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Is incidence of type 2 diabetes related to fruit and vegetable intake?This meta-analysis reviews data from 6 studies involving
more than 220,000 subjects. The pooled results shows that increased consumption
of fruit, vegetables, or both showed no benefit in incidence of type 2 diabetes.
However, 4 of the studies had data on the intake of green leafy vegetables and
those with high intake of these had a significant reduction (14%) in the
incidence of type 2 diabetes.
An editorial commentary commends the study and notes that
the finding is independent of weight loss. He also points out that there are
other relevant lifestyle modifications—e.g. decreased caloric
intake—that will decrease the incidence of type 2 diabetes and its
consequences.
BMJ 2010;341:c4229 &
c4395.
Psychiatric morbidity and hazardous alcohol use in Australian doctorsThe mental health of doctors is an important issue for their
patients. This study involves a postal survey of 2999 doctors (including all
major specialty groups, trainees and general practitioners) insured with an
Australian medical insurance company.
The authors report that the personality trait of neuroticism
was most strongly associated with psychiatric morbidity. In addition,
work-related factors including experiencing a current medicolegal matter, not
having had a holiday in the past year, and working 60 or more hours per week
were also significantly associated with psychiatric morbidity.
Hazardous drinking of alcohol was found to be related to
demographic and personality traits rather than work-related, and included being
male, having an Australian medical degree, neuroticism and extroversion.
We would not be surprised if these findings were also
representative on our side of the Tasman.
Med J Aust
2010;193:161–6.
Rosiglitazone and the US Food and Drug Administration (FDA)When this drug was first introduced it was widely proclaimed
that it was a great innovation as it was capable of lowering the glycated
haemoglobin by 1% and would obviously be beneficial to those with type 2
diabetes.
But in 2007, a meta-analysis of controlled clinical trials
found increases in the risk of myocardial infarction and a near-significant
increased risk of death from cardiovascular causes when rosiglitazone was
compared with placebo or with standard diabetes drugs.
Since then, GlaxoSmithKline (the makers) and the FDA have
had a dialogue on whether or not this drug is safe. Currently the FDA is
restricting access to rosiglitazone by requiring the drug sponsor to submit a
Risk Evaluation and Mitigation Strategy.
Others suggest that the drug should be withdrawn, or
probably never have been licensed.
N Engl J Med
2010;363:1489–91.
Risk of birth defects after the use of antiviral agents in the first trimester of pregnancy?The antiviral agents acyclovir, valacyclovir, and
famciclovir are used in the treatment of herpes simplex and zoster. Generally
speaking they are regarded as efficacious and safe.
The authors of this Danish study review their safety in
terms of birth defects when used in the first trimester. Their study is a
population-based cohort study involving over 800,000 live-born infants. They
found a 2.2% incidence of major birth defects in those whose mother had had
antiviral treatment in the first trimester. However the incidence rate was 2.4%
amongst those not exposed to the antiviral drugs. Somewhat reassuring, however
an editorial points out that the data mainly relates to acyclovir, which was the
drug used in 86% of cases.
JAMA
2010;304(8):859–66 & 905–6.
Another disappointment in the treatment of Alzheimer’s diseaseAmyloid–β plaques are regarded as the defining
lesions in Alzheimer’s disease and the drug company Eli Lilly have
produced a drug, semagacestat, which blocks the enzyme γ-secretase, which
helps to produce amyloid-β. However, preliminary data from two large trials
involving more than 2600 patients are disappointing as no clinical improvement
have been noted.
Furthermore the drug seems to increase the risk for skin
cancer, presumably because γ-secretase also processes several other
important proteins, including epidermal growth factor receptor—the loss of
which causes skin cancer in animal models.
The trials have been halted.
Nature
2010;466:1031.
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