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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 05-November-2010, Vol 123 No 1325

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 doctors

The 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 disease

Amyloid–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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