ShortCuts- This Week in the Journals

October 14, 2008

300px-rogue_river_oregon_usa.jpgCommentary by Andrew McKinstry MD PGY-1

Reviewed by Michael Poles MD, Associate Editor, Clinical Correlations 

It may have been Columbus Day, but that doesn’t mean any of the journals took any time off, so here we go…

The protective effect of circumcision in HIV Infection was called into questioned by a meta-analysis published in the Journal of the American Medical Association this week. This article suggests that men who have sex with men (MSM) do not benefit from reduced HIV infection rates if circumcised, in contrast to previous studies that suggested such a benefit with heterosexual intercourse.  The study, which compiled a total of 53,567 MSM from 15 studies, found that while the circumcised group had a decreased chance of HIV infection, the difference was not statistically significant.

This past week also brought an article concerning the control of hospital-acquired infections. A task force appointed by the Healthcare Epidemiology Society of America and the Infectious Diseases Society of America Standards and Practice Guidelines Committee published these guidelines for controlling six types of common hospital-acquired infections (HAI) in the Journal of Infectious Diseases.  The guidelines specify prevention measures to avoid central line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, surgical site infections, methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection.  For each of these common HAIs, the task force issued basic practices meant to be adopted as standard of care for all hospital settings, as well as “special approaches” when those basic practices alone fail to control the various infections.

The US Preventive Services Task Force, in the latest Annals of Internal Medicine, explains why Grandpa won’t be needing that colonoscopy after all. In a move, that will likely be considered controversial, the task force has issued recommendations against routine screening for colorectal cancer (high sensitivity fecal occult- blood test, signmoidoscopy and colonoscopy) in patients over the age of 75.  They felt that due to the slow progression from precursor lesion to malignancy, patients over 75 did not gain a net benefit from the screening.  [See also: Breaking News]

As if decay of our planet wasn’t enough, a recent in vitro study, descibed in Environmental Health Perspectives, by the NIH, has provided another reason to stop using plastic water bottles. Bisphenol A (BPA), present in these bottles, has garnered significant media attention over the past few months owing to its suspected role in carcinogenesis.  The article describes this study, which demonstrated that environmentally-relevant levels of BPA increases resistance of estrogen receptor-positive breast-cancer cell lines to the common chemotherapeutic agents doxorubicin, cisplatin and vinblastine.  The exact mechanism of increased chemoresistance was not identified, though the authors postulated that increased expressions of anti-apoptotic proteins was a significant contributor.

While the preponderance of studies have not revealed a benefit, a study published in this week’s issue of Stroke suggests that Gingko Biloba extract may possibly be neuroprotective in ischemic stroke. The study, which used a mouse-model of induced ischemic CVA, showed a significantly decreased loss of neurological function and decreased infarct size in mice who had taken the extract, an effect that appears to be dependent on heme oxygenase-1 induction.  The study suggests a future role for Gingko extract in preventative or therapeutic treatment of ischemic stroke.

Lastly, an article in the New England Journal of Medicine provides data showing that long-term tiotropium use is beneficial in COPD. This four-year randomized, double-blind placebo-control trial of tiotropium use in patients with COPD mirrored earlier findings of shorter-term use of this agent in COPD- namely, showing an improvement in lung function, quality of life, and exacerbations without any significant reduction in the rate of decline of lung function as measured by FEV1.

Image courtesy of Wikimedia Commons