Category Archives: Neurology

Dyslipidemia increases the risk of atherosclerotic cardiovascular disease and is incompletely reversed by statin therapy alone in many patients. Thyroid hormones lower levels of serum low-density lipoprotein (LDL) cholesterol and has other potentially favorable actions on lipoprotein metabolism. Consequently, thyromimetic drugs hold promise as lipid-lowering agents if adverse effects can be avoided.

In this 12-week trial, the thyroid hormone analogue eprotirome was associated with decreases in levels of atherogenic lipoproteins in patients receiving treatment with statins.

The satirical $25 million ad campaign is launched by a new alliance of carrot growers - “a bunch of carrot farmers” - and is designed to reposition baby carrots as snacks with sass.

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in hematology:

Transplantation in aplastic anemia

In patients with severe aplastic anemia over the age of 40 who received allogeneic hematopoietic cell transplantation from an HLA-identical sibling, overall survival was 65 percent.

Improved survival when rituximab is added to fludarabine plus cyclophosphamide in CLL

There were higher response rates and survival with six courses of FCR (fludarabine, cyclophosphamide, and rituximab) when compared with six courses of FC (fludarabine, cyclophosphamide).

Second generation tyrosine kinase inhibitors (TKIs) for CML

Trials comparing dasatinib or nilotinib to imatinib for chronic myeloid leukemia (CML) demonstrated faster and deeper responses with these second generation tyrosine kinase inhibitors.

Improved understanding of pathobiology of multiple myeloma

Virtually all multiple myeloma (MM) cases are preceded by a premalignant plasma cell proliferative disorder known as monoclonal gammopathy of undetermined significance (MGUS). The pathobiology of myeloma as a two-step process - first there is the establishment of a limited stage of clonal proliferation (MGUS); then there is progression of MGUS to MM.

Denileukin diftitox superior to placebo for relapsed mycosis fungoides

There were better response rates with the recombinant interleukin-2-diphtheria toxin fusion protein denileukin diftitox used for therapy of mycosis fungoides and Sezary syndrome.

Survival in sickle cell disease

The estimated survival at 18 years is now 94 percent for those with HbSS or HbS/beta(0) thalassemia and 98 percent for those with HbSC or HbS/beta(+) thalassemia.

References:
What's new in hematology. UpToDate.

As many as 22% of people with type 2 diabetes could have vitamin B-12 deficiency.

This BMJ study evaluated the effects of metformin on the incidence of vitamin B-12 deficiency (lower than 150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin.

Compared with placebo, metformin treatment was associated with a decrease in vitamin B-12 concentration of -19%.

The absolute risk of vitamin B-12 deficiency (lower than 150 pmol/l) at study end was 7.2 percentage points higher in the metformin group than in the placebo group with a number needed to harm of 13.8 per 4.3 years.

Long term treatment with metformin may increase the risk of vitamin B-12 deficiency, which results in raised homocysteine concentrations. Vitamin B-12 deficiency is preventable; therefore, regular measurement of vitamin B-12 concentrations during long term metformin treatment should be considered.

People who get less than 6 hours sleep per night had an increased risk of dying prematurely in a recent study. Those who slept for less than that amount of time were 12% more likely to die early, though researchers also found a link between sleeping more than 9 hours and premature death.

The study aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.

Just one sleepless night can hamper the body's ability to use insulin to process sugar in the bloodstream. Insulin sensitivity is not fixed in healthy people, but depends on the duration of sleep in the preceding night.

"Society pushes us to sleep less and less," one of the study investigators said, adding that about 20% of the population in the United States and Britain sleeps less than 5 hours.

Adults typically need between 7 and 9 hours sleep a night. If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol.

Human subjects are paid in Phase 1 clinical trials to test the toxicity levels of new drugs. Some make a profession out of it, but researchers worry about health risks.

References:
Clinical Trials: Professional Guinea Pigs. TIME.