Reported in Unavadis, a large study of Swedish health registry data indicates that lymphoma risk remains elevated among patients with rheumatoid arthritis (RA), despite evolution of treatment. Treatment advances for RA do not appear to have affected lymphoma risk. Records from 12,656 patients with RA from the Swedish Rheumatology Register linked to Swedish Cancer Register were compared with control patients for lymphoma incidence over time.
Comment: Disturbing since I would expect our newer treatments to decrease lymphoma risk.
Case Studies Underscore Ophthalmology’s Concerns About Eyeball Tattoos
Dava Stewart writing in MD reported because eyeball tattoos are not performed by ophthalmologists, experts are concerned about their many short-term risks, and warn that the long term risks could include permanent damage, according to the authors of two recent case studies. Published in American Journal of Ophthalmology Case Reports, two new case studies demonstrate the risks that go along with what the authors call this “relatively new extreme body modification.”
The two case studies are both of Mexican men, one 26 years old and the second 17. Both developed complications after having an eyeball tattoo. The authors say that the cosmetic procedure “involves injecting some type of pigment directly under the bulbar conjunctiva with a needle.”
The authors list multiple risks involved in eyeball tattoos: globe penetration, endophthalmitis, retinal detachment, traumatic cataract, a severe ocular inflammatory reaction, blindness due to ocular inflammation, as well as increased severity of uveitis. They conclude by suggesting, “Regulations prohibiting the practice of these procedures are required, because despite warnings of multiple health risks, more people are looking to get this procedure nowadays.”
The two case studies were written by Gonzalo Duarte of the Eye Clinic for Inflammatory Diseases at the Dr. Luis Sanchez Bulnes Hospital, and colleagues.
Comment: Hmmmm. What some people will do to their bodies….
Patients with Parkinson’s Disease Are at Risk for Carpal Tunnel Syndrome
Dr. Lara Pullen writing in the Rheumatologist reported patients with carpal tunnel syndrome experience pain, numbness and tingling that can be characterized as an upper limb neuropathy. CTS is more common in women, with a female to male ratio of 3:1. Various studies have described the incidence of CTS in the general population as between 2.5 and 5 cases per 1,000 person years.
Individuals with Parkinson’s disease may be especially vulnerable to CTS. One study suggests that patients with Parkinson’s may be at increased risk of CTS because of the repetitive movement due to tremor.2 Others have noted the peripheral neuropathy that is associated with Parkinson’s and wondered whether peripheral neuropathy is intrinsic to Parkinson’s, a consequence of levodopa exposure or both.3 A body of evidence suggests that a form of small fiber neuropathy is intrinsic to Parkinson’s, and thus, experts have suggested that patients with early and advanced Parkinson’s be strictly monitored for subtle signs of neuropathy.
Depression… it’s already starting in young doctors
Many Medical Students Appear To Struggle With Depression, Research Reveals
Liz Kowalczyk writing in the Boston Globe reported that future physicians appear to “suffer depression, or depressive symptoms, at higher rates than the general population,” a meta-analysis involving “nearly 200 smaller studies from 47 countries” suggests. In fact, about “27 percent” of medical students appear to suffer from “depression in medical school,” the research revealed. The findings were published in the Journal of the American Medication Association.
Comment: I have news for these students… medical practice today can be even more depressing.
Immunotherapy Drugs Sometimes Cause Immune Response Against Healthy Organs
Matt Richtel writing for the New York Times reported that “immunotherapy drugs have been hailed as a breakthrough in cancer treatment.” However, “as their use grows,” physicians are finding that “an unleashed immune system can attack healthy, vital organs: notably the bowel, the liver and the lungs, but also the kidneys, the adrenal and pituitary glands, the pancreas and, in rare cases, the heart.” Physicians “at Yale believe immunotherapy is causing a new type of acute-onset diabetes, with at least 17 cases there so far.”
Comment: All effective therapies have potential side effects so I’m not surprised.
Paula Span writing in the New York Times reported on “an ongoing and vexing public health problem: People once vigilant about vaccinating their children aren’t nearly as careful about protecting themselves as they age, even though diseases like influenza, pneumonia and shingles…are particularly dangerous for older people.” Carolyn Bridges, MD, Associate Director for Adult Immunization at the CDC, said, “Trying to prevent these common and often debilitating conditions is incredibly important for older adults.”
Comment: Shame on you if you aren’t getting your shots.
Too little sleep takes a toll on your heart, according to a new study presented at the 2016 annual meeting of the Radiological Society of North America (RSNA), Nov. 27-Dec. 1 in Chicago.
Alexandra Sifferlin reports, about twenty healthy radiologists had their hearts imaged before and after a 24-hour shift where they got an average of three hours of sleep. The also had their blood pressure and heart rate measured, and they provided blood and urine samples. Comparing the two images showed increases in heart strain, which can be a precursor for heart problems. The doctors also showed increases in blood pressure, heart rate and thyroid hormones, which are released in response to stress.
Comment: Make sure you get your sleep… you life might depend on it!
Drowsy driving almost as bad as being drunk… maybe
AAA Study: Drowsy Driving As Risky As Drunk Driving
Scot Pelley reporting for CBS News stated a new AAA study suggested “that getting behind the wheel on four or five hours’ sleep is just as dangerous as driving drunk.” According to the broadcast, a little over one in three drivers in the US does not get “the recommended seven hours of sleep daily,” and those who do get “just five or six hours” are “almost twice as likely to be involved in an accident.” As a driver’s hours of sleep decreased, the risk of an accident increased exponentially, with “teenagers, older adults, and people who have a sleep debt” at “the highest risk.”
Tocilizumab Receives Breakthrough Designation for GCA
The FDA granted the designation of breakthrough therapy to tocilizumab (Actemra) for treating GCA (Giant Cell Arteritis). This autoimmune disease causes inflammation of arteries both medium and large in size, predominantly in the head, but also in the aorta and branches of the aorta.1
To date, GCA treatment has been limited to high-dose steroids, which are used as an emergency treatment to prevent vision loss and other damage. Long-term, flare-free remission cannot always be maintained with steroids. Because of the variety of symptoms, GCA patients are usually seen by myriad specialists, including rheumatologists.
The FDA gives a breakthrough designation to expedite the development and review of treatments that show early evidence of potential clinical benefit in serious diseases to ensure patients receive access to medication as quickly as possible. Positive results of tocilizumab use in patients with GCA were seen in the Phase 3 GiACTA study. Patients treated with tocilizumab, initially as combination therapy for six months with glucocorticoids, had sustained remission though one year of treatment compared with patients who received only glucocorticoids for six to 12 months.
Comment: GCA is a serious condition and this is great news.