Monthly Archives: Şubat 2010

Smokin’ Bad

Bad news came from the journal, Annals of Internal Medicine, to the smokers. People kept thinking that if you do not inhale, as cigars and pipes, it will not do any harm to your lungs. This postulate, in fact, has not been proven in researchs¸ perhaps no one has asked this unique question. Albeit, association with cigar/pipe/cigarette  smoking and head and neck cancer is clearer than lung cancer.

Dr. Josanna Rodriguez from Columbia University has asked 3528 participants a detailed questionnaire of their smoking habits, and cross checked with their urine cotinine levels. They measured their lung functions with spirometry.

The conclusion is: “Pipe and cigar smoking increased urine cotinine levels and was associated with decreased lung function and increased odds of airflow obstruction, even in participants who had never smoked cigarettes.”

J. Rodriguez, R. Jiang, W.C. Johnson, B.A. MacKenzie, L.J. Smith, and R.G. Barr. “The Association of Pipe and Cigar Use With Cotinine Levels, Lung Function, and Airflow Obstruction. A Cross-sectional Study”. Annals of Internal Medicine (volume 152, p. 201-210).

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New ADA Recommendation for Gestational Diabetes Unveiled

Previous American Diabetes Association recommendation, for all pregnant women, was to undergo screening for gestational diabetes. This approach had, however overestimated diabetes frequency in low risk population, and in contrast it underestimated it in high risk population.

Now, if the pregnant has low risk of diabetes, no screening is recommended. The low risk is defined as having all of the features below:

  • Age <25 years

  • Weight normal before pregnancy

  • Member of an ethnic group with a low prevalence of diabetes

  • No known diabetes in first-degree relatives

  • No history of abnormal glucose tolerance

  • No history of poor obstetrical outcome

On the other hand if the pregnant has high risk, she should be screened for diabetes as soon as possible after the confirmation of pregnancy. Criteria for very high risk are:

  • Severe obesity

  • Prior history of GDM or delivery of large-for-gestational-age infant

  • Presence of glycosuria

  • Diagnosis of PCOS

  • Strong family history of type 2 diabetes

  • If early screening does not yield any problem, them the pregnant must undergo routine gdm screening at 24-28 weeks of gestation

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Golden Era to Platinum Era for Metformin

Metformin is the drug of choice in type II diabetes patients. It is very effective in controlling blood sugar levels with modest weight lost. In type 2 diabetes mellitus patients, the disease generally originates, and progress from overweight. The overweight people, whose waist circumference are greater than normal, postulated to have insulin resistance. Insulin resistance means more than normal levels of insulin is needed to achieve the same effects, which results hyperinsulinemia. Insulin itself is a growth promoting  hormone with mitogenic effects, and also been suggested to promote cancerogenesis. On the other  hand, metformin is shown to reduce cancer mortality risk.

In this prospective cohort study that was published in Diabetes Care, the authors concluded that:” Although the design cannot provide a conclusion about casuality, our results suggest a protective effect of metformin on cancer mortality. ”

“Metformin Associated withLower Cancer Mortality in Type 2 Diabetes. Zodiac-16”.

Diabetes  Care 33:322-326, 2010.

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Being Caged in a Vegetative State

Today, a jaw dropping study is published in our highly respected journal, New England Journal of Medicine (NEJM).  The researchers had a unique question: do patients who are in vegetative state or minimally conscious state have functioning brain activity, or awareness, but unable to express them?

Here comes the intriguing answer: some of them yes, they have. It sounds too good to be true in a science fiction movie, but with the aid of functional magnetic resonance assessment of the brain, the authors had shown 5 of the 54 patients who were enrolled in the study had been able to willfully modulate their brain activity.

Published at http://www.nejm.org February 3, 2010 (10.1056/NEJMoa0905370)

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Impact of Environmental Tobacco Smoke on the Incidence of Mutations in Epidermal Growth Factor Receptor Gene in Never-Smoker Patients With Non–Small-Cell Lung Cancer

The heading  is long, but the fact is short and brief: if someone around you smokes, you are a smoker, too.  The never smoker non-small-cell lung cancer (NSCLC) patients have high percentage of EGFR mutations in their tumor cells than smokers, and these mutations make the neoplastic cells(cancer cells) prone to anti-neoplastic effects of Tyrosine Kinase Inhibitors (TKI) such as erlotinib, or gefitinib. Nevertheless, the smokers’ cancer cells mostly do not have these mutations, so no clear benefit from TKI’s is generally achieved.

Dr. Young Joo Lee, and his colleagues has shown that environmental tobacco smoke exposure is negatively associated with EGFR mutations in never smokers with NSCLC.

So the motto of smokers should not be: “Live (smoke) and let die!”

 Journal of Clinical Oncology, Vol 28, No 3 (January 20), 2010: pp. 487-492

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Physical Activity and Incident Cognitive Impairment in Elderly Persons

Dr. Thorleif Etgen and his colleagues has searched for a possible correlation with physical activity and incident cognitive impairment who are older than 55 years old, and have reported their findings in Archives of Internal Medicine.

The results were not startling as you have guessed: a little can be enough for being happy, and of course not forgetting your happiness; ie. moderate (physical activity <3 times/wk), and high activity (physical activity 3 or more times/wk) is associated with a reduced incidence of cognitive impairment after 2 years in a large population-based cohort of elderly subjects.

Arch Intern Med. 2010;170(2):186-193.

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Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis

The casual relationship with smoking and lung cancer is a well established fact. However, it was not well-known whether quitting smoking after a diagnosis of early stage lung cancer is of beneficial. A Parson and his colleagues found a correlation between smoking and prognosis in aforementioned patients. The patients who continued smoking after the diagnosis did worse than their counterparts. In this meta-analysis published in British Medical Journal, the authors concluded that:”the estimated number of deaths prevented is larger than would be expected from reduction of cardiorespiratory deaths after smoking cessation, so most of the mortality gain is likely to be due to reduced cancer progression. These findings indicate that offering smoking cessation treatment to patients presenting with early stage lung cancer may be beneficial.

BMJ 2010;340:b5569

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