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Sulindac (Clinoril) which is a non-steroidal anti-inflammatory drug such as Motrin may prove to be effective in suppressing endometriosis related symptoms. Although it needs further clinical study, researchers in Vienna were able to show that Sulindac can suppress endometriosis at molecular level based on their studies in the Laboratory. Journal of Clinical Endocrinology and metabolism.
Payment to Doctors for patient recruitment to clinical trials has not been studied well despite millions of dollars paid to physicians who conduct such trials by the pharmaceutical companies. Knowing that pharmaceutical companies do not usually spend money unless they know they will get something in return, and physician bias that can occur when they are paid thousands of dollars per each patients, more studies are needed to make sure these trials are conducted well and that these influences would not affect the outcome. Etanica Medical Review
Botox Injections were tried for treatment of tennis elbow. Although there was a mild response, a number of patients did develop weakness and paralysis in their fingers afterwards. Based on this study Botox injections should be avoided for treatment of tendonitis. Annals of Internal Medicine
Gout can now be treated with a new medication called Febuxostat. This medication at a daily dose of 80 mg or 120 mg, was more effective than the traditional treatment of Zyloprim or allopurinol in lowering serum urate in the blood with fewer gouty attacks than those treated with allopurinol. New England Journal Medicine
Remicade, an intravenous treatment used for treatment of Rheumatoid Arthritis and Crohn's disease, appears to be also effective for treatment of Ulcerative Colitis (a disease causing ulceration of colon with pain, cramps, bleeding) in a study of 364 patients with moderate to sever Ulcerative Colitis.New England Journal Medicine
Hepatitis C
testing for
antibody to hepatitis C may not be enough to screen organ donors. Unfortunately a recent report in the Annals of Internal Medicine showed transmission of hepatitis C to organ donor recipients from an organ donor whose hepatitis C antibody testing was actually negative. Later testing for
Hepatitis C Nucleic Acid testing was positive in this organ donor. Since an organ donor tissues such as tendons, skin, cornea can be given to as many as 100 recipients, a more through screening of the donors may have to be done.
Cost-Effectiveness of Fosomax Therapy for Postmenopausal Women with bone loss without Osteoporosis
Alendronate therapy for postmenopausal women with femoral neck T-scores better than –2.5 and no history of clinical fractures or other bone mineral density-independent risk factors for fracture is not cost-effective, assuming U.S. costs of alendronate and currently available estimates of alendronate efficacy in osteopenic women.
COX-2
Inhibition and Cardiovascular Risk
after CABG Surgery
When administered to patients
for pain control after coronary-artery
bypass surgery, valdecoxib and
its intravenous prodrug, parecoxib,
were found to be associated with
an increased risk of cardiovascular
thromboembolic events. These
findings add to the growing concern
that the use of COX-2 inhibitors
increases the risk of cardiovascular
events, particularly in persons
who are at risk for such events.
Bacterial
infection
of
vagina,
is
a
serious
health
problem
for
millions
of
women.
This
condition
is
not
very
well
understood.
This
New
England
Journal
of
Medicine
study
showed
that
these
infections
are
complicated
and
involve
number
of
different
bacterias
some
of
which
were
rather
specific
for
this
problem
and
of
Clostridiales
family.
This
hopefully
should
result
in
finding
a
more
effective
treatment
for
these
patients.
Morphine,
Neurontin, and Their Combination for
Neuropathic Pain
In
a randomized trial, the combination of
morphine and gabapentin
led
to better pain control than either
agent alone in patients
with
diabetic neuropathy or postherpetic
neuralgia. The dose
of each
agent was lower when used in
combination than when used
alone.
Adverse effects were not more severe
with the combined
formulation.
These
findings suggest that treatment with
the combined formulation
of
morphine and gabapentin for
neuropathic pain is superior
to
treatment with either agent alone.
Heart
Risks Associated with Celebrex
Using data from a clinical
trial of celecoxib to prevent
colorectal
adenomas, these
investigators analyzed cardiovascular
events
over a three-year
follow-up period. There was a
dose-related
increase in
the risk of a composite outcome of
death from cardiovascular
causes,
myocardial infarction, stroke, or
heart failure. The
hazard
ratio was 2.3 with a 200-mg dose and
3.4 with a 400-mg
dose.
These results raise concern that the
use of celecoxib
is
associated with a serious risk of
cardiovascular events.
COX-2
Inhibition and Cardiovascular Risk
after CABG Surgery
When administered to patients
for pain control after coronary-artery
bypass surgery, valdecoxib and
its intravenous prodrug, parecoxib,
were found to be associated with
an increased risk of cardiovascular
thromboembolic events. These
findings add to the growing concern
that the use of COX-2 inhibitors
increases the risk of cardiovascular
events, particularly in persons
who are at risk for such events.
Cardiovascular
Events Associated with Rofecoxib
In a clinical trial of
chemoprevention for colorectal
adenomas,
the use of
rofecoxib was found to be associated
with a significantly
increased
risk of cardiovascular events,
primarily myocardial
infarctions
and ischemic cerebrovascular events.
Although rofecoxib
has been
removed from the market by the
manufacturer, these
data
need to be carefully considered in
making decisions about
any
future use of rofecoxib.
Enbrel
is
not effective for treatment of
Wegener'e Granulomatosis as was shown
in a study in the New England Journal
of Medicine. There was no difference
in the control and treated group in
terms of remission or flare-ups. The
outcome of this study was very much
expected as Enbrel also does not
re-activate TB (another granulomatous
disease) as do Humira or Remicade.
Humira and Remicade may actually turn
out to be more effective in Wegener'e
Granulomatosis. There were more solid
tumors in the Enbrel group that is
concerning.
Fracture
in men
is rather uncommon. Recent study in
the New England Journal of Medicine
(NEJM) showed that use of Lupron,
a hormone that inhibits male
testosterone and is now used to treat
prostate cancer, can increase risk of
fracture in Men. Therefore men who are
getting Lupron should have bone
density testing and discuss treatment
for Osteoporosis with their physicians
or see a rheumatologist
for treatment.
In
a study comparing new and old
anti-inflammatory medications, those
treated with anti-inflammatory pain
medication Vioxx
seem to have had a higher risk of
heart attack compared to traditional
anti-inflammatory medications such as
Motrin. Celebrex
seem to have the lowest risk and those
who took Naprosyn
had the highest risk. These were
reported in a study in the Annals of
Internal Medicine (AIM). There are
also conflicting reports on the risks
of these medications as cited in other
studies. The recommendations of the
American College of Rheumatology about
the use of these medications is listed
here.
Topical
NSAIDs
such as those made with
anti-inflammatory medications such as
Volteran of Ketoprofen (similar to aspirin
and motrin)
were no better than placebo in
patients with Osteoarthritis as
reported in the British
Medical Journal (BMJ).
Vestibular
neuritis is the second most common
cause of peripheral vestibular vertigo.
Its assumed cause is a reactivation of
herpes simplex virus type 1 infection.
Therefore, corticosteroids,
antiviral agents, or a combination of
the two might improve the outcome in
patients with vestibular neuritis.
This study in the New England Journal
of Medicine showed that steroids
significantly improves the recovery of
vestibular function in patients with
vestibular neuritis, whereas
anti-viral drug does not.
Presece
of certain genes in Lupus patients can
be associated with risk factors such
as stoke and heart attack as was
reported in the New England Journal of
Medicine. Mannose-binding lectin gene
are associated with Lupus
as well as with severe atherosclerosis.
In this study, author showed that
those patients with Lupus who have
homozygosity for this gene are at
increased risk of developing arterial
blockage such as stroke and heart
attack.
D-Dimer
blood test that is done to
look for possible blood clots is most
accurate when done by enzyme-linked
immunosorbent assays (ELISAs) that had
the highest sensitivity and lowest
negative likelihood ratio, which makes
ELISA the best D-dimer test for
excluding blood
clots in legs and lungs.
Vitamin
C has been shown to kill cancer
cell in test tubes. Unfortunately, the
Vitamin C taken by mouth does not
increase the level of Vitamin C in the
blood high enough to have any effect
because the body does not absorb
vitamin C beyond what it needs. The
vitamin C administered intravenously (
IV ) seems to produce levels 70 times
greater than if taken by mouth. More
research is needed to see if levels
this high will help in treatment of
cancer. The
Annals of Internal Medicine
CRP
test
may not have as much value as has been
reported for predicting risk of heart
attack
based on a recent study. CRP or
C-reactive Protein is a test of
inflammation that can increase with
heart attack as well as certain types
of arthritis and infection. The
New England Journal of Medicine
For
patients with proliferative lupus
nephritis,
short-term
treatment with intravenous Cytoxan
followed
by maintenance
therapy with mycophenolate mofetil or
azathioprine
appears to be
more effective and safer than
long-term therapy
with
intravenous Cytoxan.
The
New England Journal of Medicine
Fosomax
is effective in preventing bone loss
and
reduced the rates of fracture
after
cardiac transplantation. The
New England Journal of Medicine
B-type
natriuretic peptide levels
are higher in patients
with
congestive heart failure than in
patients with shortness of breath
from other causes. Therefore
measuring this test in patients with
shortness of breath can tell you if
the cause is from heart failure
resulting in early treatment and
discharge from hospital. The
New England Journal of Medicine
C-reactive
Protein is
a test of inflammation that
may
help in detection of colorectal
cancer. Patients with colon cancer
were noted to have elevated C-reactive
protein test before. This may be a
useful test in early detection of
colon cancer. The
Journal of The American Medical
Association
Remicade,
the new rheumatoid arthritis drug,
appears to be effective in treatment
of herniated
disc and sciatica. This
study involved 10 patients and the
treatment was highly effective with
none of the patients requiring surgery
and all returning to work within one
month of treatment. Remicade blocks
TNF that was shown to play a
significant role in inflammation
caused by herniated disc. Rheumatology
Patients
with Rheumatoid
Arthritis in United
Kingdom continue to get
sub-standard care for treatment of
their Rheumatoid Arthritis. This study
showed that Methotrexate is now the
preferred drug over Sulfasalazine
neither of which match the newer drugs
such as Enbrel in terms of their
effectiveness. Both of these drugs are
heavily used in Europe because of
their low cost. Combination of Enbrel
and Methotrexate appears to be very
effective in treatment of Rheumatoid
Arthritis. Rheumatology
Sacroilitis,
arthritis in the sacroiliac
joint, is a common cause of
low back pain often unrecognized due
to lack of specific testing. These
patients often have pain in low back
region that gets worse with rest and
improves with activity. This study
shows that MRI
examination was able to detect changes
in sacroiliac joints in early stages.
The diagnosis is important as there
are good treatments available and also
to avoid unnecessary treatments,
surgery and disability. Rheumatology
New
osteoporosis drug,
strontium ranelate, an orally active
drug that dissociates bone
remodeling by increasing bone
formation
and decreasing
bone resorption. This study showed
that strontium
ranelate was able to reduce the
risk
of vertebral fractures and to
increase bone mineral density. The
New England Journal Of Medicine
Graded
activity was more effective
than usual
care in reducing
the number of days of absence from
work from 87 to 58 days because
of
low back pain.
This study showed that Graded activity
is more effective in returning people
with low back pain to work faster. The
Annals of Internal Medicine
Treatment
of selected patients with AL amyloidosis,
a fatal disease resulting from
tissue
deposition of amyloid fibrils derived
from monoclonal
immunoglobulin
light chains,
by
using high-dose melphalan and
stem-cell transplantation resulted
in hematologic remission,
improved 5-year survival from 5 months
to 4.8 years, and reversal
of
amyloid-related disease in a
substantial proportion (40%).
This study showed that there are
better treatments now available for
Amyloidosis with increase in rates of
remission and survival.
The
Annals of Internal Medicine
High
plasma homocysteine
level has been associated
with
increased risk for coronary heart
disease (CHD) events
in
nondiabetic individuals, especially in
those with previously
diagnosed
CHD. In persons with type 2 diabetes
mellitus, the
association
between homocysteine level and
cardiovascular disease
may
be stronger than that in nondiabetic
individuals. This study showed that in
patients with type 2 diabetes,
plasma
homocysteine level was a strong and
independent risk
factor for
CHD events.This
study showed that homocysteine is an
even bigger problem in diabetic
patients and requires more aggressive
treatment. The
Annals of Internal Medicine
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