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Swine flu narcolepsy risk confirmed by second study

MD-FM Thursday March 07, 2013

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

Hello. And with me is Sarah Maxwell.

To begin with, some cases of narcolepsy in children were associated with having had the swine-‘flu vaccination, according to a study just published in the British Medical Journal …

Yes, although the risk of any child developing narcolepsy is very low, swine-‘flu vaccination increased it 15-fold! A study group from England showed: out of 50,000 children vaccinated for swine ‘flu, one case of narcolepsy was attributable to the jab — and this finding is also consistent with 2009 data from Finland. Immunisation for H1-N1 has already been withdrawn but clinician investigator John Shneerson said these findings are different from other ‘flu vaccines:

IN:  It’s an unusual immunisation because it had an adjuvant which is really a second……to increase the strength of the immune response to the flu virus. And it looks as if it was the adjuvant which actually caused the damage to the hyperthermus and caused the narcolepsy. Now this is important because most other vaccines don’t have an adjuvant in so what we’ve seen with this one isn’t applicable to the majority of vaccines that are in general use.

And Dr Shneerson added that the absolute risk is in fact very low:

IN: if you do the calculations its probably only 15 or 20 patients with narcolepsy developed it as a result of this immunisation. And some of those may have developed it at a later date anyway because there is a genetic component, so only some people are if you like vulnerable or predisposed to develop narcolepsy due to any immune stimulus. So it may be that many of the cases we’ve seen were just brought forward and would have occurred anyway a few years down the line. So this isn’t a large number, its an important finding but its not as if there is an epidemic of narcolepsy or going to be an epidemic of it in the future.

Dr John Shneerson, from the Respiratory Support and Sleep Centre at Papworth Hospital, in Cambridge.


What do autism, attention deficit hyperactivity disorder, bi-polar disorder, major depressive disorder and schizophrenia have in common — apart from being hard to treat? Well, according to findings reported in The Lancet, gene markers — that could also cause these conditions…

Yes, all of these disorders have gene markers — known as single nucleotide polymorphisms — in common. And there’s hope they could be used not only for diagnosis but also for better understanding disease processes, and therefore help design drug treatments. Jordan Smoller from Boston:

Bob- JORDAN SMOLLER 01 (calcium channels in common)
We were able to find four regions of the genome that were strongly associated with multiple disorders and in most cases all five of  these disorders, and two of them actually clustered in genes involved in calcium channel signalling which is important to how neurons communicate and so that suggested there might actually be a biological pathway underlying some of this shared biology and in fact another analysis we did supported that, that calcium channel signaling genes seemed to be related to all five of these disorders.

And wouldn’t it be amazing if drugs modulating calcium channels turned out to have wide-spread therapeutic potential in psychiatry?

I do think that it raises the possibility that medications that target calcium channels might have broad effects and of course there are calcium channel blockers already in existence but that haven’t really been tested in any systematic way for these disorders by and large although there has been an earlier literature for bipolar disorder. So this raises a whole set of clues that we and others will want to follow up to see if there are any therapeutic implications.

That was doctor Jordan Smoller, Professor of Psychiatry at Harvard Medical School and Director of the Psychiatric and Neuro-developmental Genetics Unit at Massachusetts General Hospital.



Skin photosensitivity now, and guidance for people with darker skins: just because you’re not white doesn’t make you immune to the ravages of solar energy…

Yes, and this has been a neglected area of study — neglected until now that is. And delegates at The American Academy of Dermatology conference in Miami heard some important messages from Susan Taylor:

It’s clear that people of color, those of latin and asian and latino descent, are much less likely on whole to develop skin cancer than people of European decent or those with white skin but the important point is that people of colour do get skin cancer and we’re very concerned about melanoma in particular because the prognosis is worse.”
So when you’re seeing your patient of African, Asian or Latino origin, Dr Taylor has some clear advice:

Ask that patients to take their shoes and socks off, so that when you come in you can examine very quickly in under a minute their palms their soles the areas between their toes and their finger nails and toenails because those are the areas people of colour are most likely to develop skin cancer. Number two its important to inform and educate your patient that yes they can get skin cancer and its important for them to use sun screen on a daily basis, spf 30 or higher and reapply it every two hours.

That was New York City-based dermatologist, Dr Susan Taylor.  

For patients with asthma, a single inhaler that does everything can lower rates of asthma exacerbations according to two papers in The Lancet: one from Europe, the other from New Zealand…

Yes, Single-inhaler Maintenance And Reliever Therapy, or SMART, is one device that delivers both the inhaled cortico-steroid AND a long acting broncho-dilator with rapid onset of action. The idea is that patients use their symptoms to guide their therapy increasing or decreasing the dose as they consider necessary.
The take home message is that we know that single maintenance and rescue therapy with a combination of an inhaled steroid and a long acting beta agonist works and is better than giving it as a fixed daily dose. On the hand we need more research to find out what individual patient will benefit best from this treatment option.
That was René Aalbers from Groningen in the Netherlands who wrote the editorial. One the studies used budesonide plus formoterol in the inhaler, the other study tried a combination of beclometasone with formnoterol. The SMART regimen led to higher exposure to inhaled steroid but lower exposure to oral steroids, and overall both studies found SMART therapy was favourable.

The important criticism you could have, not about the two studies but about the concept is that you only use symptoms to find out how much medication you should use. The problem is there is no good correlation between symptoms and objective parameters, so is it safe on the long run and that’s an important question that still has to be answered.

Dr René Aalbers, from the Martini Hospital in Groningen.



It’s been an exciting week in HIV/AIDS medicine with news from Atlanta of a baby being functionally cured of the infection. And it’s been announced that HIV seems to have a direct and independent impact on cardiac health:  

Yes, investigators from the University of Pittsburg looked at 55,000 army veterans who didn’t have HIV and compared their rates of acute myocardial infarction with those of 27,000 former soldiers who were HIV positive: Matthew Freiberg: ?
What we found is when we looked over approximately 5.9 years that was the median time of follow-up, we found there was about a 48% increased risk of having a heart attack if you were HIV infected as compared to being uninfected.

But how could the researchers tell if this increased risk was caused by the virus or by anti-retroviral treatment?

Well they can’t fully, but Dr Freiberg said previous research suggests the virus plays a big part, though it’s likely to be a combination of both. He added that this finding still gives doctors some clear management guidelines, namely that HIV status needs to be added into heart risk models like the Framingham score.

BREVE 1 Sur fond musical
Finally, in brief:

Patients with rheumatoid arthritis being treated with anti tumor necrosis factor therapies were not at higher risk of herpes zoster compared with patients who had non-biologic treatment regimens, according to an American study with 60 000 patients appearing in JAMA.


Large amounts of visceral abdominal fat relative to subcutaneous fat — as measured by CT scan — was associated with a significant increase in the risk of Barrett’s oesophagus — this is from a study in the journal : Gut. The authors suggest gastroesophageal reflux disease may mediate some, but not all, of this association.

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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