What's the Buzz in Medicine?

Swine Flu Back in Season

July and August may be summertime in Southern California, but in the Southern Hemisphere these months bring cold and rain --- and something else: flu season.

The H1N1 virus responsible for the "swine flu" pandemic in June, 2009, has continued to propagate during the Southern Hemisphere’s winter months. While the World Health Organization (WHO) states that the virus is stable, it is expected to return to the United States within a matter of weeks.

Tests for a vaccine against the swine flu began in earnest in late July, 2009, with batches anticipated to be available to the public by September; the first set of volunteers received their shots this week. The U.S. government has already outlined priorities for who should receive the vaccine first: pregnant women, children and young adults ages (6 months to 24 years), and healthcare workers. Furthermore, the Center for Disease Control and Prevention (CDC) cautions that people are at higher risk if they have underlying conditions such as asthma, diabetes, obesity, heart disease or a weakened immune system.

One important note: don’t look to Tamiflu for help. Researchers from Oxford University recently published a study in the British Medical Journal which demonstrated no clear benefit from the anti-flu medication for the swine flu, including no difference in asthma flare-ups or the likelihood of children needing antibiotics.

Experts at the National Health Institute urge that the pandemic is cause for preparation, not panic. U.S. federal officials have recommended that schools remain open.

Stay informed about how best to prepare for the early flu season and be notified when vaccines are available by subscribing to our daily updates. You’ll know what the buzz is if you sign up for:

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Commonly-used Painkillers Linked to Sudden Death.

After Vioxx (generic name: rofecoxib) was pulled from the US market several years ago (due to its association with heart problems and sudden death), a question lingered: what about other anti-inflammatories? Will Aleve trigger sudden death?

At the recent annual meeting of the American College of Cardiology, Frederik Folke, MD, reported the results of his study involving 12,000 Danes who experienced sudden cardiac arrest earlier in the decade. Folke used the nationwide pharmacy dispensing records to discover which of those in the study had been on anti-inflammatory medications. The study confirmed the Vioxx link with sudden cardiac death. More disturbing, however, was the association of two other commonly-used painkillers in the US to a doubling of cardiac death cases: Voltaren (generic name: diclofenac) and Celebrex (generic name: celecoxib).

Anti-inflammatories with no association with sudden death included ibuprofen, Alleve, and Naprosyn.

Folke warned the ACC that the frequent prescribing of Voltaren and Celebrex may increase risk of sudden cardiac arrest if not used judiciously.

Adding to this concern is the recent review, published just weeks ago in the American Journal of Cardiology (Mount Sinai School of Medicine, New York). The review confirmed most of the same findings of the Danish study. It isn’t reassuring that these studies follow on the heels of an article in Cardiology Clinics (November 2008, University of Wisconsin) basically supporting the same conclusions made by Folke.

At this time, the Medical Director for Caduceus Medical Group recommends extreme caution in taking Celebrex and Voltaren to any patient who is at a high risk of heart disease. Depending on the patient’s risk factors, cardiac testing such as a treadmill or stress echo may be warranted prior to beginning these two medications. It may also be wise to consider a consultation with a cardiologist if the safer anti-inflammatory pain medications are not successful.

US Preventive Services Task Force issues differing opinion on daily aspirin use, limiting its benefits to specific age groups and gender. So, how do we answer the question: "Doc, should I be taking a daily aspirin?"

The United States Preventive Services Task Force (USPSTF) officially confirmed that daily aspirin is beneficial in preventing heart attacks and strokes. However, drawing on data from recent studies, the USPSTF concluded that aspirin therapy reduces the risk of heart attacks and strokes in appropriate candidates. The USPSTF recommendations differ from those of the American Collge of Cardiology, as well as the American Heart Association. Those groups recommend daily aspirin in high-risk patients, but offer no age or gender recommendations.

The USPSTF is known for being very demanding with evidence prior to making any type of recommendation. Its last mention of aspirin to prevent heart disease was in 2002, when it believed there was not enough data to make any specific recommendations on aspirin use as a therapy.

The current guidelines recommended by the USPSTF:

• All men aged 45 to 79 years who have few risks of aspirin-related side effects and who have potential benefits in terms of their risk reduction.
• Women aged 55 to 79 years of this same category.
• Dosage: one aspirin per day of approximately 75 mg.

The outcome study clearly showed a lower risk of heart attack and stroke in male candidates and the risk of stroke only in female candidates. Caduceus supports the stance taken by the USPSTF and welcomes the simplicity of the guidelines.

This makes it much easier to answer the question: "Doc, should I be taking a daily aspirin?"

The American College of Physicians offer guidelines on screening for osteoporosis in men.

Even though osteoporosis is usually thought of as a disease that affects women, fractures due to thin bones also result in considerable morbidity and mortality in men. One of the main reasons may be the disease is substantially under diagnosed and under treated in the male population.

The American College of Physicians in a study published in the Annuals of Internal Medicine in May 2008 found that androgen deprivation is a strong predictor for osteoporosis and fractures in men. A thin body mass, cigarette smoking, low oral calcium intake, physical inactivity, as well as oral cortisone use were also noted to be risk factors for osteoporosis in men.

The ACP concluded the physician should order Dexa scanning for men who are at increased risk for osteoporosis, preferably before age 65. No studies have evaluated the optimal interval for repeat Dexa scanning. The ACP recommended that Dexa scanning is the standard for diagnosing osteoporosis in men.

New Synvisc requires only one injection for successful knee pain relief

Synvisc-One has been approved by the FDA for the relief of pain associated with osteoarthritis of the knee. Previously, Synvisc required three injections over several months to achieve successful pain relief in osteoarthritis. The new Synvisc-One may extend the benefits of this approach to a broader set of patients as well as reducing the cost of the treatment.

Synvisc was first approved in the United States in 1997 and has been in use worldwide for more than 16 years. It has proved successful in pain relief as well as reducing the need for total knee replacement surgery.

"Patients suffering from osteoarthritis may experience clinically significant pain relief for up to six months, and for some patients this pain relief can potentially translate into a delay in the need for total knee replacement," said Dr. Jack Bert, President of the Arthroscopy Association of North America and Clinical Professor at the University of Minnesota School of Medicine.

Synvisc injection is a procedure in which hyaluronic acid is injected into the knee joint to replace synovial fluid that typically becomes degraded in patients with arthritis. In the synovial fluid, hyaluronic acid relieves pain and improves the knee’s natural shock-absorbing abilities.

M.D. CONSULT CONTRIBUTED TO THIS STORY.