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The old antipsychotic drugs are just as dangerous as the new ones when given to elderly patients with Dementia. In this study of 890 patients over the age of 65, 18% of those given a conventional drug were dead, compared with 15% of those given an the new drugs after 180 days. New England Journal Medicine
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
Marijuana use appears to increase the risk of fatal car crash in a study of 10 748 drivers, with known drug and alcohol concentrations, who were involved in fatal crashes in France from October 2001 to September 2003. This increased risk was independent of alcohol although alcohol certainly has a greater risk. British Medical Journal
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
Natalizumab, a humanized monoclonal antibody against integrin, inhibits leukocyte adhesion and migration into inflamed tissue. This study in the New England Journal of Medicine showed no benefits from this medication in patients with Crohn's disease (a condition causing bowel inflammation or colitis with diarrhea and bleeding).
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.
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.
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.
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
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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