eg, ventricular fibrillation/ventricular tachycardia) in 54.6% of cases. (more…)
Author Interviews, Eating Disorders, Nature / 17.11.2014

Pietro Cottone, Ph.D. Associate Professor Departments of Pharmacology and Psychiatry Laboratory of Addictive Disorders Boston University School of Medicine Boston, MA 02118MedicalResearch.com Interview with: Pietro Cottone, Ph.D. Associate Professor Departments of Pharmacology and Psychiatry Laboratory of Addictive Disorders Boston University School of Medicine Boston, MA 02118 Medical Research: What is the background for this study? What are the main findings? Dr. Cottone: Binge-eating disorder affects over ten million people in the USA and it is characterized by excessive consumption of junk food within brief periods of time, accompanied by loss of control, uncomfortable fullness and intense feelings of disgust and embarrassment. Increasing evidence suggests that binge-eating disorder can be regarded as an addiction behavior. Memantine, a neuroprotective drug which blocks the glutamatergic system in the brain, is an Alzheimer's disease medication, and it has been shown potential to treat a variety of addictive disorders. We first developed a rodent model of binge eating by providing a sugary, chocolate diet only for one hour a day, while the control group was given the standard laboratory diet. Rats exposed to the sugary diet rapidly develop binge eating behavior, observed as a 4 fold increase in food intake compared to controls. Furthermore, binge eating rats are willing to work to a much greater extent to obtain just the cue associated with the sugary food (not the actual food), as compared to controls. In addition, binge eating subjects exhibit compulsive behavior by putting themselves in a potentially risky situation in order to get to the sugary food, while the control group obviously avoids that risk. We then tested whether administering memantine could reduce binge eating of the sugary diet, the strength of cues associated with junk food as well as the compulsiveness associated with binge eating. In addition, we studied which area of the brain was mediating the effects of memantine, by injecting the drug directly into the brain of binge eating rats. Our data show that memantine was able to block binge eating of the sugary diet, the willingness to work to obtain a cue associated with junk food, as well as the risky behavior of rats when the sugary diet was provided in a potentially unsafe environment. When we injected the drug directly into the nucleus accumbens of rats, they stopped binge eating. Importantly, the drug had no effects in control rats eating a standard laboratory diet. (more…)
Cannabis, Heart Disease / 17.11.2014

Matthew L. Springer, Ph.D. Associate Professor of Medicine Division of Cardiology Cardiovascular Research Institute Broad Center of Regeneration Medicine and Stem Cell Research Center for Tobacco Control Research & Education Helen Diller Family Comprehensive Cancer Center University of California, San Francisco MedicalResearch.com Interview with: Matthew L. Springer, Ph.D. Associate Professor of Medicine Division of Cardiology Cardiovascular Research Institute Broad Center of Regeneration Medicine and Stem Cell Research Center for Tobacco Control Research & Education Helen Diller Family Comprehensive Cancer Center University of California, San Francisco     Medical Research: What is the background for this study? What are the main findings? Dr. Springer: The general public is aware that cigarette secondhand smoke is harmful. However, many people who actively avoid tobacco secondhand smoke don't feel the need to avoid marijuana secondhand smoke; they don't consider it harmful because there's no nicotine and because we who tell them to avoid tobacco smoke don't tell them to avoid marijuana smoke.  However, secondhand smoke from tobacco and marijuana is very similar in chemical composition (4000-7000 chemicals depending on whom you ask), aside from the nicotine and the THC (the psychoactive drug in marijuana). We and others have shown that brief exposure to tobacco secondhand smoke, such as 30 minutes, at real-world levels impairs vascular function in humans.  We developed a way to study vascular function (measured as arterial flow-mediated dilation; FMD) in living rats, and recently published that even one minute of sidestream smoke from the burning tips of tobacco cigarettes, a well-accepted model for secondhand smoke, is enough to start detecting impairment of FMD.  The main findings of the current study are that in laboratory rats, FMD was substantially impaired by a 30 minute exposure to marijuana secondhand smoke, when measured 10 minutes after the end of exposure.  Impairment was comparable to that resulting from exposure to tobacco sidestream smoke, although whereas impairment from tobacco smoke was temporary and had normalized by 40 minutes later, FMD was still impaired 40 minutes after the end of exposure to marijuana smoke.  Smoke from marijuana lacking THC still impaired FMD, showing that  (more…)
Author Interviews, General Medicine, Heart Disease, JAMA / 16.11.2014

Manesh Patel, MD Associate Professor of Medicine Director Interventional Cardiology and Catheterization Labs Duke University Health System Duke Clinical Research InstituteMedicalResearch.com Interview with: Manesh Patel, MD Associate Professor of Medicine Director Interventional Cardiology and Catheterization Labs Duke University Health System Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Patel: In clinical practice, patients with acute myocardial infarction are found to have non-IRA disease of varying significant and location.  The current recommendations are to have patients recover from the acute myocardial infarction and get non-invasive testing to determine revascualrization after 4-6 six weeks in uncomplicated patients.  These data demonstrate that non-IRA disease is common (>50% of STEMI patients) and that these patients have an elevated 30-day mortality. (more…)
Author Interviews, Ebola, Lancet / 16.11.2014

Professor Tom Solomon, FRCP PhD Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections Director, Institute of Infection and Global Health, University of Liverpool MedicalResearch.com Interview with: Professor Tom Solomon, FRCP PhD Director, NIHR Health Protection Research Unit in Emerging and Zoonotic Infections Director, Institute of Infection and Global Health, University of Liverpool Medical Research: What is the background for this study? What are the main findings? Dr. Solomon: Since the Ebola outbreak began there has been concern about transmission to new countries by airline passengers who were infected, but didn’t know it. This was underscored by such transmission to Nigeria, and to USA. Screening for symptoms of Ebola virus disease in airline passengers whose journeys originated from the three most affected countries—Guinea, Liberia, and Sierra Leone—has recently been introduced at some airports. We examined the current growth rate of the epidemic in West Africa, and airline travel patterns to predict how many people with Ebola are likely to attempt to fly. Our research showed that we can expect approximately 29 infected passengers to try and leave West Africa by the end of the year. Based on the incubation period of the virus, and looking at how long people have symptoms before they are hospitalised, we estimated ten of these people with Ebola would have symptoms of the disease as they leave the affected countries, and so would be detected by exit screening. Of the remaining 19, one to two would be expected to fly to the UK, and up to three to the USA, based on current airline passenger data. At most one of these passengers would have developed symptoms by the time they arrive in the UK or USA, and thus would be detected by entry screening (more…)
ALS, Author Interviews, JAMA / 16.11.2014

MedicalResearch.com Interview with: Charles Tzu Chi Lee, PhD Associate Prof., Department of Public Health Kaohsiung Medical University, Kaohsiung, Taiwan Sanmin District, Kaohsiung City Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease and most patients die within three to five years after symptoms appear. Studies have suggested angiotensin-converting enzyme inhibitors (ACEIs) may decrease the risk for developing neurodegenerative diseases. But there was still no human study discussing ACEIs use and ALS risk in literature. The study results indicate that when compared with patients who did not use ACEIs, the risk reduction was 17 percent (adjusted odds ratio of 0.83) for the group prescribed ACEIs lower than 449.5 cumulative defined daily dose (cDDD) and 57 percent (adjusted odds ratio 0.43) for the group prescribed ACEIs greater than 449.5 cDDD. (more…)
Author Interviews, HPV, Sexual Health / 16.11.2014

Eduardo L. Franco DrPH, FRSC, FCAHS James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology Minda de Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology McGill University Montreal, Quebec, CanadaMedicalResearch.com Interview with; Eduardo L. Franco DrPH, FRSC, FCAHS James McGill Professor Departments of Oncology and Epidemiology & Biostatistics, Director, Division of Cancer Epidemiology, Minda de Gunzburg Chair, Department of Oncology, Division of Cancer Epidemiology Department of Oncology McGill University, Montreal, Quebec, Canada Medical Research: What should clinicians and patients take away from your report? Dr. Franco: Our findings of oral transmission of human papillomavirus (HPV) infection in men are part of a larger molecular epidemiologic study called ‘HPV Infection and Transmission among Couples through Heterosexual Activity’ (HITCH) cohort study. The focus of the HITCH study is to understand how HPV is transmitted within couples via sexual contact and other behaviors. We measure the presence of this virus using highly-sensitive molecular assays for HPV DNA in the genital surfaces (vagina and penis), oral cavity, and hands. We also take a blood sample to look for the presence of antibodies against HPV. We take multiple samples over a period of two years at pre-scheduled visits. We have previously published results focused exclusively on genital transmission. The present report is the first in the HITCH study to look at what happens in terms of characteristics that place male participants to be at risk of oral HPV infection. To our knowledge, this is the first study to show a high risk of oral HPV infection among men whose female partners had a genital or oral HPV infection, suggesting that transmission may occur through oral or genital routes. We looked at transmission for 36 individual HPV genotypes, which improved our ability to study risk determinants. Risk was also significantly higher among men who had ever smoked, had a high number of lifetime sex partners, or were in non-monogamous relationships. Our results are largely consistent with previous studies that have found male sex practices and smoking to be the most significant risk factors for oral HPV infection. (more…)
Author Interviews, Nutrition, Sugar / 16.11.2014

Jill Kanaley, PhD Professor and associate chair Department of Nutrition and Exercise Physiology University of MissouriMedicalResearch.com Interview with: Jill Kanaley, PhD Professor and Associate Ahair Department of Nutrition and Exercise Physiology University of Missouri Abstract: Background: Adolescents consume more sugar-sweetened beverages than do individuals in any other age group, but it is unknown how the type of sugar-sweetened beverage affects metabolic health in this population. Objective: The objective was to compare the metabolic health effects of short-term (2-wk) consumption of high-fructose (HF) and high-glucose (HG)–sweetened beverages in adolescents (15–20 y of age). Design: In a counterbalanced, single-blind fashion, 40 male and female adolescents completed two 2-wk trials that included 1) an HF trial in which they consumed 710 mL of a sugar-sweetened beverage/d (equivalent to 50 g fructose/d and 15 g glucose/d) for 2 wk and 2) an HG trial in which they consumed 710 mL of a sugar-sweetened beverage/d (equivalent to 50 g glucose/d and 15 g fructose/ d) for 2 wk in addition to their normal ad libitum diet. In addition, the participants maintained similar physical activity levels during each trial. The day after each trial, insulin sensitivity and resistance [assessed via Quantitative Insulin Sensitivity Check Index (QUICKI) and homeostatic model assessment of insulin resistance (HOMA-IR) index] and fasting and postprandial glucose, lactate, lipid, cholesterol, insulin, C-peptide, insulin secretion, and clearance responses to HF or HG mixed meals were assessed. Results: Body weight, QUICKI (whole-body insulin sensitivity), HOMA-IR (hepatic insulin resistance), and fasting lipids, cholesterol, glucose, lactate, and insulin secretion or clearance were not different between trials. Fasting HDL- and HDL3-cholesterol concentrations were w10–31% greater (P , 0.05) in female adolescents than in male adolescents. Postprandial triacylglycerol, HDL-cholesterol, HDL3-cholesterol, and glucose concentrations were not different between HF and HG trials. The lactate incremental area under the curve was w3.7-fold greater during the HF trial (P , 0.05), whereas insulin secretion was 19% greater during the HG trial (P , 0.05). Conclusions: Moderate amounts of HF- or HG-sweetened beverages for 2 wk did not have differential effects on fasting or postprandial cholesterol, triacylglycerol, glucose, or hepatic insulin clearance in weight-stable, physically active adolescents. (more…)
Author Interviews, Emergency Care, Heart Disease / 16.11.2014

Dr. Marc-Alexander Ohlow, MD, adjunct Professor of Medicine Cardiology Department Zentralklinik Bad Berka, GermanyMedicalResearch.com Interview with: Dr. Marc-Alexander Ohlow, MD, Adjunct Professor of Medicine Cardiology Department Zentralklinik Bad Berka, Germany MedicalResearch.com: What are the main findings of the study? Dr. Ohlow: This paper reports the finding of a retrospective study including 4.311 consecutive patients with suspected acute coronary syndrome (ACS). Out of them 272 patients with acute onset of chest pain and elevated levels of cardiac necrosis markers did not have significant (≥50% diameter stenosis) coronary artery stenosis on coronary angiography. Aim of this study was to provide further information and understanding of the clinical characteristics and outcome of patients with acute coronary syndrome without critical stenosis, and comparing those with a consecutive series of patients with ACS requiring percutaneous coronary intervention (non-ST-elevation myocardial infarction patients). Patients presenting without significant coronary stenosis, but with chest pain and elevated troponin level were younger, had less severe angina symptoms, were more likely to be women, had lower level of myocardial necrosis markers (troponin and creatine kinase), and had higher left ventricular ejection fraction compared to patients undergoing angioplasty due to significant coronary obstruction. (more…)
Author Interviews, BMJ, Erasmus, Heart Disease / 16.11.2014

Marco Valgimigli, MD, PhD Associate Professor of Medicine Erasmus MC, Thoraxcenter, Rotterdam The NetherlandsMedicalResearch.com Interview with: Marco Valgimigli, MD, PhD Associate Professor of Medicine Erasmus MC, Thoraxcenter, Rotterdam The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Valgimigli: Drug-Eluting Stents are regarded as more thrombogenic devices as compared to Bare Metal Stents. We have pooled all available datasets comparing a specific second generation Drug-Eluting Stent, namely cobalt chromium everolimus eluting stent (co-Cr EES) versus Bare Metal Stents and found that cardiac mortality along with all other non-fatal endpoints investigated, including myocardial infarction or stent thrombosis were reduced after co-Cr EES. (more…)
Kidney Disease / 16.11.2014

Anu Wadhwa, M.D. Assistant Professor of Medicine Division of Nephrology and Hypertension Loyola University Medical Center/ Hines VA Hospital Maywood, IL-60153MedicalResearch.com Interview with: Anu Wadhwa, M.D. Assistant Professor of Medicine Division of Nephrology and Hypertension Loyola University Medical Center/ Hines VA Hospital Maywood, IL-60153 Medical Research: What is the background for this study? Dr. Wadhwa: Patients with end stage renal disease rely on dialysis treatments to survive. Hence this population is very vulnerable during emergencies or disaster situations. We believe that patient education on an individual level is the cornerstone of a successful disaster plan. In this quality improvement study, we assessed disaster preparedness in our dialysis patients and evaluated multidisciplinary approach to disseminate this information. Multidisciplinary team of physicians, nurses, dieticians and social workers reviewed preparedness-relevant topics with the patients. Patients were provided purple cards (created by KCER) with emergency information to carry with them at all times. A simple yes/no questionnaire asking disaster preparedness relevant questions was given to the patients before and after this education was provided. Disaster preparedness was defined as perceived preparedness (survey question) and a positive response to at least three key questions-having a plan they have had discussed with a family member or dialysis unit, knowledge of backup dialysis facility and familiarity with emergency diet plan. (more…)
OBGYNE, Pediatrics, Weight Research / 16.11.2014

MedicalResearch.com Interview with: Ian R. Macumber MD Pediatric Nephrology, Seattle Children's Hospital Seattle, Washington Medical Research: What are the main findings of the study? Dr. Macumber: The main finding is that there is a strong association between maternal obesity and odds of congenital anomalies of the kidney and urinary tract (CAKUT) in offspring.  This relationship remains strong when looking at offspring with renal malformation (excluding non-renal congenital anomalies of the kidney and urinary tract), or in offspring with isolated congenital anomalies of the kidney and urinary tract (no congenital anomalies elsewhere in the body).  There is a dose-response relationship to this association, with the offspring of extremely obese mothers have even higher odds of having congenital anomalies of the kidney and urinary tract. (more…)
Blood Pressure - Hypertension / 16.11.2014

Swapnil Hiremath, MedicalResearch.com Interview with: Swapnil Hiremath, MD, MPH Assistant Professor Nephrologist, The Ottawa Hospital Faculty of Medicine at University of Ottawa Medical Research: What are the main findings of the study? Dr. Hiremath: Our study was a retrospective analysis of the data from the Nephrology Nurse BP assessment clinic at the Ottawa Hospital. Patients from the nephrology clinic were referred to this clinic not just for validation of their home BP machines, but also for lifestyle education and teaching the correct technique. We validated the monitors brought in by patients using a set protocol (including: confirming equal blood pressure in both arms, measuring BP simultaneously in both arms by an RN using proper technique, taking three resting readings and averaging them). Firstly, there was a statistically significant difference when we compared the average blood pressure measurement (both systolic and diastolic) values from the home monitor compared to the mercury monitor. Secondly, when we calculated the proportions of home BP machines that were accurate (using different thresholds of 3 mm, 5 mm and 10 mm Hg difference between home and mercury monitors) a significant proportion of home monitors were inaccurate. These findings have important implications – if clinicians are using data from home monitors to make therapeutic decisions, then some patients may be undertreated – or over treated needlessly. (more…)
Kidney Disease, Transplantation / 15.11.2014

Anthony Bleyer, Jr. Wake Forest University Class of 2015, Economics President, Club Sports Union Senior Captain, Wake Forest Men's Ultimate MedicalResearch.com Interview with: Anthony Bleyer, Jr.  Wake Forest University Class of 2015, Economics President, Club Sports Union Senior Captain, Wake Forest Men's Ultimate Medical Research: What is the background for this study? What are the main findings? Response: There are over 100,000 individuals waiting for a kidney transplant, but each year only approximately 6,000 individuals have living donors who donate them a kidney; the rest of the individuals must remain on dialysis until they receive a kidney from an individual who has died and is a kidney donor.  A major limiting factor for kidney donation is that many individuals are not healthy enough to donate a kidney because they have  excessive obesity, diabetes mellitus, blood pressure that is too high, or they have other health conditions.  While it was known that obesity, hypertension, and other health conditions are contraindications to kidney transplant, there was no data about what percentage of the US population would be able to donate a kidney.  To study this, we (a team of kidney doctors and researchers at Wake Forest School of Medicine, Winston-Salem, NC) analyzed data from the National Health and Nutrition Survey. This study is a population-based sample that is representative of the US population. Based on data from this study, we determined that 55.2% of the U.S. population would not have met eligibility criteria for kidney donation, often due to preventable health conditions.  19.2% of the population would have been unable to donate due to hypertension, 15% due to obesity, 11.6% due to excessive alcohol intake, and 11.5% due to diabetes.  60.1% of individuals with an adjusted family household income (AFHI) <$35,000 did not meet eligibility criteria vs. 49.3% for an AFHI > $100,000.   If one considers non-US citizenship and a family income below the poverty threshold as exclusion criteria, 68.5% of the US population would be unable to donate. (more…)
Author Interviews, HIV / 15.11.2014

Prof. Dr. Jan Münch Institute of Molecular Virology Ulm University Medical Center Ulm, GermanyMedicalResearch.com Interview with Prof. Dr. Jan Münch Institute of Molecular Virology Ulm University Medical Center Ulm, Germany Medical Research: What is the background for this study? Dr. Münch: Most anti-HIV microbicides have potent antiviral activity in vitro but were largely inactive in clinical trials. Here we set out to explore whether the HIV infection enhancing activity of amyloid fibrils in human semen interferes with the antiviral efficacy of microbicides and antiviral drugs.  (more…)
Author Interviews, JAMA, Pediatrics, Vaccine Studies / 15.11.2014

Elyse O. Kharbanda MD MPH HealthPartners Medical and Dental GroupMedicalResearch.com Interview Elyse O. Kharbanda MD MPH HealthPartners Medical and Dental Group Medical Research: What is the background for this study? What are the main findings? Dr. Kharbanda: In 2010, due to a pertussis outbreak and neonatal deaths, the California Department of Public Health recommended that the Tdap vaccine be administered during pregnancy.  Tdap is now recommended by the Advisory Committee on Immunization Practices (ACIP) for all pregnant women during each pregnancy.  We wanted to assess the impact of this recommendation. The main findings were that Tdap vaccination during pregnancy was not associated with increased risk for hypertensive disorders of pregnancy, preterm birth, or having a baby who is small for his or her gestational age. The study found a small increased risk for being diagnosed with chorioamnionitis, an inflammation of the fetal membranes caused by bacterial infection.  These findings should be interpreted with caution as the magnitude of the risk was small.  In addition, there was no associated risk for preterm birth, which often occurs as a result of chorioamnionitis.  Furthermore, among the subset of women with a chorioamnionitis diagnosis whose charts were reviewed, many did not have a clinical picture that was clearly consistent with chorioamnionitis. (more…)
Author Interviews, OBGYNE, Statins / 14.11.2014

Mostafa Borahay, MD, FACOG Assistant Professor, Director of Simulation Education Department of Obstetrics and Gynecology University of Texas Medical BranchMedicalResearch.com Interview with: Mostafa Borahay, MD, FACOG Assistant Professor, Director of Simulation Education Department of Obstetrics and Gynecology University of Texas Medical BranchCo-director of Minimally Invasive Gynecologic Surgery University of Texas Medical Branch Medical Research: What is the background for this study? What are the main findings? Dr. Borahay: Uterine fibroids are the most common type of tumor in the female reproductive system, accounting for half of the 600,000 hysterectomies done annually in the U.S. Their estimated annual cost is up to $34 billion in the U.S. alone. Despite this, the exact cause of these tumors is not well understood, as there are several genetic, familial and hormonal abnormalities linked with their development. Even more, we currently don’t have a satisfactory medical treatment for these tumors. Our team investigated the impact of simvastatin on human uterine fibroid cell growth. Statins, such as simvastatin, are commonly prescribed to lower high cholesterol levels. Statins work by blocking an early step in cholesterol production. Beyond these well-known cholesterol-lowering abilities, statins also combat certain tumors. Statins have previously been shown to have anti-tumor effects on breast, ovarian, prostate, colon, leukemia and lung cancers. However, the effect of statins on uterine fibroids was unknown. We found that simvastatin impedes the growth of uterine fibroid tumor cells. We also studied the way simvastatin works to suppress these tumors. Simvastatin was shown to inhibit ERK phosphorylation, which is a critical step in the molecular pathway that prompts the growth of new cells. In addition, simvastatin stops the progression of tumor cells that have already begun to grow and induces calcium-dependent cell death mechanisms in fibroid tumor cells. Therefore, we identified a novel pathway by which simvastatin induces the death of uterine fibroid tumor cells. (more…)
Author Interviews, JAMA, Surgical Research / 14.11.2014

Rachel Bhak MS Department of Veterans Affairs Cooperative Studies Program Coordinating Center West Haven, ConnecticutMedicalResearch.com Interview with: Rachel Bhak MS Department of Veterans Affairs Cooperative Studies Program Coordinating Center West Haven, Connecticut Medical Research: What is the background for this study? What are the main findings? Ms. Bhak: Abdominal aortic aneurysms (AAA) and their rupture are potentially fatal, so monitoring and understanding their expansion is of utmost importance. This study sought to characterize factors associated with Abdominal aortic aneurysms expansion, as well as their different growth patterns. The main findings are that current smoking and diastolic blood pressure are associated with increased linear expansion rate, diabetes with a decreased linear expansion rate, and diastolic blood pressure and baseline abdominal aortic aneurysms diameter with an accelerated expansion rate. (more…)
Author Interviews, JAMA, Neurological Disorders / 14.11.2014

MedicalResearch.com Interview with: Charles Tzu Chi Lee, PhD Associate Prof., Department of Public Health Kaohsiung Medical University, Kaohsiung, Taiwan Kaohsiung City 80708, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease and most patients die within three to five years after symptoms appear. Studies have suggested angiotensin-converting enzyme inhibitors (ACEIs) may decrease the risk for developing neurodegenerative diseases. But. there was still no human study discussing ACEIs use and ALS risk in literature. The study results indicate that when compared with patients who did not use ACEIs, the risk reduction was 17 percent (adjusted odds ratio of 0.83) for the group prescribed ACEIs lower than 449.5 cumulative defined daily dose (cDDD) and 57 percent (adjusted odds ratio 0.43) for the group prescribed angiotensin-converting enzyme inhibitors greater than 449.5 cDDD. (more…)
Author Interviews, Kidney Disease, Pharmacology / 14.11.2014

MedicalResearch.com Interview with: Naoka Murakami MD PhD Mount Sinai Beth Israel Department of Medicine Medical Research: What is the background of the study? What are the main findings?  Dr. Murakami: Dialysis patients live in a complex sociomedical situation and are highly dependent on technologies to sustain their lives; such as transportation, electricity and water for the dialysis apparatus. Interruption of this infrastructure by a natural disaster can result in devastating outcomes. During triage of patients arriving at Mount Sinai Beth Israel in the immediate aftermath of hurricane Sandy, we observed that many dialysis patients did not know about their medications, their comorbid conditions nor their dialysis prescriptions. Therefore we conducted a cross-sectional follow-up study of 357 hemodialysis patients in five dialysis units in lower Manhattan, New York. Using checklists prepared by the National Kidney Foundation and the Department of Homeland Security, we found that 26.3% subjects missed dialysis sessions and 66.1% received dialysis at non-regular dialysis unit(s). We observed that the distribution of a “Dialysis emergency packet” significantly improved retention of medical records at home. Analysis showed that dialysis-specific preparedness, racial ethnicity (non-African American, Hispanic or Caucasian), reception of dialysis in affiliated units, and older age, were associated with a significant reduction in missed dialyses. (more…)
Author Interviews, Rheumatology / 13.11.2014

Diederik De Cock PhD student - CareRA project Department RheumatologyMedicalResearch.com Interview with: Diederik De Cock PhD student - CareRA project Department Rheumatology Medical Research: What is the background for this study? What are the main findings? Response: Rheumatoid Arthritis (RA) is a chronic systemic auto immune disease characterized by pain and swelling in the joints, mostly in arms and legs. Around 1% of the world population is affected by this hazardous disease. Left untreated this can lead in the short term to loss of quality of life and in the long term to major bone damage and immobility. Rheumatoid Arthritis can not be cured, but the disease can be suppressed. International guidelines recommend to treat a patient with Rheumatoid Arthritis early, intensive and to target low disease activity, but leave much freedom in choice of medication and strategy.  Our CareRA ( Care in early RA) research group, under the leadership of Prof Dr Verschueren and Prof Dr Westhovens tried to untangle long standing questions regarding the management of Rheumatoid Arthritis. In this RCT, we want to question the benefit of a combination of disease modifying anti rheumatic drugs compared to monotherapy and the benefit of a high starting dose of glucocorticoids versus moderate dose. We choose glucocorticoid therapy over biological therapy because of its widespread use in RA and cost-effectiveness compared to the expensive biological therapy. Therefore, 290 patients with the presence of poor prognostic markers (disease activity, erosions and serum markers RF/ACPA) were randomzied into 1 of 3 medication schemes: 1. Cobra Classic: methotrexate + sulphasalazine + 60mg glucocorticoid starting dose 2. Cobra Slim:  methotrexate + 30mg glucocorticoid starting dose 3. Cobra Avant-Garde: methotrexate + leflunomide + 30 mg glucocorticoid starting dose The glucocorticoid doses were tapered every week. After 6 or 7 weeks, they were on maintenance dosage and discontinued after 28 weeks. All patients are followed in a tight control schedule ( a close follow-up scheme), aiming for low disease acitvity. After 16 weeks, 7 out of 10 patients were in remission, a state where the disease is clinically suppressed. No differences in efficacy outcomes were observed between the three groups. However, the safety profile of the Cobra Slim group is much more favourable because only half of the number of adverse events were observed in this group compared to Classic and Avant-Garde. (more…)
Author Interviews, HIV, Occupational Health / 13.11.2014

MedicalResearch.com Interview with: Luís Fernando de Macedo Brígido M.D. Ph.D. Núcleo de Doenças de Vinculação Sanguínea e Sexual Centro de Virologia  Instituto Adolfo Lutz São Paulo Brasil Medical Research: What is the background for this study? What are the main findings? Response: Fomite transmission of HIV, especially in occupational exposure, have been reported, but the use of manicure utensils has not been previously associated to HIV transmission.  We report a case where none of the classical modes of transmission were identified, and a detailed review of clinical history and phylogenetic analysis allowed the association of the case’s infection to manicure care episodes at home with an HIV infected women many years ago. (more…)
Author Interviews, Chemotherapy, Colon Cancer / 13.11.2014

MedicalResearch.com Interview with: Xianglin L. Du, MB, MS, Ph.D.  Professor of Epidemiology, Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, TX 77030, USA. Medical Research: What is the background for this study? Dr. Du: Widespread use of screening and advances in screening strategies played a key role in colorectal cancer survival improvement. With the increasing evidence on the benefit of fecal occult blood test and sigmoidoscopy during 1990s, the U.S. Preventive Service Task Force for the first time in 1996 recommended the annual use of fecal occult blood test, periodic use of sigmoidoscopy, or routine use of both modalities for all persons aged 50 or older. Because colonoscopy is able to detect lesions in the entire colon and has a high sensitivity for lesions of over 10mm in size, Medicare began to cover colonoscopy since 2001 for individuals with average-risk of colorectal cancer. Advances in chemotherapy, particularly some new therapeutic regimens approved by Food and Drug Administration (FDA) over the past decades also played a key role in survival improvement for patients with colorectal cancer. However, the overall impact of newly approved chemotherapy regimens on survival in population-based elderly patients remains unclear. It is also unknown what proportion of survival improvement was attributable to changes in tumor stage and size due to screening, and what proportion was attributable to more effective chemotherapy regimens. Hence, we studied a large nationwide and population-based cohort of elderly colorectal cancer patients to examine the changes in tumor stage and tumor size from 1992 to 2009, and to further quantify the effects of changes in stage/size and chemotherapy regimens on improved survival over the two decades. (more…)
Author Interviews, Cancer Research, Omega-3 Fatty Acids / 13.11.2014

James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart InstituteMedicalResearch.com Interview with: James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. DiNicolantonio: Daily low-dose aspirin has been shown to decrease the risk for cancer in a meta-analysis of randomized controlled trials, which is likely attributable to its ability to modestly decrease the activity of cyclooxygenase-2 (cox-2), an enzyme which contributes importantly to the genesis and progression of adenocarcinomas. Adenocarcinomas are cancer of the glands, the most common type of breast cancer (invasive ductal carcinoma) is an adenocarcinoma, additionally many cancers of the lung, intestine, esophagus, colon are adenocarcinomas. We show that an ample dietary intake of long-chain omega-3 fats—the type prominent in fatty fish—would oppose cox-2 activity.  Additionally, we cite numerous evidence that a higher intake of long-chain omega-3 fats has been found to reduce the risk for numerous types of cancer - especially when looking at trials that excluded fried or preserved fish (or fish high in omega-6), excluded trials with a high background intake of omega-6, and included trials where the "high" intake group - actually ate 2 servings of fish or more per week. Additionally, basic science as well as randomized data showing that long-chain omega-3s can reduce the number and size of colon polyps supports this argument. (more…)