This week in the medical journals
By Michael Smith
Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.
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New uses for old drugs?
Researchers at the Mayo clinic in Rochester, Minnesota, say that a short course of the HIV drug nelfinavir boosts the immune system. The finding, reported in the journal AIDS, has a host of possible applications, but the most striking is that it may help improve the usefulness of cancer vaccines. It may also have applications in older patients whose immune systems are weakened by age.
And in Boston, Massachusetts, researchers have found evidence that the statin drugs -- used to lower cholesterol -- may also protect against bone fractures.
Compared with non-statin users, patients taking statins had a 30 percent lower risk of fracture, the investigators reported in the Archives of Internal Medicine. The study is based on analyzing medical records from more than 90,000 veterans, most of them men, who received care in the Veterans Administration medical system.
More evidence against smoking
Researchers in Winston-Salem, North Carolina, say puffing cigarettes is associated with an increased risk of developing Type 2 diabetes. A prospective observational study showed that smokers are more than twice as likely to develop the condition than nonsmokers, suggesting "another poor health outcome associated with cigarettes, supporting (the) surgeon general's warnings against cigarette smoking," the researchers wrote in the journal Diabetes Care.
Naturally, the best bet is to quit, but for many heavy smokers that's tough. Danish researchers show this week that even cutting down can reduce the risk of lung cancer. Dropping from a pack a day to half that -- 10 cigarettes or fewer -- reduces the risk of lung cancer by 27 percent, they write in the Journal of the American Medical Association. But it's still better to quit, because the same researchers have already shown that cutting down does nothing to reduce the risk of heart attack and other ill effects.
While we are on the subject of lung cancer, Houston investigators say a diet rich in compounds known as phytoestrogens -- found in soy, spinach, carrots, broccoli, and other vegetables -- appears to reduce the risk of lung cancer. In a study reported in the Journal of the American Medical Association, people whose diets included the most phytoestrogens had a 46 percent reduction in the risk of lung cancer.
And that is nothing to cough at.
Predicting cognitive difficulties in older people isn't easy, but two studies this week offer some guidance.
Chicago researchers say an unexplained and persistent loss of body mass in an older person may be the first sign of Alzheimer's disease. It has long been known that people with the disease lose weight, but a new study, in the journal Neurology, says that the decline begins years before there's a formal diagnosis.
Sudden weight loss in an older patient is something doctors should look out for, and consider the possibility of incipient Alzheimer's, the researcher argue. And a low intake of B vitamins, especially folate, and high homocysteine levels predict cognitive decline in middle-age and elderly men, researchers in Boston say.
Folate -- found in meats, beans, vegetables, and a range of other foods -- appeared to protect against cognitive decline, the researchers report in the American Journal of Clinical Nutrition.High levels of homocysteine, an amino acid considered to indicate vascular disease, were associated with reduced cognitive function. Two findings may be sides of the same coin, the researchers note -- increased folate has been linked to reduced homocysteine.
Disparities in care
Not everybody gets the same level of care, two studies show this week.
Researchers in Ann Arbor, Michigan, found that strokes are more likely to kill women than men -- perhaps because women who suffer strokes are less likely to receive important follow-up tests than their male counterparts. Sixty-two percent of all stroke deaths occur in women even though women have a lower stroke rate than men. At the same time women were 43 percent less likely than men to have a carotid artery exam and 36 percent less likely to undergo an echocardiogram, they reported in Neurology.
Meanwhile, Tucson researchers say Hispanics in the U.S. have a much higher rate of cataracts than whites, but language barriers and lack of medical insurance prevent many from receiving much-needed cataract surgery. Hispanics 65 or older were nearly four times more likely than whites of the same age to have clinically significant cataracts and bilateral cataract surgery compared with whites or African Americans, they report in Archives of Ophthalmology.
Cancer risk news
Dutch researchers report that young left-handed women have twice the risk of premenopausal breast cancer as do right-handed women.
Exactly why that should be so remains an open question, although the researchers suggest in the British Medical Journal that it may have something to with intrauterine exposure to steroid hormones. And investigators in Hershey, Pennsylvania, say that kidney transplant patients are nearly four times more likely to develop melanoma than the general population. The risk is greater for men than for women and increases steadily with age, they report in the journal Cancer.
Drugs given to prevent rejection of the organ are probably to blame for the increased risk, the investigators suggest.
Sleepy (and safe) time
Nitrous oxide -- known as laughing gas to generations of dental patients -- is safer than had been thought.
The anesthesia drug had been thought to increase the risk of post-operative infection, but researchers in Louisville, Kentucky, say that's not so. In a randomized study of 418 patients who underwent colon surgery, there were no differences in postoperative infection rates, wound healing, length of stay, or death between patients who received surgical anesthesia with 65 percent nitrous oxide or nitrogen, they report in The Lancet.
It's rare for a study to say a new drug shouldn't be used, but that's what investigators say about Xigris (drotrecogin alfa, activated) in the New England Journal of Medicine.
A large study evaluating the anti-sepsis drug in patients at a low risk of death was stopped early because there was no evidence of a benefit and there was an increased incidence of serious bleeding complications among patients receiving the drug.
On the other hand, Xigris can still be used for sepsis patients thought to be at a high risk of death, where the benefit outweighs the risk, the investigators say.
Forget the O.J., pass the P.J.
A glass of orange juice is popular choice as a part of healthy breakfast, but researchers at the University of Wisconsin reported this week that a glass of pomegranate juice packs more potential than orange juice in the fight against prostate cancer.
Turns out, they write in Proceedings of the National Academy of Sciences, that pomegranate juice is supercharged with an abundance of antioxidants, which slowed the growth of prostate cancer -- in mice. Human studies are in the works.
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