The FDA (Food and Drug Administration) recently released a public health advisory on Chantix (varenicline), a smoking cessation drug manufactured by Pfizer. This follows an earlier investigation last year on reported behavioral changes associated with use of the drug. The presence of neurologic or psychiatric effects is not completely surprising, considering that Chantix interferes with the brain’s dopamine system. The dysregulation of dopamine has already been implicated in some neuropsychiatric disorders, such as Parkinson’s disease and schizophrenia. Although the drug does not necessarily need to be withdrawn from the market, the FDA cautions both patients and health care providers to be vigilant about past psychiatric conditions and noted mood/behavior changes while on the drug. The FDA adds that use of the drug may interfere with the ability to drive.

Given that lung cancer and heart disease remain among the top killers in the United States, smoking cessation is a key strategy in preventive health. It is hard enough for a smoker to quit. Fortunately there are still several other pharmacologic and non-pharmacologic tools to aid in smoking cessation, including nicotine patches, Wellbutrin (bupropion), and a great coach-physician.

5min Life Videopedia may appear like another of the million YouTube clones on the Internet. It, however, distinguishes itself from its competitors by focusing on brief instructional videos. The site builds on two premises: 1) “everybody is an expert in something and has something to teach others”; and 2) “any solution can be visually explained in no more than 5 minutes.” As a result, we have a great online video resource where users can provide or find answers to practical questions in a few short minutes.

The site has a Health category, which features informative health-related videos geared for the general public. The category addresses a breadth of topics, ranging from cardiology and dermatology to nutrition and first-aid. Some video clips demonstrate adult CPR, teach massage techniques, and discuss diverse medical issues (e.g., testicular pain, Golfer’s elbow, seizures in children, dealing with colic). There is also a section dedicated to performing self-exams, such as the testicular and breast exams.

Having launched only a few months ago, 5min is relatively new, yet its video catalog is quite impressive. As of today, the user affiliated with DrMDK.com, a pediatrics website, is the largest overall contributor to 5min (329 uploads) and its Health category (209 uploads). Most of the videos simply consist of pediatricians briefly speaking about a topic before a camera, which makes the thought of creating such videos less daunting. Teaching physicians, who are accustomed to engaging in lengthy discourse in their fields of interest, should have no problem.

The American Lung Association just released the 2007 State of the Air, an annual report examining air pollution levels in American cities and counties. The three principal reporting categories include short-term particle pollution (24-hour PM_2.5), year-round particle pollution (Annual PM_2.5), and ozone content. This year’s dishonor for most polluted city goes to the Los Angeles metro (includes Long Beach and Riverside), which leads U.S. cities in all three categories. This is not surprising, given the pervasive orange-gray blanket over the Los Angeles sky. Interestingly, despite strict emission laws, several other Californian cities and counties rank very highly in the list. Detroit (Michigan), home to the automotive industry, shares fourth place with Birmingham, Alabama.

As for the cleanest cities, Cheyenne (Wyoming) was ranked the best for long-term particle pollution, followed by Santa Fe (New Mexico) and Honolulu (Hawaii). To be fair to California, three of its cities (Salinas, Redding, and San Luis Obispo) were included in the top 25.

Dr. George Lundberg, a pathologist by training and Editor-in-Chief of Medscape General Medicine, presents an intriguing method for treating seborrheic keratosis. He terms the procedure “fingernail surgery”. Dr. Lundberg also provides a helpful hint on how to differentiate seborrheic keratosis from other skin lesions, such as cancer.

Please remember that information from the Internet, including this site, cannot replace the professional opinion of a licensed physician. Consult your medical doctor when you notice a questionable skin lesion, especially if it has irregular borders, non-homogenous appearance, or changed in any way.

Alzheimer disease is a chronic condition that afflicts more than 14% of the geriatric population. It is the most common cause of dementia, characterized by a progressive decline in cognitive function. Although there are pharmaceutical drugs (i.e., donepezil) that attempt to stave this decline, there is yet no cure.

A recent study published in the American Journal of Clinical Nutrition has correlated green tea consumption with a lower prevalence of cognitive impairment. Although previous animal studies have suggested a protective effect of green tea against neurodegenerative diseases, this is the first study that addresses the topic in humans.

Researchers at the Tohoku University School of Medicine (Sendai, Japan) surveyed 1003 geriatric citizens at ages 70 years or older from the Tsurugaya district of Sendai City. The study examined several variables, including the consumption of certain beverages, the health status, and the social habits of the participants. Their cognitive function was assessed using the Mini-Mental Status Examination (MMSE), a tool commonly used by neurologists and geriatricians.

The study found that participants who routinely consumed greater quantities of green tea generally scored higher on the MMSE. Consumption of black or oolong tea, or coffee did not produce similar trends. The researchers also adjusted the data for several possible confounders, such as presence of different diseases, level of physical activity, educational background, dietary habits, and substance use. The results still demonstrated a positive effect of green tea in cognitive function.

Does green tea hold promise for dementia patients? Can it reverse the cognitive decline in Alzheimer disease? What about using it as prophylaxis by healthy individuals? The findings are exciting, but there is yet much research needed to validate and extend the results of the Tsurugaya Project.

• Source
• Kuriyama S, Hozawa A, Ohmori K, Shimazu T, Matsui T, Ebihara S, Awata S, Nagatomi R, Arai H, Tsuji I. Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project. Am J Clin Nutr 2006;83:355-61.

Technorati Tags:
tea
green tea
Alzheimer
Parkinson
nutrition
medicine
medical
health

Melatonin is a hormone produced by the pineal gland and associated with regulation of the sleep cycle. There have consequently been melatonin products, and biosynthetic variants (i.e., ramelteon), marketed as sleep aid products. A popular use for melatonin has been to combat jet lag or for adaptation to different time zones. Two recurring questions I have encountered regarding melatonin are whether it actually works and whether there are any adverse side-effects.

The February 10 issue of the British Medical Journal includes a study by a Canadian group that reviewed the efficacy and safety of melatonin use with secondary sleep disorders and sleep restriction. Secondary sleep disorders are sleep problems with a physiologic cause, such as hyperthyroidism or substance abuse (toxicity). Sleep restriction, on the other hand, results from voluntary sleep disruption. On-call physicians or third-shift police officers are examples of people who endure sleep restriction.

According to the meta-analysis (a review of several research efforts examining the same topic) of 15 separate studies (524 participants), melatonin is not effective for both secondary sleep disorders and sleep restriction. Commonly reported side-effects were drowsiness, headache, nausea, and dizziness. Otherwise, the report does not indicate significant adverse effects of short-term melatonin use (3 months or less).

In another meta-analysis performed by the same group, and published two months earlier in the Journal of General Internal Medicine, there is some evidence of efficacy in delayed sleep phase syndrome (DSPS), a shift in the circadian rhythm that makes it difficult for the person to fall asleep and wake up. Study participants who suffered from this disorder were able to fall asleep around 38.8 minutes earlier with melatonin. The study does not however report significant improvement in sleep onset with melatonin use for other sleep disorders. The findings on safety are similar here as in the BMJ article.

In short, melatonin is not effective for most sleep disorders, but it is safe with short-term use.

• Sources
• Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, Baker G, Klassen TP, Vohra S. The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis. J Gen Intern Med 2005;20:1151-8.
• Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, Vohra S, Klassen TP, Baker G. Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis. BMJ 2006.

Technorati Tags:
melatonin
safety
insomnia
sleep
sleep problem
sleep disorder
medical
medicine

Roche Laboratories has produced an interesting marketing adjunct to its famous Tamiflu^® (oseltamivir) drug: The Tamiflu Desktop Flu Tracker. The software tracks the latest trends of reported influenza cases throughout the United States and generates a geographical representation of disease demographics. The Desktop Flu Tracker also lets you set alerts for flu outbreaks in different neighborhoods. Additional preventative health information is included. Learn the classic symptoms of flu and how it differs from the common cold.

The program currently runs on Windows (98SE and above). It is not available for the MacOS.

Technorati Tags:
tamiflu
flu
flu tracker
oseltamivir
antibiotics
vaccine
virus
medicine
health
medical
education

USA Today reports on new guidelines published by the American College of Chest Physicians (ACCP). Interestingly, the ACCP concludes that over-the-counter (non-prescription) cough syrup purchased at your local pharmacy may be ineffective at doing its job: suppressing your cough. The success some people have experienced from these medications may be from a placebo effect or from natural recovery. Note to self: save money and buy Ricola candy instead. If symptoms persist, definitely consult a physician.

This is a similar phenomenon to antibiotics and viral illnesses. Antibiotics that target bacteria are simply ineffective against illnesses caused by viruses, yet many still view antibiotics as a panacea against disease. Unfortunately, in our medicine-driven world, many patients are not satisfied unless they leave the doctor’s office with a prescription in hand.