Health Newsletter:December 2002
Related Links:From WebHealth
Bone Growth Can Be Stimulated Even In Desperate Cases
In the past bone fractures that did not heal (called "non-union of a fracture" in medical terms) could not be treated other than with an electrical device, called bone stimulator. But now a large international team of 66 researchers from the US and South Africa have published a well controlled randomized study in the American Journal of Bone and Joint Surgery (84:2123-2134;2002). Dr.S.Govender et al. used a newly developed protein substance (rhBMP-2, from the Wyeth Laboratories) to treat 450 comparable open shin bone fractures.
The patients were either treated conventionally or with the additional help of this bone growth substance and data on wound healing, infection rates and delayed unions were collected. At 6 weeks 83% of the experimental group showed complete wound healing of the soft tissue compared to 65% of the control group. There were also significantly lower hardware failures, wound infections and need for postoperative visits by the doctor. At the 12 month follow-up point there were 44% less non-unions when the two groups were compared with a lot less invasive secondary surgeries being needed.The authors of the two scientific collaborative teams concluded that this new bone producing protein will raise the standard of treating complex fractures that are difficult to heal.
See this link for more information
What Goes Around Comes Around With Blood Pressure Medications
A large clinical study with 42,418 men and women 55 years and older has been published in the American Medical Association Journal recently(JAMA 2002:288:2981-2997,3039). The thiazide type water pill chlorthalidone(12.5 mg to 25 mg/day) is the clear winner in this trial, called the ALLHAT trial. It stands for "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial" and is the largest hypertension trial that was ever performed going over a period of 5 years.
In this trial a calcium channel blocker(amlodipine) and an ACE (=angiotensin converting enzyme)inhibitor(lisinopril) were tested as the initial medication and compared to chlorthalidone.There was a 15% higher risk to develop a stroke with lisinopril and a 38% increased risk with amlodipine to develop congestive heart failure when compared to the chlorthalidone group. The interesting conclusion from this study is that the least expensive therapy for high blood pressure turns out to be the safest. Another ineresting finding was that black patients responded much better to water pills than to ACE inhibitors, which had been noted before by other authors. When more than one medication is required to control high blood pressure, the dosage of the second medication can often be kept lower with a combined therapy thus reducing the likelihood of side-effects and complications.
Comments
Several decades ago the teaching was that the doctor would start a new high blood pressure patient with a water pill first, and combine this with a second or even third pill of a different medication class, if the water pill would not be effective enough on its own (it was called the "step care therapy"). For decades the side effects of the water pill consisting of low potassium blood levels brought the water pill treatment in disrepute. The original trials,however, were done with chlorthalidone doses of 50 and 100 mg per day, much higher than would now be recommended. It appears that with this study medicine has gone a full circle back to the old stand-by water pill, but at a much safer, lower dosage.
Other useful link (regarding hypertension): Hypertension
Study Shows Echinacea Not Effective For The Common Cold
A study was done on 148 college students at the University of Wisconsin to see whether Echinacea was more effective than placebo ("fake pills" with no herb in it). The study was published recently in the Annals of Internal Medicine (Ann Intern Med 2002; 137:939-946,1001-1002).
The students were given 1Gram capsules of a mixture of Echinacea herbs that can he bought in health food stores. With the onset of the common cold the students were given 1 capsule 6 times daily for the first day and three times daily from the second to the 10th day. The researchers examined all the students in the placebo group and the Echinacea group for symptoms, duration of the cold and the severity of the cold. The mean duration for both groups was 6 days. None of the criteria in measuring the severity of the cold symptoms were different in both groups. Dr. Barrett,the lead investigator, said that the findings of this trial should not be "the last word" on Echinacea. More studies are needed regarding this matter.
Comments
One of the problems with such a study is that the investigators assumed that a placebo pill would not have an effect.However,countless other studies have shown that a placebo often has a 15% to 20% effect. On the other hand it is difficult to have another control for this by not taking any pill (it would be obvious to the subject being investigated that they are the negative control and the negative placebo effect would kick in). So, don't stop taking Echinacea yet, if you have been taking this normally to treat a common cold. On the other hand, if you never took it in the past, perhaps you want to wait first what other studies will say in future regarding Echinacea.
Obesity (Excessive Weight) A Predictor Of High Risk For Stroke
In the Dec.9th issue of the Archives of Internal Medicine an important follow-up from the US Physicians' Health Study was published. It examined the effect of obesity on the development of stroke later in life. 21,414 male physicians of the US have been followed now for 12.5 years in this study. At present there were 747 strokes (631 ischemic, 104 hemorrhagic, 12 others).
They found that the rates of strokes were in direct relation to the amount of excessive weight,in other words the higher the weight, the higher the risk to develop a stroke. It did not matter what kind of stroke it was (ischemic stroke or hemorrhagic stroke), a body mass index above 30 was always associated with a 1.9-fold risk to develop a stroke when compared to normal weight controls (body mass index less than 25). This risk of obesity was independent from other risk factors such as diabetes, high cholesterol or high blood pressure. Dr. Kurth from the Brigham and Women's Hospital, Boston, said that this finding is very significant in view of the fact that many young adults in the US are either overweight or obese and they will be exposed to this risk for a longer period of time inreasing the risk to develop strokes even further. He hopes that physicians will concentrate on treating obesity more aggressively preventing a stroke. In industrial countries strokes are the main cause of disability and are on the third place on the list of causes of death.
Other information about strokes can be found through this link: Stroke And Brain Aneurysm
Arch Intern Med 2002;162:2557-2562.
Folic Acid In Cereal Reduces Abnormalities Of The Brain In The Unborn Child
In 1998 the Canadian government approved the mandatory addition of folic acid in cereal products as studies in the past had shown that pregnant women did not always take their prenatal folic acid supplements to prevent neural tube defects (abnormalities in brain and spine formation).
A total of 336,963 women who were either pregnant before or after the 1998 folic acid fortification program was institued,were screened for open neural tube defects. The result was that prior to the legislation there were 113 cases per 100,000 pregnancies. After 1998 there were only 58 per 100,000 pregnancies found. Dr. Joel G. Ray from the Sunnybrook and Women's College Health Sciences Center in Toronto who was the lead researcher stated that a food fortification program with folic acid in addition to the regular prenatal folic acid tablet supplementation is essential. To a large extent this will prevent these devastating congenital malformations that cause disabilities or death.
Comments
It is also important for women to know that folic acid tablets need to be taken already before, around and after conception to be most effective with regard to preventing brain and spinal malformations. The nervous tissue is one of the fastest growing tissues in the first few weeks of pregnancy. Any deficiency of cell differentiation, for which folic acid is an essential ingredient, has devastating longterm consequences.
Lancet 2002;360:2047-2048.
