Health Updates 8 August 2012

  • Chronic ‘butter flavoring‘ exposure linked to harmful brain process: “Chronic exposure to an artificial butter flavoring ingredient, known as diacetyl, may worsen the harmful effects of a protein in the brain linked to Alzheimer’s disease, according to a new study.  The findings should serve as a red flag for factory workers with significant exposure to the food-flavoring ingredient, researchers from the University of Minnesota said in the report published in a recent issue of the journal Chemical Research in Toxicology.  Diacetyl is used to give a buttery taste and aroma to common food items such as margarines, snack foods, candy, baked goods, pet foods and other products.  The investigators pointed out that previous studies have already linked diacetyl to respiratory and other health problems among workers at microwave popcorn and food-flavoring plants.  Although diacetyl forms naturally in fermented beverages, such as beer and wine, its chemical structure is similar to a substance that makes beta-amyloid proteins clump together in the brain.  This clumping, the study authors noted, is a hallmark of Alzheimer’s disease.  In their study, the researchers found that diacetyl also increases the amount of beta-amyloid clumping in the brain.  And it worsened the beta-amyloid protein’s harmful effects on nerve cells grown in a lab where cells were exposed to the same levels of diacetyl that factory workers might be exposed to in their jobs.  The study authors pointed out that other experiments revealed that diacetyl also crosses the ‘blood-brain barrier‘, which helps protect the brain from dangerous substances.  Diacetyl also prevented a beneficial protein from protecting nerve cells.” (HealthDay)
  • White kids may get too many head CTs:  “Among children who suffered minor blows to the head, whites were more likely to receive unneeded cranial CT scans in the ED than were blacks or Hispanics, researchers found.  In a national network of pediatric emergency centers, scans were performed in 84.1% of the high-risk white children compared with 79.8% of the black and Hispanic children combined, reported JoAnne E. Natale, MD,PhD, of the University of California Davis, and colleagues.  But 17% of low-risk white children were also scanned versus 9.6% of black and Hispanic children….In the intermediate-risk children, CT scans were performed in 57.9% of whites and 50.8% of blacks and Hispanics….For many cases of mild head trauma involving white children in which the risk of clinically important brain injury was considered low, ‘parental anxiety and request’ was an important influence on the decision to order the scans.  Natale’s group wrote in the August issues of Archives of Pediatric and Adolescent Medicine.  Racial disparities in healthcare are usually presumed to reflect inadequate care for minority groups.  But Natale and colleagues noted that such disparities can also manifest as ‘overuse of care among patients of nonminority races/ethnicities’.  In this case, the clinically unnecessary CT scans exposed the children to long-term radiation hazards as well as increasing the cost of care, ‘at a time when financial restraint is increasingly emphasized,’ the researchers wrote….’Our results suggest that physician decision making about emergency cranial CT use for minor blunt trauma is influenced by patient or family race/ethnicity, particularly at the lowest level of injury severity, for which few children should undergo cranial CT to avoid irradiation’, Natale and colleagues wrote….For 11.5% of the scans ordered for low-risk white children, doctors cited parental anxiety or request as ‘one of the most important indications’, compared with 4.9% of scans ordered for low-risk minority children.  ‘Racial/ethnic disparities became more pronounced as clinical indications for cranial CT use diminished,’ the researchers concluded.”  The study indicates that waste in our healthcare system may result, at least in part, from the same factors or mechanisms that create inequalities. (John Gever, MedPage Today)
  • Trials for Alzheimer’s drug  halted after poor results: “Johnson & Johnson and Pfizer announced on Monday that they were halting development of a closely watched Alzheimer’s drug after two clinical trials failed to show that it was effective in patients with mild to moderate forms of the disease.  Late last month, results of a large clinical trial of the drug, called bapineuzumab, failed to show that patients – all of whom carried a particular gene that raises the risk of getting Alzheimer’s – improved either cognition or daily functioning compared with a placebo.  The companies announced Monday that the results of a second trial, which tested the drug on patients who did not carry the gene, also did not meet its goals.  Because the results of the earlier trial were already known, the decision to discontinue the drug was not altogether unexpected.  Bapineuzumab, like other Alzheimer’s drugs being developed, targets beta amyloid, a protein that has toxic effects on the brain and is believed to be a cause of the disease.  Given the failure of the drug, some have called that theory into question.  But Dr. Husseini K. Manji, the global therapeutic area head for neuroscience at Janssen Research and Development, a unit of Johnson & Johnson, said the failed trials did not mean researchers should abandon the beta amyloid theory.  ‘While we are disappointed in the results of the two bapineuzumab IV studies, particularly in light of the urgent needs for new advancements in Alzheimer’s disease, we believe that targeting and clearing beta amyloid remains a promising path to potential clinical benefits for people suffering from this disease,’ he said in a news release.” (NY Times)
  • Remote device monitoring saves time – if patients call in: “Remote monitoring of cardiovascular implantable electronic devices is efficient, as long as patients keep to their scheduled transmission times, researchers found.  Overall, remote interrogation of devices was faster than in-person evaluation (11 minutes versus 27)…Edmond M. Cronin, MD, from the Cleveland Clinic, and colleagues reported online in HeartRhythm.  However, 49.2% of patients — a mean of 21 a day — missed their scheduled transmissions, resulting in an average of nearly an hour a day spent on telephone follow-up with those patients.  The rate of missed scheduled remote transmissions was surprising, Cronin and colleagues said.  ‘We believe this is the first report of the magnitude of this problem in an unselected device clinic population,’ they wrote.  Patient noncompliance is more likely to occur with remote monitoring systems that rely on patient interaction and most of the systems utilized at the Cleveland Clinic require manual transmission over a landline.  Consequently, ‘once a patient is enrolled in remote monitoring, it does not guarantee their engagement with it,’  the researchers concluded.  Because of the expanding indications for cardiovascular implantable electronic devices, there has been a ‘dramatic increase’ in the number of implants, which further ‘translates into an ever-increasing burden of follow-up for device clinics.  Many in-person device interrogations do not lead to reprogramming or medication change and only a small minority of scheduled 3-month checks are ‘actionable’, they said.  Consequently, ‘clinically important patient or device events may remain undetected for a considerable time between interrogations’. …Some studies have suggested that remote monitoring saves money and reduces the risk of death by identifying actionable events earlier than in-office visits.  For these reasons, remote monitoring has been gaining acceptance.  But whether it actually reduces the total time required for each device follow-up is not known, Cronin and colleagues said.” (Chris Kaiser, MedPage Today)

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