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New England Journal of Medicine

Drug cuts deaths, hospital stays in heart attack patients

A drug that blocks a heart-harming hormone can significantly reduce the risk of death and hospitalization in heart attack patients who have heart failure, with minimal side effects, a new international study released today shows. The life-saving effect began soon after patients begin taking the drug, called eplerenone, following their heart attacks. The effect was especially strong if patients were also on other heart medications, according to the results of the randomized, double-blind, placebo-controlled study of 6,632 patients in 37 countries.

Researchers identify ocular side effects of commonly prescribed drugs

Drugs commonly prescribed to osteoporosis and cancer patients may also cause serious ocular side effects in some cases. That’s the conclusion of a study published today by scientists at the Oregon Health & Science University Casey Eye Institute. This research is expected to alert physicians to monitor patients for eye problems not previously associated with the drug. The announcement may also help physicians identify problems earlier, therefore preventing long-term sight damage. Finally, this finding may prompt drug companies to update their product labeling, forewarning physicians and users.

Estrogen plus progestin not helpful to quality of life in postmenopausal women

Taking a combination of the hormones estrogen and progestin does not improve the quality of life for women who are free of menopause-related symptoms, but does expose them to a slightly higher risk of heart attacks, strokes and breast cancer, a new multi-center national study concludes. For that reason, medical scientists now recommend against the combined therapy in the absence of such symptoms.

New drug combo improves survival in aggressive bone cancer

Adding two experimental drugs to the standard four-drug chemotherapy regimen has significantly improved survival in patients with non-metastatic Ewing?s sarcoma, a highly malignant bone cancer of children and young adults. The large multi-institutional trial showed that the overall survival rate increased from 61 percent to 72 percent for Ewing?s sarcoma patients with localized disease who underwent the experimental six-drug chemotherapy.

This is your heart on drugs

The largest-ever study of cocaine users who suffered heart-related effects from taking the drug finds that a specially designed plan of emergency-room care for such patients can save both lives and money. Such plans have been in place for traditional chest pain patients for years, and many hospitals set aside part of their ERs to hold them for observation. But doctors have lacked criteria to help them decide how long to hold patients whose chest pain was caused by cocaine – even as millions of Americans are using the drug.

Health benefits of moderate drinking may not apply to African Americans

The widely reported health benefits of drinking a moderate amount of alcohol do not extend to African-Americans, according to a new study. These findings follow a widely reported Jan. 9 New England Journal of Medicine article saying that moderate daily or near-daily alcohol consumption could decrease a man’s risk of heart disease. The researchers in the new study, published in the January issue of the journal Alcoholism: Clinical and Experimental Research, suggest that the difference in protective benefits of alcohol for black men could also be a result of not how much people drink but how they do it.

Presence of T-Cells Predicts Survival in Ovarian Cancer

The presence of tumor-infiltrating lymphocytes predicts the length of remission after chemotherapy and the overall survival of patients with ovarian cancer, according to researchers from the Abramson Cancer Center and the Center on Women’s Health at the University of Pennsylvania School of Medicine. Their findings, which are presented in the January 16th issue of the New England Journal of Medicine, constitute the first proof that a spontaneous immune response against the tumor dramatically impacts the clinical course of ovarian cancer. These novel findings generate hope that immune therapies may significantly prolong the response to chemotherapy and improve the survival of patients with advanced ovarian carcinoma.

Community-based treatment of TB can save hundreds of thousands of lives

Multidrug-resistant tuberculosis no longer must be considered a death sentence for infected individuals living in resource-poor nations, according to a study by a consortium of researchers led by Harvard Medical School’s Program in Infectious Disease and Social Change. The study, which appears in this week’s New England Journal of Medicine, provides the first hard evidence that outpatient community care in poor, urban shantytowns can work for this most difficult to treat form of tuberculosis. The multidrug-resistant tuberculosis treatment model could ultimately help save hundreds of thousands of lives worldwide.

Amputation, Reconstructive Surgery Have Same Outcomes for Severe Leg Injuries

Patients with severe leg injuries often face a difficult choice of whether to have multiple operations to repair their damaged limb or undergo amputation. With advances in medical technology, limb reconstruction has replaced amputation as the primary treatment at many trauma centers. But a new study finds that patients have similar outcomes regardless of the treatment. The study, coordinated by the Johns Hopkins Bloomberg School of Public Health, was conducted at the University of Maryland Shock Trauma Center and seven other trauma centers across the country. It found that while patients who undergo reconstructive surgery have a higher risk of complications, additional surgeries, and hospitalizations, they fared about the same as those patients who have a leg amputated. After two years, both groups had similarly high levels of disability and psychological distress, and only about half of the people in each group were able to return to work.

Researchers study screening, treatment of immigrants for tuberculosis

Study findings from the Inner City Health Research Unit at St. Michael’s Hospital/ University of Toronto and the NewYork-Presbyterian Hospital Weill Cornell Medical Center demonstrate that screening and treating new immigrants from developing nations for the latent stage of tuberculosis infection would result in substantial public health and economic benefits. Results are published in tomorrow’s issue of The New England Journal of Medicine. Tuberculosis is one of the world’s most prevalent diseases which infects nearly two billion people worldwide or roughly one-third of the world’s total population, most of which live in developing nations.

Controlling Heart’s Irregular Rhythm No Better Than Controlling Rate

The preferred and most frequently used initial therapy for the common heart rhythm disorder atrial fibrillation (AF) is a strategy to restore and maintain a normal heart rhythm. However, a study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health found that this “heart rhythm” strategy prevents no more deaths than the alternative, often secondary, approach to treatment which merely controls the rate at which the heart beats – and may have some disadvantages, including more hospitalizations and adverse drug effects.