Long-term benefit found for glucosamine in osteoarthritis
Trial results suggest that glucosamine sulphate is a beneficial disease
modifying agent in osteoarthritis.
Researchers investigated the effect of glucosamine sulphate on the progression
of osteoarthritis over a three-year period. A total of 212 patients aged
over 50 with osteoarthritis of the knee were assigned 1,500mg glucosamine
sulphate or placebo once daily. After three years, there was, on average,
no significant joint-space loss in patients who received glucosamine sulphate.
In contrast, patients who received placebo had significant joint-space
narrowing.
Patients were also assessed for symptoms of osteoarthritis using a symptom
score (WOMAC score). Patients in the glucosamine group had, on average,
a 24 per cent improvement in symptoms according to the WOMAC score, compared
with a 10 per cent worsening in the placebo group.
There were no differences between groups in terms of safety, say the researchers.
A similar number of patients in each group did not complete the three-year
study and there were no significant differences in the reasons for withdrawal.
Routine laboratory tests did not show any general system or metabolic
changes, including glycaemic homeostasis (as had been suggested by some
experimental models).
The researchers note that the precise mechanism of action of glucosamine
sulphate is not known. They suggest that the long-term effects recorded
in this study could be a result of reported effects of the compound on
cartilage metabolism. This could include stimulation of anabolic activities,
and the depression of catabolic activities (Lancet 2001;357:251).
Commenting on the use of nutritional supplements as therapeutic agents,
Dr Tim McAlindon (arthritis centre, Boston university, United States)
said in a leading article: “Health care professionals generally expect
to be involved in medical decisions,” but are “not regarded as a repository
of objective advice about nutritional products . . . This situation must
change.” (ibid, p247.)
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Urgent need for early identification of spinal fractures,
say researchers
Almost 20 per cent of women with postmenopausal osteoporosis who suffer
a spinal fracture will suffer an additional fracture within a year, according
to the results of a new study. Dr Robert Lindsay (Helen Hayes hospital,
New York, United States) and colleagues analysed data from four three-year
osteoporosis trials. The analysis looked at women who had been randomised
to receive placebo in the trials.
Vertebral fracture status was recorded in 2,725 women at entry to the
trials. The researchers found that new vertebral fractures occurred in
381 subjects, 67 per cent of whom had asymptomatic fractures. The presence
of one or more previous vertebral fractures at the start of the trial
increased the risk of sustaining a vertebral fracture during the initial
year by five-fold compared with the incidence in subjects without previous
vertebral fractures, they say.
Overall, occurrence of a second vertebral fracture within one year of
the initial fracture was 19.2 per cent (95 per cent confidence interval,
13.6-24.8 per cent).
The researchers comment that their finding has important clinical implications
and occurred despite subjects receiving 1,000mg calcium each per day and,
in some cases, supplemental vitamin D. “The increased fracture risk in
the immediate period following a fracture demonstrates the urgency of
identification and intervention,” they say. (Journal of the American
Medical Association 2001;285:320.)
In a press release issued on behalf of Aventis Pharma and Procter & Gamble
Pharmaceuticals (the respective manufacturers of the bisphosphonates risedronate
and etidronate in the United Kingdom), Professor Cyrus Cooper (professor
of rheumatology, University of Southampton, and co-author of the study)
said: “The study shows the first vertebral fracture is a dramatic turning
point converting a frequently symptomless condition to a rapidly progressing
disease that requires rapid treatment.”
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High impact activity may reduce hip fractures
Researchers from the University of Cambridge have found that men and
women who regularly participate in high impact physical activity may be
at lower risk of hip fracture. High impact activities included step aerobics,
jogging, football and netball.
In the population based study, the researchers looked at the association
between reported physical activity and ultrasound attenuation by the heel
bone in 2,296 men and 2,914 women. Low ultrasound attenuation is associated
with a higher risk of hip fracture, they say.
They found that men who reported participating in two or more hours of
high impact activity had 9.5 per cent higher ultrasound attenuation than
men who reported no activity of this type. Women who reported any high
impact activity had 3.4 per cent higher ultrasound attenuation than those
who reported none. There was no association with moderate or low impact
physical activity, they say (British Medical Journal, 2001;322:140).
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New disinfectant against MRSA?
Researchers from Japan report that a new disinfectant, OPB-2045 (Otsuka
Pharmaceuticals), may be useful for the prevention of methicillin-resistant
Staphylococcus aureus (MRSA) infection.
A study showed that OPB-2045 had strong bactericidal action against MRSA
and suggested that the disinfectant may act on the cell wall of the bacteria.
The researchers say that OPB-2045 would be a useful disinfectant against
MRSA but caution that its activity is diminished in the presence of organic
material, so care would be needed when using it in dirty conditions (Journal
of Pharmacy and Pharmacology 2000;52:1547).
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Dexamethasone: “lack of benefit” in premature infants
Early administration of dexamethasone to prevent chronic lung disease
is not advisable in extremely-low-birth-weight infants, say American researchers.
In a study to test the effects of moderate doses of dexamethasone in premature
infants, Dr Ann Stark (Brigham and Women’s hospital, Boston) and colleagues
found that treatment with dexamethasone did not reduce the risk of death
or chronic lung disease. In addition, they saw a high rate of spontaneous
gastrointestinal perforation in the dexamethasone-treated infants, which
resulted in early termination of the trial.
The researchers randomly assigned 220 infants with a birth weight of 501g
to 1,000g, who had been treated with mechanical ventilation within 12
hours of birth, to receive dexamethasone or placebo. Treatment was started
within 24 hours of birth at a dose of 0.15mg/kg daily for three days,
followed by a reduction in dose over seven days.
They found that the relative risk of death or chronic lung disease in
the dexamethasone-treated infants, compared with the placebo group, was
0.9 (95 per cent confidence interval, 0.8 to 1.1). Infants in the dexamethasone
group were less likely to receive oxygen supplementation 28 days after
birth or to be diagnosed with pulmonary interstitial emphysema, than those
in the placebo group. However, the frequency of pneumothorax, pulmonary
haemorrhage and patent ductus arteriosus was similar for both groups.
The dexamethasone-treated infants were more likely to have hypertension
or to be receiving insulin treatment for hyperglycaemia, the researchers
say.
During the first two weeks after birth, the occurrence of spontaneous
gastrointestinal perforation in the dexamethasone-treated infants was
more than three times that in the placebo group (13 per cent versus 4
per cent). The risk of perforation appeared to be increased by concomitant
indomethacin treatment, say the researchers.
They conclude: “Given these serious complications and the lack of a discernible
benefit, we believe that early treatment with dexamethasone to prevent
chronic lung disease in extremely-low-birth-weight infants is not indicated.”
(New England Journal of Medicine 2001;344:95.)
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Study shows benefit for irbesartan
More patients persist with treatment with irbesartan (Aprovel) than
with other antihypertensives, a study has shown.
The study was based on an analysis of general practitioners’ records for
2,416 patients. It showed that more patients stayed on monotherapy with
irbesartan than with other antihypertensive therapies (61 per cent versus
44 per cent, respectively). In addition, it indicated that more patients
persisted with initial antihypertensive regimens that contained irbesartan
than did with regimens containing other antihypertensive agents, including
other angiotensin II receptor antagonists. The findings were presented
at an international forum on angiotensin II receptor antagonism in Monte
Carlo on January 25.
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Triclosan may protect against malaria, say researchers
Triclosan, an antimicrobial agent used in mouthwashes, skin cleansers
and deodorants, may be effective for treating malaria, say researchers
from India.
Dr Namita Surolia (Jawaharlal Nehru Centre for Advanced Scientific Research)
and colleagues found that, following infection of mice with Plasmodium
berghei (a model for human malaria), a single subcutaneous injection
of triclosan 38mg/kg completely cleared the malaria parasite from circulation.
A single injection of triclosan 3mg/kg inhibited 75 per cent of the parasitaemia
within 24 hours of administration and no side effects were observed at
a dose of 40mg/kg, say the researchers. Triclosan was also found to inhibit
the growth of Plasmodium falciparum in vitro.
The researchers say that triclosan is effective because it inhibits the
action of the parasitic enzyme enoyl-ACP reductase (FabI) which is involved
in the biosynthesis of type II fatty acids (Nature Medicine 2001;7:167).
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Lung disease linked to poor oral health
Poor oral health may increase the risk of serious pulmonary disease,
say American researchers.
Dr Frank Scannapieco (school of dental medicine, State University of New
York, Buffalo) and colleagues found an association between chronic respiratory
disease and periodontal disease in an analysis of data from the third
National Health and Nutrition Examination Survey (NHANES III).
The survey used data from sources that included (i) questionnaires that
had been completed by participants, (ii) a physical examination, which
had measured participants’ forced expiratory volume, and (iii) a dental
examination, which had assessed the loss of gum attachment supporting
the teeth, the amount of gum bleeding, the number of cavities and the
number of teeth.
The researchers found that in the 13,792 eligible participants, lung function
appeared to diminish as the amount of gum-attachment loss increased. This
suggests that periodontal disease activity may contribute to chronic obstructive
pulmonary disease, they say.
Commenting on the link between chronic respiratory disease and oral health,
Dr Scannapieco said: “It is possible that improved oral health is one
factor that may help prevent progression of this disease, which is responsible
for 2.2 million deaths a year worldwide.”
The study is published in the Journal of Periodontology (2001;72:50).
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Tooth protection - a consequence of HRT?
Women who have used hormone replacement therapy (HRT) have more of their
own teeth than women who have not, according to a review of 20 studies
by Bandolier (2001;[Jan]:83).
The studies, which were published between 1980 and 1998, included 13,700
postmenopausal women with documented osteoporosis. Overall, 47 per cent
of the women used dentures but this increased to 69 per cent for the women
who had no history of HRT use. Only 27 per cent of the women who had used
HRT had dentures and they also had more remaining teeth than the no-HRT
women (22 teeth versus 16 teeth, respectively).
The review estimates that HRT use saves an average of £71 per year in
dental treatment for each woman treated and concludes: “HRT use prevents
costs elsewhere.”
Bandolier can be accessed through its webpage (www.jr2.ox.ac.uk/Bandolier).
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UK study shows increase in childhood obesity
There has been a substantial increase in the prevalence of childhood
obesity in the United Kingdom since 1984, a study has shown.
Dr Susan Chinn and colleagues (King’s College London) estimated the percentage
of white children aged between four and 11 years who were overweight or
obese, using data from the national study of health and growth which started
in 1972. They found that between 1984 and 1994, the percentage of overweight
boys in England increased from 5.4 per cent to 9 per cent (out of a total
of 10,414) and in Scotland from 6.4 per cent to 10 per cent (out of 5,385).
Values for girls showed an increase from 9.3 per cent to 13.5 per cent
for English girls (out of 9,737) and 10.4 per cent to 15.8 per cent for
Scottish girls (out of 5,219). The greatest increase in the prevalence
of overweight children was seen in the nine to 11 age group. The prevalence
of obesity increased correspondingly in all age groups.
The researchers comment that “the rising trends are likely to be reflected
in increases in adult obesity and associated morbidity” (British Medical
Journal 2001; 322:24).
A report, “Couch kids: the growing epidemic”, published by the British
Heart foundation last year (PJ, June 10, 2000, p872
and p889) highlighted
the importance of physical activity for young people.
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Sandoglobulin supply reduced
Supplies of Novartis Pharmaceuticals’s Sandoglobulin (normal immunoglobulin
for intravenous use) have been reduced in the UK. This is because the
manufacturer of the product, ZLB Bioplasma, is unable to maintain supplies
to Novartis globally
Novartis recommends that, until further notice, no new patients should
be started on Sandoglobulin. All patients being treated for acute conditions
(courses of up to five days’ duration) should complete their current course
only, and thereafter an alternative product should be given. Patients
receiving long-term treatment with Sandoglobulin in hospital should be
given an alternative product as soon as possible, and preferably by the
end of February. Patients receiving long-term therapy with Sandoglobulin
at home should continue on this treatment, pending further advice. The
company further recommends that patients who have had adverse reactions
to other intravenous immunoglobulins but tolerate Sandoglobulin should
continue on this product until their physician has discussed the issue
with Dr Michael Zalac at Novartis (tel 01276 698791).
Novartis has set up a website to help clinicians manage supplies (see
p169).
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Afternoon glucose tests can miss undiagnosed diabetes
Half of all cases of undiagnosed diabetes could be missed in patients
examined in the afternoon, say researchers from the United States.
In a US population-based survey conducted between 1988 and 1994, the fasting
plasma glucose levels of patients tested in the morning were compared
with those seen in patients tested in the afternoon. Mean fasting plasma
glucose levels were found to be higher in the morning group than in the
afternoon group (5.41 mmol/L versus 5.12 mmol/L).
Consequently, the prevalence of glucose levels indicating diabetes in
afternoon subjects (1.4 per cent) was half that of the morning subjects
(2.8 per cent). The researchers add that because of the consistent decline
in fasting plasma glucose throughout the morning, even the difference
between 8am and 10am glucose levels can be significant. They recommend
repeating the test on a different day, preferably in the morning, to confirm
a diagnosis. The study is published in the Journal of the American
Medical Association (2000;284:3157).
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