Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
President, Heart Care
Foundation of India
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)
FIRST NATIONAL DAILY MEDICAL NEWSPAPER OF INDIA
21st November Saturday
High dose Folic Acid and B12 May Hike Cancer Risk?
High dose folic acid and vitamin B12 supplements were associated with an increased incidence of cancer, particularly lung cancer, as per a post hoc analysis of two Norwegian trials. However, the results should not turn women away from normal folic acid supplements that can help prevent birth defects.
In the study among participants who received folic acid plus vitamin B12, 10% developed cancer compared with 8.4% of those who did not receive the two vitamins. Dr Marta Ebbing, of Haukeland University Hospital in Bergen, the lead author of the article in JAMA Nov issue said that in the folic acid group, there were 56 cases of lung cancer compared with 36 cases in those who did not get the supplements.
However, the effects of essential nutrients at dietary levels seem to be different from those at pill levels.
Since 1998, the U.S. and many other countries (but not Norway), have mandated folic acid supplementation of grain products to reduce the incidence of neural tube birth defects. The Norwegian trials originally sought to determine if homocysteine lowering treatment with folic acid and vitamin B12 could protect against cardiovascular morbidity and mortality in high-risk patients, but found no benefit.
Participants in the trials were randomized to one of four regimens: folic acid plus vitamins B12 and B6, folic acid plus vitamin B12, vitamin B6 alone, or placebo. Folic acid was given in doses of 0.8 mg/day, while vitamin B12 was given in doses of 0.4 mg/day.
Many debate over this study results as folic acid was never given alone, but always with vitamin B12, and in doses that were two times the U.S. recommended daily allowance. Also the dose of vitamin B12 was much higher. The current recommended daily allowance for vitamin B12 in the U.S. is 2.4 μg/day. In this study, the daily dose that was given was 400 μg. The result could reflect the high dose of B12.
The bottom line for patients, is that high dose supplements should not be used for chronic disease prevention. However among younger, fertile women, the risk of fueling an occult neoplasm is low in comparison to the neural tube defect prevention benefit.
Dr K K Aggarwal
Niacin 2g better than adding ezetimibe
Boosting HDL cholesterol with extended-release niacin is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe. n the study compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean and maximal carotid intima-media thickness (Allen J. Taylor, MD, of the Walter Reed Army Medical Center)
Investigational PPI NSAID May Cut GI Bleeds in OA
An investigational compound that combines an NSAID and a proton pump inhibitor in an enteric coated pill significantly reduced the rate of gastrointestinal ulcers in high risk patients with arthritis, even when the drug was taken on top of low-dose aspirin, researchers reported here. Patients randomized to PN400, which provides sequential delivery of immediate-release esomeprazole (20 mg) and naproxen (500 mg), had a gastric ulcer rate of 4.1% versus 23.1% in the control arm (P<0.001), according to results reported by Jay L. Goldstein, MD, of the University of Illinois at Chicago, and colleagues.
Allopurinol Sensitivity More Likely in Patients with Renal Problems
Hypersensitivity to allopurinol, often leading to acute kidney failure, is up to three times as common in patients who already suffer renal impairment. After adjustment for potential confounding factors, separate analyses of two commercial claims databases found odds ratios of 3.29 and 2.06 for allopurinol hypersensitivity reactions among patients with records indicating renal impairment, according to Dinesh Khanna, MD, of the University of California Los Angeles.
New OA guidelines
A forthcoming revision to the American College of Rheumatology's osteoarthritis treatment guidelines will probably recommend against some popular over the counter treatments. The ACR's current osteoarthritis guideline, published in 2000, endorsed capsaicin creams and was neutral about glucosamine and chondroitin sulfate supplements. Topical capsaicin will continue to be recommended for hand osteoarthritis, but the committee found no use for glucosamine or chondroitin sulfate.
Markers Identify RA Patients Who Need Early Med Switch
Two standard markers can identify early stage rheumatoid arthritis patients whose disease is unlikely to respond to methotrexate alone. After 12 weeks of methotrexate treatment, levels of C-reactive peptide (CRP) and swollen joint counts predict with moderately good accuracy those who will have major disease progression if they stay on the drug as monotherapy, according Michael Weinblatt, MD, of Brigham and Women's Hospital in Boston.
Efficacy of sildenafil on erectile dysfunction of newlyweds
To explore the efficacy of sildenafil on erectile dysfunction (ED) of newlyweds, the author studied 60 outpatients within a month of marriage, who suffered from sexual intercourse (SI) failure caused by ED and showed no improvement after receiving sex education and psychological consultation. The patients were given oral sildenafil, 100 mg for the first and second times, 50 mg for the third and fourth times, no more than once every day, with a 1- to 3- day break between every two times. Four times of sildenafil administration formed one course of treatment.
Sildenafil was taken 1 h before SI and was aided with adequate sexual stimulation. The rates of successful SI due to improved erection during and after a course of sildenafil treatment were 93.3% and 85%. In the groups with one and more than one SI failure the successful SI rates after a sildenafil treatment course were 93.1% and 77.4%.
Oral sildenafil with psychological therapy in the treatment of ED of newlyweds proves to be effective in restoring the patients' sexual function and relieving their mental pressure or stress. (He Q, Yang JR, Liu LF; Andrologia 41 (6), 348-51 (Dec 2009)
A hip fracture can be a very serious injury
People who break a hip are up to 18 percent more likely to die within a year that other people their age. What increase your risk of hip fracture:
1. Being 65 or older.
2. Being female.
3. Having a family history of fractures in older age, especially for Asians and whites.
4. Having a slender, slim body type.
5. Not getting enough dietary calcium.
6. Drinking too much alcohol or smoking.
7. Having impaired eyesight, arthritis or poor balance.
8. Taking certain medications that may make you dizzy or weak.
"Doctor, doctor, people keep ignoring me.
Mistake to be avoided Intracardiac adrenaline
A patient was brought to the emergency room and was found to be in asystole. The patient was immediately intubated and cardiac massage was started. Adrenaline 1 mg/i.v. was given every 3 minutes. Atropine i.v. was also added. No response was seen. The Doctor on duty then gave the patient intracardiac adrenaline. Patient did not show any response and finally the efforts were terminated and patient declared dead.
Various trials all over the world have shown that use of intracardiac adrenaline offers no advantage. Rather has shown to cause injury of the myocardium. It can also lead to cardiac rupture. Hence this step should be clearly avoided in cardiopulmonary resuscitation of patients during clinical practice.
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