Monday, March 18, 2019

Tramadol Linked to Higher Mortality Risk in Osteoarthritis

New tramadol use among patients with osteoarthritis is associated with increased mortality risk, an observational study in JAMA suggests. Some guidelines recommend tramadol, a weak opioid agonist, to manage osteoarthritis pain.

Using U.K electronic medical records, researchers matched patients with hip, knee, or hand osteoarthritis who began taking tramadol to those who began naproxen, diclofenac, celecoxib, etoricoxib (not approved in U.S.), or codeine. Nearly 90,000 patients aged 50 and older were included.

Patients who started using tramadol had a higher mortality rate over the ensuing year than users of every other medication except codeine. For example, the mortality rate was 23.5 per 1000 person-years with tramadol versus 13.8 per 1000 with naproxen.
The authors caution that the findings "were susceptible to confounding by indication," given that tramadol users had greater comorbidity than NSAID users before propensity score matching.

My Take:
Some guidelines are recommending Tramadol as a replacement for Oxycodone in light of the skyrocketing death rate associated with its’ use. Tramadol is used in opioid agonist therapy (OAT), a treatment used to help addicts overcome opioid addiction. While it is an effective pain killer, it has addiction and overuse issues as well.

Friday, March 15, 2019

Napping may be as good as drugs for lowering blood pressure

A midday nap may be just what you need, not just to boost your energy levels but also to lower high blood pressure. This, at least, is what new research from Greece suggests.

A new study that investigators from the Asklepieion General Hospital in Voula, Greece conducted now suggests that taking a nap at midday can effectively help people lower their blood pressure levels.

In this study, the investigators worked with 212 participants who had a mean blood pressure of 129.9 mm Hg. The participants were, on average, 62 years old, and close to one in four of them smoked, had a diagnosis of type II diabetes, or both.

The team split the participants into two groups — one that practiced midday napping and one that did not take up this practice. Over 24 consecutive hours, the researchers took note of the participants' blood pressure measurements, the duration of their midday naps, their general lifestyle choices (such as alcohol consumption and physical activity), and their pulse wave velocity, which measures artery stiffness.

Wednesday, March 13, 2019

Wisdom Wednesday: Alzheimer's: 'Holy herb' extracts shows promise as future treatment


Yerba santa, a plant with a long history of medicinal use in its native California, contains an active compound that could treat people with Alzheimer's disease one day. This was the conclusion that scientists at the Salk Institute for Biological Studies in La Jolla, CA came to after testing 400 plant extracts with known medicinal properties. Using a new drug-discovery screen, they tested the compounds for their ability to deter the effects of aging on the brain. The initial round of tests yielded several extracts that protected against a type of cell death that occurs in Alzheimer's and other aging-related diseases. Further tests revealed that sterubin, an extract of Eriodictyon californicum, or Yerba santa, was the most able to shield against inflammation and other triggers of brain cell death.

Native tribes of California have long valued Yerba santa, which is the Spanish for "holy herb," very highly as a medicine for respiratory illnesses, fever, infections, bruising, pain, and headaches.

According to a 2018 Alzheimer's Disease International report, dementia affects 50 million people worldwide, two-thirds of whom have Alzheimer's disease. In the U.S., the number of people living with Alzheimer's disease is set to rise from approximately 5.7 million people today to nearly 14 million by 2050.

Monday, March 11, 2019

Vitamin D and Brain Health

New research finds that vitamin D deficiency affects a type of brain "scaffolding" that supports the neurons. This finding could lead to new therapies for the neurological symptoms of mental health conditions such as schizophrenia.

Vitamin D, which people sometimes refer to as the "sunshine vitamin," is necessary for maintaining healthy bones. It also benefits the immune and cardiovascular systems, as well as endocrine function. For instance, research has suggested that insufficient vitamin D may compromise the immune system, raise the risk of hypertension, and negatively affect insulin secretion in people with type 2 diabetes.

Newer studies have focused on the potential link between vitamin D and brain health. For example, a recent study that Medical News Today reported on reinforced the notion that there may be an association between vitamin D deficiency and a higher risk of schizophrenia.

Other studies have shown that depriving middle-aged rodents of vitamin D led them to develop brain damage and perform less well on cognitive tests. Researchers have also found that people who survive sudden cardiac arrest are less likely to recover brain function if they have low levels of vitamin D.

Friday, March 8, 2019

Blueberries May Reduce Cardiovascular Risk By 20 Percent

The phytochemicals that give blueberries their blue color can significantly improve cardiovascular health, finds a new two part study. Dubbed "the silent killer" because it has no visible symptoms in its early stages, hypertension affects approximately 1 in 3 adults in the United States.

The condition puts a strain on the cardiovascular system, which in the long run may contribute to heart failure, stroke, and kidney failure. The National Institutes of Health (NIH) recommend that people with high blood pressure stay in control of the condition by eating healthfully, exercising, not smoking, and maintaining a healthy weight.

But should you eat anything in particular to keep your arteries healthy? In a previous Spotlight feature, we rounded up 16 foods that studies have suggested can improve cardiovascular health. Along with broccoli, spinach, pulses, and fish, berries may also reduce heart disease, due to their antioxidant polyphenols.

New research zooms in on the cardiovascular effects of blueberries and finds that anthocyanins — the phytochemicals that give blueberries their color — mediate the beneficial effects that this fruit has on the cardiovascular system. The lead author of the study is Ana Rodriguez Mateos, Ph.D., from the Department of Nutritional Sciences at King's College London, in the United Kingdom. The researchers published their findings in The Journals of Gerontology: Series A.

Wednesday, March 6, 2019

Wisdom Wednesday: DEXA


The dual-energy X-ray absorptiometry (DEXA) scan uses two low-energy X-ray beams that separates the images into two components, including soft tissue and bone. When determining whether a person has low bone density or whether the condition is getting worse, a DEXA scan tends to be more accurate than a typical X-ray because it can detect even small changes in bone loss. Doctors also consider it more reliable than other methods of calculating body fat percentage, including underwater weighing. Scan results may indicate the severity of bone loss and help doctors determine a person's risk of developing a fracture. When assessing body composition, the results may also help determine a person's level of visceral fat, which the body stores around certain internal organs.

The most common purpose of a DEXA scan is to assess whether a person's bones are weak and or at risk of fracture. It also helps a doctor diagnose osteoporosis. Osteoporosis causes the bones to lose density or become thin. When the bones get thin, they also become fragile, which makes them more susceptible to breaks. Determining whether a person has osteoporosis as early as possible is important to prevent the condition from becoming worse. It also reduces the risk of fractures. A DEXA scan is also a useful diagnostic tool to assess whether or not osteoporosis is getting worse. After the first DEXA scan, a doctor will usually order another scan in a couple of years to determine whether the bone density has changed.

Monday, March 4, 2019

Large Trials Cast Doubt on Low-Dose Aspirin's Benefits

Hello. I'm David Kerr, professor of cancer medicine at the University of Oxford. As many of you know—those who listen to my small rants on Medscape from time to time—I have been conducting a long-distance love affair with aspirin for some time in terms of its cancer-preventive properties.

I have to say that this love affair has been strained somewhat by the recent publication of two important pieces. One was published in the Lancet, written by Peter Rothwell and colleagues, and the other is a report of a combined Australian-US trial in the New England Journal of Medicine.

First, let's discuss Peter's study. Dr. Rothwell and his colleagues suggest that there is not a single dose of aspirin, a one-size fits-all dose, in terms of its cancer- or cardiovascular-preventive properties. They analyzed an enormous dataset from a large series of randomized trials, databases he has been successfully working on for some time. They investigated the benefits and disadvantages of aspirin according to height and weight, predominately weight. They found that the benefits of low-dose aspirin, 75-100 mg daily, in terms of cardiovascular prevention, were relatively confined to those who weigh less than 70 kg.

In the analyzed studies, the vast majority of men, 80% of whom were 70 kg or more, had no obvious benefits from aspirin at all. That's interesting. What was, for me, more worrisome was when they started to look at the disadvantages. They found that subjects taking low-dose aspirin who were under 70 kg had real possibility of harm—an increased incidence of early cancer. This is particularly pronounced in those patients who are more than 70 years old. They concluded that we should further explore the dose of aspirin. The clinical pharmacology of aspirin has been studied since the late 1960s. There is a relationship between pharmacokinetics, steady-state plasma concentrations, weight, and age. As we grow older, liver function deteriorates, and therefore we clear drugs less effectively. This could potentially underlie what is happening. We need more mechanistic work to understand this better.