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GLG News by this Author
Analyses are solely the work of the authors and have not been edited or endorsed by GLG.
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ACE Inhibitors Decrease Cardiovascular Events in Marfan's Syndrome.
September 1, 2008
ACE Inhibitor May Ease Cardiac Risks in Marfan's Syndrome | www.medpagetoday.com
ACEI are known for their ability to reduce afterload effectively and even to contribute favorably to cardiac remodeling in heart failure. Results described, therefore, are logical, even though some "statistically significant" differences, like reduction of mean pressure by 1 mm Hg, are not clinically significant.
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Stents vs. Drugs: Same for Patients, Very Different for Providers
August 18, 2008
Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com
To stent or not to stent: presence and degree of coronary artery disease, effectiveness of medical therapy and significance of symptoms and, therefore, indications for coronary stents placement are determined by very same physicians who place stents. Stents are reimbursed 10-20 times better than medical management.
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GlaxoSmithKline (GSK): treatment of obesity
August 4, 2008
Just Sitting Back to Get in Shape: Two Pills Do teh Work of Exercise | online.wsj.com
More than half of U.S. adults are overweight, nearly one-quarter are obese and about 10% are morbidly obese. Only effective treatment of morbid obesity is gastric bypass; there is no good treatment for obesity or overweight. Acadesine was shown to be effective in the mice, and if effective in the humans will have a market of over 25% of U.S. adults.
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July 28, 2008
SIRS-Lab Pre-Announces Biomarker Based Sepsis Test | www.medcompare.com
Sepsis is a complex clinical syndrome situated in a category including SIRS(systemic inflammatory response syndrome), MOF(multiple organ failure), septic shock etc. If the biomarker is simply diagnostic, just like CRP(C-reactive protein), I doubt it is going to affect management of sepsis. If, however, this marker is essential for pathogenesis of sepsis and can be modified by therapeutic interventions, it will likely be very beneficial in the treatment, like fibrinogen split products in management of DIC.
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It is ALL about the size of the scar.
July 28, 2008
Ekkyo Describes The First Benefits Of Controlled Hyperthermia In Humans In "Lasers In Surgery And Medicine" | www.medicalnewstoday.com
Ekkyo is designing a laser device preventing and reducing scar formation. The size of the scar is almost always a major concern of the patient after any kind of operation including major life-saving cardiovascular procedures, tumor resections, transplants etc. Primary due to patients' perception, the industry of minimally invasive, laparoscopic, endoscopic, endovascular, thoracoscopic, robotic etc. procedures was created. The size of the scar associates in patients' mind with complexity of the operation. It affects, therefore, recovery time, pain threshold and need for pain meds, length of staying and utilization of hospital resources, ambulation rates and complication incidence.
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If it bleeds, it leads: "anaesthetics can make the pain worse".
June 30, 2008
Why anaesthetics can make the pain worse | www.newscientist.com
Completely misinterpreted and poorly represented study described in misleading way. Many injectable drugs (and perhaps all no-injectables), not only Propofol, cause irritation at the site of injection. Many inhalable substances (and all non-inhalable ones) irritate airway. Who would ever think of comparing these effects with pain and suffering of surgery!? Inflammation coincidentally is the essential part of healing process. Proper name for the article should be "Some medications can cause some other effects in some animals", but who would read article named like that?
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Being rich and lean is better than being poor and obese.
June 30, 2008
Obesity costs employers $45 bil a year | www.nytimes.com
The article is focused on colorful description of a single implication of a major problem. Even without being aware that obesity is major contributor to hypertension, diabetes, degenerative joint disease, depression, pseudotumor cerebelli etc., isn't obvious that caring 2-3 times more body weight leaves 2-3 less energy for doing anything else? Nevertheless, obesity is the most misunderstood and mismanaged conditions. Common concept of "healthy diet and active life style" has nothing to do for treatment of it. All known diet programs have only a short-term effect. Caloric value of exercising is incomparable with such of any nutrients. In order to maintain needed amount of essential (not synthetized by human body) nutrients and not knowing ahead how much of them will be needed, all living creatures overeat. In non-obese individuals, excessive amount of these nutrients is being excreted. In obese ones, it is being retained as fat.
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Electronic health records: need to improve either quality or quantity of medical care delivered.
June 23, 2008
Most Doctors Aren’t Using Electronic Health Records | www.nytimes.com
Difficulties in introduction of electronic records in clinical practice, in my mind, are due to the following. First, there is no improvement in quality of care and/or there is no financial benefit for majority of practices. Second, high cost of support, rather than purchase. Third, implementation is usually lengthy and requires physician's involvement, meaning time taken from seeing patients. Forth, majority of primary health care is performed in very small practices where benefit from electronic medical records is even less. Fifth, there is no usable system made for medical specialties or a system which can be easily customized for specialties. Finally, there are many products with very different, sometimes extremely unusual, language being used instead of common "File", "Edit", "View" etc. making usage of them fairly "contra-intuitive".
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Growing market for nutraceuticals.
June 18, 2008
GNC, Vitabiotics to tap domestic nutraceutical mart | business-standard.com
Over the years, I do see once in a while a patient not taking any prescribed medications. Progressively less often, however, I see a patient who is not taking any "supplements"! Growing popularity of nutraceuticals is based, in my opinion, on several factors. First, frustration of patients with overregulated healthcare industry in general and drug prescription policies in particular. Second, constant presence of placebo effect. Third, increasing quantity of life expectancy and, therefore, quality of life expectations.
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Heroic attempt of Medtronic to safe stenting market.
June 12, 2008
Medtronic Says Thrombus Aspiration Before Stenting Betters Survival Rates Of Myocardial Infarction Patients | www.rttnews.com
I believe it is a standard of practice to aspirate thrombus, if such is present, prior to placing a stent not only in coronary arteries, but also in any kind of peripheral circulation. Not only it makes sense, but also maintains the instrumented segment functional by preserving distal outflow.
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June 10, 2008
Study Finds Chinese Food Good For Your Heart | www.medicalnewstoday.com
The referred trial involves patients of 18-70 years of age who suffered a heart attack previous year. The ingredients of "XZK capsules have not been isolated and studied yet." The capsules contained "a combination of lovastatin, lovastatin hydroxyl acid, ergosterol and other components." Pills were found to reduce cardiovascular events rate and mortality by 1/3 and cancer morality by 2/3. Summary: if you happened to have MI at 17 years of age and will take combination of known and unknown drugs for 5 years, you are less likely to die from another MI and much less likely to die from any kind of cancer. It is a miracle!
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Perspectives for utilization of a new magnetic device
June 10, 2008
Magnetic device as the drug | www.medicicom.com
The effects attributed to newly invented device are not based on known principles of human physiology and, therefore, will not pass to enroll in clinical trials. Magnets were used in medicine since Hippocrates (460-360BC) for hemorrhage control. Current applications include immunomagnetic cell separation, immunoassay, magnetic resonance imaging, drug and gene delivery, radionuclide therapy hyperthermia and artificial muscle development.
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Hypoglycemia might be as bad as hyperglycemia.
June 9, 2008
Tight Rein on Blood Sugar Has No Heart Benefit | www.nytimes.com
Two studies (ACCORD and ADVANCE) designed to confirm positive effect of tight blood sugar control on the rate of cardiovascular and cerebrovascular events failed to do so. Incidence of hypoglycemia, weight gain and fluid retention, however, was significantly higher in ACCORD trial. Almost half of all cardiovascular deaths was from "unexpected or presumed cardiovascular" events. Perhaps, negative effect of hypoglycemia and weight gain, therefore, overwhelmed positive effect of intense glucose control.
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Relative ineffectiveness of chemotherapy for NSCLC
June 6, 2008
Potential lung cancer epidemic looming in Asia | www.pipelinereview.com
Drugs are relatively ineffective for NSCLC due to the following. Firstly, stage III is the main target of chemotherapy, while being very heterogenous combination of T and N criteria. Outcome results, therefore, are controversial. Next, lung cancer is more than many other malignancies is caused by an modifiable factor, smoking. The lung cancer patients, for that reason, are poorly compliant with the treatment. Finally, close proximity of major cardiovascular structures creates scenarios when even relatively small advancement of the primary tumor leads to highly morbid or lethal situation not allowing enough time for developing systemic disease susceptible to chemotherapy.
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June 3, 2008
Higher Risk of Death and Stroke in Patients Given Beta Blockers After Non-Cardiac Surgery (POISE Trial) | pharmalive.com
The heart is responsible for maintenance of systemic circulation and, therefore, perfusion of the entire body. Beta blockers protect the heart by decreasing its work and, consequently, compromise systemic circulation. It is not a surprise that the most sensitive to decreased perfusion organ, brain, suffers the most. Coincidental, systemic hypotension predisposes to infectious complications as well by facilitating bacterial translocation via barrier organs. The study contributes nothing new to known concepts of circulatory physiology. Emphasis should be placed on risk factor differentiation: which patient would benefit from beta blocker and which one would be harmed by them. Beta blockers should be considered in patients with known cardiac history, with risk factors for coronary atherosclerosis and with abnormal stress test. Since hypotension explained only a half of all strokes, carotid artery stenosis should have been considered as another risk factor.
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