25 years ago there was the invention of cochlear implants for people with sensorineural deafness. The first ones were unwieldy and didn’t work very well, yet look at where they are now. Now, we have the invention of the first retinal implant. [more]
This is a very new prototype, and one that as yet can only allow people to make out colours. And yet, it is a huge step forward in the world of vision. Few people expected that we would be anywhere near having a retinal implant in 2010, and yet here we are. Yet again, the search for better health helping drive forward technological innovation.
What’s happening in the world of medical journals this week?
- The use of buprenorphine instead of methadone in opioid dependant pregnant women [more]
- How the Haitian cholera epidemic came to pass despite there being no record of cholera in Haiti for 100 years [more]
- Breast cancer suvivors can now do weightlifting without worrying about increasing chances of lymphoedema! [more]
- A new drug for children with acute lypmhoblastic leukaemia [more]
- We all know about MRSA and C. diff in the developed world, but what of healthcare-asscoiated morbidity in the developing world? Perhaps unsurprisingly the infections tend to be different to the ones we are used to [more]
- Use of varencicline to help people stop smoking ‘smokeless tobacco’ [more]
According to a new study in JAMA, detection of highly sensitive troponin T in the blood can be an predictor for future cardiovascular morbidity. [more]
Essentially, troponin is a product of the breakdown of cardiac muscle. There are various types of troponin, and unfortunately it can be raised not only after a heart attack, but in other conditions that put strain on the heart, such as heart failure or pulmonary embolism. Furthermore, it can also be elevated in people with chronic kidney disease and in sepsis, not to mention other conditions. Thus, the more sensitive a troponin test you can do (by making it search only for heart specific troponin), the better.
This study used a ‘highly sensitive’ troponin, which was meant to do just that. So should you be going to your doctor to ask for this?
Well, of course you should ask your doctor certainly if you have any questions. However, as stated above, there is a difficulty in knowing the cause of the raised troponin. Of course, having a raised troponin likely indicates that there is some sort of ‘badness’ going on somewhere, and it is unsurprising that an elevated level is not a good thing. But looking at the study, we can also see that there was a significant portion of people who had a raised troponin who were perfectly healthy.
This very much is a work in progress, and it certainly is not a test to be done randomly. futuremedicine is of the belief that in fact troponins should only be done in hospital, and should only be taken as part of the work-up for a patient. This reminds us of the old debate about CRP, another biomarker.
This is the conclusion by the Department of Health for 17% of England hospitals. [more]
futuremedicine does not work in England, however judging on where it does work, it can certainly believe this conclusion (and actually is surprised it isn’t more!). Many hospital buildings were of course built in the Victorian age, but unfortunately even the ones built in the 70s are all past it. The problem is poor planning back then, combined with the rise in the ageing population. This of course doesn’t take into account the increased expectations of the modern age (who want’s mixed-sex wards?) and the increasing trend towards single rooms (or lack of them) for infection control purposes.
Interestingly, many new hospitals seem to be smaller in bed capacity than the ones they are designed to replace.
futuremedicine thinks that this may be a recurring theme in the future.
So, while oncology continues to get billions of pounds pumped into it to find the next new wonder drug, someone has been busily studying a positively ‘ancient’ drug, aspirin. [more]
According to this study, daily can reduce the incidence of various malignancies. Indeed, with it’s recommendations for cardiovascular disease, perhaps everyone should be on aspirin?
But what of the negative aspects? The increased risks of GI bleeding? That of course is the main one, but there are tinnitus, angioedema and other bleeding risks.
Aspirin of course has previous in this – there was at one stage a suggestion that everyone above a certain age should be prescribed aspirin for cardiovascular prevention – it was later found that this wasn’t actually as beneficial as first thought.
This study also has to be taken with caution – the intention of these studies was not to study the effects of aspirin in cancer – I suspect a trial for this will not be conducted anytime soon. And of course, there is the question of cause and effect.
Of course, this does show the problem with many of our potential cancer management strategies – using a sledgehammer to crack a nut.
Plans for routine screening of prostate cancer have been shelved in the UK. [more]
There is a simple blood test called the PSA – levels of this hormone increase in prostate cancer. So what’s the problem?
Well, levels increase in many other conditions – prostate infections, after trauma and after sex to name a couple. So, it’s easy to see how a positive level could cause some unnecessary anxiety and lead to potentially unnecessary invasive investigation. One of the problem is of course, there is no good way to look at the prostate cells without being invasive.
Also, people who do turn out to have prostate cancer which is localised can have a very good prognosis. A common saying is that “people die with prostate cancer, rather than die of it”. It is difficult to measure the benefit of resecting a prostate cancer, rendering the patient cancer-free but also erection-free and incontinent, when the cancer may not have progressed for 15 years.
This contrasts with well established screening programmes such as cervical or breast, where there is more definite benefit as well as a more direct screening method. If the prostate was outside the body, rather than inside, we may have seen a different recommendation.
The first thing people often think of in health in Sub-Saharan Africa is the HIV/AIDS epidemic. And while this is of course a major concern, it can lead to other health issues being pushed to the background.
Meningitis is not often thought of as being epidemic anywhere, let alone Africa, yet it kills millions each year.
The ideas behind the generation of a vaccine for the condition could potentially be transposed to numerous other diseases. Along with money, infrastructure and education, health is one of the things I believe can help Africa progress and develop.