ShortCuts- This Week in the Journals

August 11, 2008


Commentary by Michael Poles MD, Associate Editor, Clinical Correlations  

Well, it is early Saturday morning and I am sitting at my keyboard with coffee in hand. Gotta figure out what interesting tidbits from the world of medicine to discuss with you. Certainly, there are plenty of timely issues; the Olympics just began. Should I discuss something related to exercise or to the smog that is enveloping the athletes? This is good coffee. It is mid-summer. Should I discuss the effect of temperature on human physiology? I keep thinking about my coffee. Perhaps that is the way to go. So many folks depend on this stuff to keep alert and active, but is it good or bad for our health? Thankfully, the NY Times has provided some answers in an article, entitled ‘Sorting out Coffee’s Contradictions.”

Caffeine is the Nation’s most popular drug and its most popular delivery system is your morning cup of Joe. Apparently your Starbucks 16oz Coffee Grande has 330mg caffeine (Red Bull has only 76mg). What are the health consequences of all of the coffee that we imbibe as a nation? First let’s dispel some myths about coffee. It appears that caffeine is not a significant diuretic; drinking up to 550mg of caffeine did not result in greater urine output. Diuresis is not seen until you drink over 575mg caffeine. Now that’s a big cup of coffee. Further, despite the stimulant effects of caffeine, daily coffee drinkers have no increased risk of heart disease, including MI, arrhythmia or sudden death. In fact, coffee may decrease the risk of cardiovascular disease. While a prior Harvard study suggested an increased pancreatic cancer risk with coffee ingestion, that idea has been largely dismissed. Coffee consumption may also decrease risk of Parkinson’s disease and type 2 diabetes. Still, coffee consumption is associated with decreased calcium intake, probably due to decreased milk ingestion, and though coffee’s stimulant effect would be expected to increase weight loss, it does not, and may be associated with weight gain. So, coffee does not seem to be harmful, and may actually be beneficial in terms of health. So go out and support your local Starbucks, Dunkin Donuts or other local coffee purveyor. Remember that coffee has been shown to enhance mood and this early in the morning, that is just what I need.

Though it is still summer, it is never too early to begin thinking about flu season. Because of the upcoming flu season, Novartis has started shipments of their flu vaccine to US health care facilities and practitioners  . This year’s influenza vaccine contains the following three strains of the influenza virus:
— A/Brisbane/59/2007 (H1N1)-like virus (A/Brisbane/59/2007 IVR-148)
— A/Brisbane/10/2007 (H3N2)-like virus (A/Uruguay/716/2007 NYMC X-175C)
— B/Florida/4/2006-like virus (B/Florida/4/2006)

It is a good idea to vaccinate as many people as early as possible this upcoming influenza season to help prevent the morbidity and mortality associated with flu each year.

The average American seeks medical care an average of four times annually. According to the CDC, this number of visits appears to have increased over the past decade, perhaps due to the aging of the populace. While this degree of health care usage undoubtedly has an impact on the rising healthcare crisis, the issue is further compounded by the degree to which medications are prescribed at these visits. 70% of these visits result in the prescription of a pharmaceutical, with analgesics leading the pack.

Obviously, humans are not the only organisms to get sick. Still, who would have thought that viruses should fear viral illnesses. French scientists identified a new strain of giant virus in a cooling tower in Paris that had been infected by a smaller type of virus, named Sputnik. Sputnik is apparently able to take up genes from the host virus and other organisms, potentially explaining high viral mutation rates.

One feared consequence of illness in children is the febrile seizure. A danish study presented in The Lancet sought to examine if febrile seizures in children are associated with mortality. They examined mortality after febrile seizures in a cohort of children in Denmark with up to 28 years of follow-up. Studying 1,675,643 children born in Denmark between Jan 1, 1977, and Dec 31, 2004, they found that of the 8,172 children who died, 232 deaths occurred in 55,215 children with a history of febrile seizures. Children with simple (≤15 min and no recurrence within 24 h) febrile seizure had a mortality rate similar to that of the background population, whereas mortality during the first 2 years was increased for those with complex (>15 min or recurrence within 24 h) febrile seizures. This finding was partly explained by pre-existing neurological abnormalities and subsequent epilepsy. Therefore, death after febrile seizures is very rare, even in high-risk children.

Finally, of interest, this week’s New England Journal of Medicine contains a clinical practice article on Malaria prevention in short-term traveler’s and a review on Monoclonal antibody therapy for B cell non-Hodgkin’s lymphoma.

Image courtesy of Wikimedia Commons