Pharmaceutical Grade Chondroitin Sulfate As First-Line Treatment of Osteoarthritis

MedicalResearch.com Interview with:

Jean-Yves Reginster M.D.,PH.D. Professor of Epidemiology, Public Health and Health Economics Head of the Bone and Cartilage Metabolism Unit University of Liège

Dr. Reginster

Jean-Yves Reginster M.D.,PH.D.
Professor of Epidemiology, Public Health and Health Economics
Head of the Bone and Cartilage Metabolism Unit
University of Liège

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Whereas several recommendations, issued by scientific societies, recommend to use Symptom-Modifying Slow Acting Drugs (SYSADOAs) for the symptomatic and structural management of osteoarthritis, no medication is currently registered, in this particular indication, by the European Medicines Agency (EMA) or by the Food and Drug Administration (FDA).

This study is the first study, conducted, with a SYSADOA which fully complies with the requirements of the EMA for the assessment of drugs to be used in the treatment of osteoarthritis, i.e. a six-month duration, two co-primary endpoints (pain and function) and a three-arm design, with a placebo and an active comparator. The main findings are that pharmaceutical grade chondroitin sulfate provides an improvement in pain and function, which is greater than placebo and not distinguishable from celecoxib, a non-steroidal anti-inflammatory drug currently licensed for the symptomatic management of osteoarthritis.

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Whose Patients Have Lower 30-Day Mortality? Younger or Older Doctors?

MedicalResearch.com Interview with:

Yusuke Tsugawa, MD, MPH, PhD</strong> Harvard T. H. Chan School of Public Health Department of Health Policy and Management Cambridge, MA 02138

Dr. Tsugawa

Yusuke Tsugawa, MD, MPH, PhD
Harvard T. H. Chan School of Public Health
Department of Health Policy and Management
Cambridge, MA 02138

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although evidence has suggested that older physicians may experience a
decline in medical knowledge and are less likely to adhere to standard care, patients in general had a perception that older doctors are more
experienced and therefore provide superior care.

Using a nationally representative sample of Medicare beneficiaries who were hospitalized
for medical conditions in 2011-2014, we found that patients treated by
younger doctors have lower 30-day mortality compared to those cared
for by older doctors, after adjusting for patient, physician, and
hospital characteristics.

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All NSAIDS Raise Risk of Heart Attack, Even When Taken For Short Period of Time

MedicalResearch.com Interview with:
Michèle Bally, BPharm, MSc, PhD

Epidemiologist, Department of Pharmacy, CHUM
Researcher, Health Innovation and Evaluation Hub, CRCHUM

MedicalResearch.com: What is the background for this study?

Response: The objective of this study was to better understand the risk of heart attack associated with using oral prescription non-steroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, celecoxib, and naproxen) the way people usually do to treat pain and inflammation in real life circumstances.

In clinical trials, NSAIDs were typically taken on a continuous basis in high standardized doses, as assigned by the trial protocol. However, the dosages and the treatment durations studied in trials may not represent the reality of many patients who use NSAIDs in low or varying doses, use these drugs on and off, or switch between NSAID medications.

We were particularly interested in determining the onset of the risk, that is how soon does the risk of heart attack start increasing? Also, we wanted to investigate the effect of dose and duration of treatment. To do this, we studied the use of a low or high dose level of NSAIDs over certain set periods of time, including taking these medications only for 1 to 7 days.

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Over 50? Exercise Linked To Improved Cognitive Function

MedicalResearch.com Interview with:
Dr. Joseph Michael Northey
UC Research Institute for Sport and Exercise (UCRISE),
Discipline of Sport and Exercise Science, Faculty of Health
University of Canberra, Canberra, Australia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Physical exercise has an important role to play in maintaining cognitive function across the lifecycle. However, the benefits of implementing a physical exercise intervention were not clear. To address these issues which prevented evidence-based prescription of exercise for cognitive function, a systematic review of all the available literature up to November of 2016 in adults older than 50 was conducted.

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Submission and Publication Bias Against Studies With Negative Results Declining

MedicalResearch.com Interview with:
Gary Evoniuk, PhD

Director of Publication Practices, Medical Communications Quality & Practices
GlaxoSmithKline Research and Development, Research Triangle Park, NC 27709

MedicalResearch.com: What is the background for this study?

Response: In recent years, industry, and to a lesser extent academia, have been criticised for failing to submit clinical trial data for publication, especially when the data are perceived to be “negative”, (i.e. unfavourable to the drug under study) leading to publication bias. We felt it was important to determine whether this criticism is based on perception or reality and so we conducted what is, to our knowledge the only study to systematically address the issue of submission and publication bias based on study outcome.

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Childhood Adversities Linked To Increased Suicide Risk in Adolescents and Young Adults

MedicalResearch.com Interview with:
Charlotte Björkenstam PhD

Dept of Clinical Neuroscience
Karolinska Institutet
Division of Insurance Medicine
Stockholm

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In a prior study we revealed that exposure to childhood adversities were associated with a substantial risk increase for self-harm. The risk was even higher for those exposed to accumulated childhood adversities. This finding together with the fact that the suicide rate among young adults is increasing (as opposed to decreasing in the general population) lead us to want to examine the relationship between childhood adversities and death by suicide.

We investigated 7 different childhood adversities, including familial death (suicide analyzed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single-parent household, public assistance recipiency, and residential instability occurring between birth and age 14. We then followed the individuals up until age 24 at most. All adversities were entailed with an increased suicide risk from IRR: 1.6 (95% CI: 1.1 to 2.4) for residential instability to IRR: 2.9 (95% CI; 1.4 to 5.9) for familial suicide. We also found a dose-response relationship between accumulating CA and suicide risk where IRR ranged between 1.1 (95% CI: 0.9 to 1.4) for those exposed to 1 CA, to 2.6 (95% CI: 1.9 to 3.4) for those exposed to 3 or more adversities.

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Inhaling Poppers Associated With Visual Toxicity

MedicalResearch.com Interview with:
Dr. Rebecca Rewbury
Sussex Eye Hospital
Brighton and Sussex University Hospitals Trust
Brighton, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ‘Poppers’ are recreational drugs which are illegal to sell for human ingestion, but are sold under the guise of household cleaning products. Inhalation leads to a brief sense of euphoria, enhanced sexual arousal and smooth muscle relaxation. The Psychoactive Substances Act 2016 was due to outlaw poppers, but they were excluded on the basis that they do not act directly on the central nervous system.

The main constituent of poppers, isopropyl nitrite, replaced isobutyl nitrite when the latter was classified as a carcinogen in 2006. Since then, there have been several case reports of ‘poppers maculopathy.’

We noted an increase in patients presenting with central visual disturbances after using poppers and describe 12 such cases. They all demonstrated similar disruption of the photoreceptor layer on retinal imaging. Onset of symptoms was frequently linked to specific brands of poppers, with 3 people having used poppers for many years and only developing side effects on changing brand. Chemical analysis showed that these products contained isopropyl nitrite. One brand of poppers, used without side effects by one patient, contained amyl nitrite, 2-methyl butyl nitrite and isobutyl alcohol, but no isopropyl nitrite.

The outcome of poppers maculopathy varied, but following abstention, visual disturbances and retinal damage tended to improve over months, if not fully resolve. Although in some cases, symptoms and/or imaging findings were prolonged. Ongoing use of implicated brands led to persistent, but not worsening maculopathy, whereas one patient that switched back to another brand showed full recovery.

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Consequences of Interpersonal Violence Against Child Athletes Persist into Adulthood

MedicalResearch.com Interview with:

Tine Vertommen, Criminologist Faculty of Medicine and Health Sciences Universiteitsplein 1 Antwerp, Belgium

Tine Vertommen

Tine Vertommen, Criminologist
Faculty of Medicine and Health Sciences
Universiteitsplein 1
Antwerp, Belgium

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A recent prevalence study into interpersonal violence against child athletes in the Netherlands and Belgium showed that 6% experienced severe sexual violence, 8% experienced severe physical violence, and 9% of respondents experienced severe psychological violence in sport (Vertommen et al., 2016). While general literature has repeatedly shown that exposure to interpersonal violence during childhood is associated with mental health problems in adulthood, this relationship has not yet been demonstrated in (former) athletes. Thus, the objective of the current study is to assess the long-term consequences of these experiences on adult mental health and quality of life.

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Knee Replacement Would Be More Cost Effective If Limited To Those With Severe Symptoms

MedicalResearch.com Interview with:

Bart S Ferket, MD, PhD Assistant Professor, Population Health Science and Policy Icahn School of Medicine at Mount Sinai

Dr. Bart Ferket

Bart S Ferket, MD, PhD
Assistant Professor, Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study?

Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms.   Continue reading

Combination Opioids and Benzodiazepines Raises Risk of Overdose

MedicalResearch.com Interview with:

Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA

Dr. Eric Sun

Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.

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Environmental Pyrethroids May Be Associated With Behavioral Problems in Children

MedicalResearch.com Interview with:
Professor Jean-Francois Viel
Department of Epidemiology and Public Health
University Hospital
Rennes, France

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of pyrethroid insecticides has increased substantially throughout the world over the past several decades, replacing organophosphate and carbamate insecticides, because of their chemical potency against many pests, their relatively low mammalian toxicity and their favorable environmental profiles. However, despite the neurotoxicity of these insecticides at high doses, the potential impact of environmental exposure to pyrethroid insecticides on child neurodevelopment has only just started to receive attention.

Using a longitudinal design (PELAGIE mother-child cohort), we were able to assess pyrethroid exposure (trough urine concentrations) both prenatally and during childhood (at 6 years of age). We showed that increased prenatal concentrations of one pyrethroid metabolite (cis-DCCA, a metabolite of permethrin, cypermethrin and cyfluthrin) were associated with internalising difficulties (children showing behaviours that are inhibited and over-controlled).

Moreover, for childhood 3-PBA (a common metabolite of up to 20 synthetic pyrethroid insecticides) concentrations, a positive association was observed with externalising difficulties (children showing behaviours that are under-controlled and having generally a more challenging temperament).

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11 Cancer Types Have Strong Connection to Obesity

MedicalResearch.com Interview with:

Dr Maria Kyrgiou MSc, PhD, MRCOG Clinical Senior Lecturer & Consultant in Gynaecologic Oncology IRDB - Department of Surgery and Cancer, Imperial College London West London Gynaecological Cancer Centre, Queen Charlotte's & Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust

Dr. Kyrgiou

Dr Maria Kyrgiou MSc, PhD, MRCOG
Clinical Senior Lecturer & Consultant in Gynaecologic Oncology
IRDB – Department of Surgery and Cancer, Imperial College London
West London Gynaecological Cancer Centre, Queen Charlotte’s & Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obesity has become a major public health challenge and it’s prevalence worldwide has more than doubled amongst women n the last four decadesExcess body weight has been associated with an increased risk of developing and dying from numerous cancers. Although the reported associations may be potentially causal, some of the associations may be flawed due to inherent study biases such as residual confounding and selective reporting of positive results.

We included 204 meta-analyses investigating associations between adiposity and the development or death from 36 primary cancers and their sub-types. Adiposity was associated with a higher risk of developing esophageal adenocarcinoma, gastric cardia, colon and rectal cancer in men, biliary tract system, pancreatic, postmenopausal breast among HRT non-users, endometrial, ovarian, and kidney cancer and multiple myeloma.

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