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Flu vaccination also protects against major cardiovascular events

MD-FM, Thursday October 24, 2013


SARAH:

MD FM — Medical News from around the world with Peter Goodwin.

 

PETER:

And with me is Sarah Maxwell. To begin with: there could be yet more benefits from being vaccinated for influenza, according to a meta-analysis — published in JAMA — that suggests it also protects against major cardiovascular events…

 

SARAH:

That’s right, the study looked at nearly 7 000 patients at high-risk of cardiovascular disease randomized to have ’flu vaccination or placebo. There was around a 36 per cent lower risk of having a myocardial infraction, stroke, getting congestive heart failure or dying from heart related causes within the following year for those who were vaccinated. What’s more, patients at higher cardiac-risk seemed to benefit the most from immunisation:

 

“Those who had a recent heart attack had a 55 percent lower risk of developing a major cardiac event and there was a benefit, or a trend towards benefit, in those with stable heart disease, although it wasn’t as powerful.”

 

SARAH:

That was Dr. Jacob Udell, from the University of Toronto in Canada. Over the years, there’s been a build-up of data linking influenza to adverse cardiovascular events. Nevertheless: many people still aren’t getting vaccinated…

 

“It is recommended in certain cardiovascular guidelines and by the CDC but, sadly, in the general population less than 50 percent of folks are getting the flu vaccine and in those who are at higher risk of cardiovascular disease, I don’t think the numbers I’ve seen lately are any higher than 60 to 70 percent of those patients getting their flu shot.”

 

SARAH:

And Dr. Udell said, getting the flu shot should be a no-brainer:

 

“I, obviously, as a healthcare professional, believe strongly that everyone should get the flu vaccine and our study gives one more weapon and one more argument to support to the reluctant or skeptical patients --particularly those who are vulnerable to heart attacks, strokes and heart failure --that this is one other way we may be able to protect them. I think if they’re looking to take a pill or exercise or do whatever they can to prevent heart disease, how could they not want this as well?”

 

SARAH:

Jacob Udell, from Toronto.


PETER:

An effective new treatment for toxoplasmosis could be a combination of two commonly prescribed drugs according to a report in PLOS Pathogens. One is the cholesterol-lowering agent, atorvastatin — which targets body chemistry in the host — and the other an osteoporosis drug — zoledronic acid — which targets the parasite. Toxoplasma gondii is an important intracellular pathogen that causes disease in humans and animals: and the scientists report that mice treated with these two agents were cured of an otherwise lethal infection.

 

PETER:

Experts estimate that, today, one in 2000 people in the UK is a carrier of the variant-Creutzfeldt-Jakob disease agent…

 

SARAH:

Yes, and that’s roughly 30 thousand people which is twice as many as previously thought. But, it’s not at all clear how many people will actually develop the disease. Sebastian Brandner, senior author of the study on this published in the British Medical Journal, gave MDFM the details:

 

“It may be that none of these people will ever develop a disease, but it’s possible that 5 percent or 10 percent develop the disease… It might be that some patients develop a form that we haven’t seen yet.”

 

SARAH:

That was professor Sebastian Brandner, from the National Hospital for Neurology and Neurosurgery in London, who said there’s no diagnostic test yet to identify infection…

 

PETER:

So could more people get infected or not?

 

SARAH:

Well, people can’t get it by eating infected meat anymore — as far as we know cows have the all-clear these days — but you could still be infected from people: through blood transfusions and during surgery. So with these new data the UK will have to keep up surveillance for decades to come. Dr. Roland Salmon wrote an editorial in the BMJ

 

“Any hope that we may have had that, somehow, we would be able to take less public health measures would seem misplaced. Clearly you have to take a number of quite costly measures in terms of using, for surgery, dedicated sets of surgical instruments or disposing of surgical instruments that have been used on cases... And in terms of blood supply: of filtering the blood supply, excluding certain donors, leukodepleting the blood supply, acquiring certain plasma products from outside of the United Kingdom or outside of Europe. It also, I think, suggests that work on development of a blood test probably should fully continue because, actually, it would be very helpful to easily assess the infectivity status of someone.”

 

SARAH:

That was Roland Salmon, from Cardiff, Wales. Outside Great Britain, many countries — which were much less affected by than the UK — exclude any person having lived for over a year in the UK during the mad cow epidemic from donating blood.

 

 

PETER:

For patients with spine compression fractures vertebral augmentation surgery — using medical cement to strengthen the bone — was linked to longer survival than using non-surgical conservative care confined to immobilising the patient and managing their pain...

 

SARAH:

Yes, that’s according to a study looking at 70,000 patients — published in the Journal of Bone & Joint Surgery. And between the two existing procedures, kyphoplasty — using a balloon — led to even better results than vertebralplasty, where you simply inject cement laparoscopically. Lead study author, Dr. Richard Skolasky:

 

“At two years following fracture, the survival rates were significantly higher in the two arms that involved vertebral augmentation and particularly so in patients who had undergone a kyphoplasty compared to the non-operative arm. Using a medical balloon to expand the disk space and then inject the cement would restore a more natural anatomical design. Kyphoplasty was associated with a lower in-hospital mortality, shorter length of stay and patients were much less likely to develop pneumonia during the index hospitalization.”

 

SARAH:

That was Richard Skolasky, from Johns Hopkins University in Baltimore, Maryland, who warned that more trials are needed to confirm these findings since this study was observational and literature on the subject show rather mixed results. While having surgery is obviously WAY more costly in the short-term — especially kyphoplasty — Dr Skolasky suspects surgery might still be the way to go:

 

“When we extend out to two years and we see these differences in survival, then I think that that’s where we probably will see cost-effectiveness.”

 

SARAH:

Richard Skolasky, from Baltimore.

 

PETER:

Babies who are bottle-fed, have an increased risk of developing hypertrophic pyloric stenosis — HPS —a form of stomach obstruction that requires surgery. It’s rare …

 

SARAH:

Yes and it’s mostly in babies born to older mothers with more than one child. That’s according to a population-based case control study — published in JAMA paediatrics — which examined the breastfeeding records of over 700 babies admitted to the hospital for HPS:

 

“The odds ratio was roughly 2.5 times increased risk of having a baby with piloric stenosis if they are bottle fed versus breastfed --for all patients. And when we broke this down by mothers’ age: for mothers over the age of 35 the association was even stronger with an odds ratio of about 6 whereas in younger mothers, specifically mothers under the age of 20, there was no significant association.”


SARAH:

That was lead study author Dr. Jarod McAteer, from Seattle’s General Hospital, who insisted that — regardless the effect of bottle-feeding — in the overall population, babies of younger mothers — not older ones — are the ones at higher risk of pillory stenosis. So, in fact, bottle-feeding appears to be a risk factor for mothers outside the normal risk population. But the reasons underlying this association are unclear...

 

There’s some thoughts that there may be a hormonal effect --there are oestrogenic components in baby formula… Also some people have suggested that infants who are bottle fed tend to take larger volumes of liquid in than a baby who is breastfed --but all of that is conjecture and has not been tested.”


SARAH:

Jarod McAteer, from Seattle, concluded that no clear recommendations should be drawn from these findings but that they further add to the existing literature supporting the overall benefits of breastfeeding.

 

PETER:

Finally, in brief: An intranasal application of the hormone oxytocin — which is thought to mediate empathy, trust, and social learning — appeared to enhance the perceived effectiveness of a placebo analgesic. Healthy volunteers were randomized in a study — reported in JAMA — to either double-blinded administration of oxytocin or saline. And the authors hypothesize that oxytocin might have increased patients’ trust in physicians’ instructions and such enhancement could be used to support, but not replace of course, active treatments through placebo mechanisms.

And: In patients with metastatic pancreatic cancer, albumin-bound paclitaxel plus gemcitabine significantly improved overall survival, progression-free survival, and response rates, compared to gemcitabine administered alone. These are the findings of a phase III randomized study — published in the New England Journal of Medicine — showing, however, that rates of peripheral neuropathy and myelosuppression were increased with the drug-combination.

 

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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