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First significant step ahead in early prevention of recurrent stroke

 MD-FM Thursday 4 July, 2013

 

 

 

Sarah:

MDFM, Medical News from around the world with Peter Goodwin.

 

P1

PETER:

Hello, and with me is Sarah Maxwell. To begin with, for patients who’ve just had a minor stroke or transient ischemic attack, adding clopidogrel to aspirin reduced their risk of having another stroke within 90 days. AND, it didn’t increase the risk of bleeding...

 

SARAH:

Yes, that’s according to a study from China that randomised over 5000 patients to have either: aspirin with clopidogrel, or aspirin with a placebo within 24 hours of having a stroke or TIA. Graeme Hankey from Australia wrote an editorial on the study in the New England Journal of Medicine:

 

AUDIO:

About one in thirty were saved from having a recurrent stroke within the next 90 days by adding clopidogrel to aspirin in that early high risk period and continuing it for that 90 days.

12secs

             

PETER:

OK, so it works in Chinese communities in China, but what about other groups? Vascular disease that can cause TIA and stroke might be slightly different in a Caucasian population for example

 

SARAH:

Well indeed, and Dr Hankey says this needs to be explored further:

 

AUDIO:

The real question is, are these very impressive results generalisable to non-chinese patients like in the UK and Australia and north America etc.. And that might not be the case, we’re not certain that this treatment has the same effect in them, but we think it does. And that’s why a similar trial is going on at the moment in North America to look for consistency of this type of treatment effect in non-chinese patients such as Caucasians

 

SARAH:

Dr Graeme Hankey, neurologist and head of the stroke unit at the Royal Perth Hospital in Australia.

 

 

 

P2

PETER:

For patients with hypertension, a multidisciplinary approach using telemonitoring can help improve and maintain better blood pressure control…

 

SARAH:

Yes, that’s the finding of a study, published in JAMA, that compared usual care to intervention with a pharmacist and telemonitoring. And it showed that blood pressure fell over 12 months…

 

PETER:

Hmm interesting, so what sort of telemonitoring do they use?

 

SARAH:

Well, it’s an easy for patients to use. There’s an automated home pressure sensor that sends readings electronically so patients can keep frequently in touch with their pharmacists by phone, rather than having to go for visits to the doctor’s office.

 

PETER:

Hmm, sounds convenient: but was it good enough?

 

AUDIO:

It was much more effective than usual care for controlling high blood pressure. What we found is over a one year period, that about twice as many patients in the telemonitoring intervention group had their blood pressure under control, compared with the usual care group

 

SARAH:

That was lead study author, Karen Margolis in Minneapolis.

Usually only about half of all patients with hypertension have their pressure under control. But Dr Margolis said that this system has been shown to be very effective, not only in this study but in a number of studies, and she emphasised you need to use a multidisciplinary approach:

 

AUDIO:

Its extremely important to involve other members of your care team, such as nurses or pharmacists in helping patients manage chronic diseases like hypertension and giving them the tools is not very difficult and I think that physicians on the ground are in a position now where they really have great evidence that this type of management works and they should try to see if they can put it into practice

 

SARAH:

Senior investigator Karen Margolis, from Health Partners Institute for Education and Research in the US.

 

 

VIRGULE MUSICALE

 

 

P3

PETER: Putting on weight after quitting smoking can reduce some of the well known benefits smoking cessation has on coronary heart disease risks. This is what the authors of a research letter in JAMA conclude, after showing that weight gain following smoking cessation weakened this beneficial association with coronary risks in postmenopausal women, especially in those with diabetes who gained 5 kg or more.

 

VIRGULE MUSICALE

 

P4

PETER:

Pathologists have identified the bugs causing septicemia as much as two days faster by using a micro-array diagnostic test, as compared with routine microbiological methods, which can take up to 4 days

 

SARAH:

Yes, this is according to a study in PLOS Medicine, which evaluated a nucleic acid test with a two-hour turn-around time. This test should allow physicians to select the most appropriate antibiotics for their patients much sooner. As we know: the earlier you get the appropriate treatment, the higher your chances of survival.

 

PETER:

OK what’s special about this test?

 

SARAH:

Well it’s a blood test and it’s already on the market. And it’s now been shown to allow you to identify DNA from any of the 12 Gram-positive bacteria most frequently associated with sepsis. It’s also able to detect three bacterial genes that confer resistance to the antibiotics vancomycin and methicillin. Nathan Ledeboer, senior author of the PLOS study which was funded by the assay’s manufactures Nanosphere:

 

 

Ledeboer: Both our traditional methods and the Nanosphere method are very very specific methodologies. What this basically allows us to do is that it tells us much faster. Because the key to positive blood cultures in reporting these results is time. You need a methodology that’s very simple to be performed, that most anybody that works in a clinical laboratory can perform, and the real beauty of this type of technology is: it’s easy

 

SARAH:

That was Dr. Ledeboer, from Wisconsin, who told us that while the test’s more expensive than traditional assays, it should reduce costs by shortening hospital stays and treatment durations.

 

 

VIRGULE MUSICALE

 

P5

PETER:

For patients with bipolar disorders, treatment with lithium reduced the risk of suicide: that’s according to a meta-analysis of clinical studies with nearly 7000 patients, published in the British Medical Journal

 

SARAH:

Yes, the investigators looked at patients with bi-polar or depressive disorder who were randomly allocated to: lithium, placebo, or another drug. The rate of suicide for patients with bipolar disorder, for example, is normally about 30 times that of the rest of the population so any drug or intervention that has an impact is welcomed. Lithium has known side effects and prescribing it has declined over the last two decades. Nevertheless this evidence shows it’s still by far the strongest option on the table in terms of anti-suicidal effects:

 

AUDIO:

The benefit of lithium on reducing suicide, we’re more confident about it than we were before, it’s very substantial indeed and is stronger and more reliable than for any other treatment. So lithium should continue to be considered as a first-line treatment in bipolar disorder, but obviously the risks and benefits need to be discussed with each individual patient. But the benefit in terms of reducing suicidal risk should be part of that conversation that patients have with their doctors

 

SARAH:

Lead study author Professor John Geddes, head of the department of Psychiatry at Oxford University in the UK.

 

 

 

BREVE 1

PETER:

Finally, in brief: A single dose of methyl-phenidate, commonly-prescribed for attention deficit hyperactivity disorder helped improve brain function in cocaine addicts. This is according to an imaging study published in JAMA Psychiatry, in which 18 cocaine addicts were randomized to receive oral methylphenidate or placebo. The images showed methylphenidate decreased connectivity in brain circuits, known to underlie self-control and craving in addictions.

 

And …..

 

BREVE 2

Going to bed late and sleeping less may lead to weight gain, these are the conclusions of a laboratory study published in the journal SLEEP, in which people who were restricted to only 4 hours of sleep, from 4 to 8 am, during 5 days, gained more weight than controls who slept 10 hours. The authors suggest this could be due to eating un-needed exrtra-calories to while-away the late-night hours.

 

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!

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