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What's New in Medicine?

By Richard Cardosi, M.D.

Let’s review some new topics and studies in medicine.

Allergies and Asthma – It seems that a lot of what we used to think about allergies may be wrong. It’s certainly been turned on its head. One study looked at Amish children in Indiana compared to Hutterites in South Dakota. It found that the incidence of asthma was much reduced in the Amish children who live in a traditional farming environment, compared to the Hutterites, who live on modernized farms with a greatly decreased exposure to allergens.

Another study in The Lancet also showed that by giving children a probiotic while increasing the amount of peanuts eaten, that 80 percent were able to be cleared of any sign of allergy. The bottom line is that it seems that we as humans evolved in an environment where immune systems have work to do.  Perhaps in the absence of an enemy to fight, the immune system will just as soon fight itself.  Of course, these therapies should be utilized only under the direction of a physician skilled in this area of medicine.

Antacid Medication – Drugs like Prilosec are among the most commonly prescribed medications in the world for stomach acid. What isn’t as well-known is that stomach acid protects against infections that cause gastroenteritis, also known as “stomach flu,” and C. Diff (clostridium difficile colitis), an infection that results after antibiotic usage in some individuals. Stomach acid also is integral in the absorption of vitamin B12. It’s reasonable to limit the use of these medications when possible.

Appendicitis – Although appendectomy remains the treatment of choice for most children with early uncomplicated appendicitis, non-operative treatment with antibiotics is an alternative for select patients and is successful 88 to 98 percent of the time. Unfortunately, appendicitis might return in the future whereas with an operation, it never can.

Aspirin for Prevention of Heart Disease – The old recommendation of taking aspirin to prevent heart disease is out the window. It turns out that if you don’t have risk factors for heart disease, the risks of bleeding may outweigh the benefits of taking aspirin. Please consult your doctor before discontinuing any aspirin regimen.

Bleeding After Childbirth – Postpartum hemorrhage or bleeding after childbirth is the leading cause of maternal death worldwide. An inexpensive generic blood clotting drug called TXA (tranexamic acid) reduces death due to postpartum hemorrhage and reduces the risk of death by as much as 31 percent.

Colon Cancer Screening – The U.S. Preventive Services Task Force issues guidelines on screening and recommends a colonoscopy at age 50 to reduce the incidence of mortality of colon cancer.  In addition to colonoscopy, there are other viable alternatives for screening.  Please discuss with your doctor which option is most appropriate for you.

Diabetes Mellitus – It’s commonly been taught that the only way to achieve good blood sugar control is to test your blood sugar through a fingerstick. In a study in The Journal of the American Medical Association it was found that routine self-monitoring of blood glucose levels did not significantly improve hemoglobin A1c levels for most patients with non-insulin treated diabetes mellitus type 2.

Football and Brain Health – In a study of 202 deceased football players, CTE (chronic traumatic encephalopathy) was diagnosed in 177.  Upon examination, it was not present in two pre-high school players, but was diagnosed in three of 14 high school, 48 of 53 college, and 110 of 111 National Football League players. Severity of the disease correlated with the level of play. The longer one played at the higher level the more likely the individual is to have brain damage. This is a very worrisome study but could be subject to selection bias.
          
Government Guidelines – Doctors are required to follow government guidelines in regard to counseling about high blood pressure and cigarette smoking. The government also monitors the doctors’ use of antibiotics and bronchitis, where antibiotics have never been shown to provide benefit.  Guidelines also call for the use of a decision tree to see if a patient needs a CAT scan after a blow to the head. The guidelines will show when a CT should be avoided since the risks of radiation probably outweigh the benefits.

Hives – A new study in The New England Journal of Medicine compared antihistamines alone and antihistamines with steroids for the treatment of hives.  It found no significant difference in the resolution of the hives between the groups.  If you have hives and don’t have any swelling of the lips, throat or tongue, skip the steroids!

Narcotic Addiction – Surveys of high school seniors in the United States show that the use of prescription opioids is strongly correlated with misuse in adolescence and that this abuse typically follows medical use by the patient.  Healthcare providers especially should be aware and avoid narcotics whenever possible and use the lowest effective dose in minimum quantity. Parents must talk to their children about their own health and help them understand the importance of avoiding strong drugs.       

In a study in the United States of more than 1,000 adults with prescription opioid use in the last 12 months, only 9 percent reported safe storage of their medications. In further analysis, in households where there were children younger than 18 years of age in the house, safe storage was reported in fewer than a third of the households.  Keep your family safe; lock up narcotics and dispose of any unused pills.  

Reproductive Health – One study of European men showed that their sperm count has dropped 60 percent in the last 40 years for unknown reasons. Luckily men produce many more sperm than are needed for reproduction.  Reasons for this are unclear.

Steroids – Drugs such as prednisone are commonly prescribed short term for a variety of medical conditions. Within the last three years, fully one in five insured Americans have received a prescription for these drugs for short-term treatment.  There is widespread consensus that they are helpful for conditions such as COPD (chronic obstructive pulmonary disease) with wheezing and asthma, or inflammatory bowel disease. However, the drugs are also given for many conditions where their benefits are questionable, including sciatic nerve pain, upper respiratory infections and allergies.

One study from The British Medical Journal showed that there is substantial risk of harm from these drugs. It found an increased risk of fracture, blood clots and sepsis for the short-term use of these drugs. The most prevalent harm was from fractures, which occurred 21 times out of 1,000. Clearly these drugs can be very helpful but should be reserved for conditions where they have shown benefit.

Tick-borne Diseases – The tick is rapidly becoming the vector of choice for a variety of different diseases in North America.  Adding to the well-known list of Lyme disease and Rocky Mountain spotted fever are Heartland virus, rickettsial diseases and relapsing fever.  The unchecked growth of the deer and raccoon populations has provided a rich reservoir for the survival and spread of ticks, some of which have nymph forms smaller than the head of a pin.

 

Richard Cardosi, M.D.

The landscape of medicine is constantly changing. Only through controlled scientific data can we make good recommendations that benefit health. The three main things everyone can do to promote good health are to stop smoking or never start, take care of your high blood pressure, and exercise.

Richard Cardosi, M.D., is the Facility Director of the Dearborn County Hospital Emergency Department.  He is affiliated with TeamHealth Emergency Medicine, Northeast Group.

Richard Cardosi, M.D.

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