Month: February 2019

Diet drinks and risk of stroke and heart attack

The American Heart Association issued an advisory last year saying that short term use of low-calorie and artificially sweetened drinks to replace sugary ones “may be an effective strategy” to promote weight loss in adults, but not children. New study from them has a few updates.

A new study shows drinking two or more diet beverages a day linked to high risk of stroke, heart attacks. The study also looked at various subtypes of ischemic stroke, which doctors use to determine treatment and medication choices. They found that small-artery occlusion, a common type of stroke caused by blockage of the smallest arteries inside the brain, was nearly 2½ times more common in women who had no heart disease or diabetes but were heavy consumers of diet drinks.

Read the full article here.

Read a CNN report on the report here.

Many uses of Ketamine

Yesterday I was letting a patient know that Ketamine infusion may be a great option to treat the depression they have. Today, I see an article on Ketamine and depression on NBC News.

Ketamine is also a great none opiate alternative way to treat pain in patients with history of cancer-related pain, or IV drug abuse.

Ketamine works on many receptors in our body including NMDA,
opioid, AMPA, GABA, cholinergic, dopaminergic and innate repair receptors, and antagonism at HCN1, potassium, calcium, and sodium channels.
The excitatory glutamatergic NMDAR is ubiquitously distributed throughout the brain and spinal cord and plays an important role in the development of pain receptors which is probably why it can be used for pain relief.

It can definitely be used to reduce opioid consumption in the hospital setting but one must watch out for schizotypical effects.

Here is a good review article on Ketamine and it’s dosing.

This is the article on Ketamine and its use for depression published in 2016.

FDA to increase oversight of dietary supplements

The Food and Drug Administration said Monday it planned to beef up oversight of the sprawling, $50-billion-a-year dietary supplements industry, warning that the sector’s explosive growth has resulted in risks to consumers — more supplements “spiked” with unlisted drug ingredients, and false and misleading claims about health benefits.

You can read more about it from NY Times or Washington Post by clicking on their names.

High level of education may not prevent dementia, study indicates

A new report found “a high level of education does not delay the start of dementia and does not slow the speed of decline.” The findings of the 2,899-participant study were published online in Neurology. Robert Wilson, the director of cognitive neurosciences at Rush Medical College and the study’s lead author, said that while educational achievement may not protect people from dementia, he recommended “continuing to read or vigorously challenge yourself with other pursuits and intellectually challenging occupations.”

Read the full report here.

FDA approves Caplacizumab for TTP

Caplacizumab (Cablivi), an Anti VWF, is a humanized monoclonal antibody fragment that binds to von Willebrand factor (VWF) and blocks VWF interaction with platelet GPlb-IX-V. Evidence to support its effectiveness in TTP comes from the HERCULES and TITAN trials that randomly assigned 145 patients (mostly adults) with acquired TTP to receive caplacizumab or placebo daily until 30 days beyond the last PEX procedure. The diagnosis of TTP was based on clinical presentation (thrombocytopenia and microangiopathic hemolysis); severe ADAMTS13 deficiency was not a criterion for entry but was subsequently documented in all but seven of the patients. All patients received daily PEX and glucocorticoids and could receive other immunosuppressive therapies. Slightly less than half received rituximab. Individuals who had an exacerbation could be switched to open-label caplacizumab. Compared with placebo, caplacizumab was associated with the outcomes:

  1. Fewer deaths (1 versus 3 [1 versus 4 percent])
  2. Faster normalization of the platelet count (rate ratio 1.55; 95% CI 1.09-2.19), which correlated with fewer days of PEX (mean, 5.8 versus 9.4)
  3. Fewer exacerbations in the 30 days after stopping PEX (12 versus 38 percent)
  4. Shorter hospitalization (mean, 9.9 versus 14.4 days) and fewer days in the intensive care unit (mean, 3.4 versus 9.7)

Caplacizumab was today approved by FDA in US (Link).

Common side effects of Cablivi reported by patients in clinical trials were bleeding of the nose or gums and headache. The prescribing information for Cablivi includes a warning to advise health care providers and patients about the risk of severe bleeding.

Cancer risk from obesity is increasing

The incidence of obesity related cancers has significantly increased. The cancer risk for six of 12 obesity-related cancers (multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancer) in young adults (25–49 years) shows steeper rises in successively younger generations. 

Read the full report here.