Author Interviews, BMJ, Exercise - Fitness, Orthopedics / 10.03.2016
More Serious Hip Injuries in Young Rugby Players
MedicalResearch.com Interview with:
David Morrissey MB PhD FRCS (Tr&Orth)
Orthopaedic Specialist Registrar
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Morrissey: Injury rates in rugby union have increased substantially over the past twenty years, both in the professional and amateur game. The pattern of injury has also changed, reflecting higher grades of trauma. Our institution is a tertiary referral centre for pelvic and acetabular trauma serving a population of 4.5 million. The majority of our cases occur as a result of high velocity trauma such as road traffic accidents. We have not previously seen hip dislocations/acetabular fractures occurring secondary to sporting participation. In the past number of years, however, we have identified four such injuries in three juvenile patients, that occurred during rugby union participation. These injury patterns may have sub-optimal outcomes in up to 30% of patients and can severely affect a young person’s life. The demographic change may be due to changes in the physical development of players as well as an increased emphasis on the tackle/ruck area. In the juvenile game, differing rates of maturation magnify size differences between players, potentially increasing the risk of injury.
Prof. Ian Wong[/caption]
MedicalResearch.com Interview with:
Professor Ian C K Wong
Fellow of Royal Pharmaceutical Society
Fellow of Royal College of Paediatrics and Child Health (Honorary)
Fellow of the Higher Education Academy
Chair in Pharmacy Practice
Head of Research Department of Practice and Policy
UCL School of Pharmacy
London
Medical Research: What is the background for this study? What are the main findings?
Dr. Wong: Previous studies had showed an increased cardiovascular risk associated with clarithromycin (a widely used antibiotic) but the duration of effect remained unclear. Therefore, we conducted this study to investigate the duration of cardiovascular adverse effect provided that the risk exists after patients receiving clarithromycin in Hong Kong. We used three study designs to examine the association (temporal relationship) between clarithromycin and cardiovascular adverse outcomes such as myocardial infarction, arrhythmia, stroke, cardiac mortality at different time points.
Dr. Joanne Cranwell[/caption]
Dr. Mia T. Minen[/caption]
Dr. Cuilin Zhang[/caption]
MedicalResearch.com Interview with:
Cuilin Zhang MD, PhD
Senior Investigator, Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health
Rockville, MD 20852
Medical Research: What is the background for this study? What are the main findings?
Dr. Zhang: Potatoes are the third most commonly consumed food crop in the world. In the United States, about 35% of women of reproductive age consume potatoes daily, accounting for 8% of daily total energy intake. Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance with onset or first recognition during pregnancy. 
Dr. Charlton[/caption]
MedicalResearch.com Interview with:
Brittany M. Charlton, ScD
Instructor
Boston Children's Hospital and Harvard Medical School
Researcher, Harvard Chan School Department of Epidemiology
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Charlton: Even though oral contraceptives can be over 99% effective with perfect use, almost 10% of women become pregnant within their first year of use. Many more women will stop using oral contraceptives when planning a pregnancy and conceive within just a few months. In both of those examples, a woman may inadvertently expose her offspring during pregnancy to exogenous sex hormones. We conducted a nationwide cohort study in Denmark in order to investigate whether oral contraceptive use shortly before or during pregnancy was associated with an increased risk of major birth defects in the offspring. Our main finding was that there was no increased risk of having a birth defect associated with oral contraceptive exposure. These results were also consistent when we broke down the birth defects into different subgroups, like limb defects.
Dr. Gágyor[/caption]
MedicalResearch.com Interview with:
Ildikó Gágyor MD
Senior researcher in primary care
Department of General Practice
University Medical Center Göttingen
Göttingen, Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Gágyor: Uncomplicated urinary tract infection is a common problem for women. Affected patients are usually treated with antibiotics to combat both unpleasant symptoms and to combat infection. However, prescription of antibiotics for a self-limiting condition, contributes to increased resistance rates posing a serious long-term threat to public health. In a double blind randomised controlled trial we examined whether symptomatic treatment of uncomplicated urinary tract infection with ibuprofen reduces the rate of antibiotic prescriptions without a significant increase in symptoms, recurrences, or complications. In all, 494 women were randomly assigned to receive: either ibuprofen for three days and antibiotics only if symptoms are persistent; or antibiotic treatment with fosfomycin. Results showed that antibiotic use could be reduced significantly: of the 248 women in the ibuprofen group two thirds recovered without antibiotics and one third received antibiotics subsequently. Women in the ibuprofen group had a higher symptom burden but in both groups, symptoms decreased within the first week (Figure 1). Six cases of pyelonephritis occurred, one in the fosfomycin group, five in the ibuprofen group.
Dr. Rashmi Patel[/caption]
MedicalResearch.com Interview with:
Dr. Rashmi Patel
MA (Cantab) MA BM BCh PGDip (Oxon) MRCPsych
Psychiatry
King's College Londo
Dr. Meri Tulic[/caption]
MedicalResearch.com Interview with:
Meri K Tulic PhD
Université de Nice Sophia-Antipolis
Immune Tolerance
Nice, France
The International Inflammation 'in-FLAME' Network
Worldwide Universities Network
Medical Research: What is the background for this study? What are the main findings?
Dr. Tulic: We know that damaged epithelial gut barrier is a hallmark of gut inflammatory diseases including inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). It has been long known that respiratory allergens such as house-dust mites (HDM) are the main causes of epithelial destruction in the lungs and initiation of allergic airway disease such as asthma. We set out to test whether house-dust mites may also be present in the human gut and may contribute to intestinal barrier dysfunction. In this paper, we have shown that house-dust mites is found in the gastrointestinal system of ~50% of all healthy subjects tested and it has detrimental effect on gut barrier function. The mechanisms include its direct destruction of tight-junction proteins which normally hold adjoining epithelial cells together, resulting in increased gut permeability. This process is driven by cysteine-proteases contained within the mite. In healthy individuals this effect is likely to be regulated by increased production of regulatory IL-10 (an anti-inflammatory mediator); our preliminary data indicate that a defect in regulatory responses may exist in IBS patients.
Dr. Franco Radaelli[/caption]
MedicalResearch.com Interview with:
Dr Franco Radaelli
Division of Digestive Endoscopy and Gastroenterology
Valduce Hospital
Como, Italy
Medical Research: What is the background for this study?
Dr. Radaelli: Split regimens of bowel preparation are strongly recommended by European and American Guidelines as they have been associated with a higher level of colon cleansing. However, there is still uncertainty on whether the higher level of cleansing associated with a split regimen also results in a higher proportion of subjects with at least one adenoma (adenoma detection rate, ADR), that represents by far a more relevant quality indicator than the level of cleansing itself.
On this background, we designed a randomized investigator-blinded controlled trial to evaluate whether a “split regimen” of low-volume 2-L PEG-ascorbate solution was superior to the traditional “full dose, the day before regimen” in terms of ADR. Differently from other studies on bowel preparation, we considered adenoma detection rate instead of the level of colon cleansing, the primary study end-point, and we designed the sample size accordingly. A precise estimation of the sample size was facilitated by including an homogeneous population of asymptomatic subjects undergoing first colonoscopy after positive-FIT within CRC organized screening program. Besides, ADR represents a very solid end-point due to the very low inter-pathology variability in the differential diagnosis between neoplastic and non-neoplastic lesions, while the assessment of the level of cleansing is hampered by unavoidable degree of subjectivity and higher degree of inter-operator variability.
Dr. Frans Boch Waldorff[/caption]
Dr. McCoy[/caption]
MedicalResearch.com Interview with:
Rozalina G. McCoy, M.D.
Senior Associate Consultant
Division of Primary Care Internal Medicine
Assistant Professor of Medicine
Mayo Clinic
Medical Research: What is the background for this study? What are the main findings?
Dr. McCoy: Blood glucose monitoring is an integral component of managing diabetes. Glycosylated hemoglobin (HbA1c) is a measure of average glycemia over approximately 3 months, and is used in routine clinical practice to monitor and adjust treatment with glucose-lowering medications. However, monitoring and treatment protocols are not well defined by professional societies and regulatory bodies; while lower thresholds of testing frequencies are often discussed, the upper boundaries are rarely mentioned. Most agree that for adult patients who are not using insulin, have stable glycemic control within the recommended targets, and have no history of severe hypoglycemia or hyperglycemia, checking once or twice a year should suffice. Yet in practice, there is a much higher prevalence of excess testing. We believe that such over-testing results in redundancy and waste, adding unnecessary costs and burdens for patients and the health care system.
We therefore conducted a large retrospective study among 31,545 adults across the U.S. with stable and controlled type 2 diabetes who had HbA1c less than 7% without use of insulin and without documented severe hypoglycemia or hyperglycemia. We found that 55% of patients had their HbA1c checked 3-4 times per year, and 6% had it checked 5 times a year or more. Such excessive testing had additional harms as well – we found that excessive testing was associated with greater risk of treatment intensification despite the fact that all patients in the study already met glycemic targets by having HbA1c under 7%. Indeed, treatment was intensified by addition of more glucose lowering drugs or insulin in 8.4% of patients (comprising 13%, 9%, and 7% of those tested 5 or more times per year; 3-4 times per year; and 1-2 times per year, respectively).
Halle Amick[/caption]
MedicalResearch.com Interview with:
Halle Amick, research associate
Sheps Center for Health Services Research
University of North Carolina at Chapel Hill
Chapel Hill, NC
Medical Research: What is the background for this study? What are the main findings?
Response: Major depressive disorder (MDD) affects more than 32 million Americans and millions more worldwide. Many patients first seek care from a primary care provider, and the most common treatment initiated in that setting is medication. Although there is an evidence base that shows certain psychotherapies to be effective treatments, primary care providers may not be familiar enough with psychotherapy to present it as a treatment option. We conducted a full review of clinical trials that compared antidepressant medication—specifically second-generation antidepressants (SGAs)—with cognitive behavioral therapy (CBT).
We found that symptom improvement and rate of remission were similar between SGAs and CBT, whether they were used alone or in combination with each other. We also found no difference in the rates of withdrawal from the clinical trials either overall or due to adverse events.
Dr. Azim[/caption]
MedicalResearch.com Interview with:
Hatem A. Azim MD PhD
Breast Cancer Translational Research Laboratory
Institut Jules Bordet
Université Libre de Bruxelles
Brussels, Belgium
Medical Research: What is the background for this study? What are the main findings?
Dr. Azim: As at breast cancer diagnosis is known to impact prognosis, with young patients having worse outcome. On the other hand, elderly patients are less studies in general and little is known on their tumor characteristics.
In this study, we aimed to define the pattern of genomic aberrations in different age groups. This can result in identifying if key potentially targetable genomic alterations are more specific to particular age groups and thus could open the door to design particular studies targeting these aberrations in these age groups. We found that age is associated with unique biological features at the DNA level, independent of tumor stage, histology and breast cancer molecular subtype.
Of particular mention, the higher prevalence of GATA3 mutation in younger patient, a known driver mutation associated with endocrine resistance. In addition, age at diagnosis appears to impact the tumor transcriptome confirming previous observations, but also highlighting novel findings, of particular relevance the higher expression of stem cell related genes in young patients.