Indian Medicine

NEW YORK (Reuters Health) - Depression increases the risk of death in patients with heart failure, but the risk apparently disappears with antidepressant use, according to a study.

"Recent studies suggest that the use of antidepressants may be associated with increased mortality (death) in patients with cardiac disease," Dr. Christopher M. O'Connor, of Duke University Medical Center, Durham, North Carolina, and colleagues note in the medical journal Archives of Internal Medicine.

"Because depression has also been shown to be associated with increased mortality in these patients, it remains unclear if this association is attributable to the use of antidepressants or to depression."

The researchers therefore studied roughly 1,000 patients hospitalized for heart failure who were followed up annually. The authors prospectively collected data on depression status and use of antidepressants.

Roughly 16 percent of the study subjects were taking some form of antidepressant during the initial hospital stay. Overall, 30 percent were considered depressed and 24.5 percent of them were taking antidepressants. The team also found that 12.5 percent of non-depressed patients were taking antidepressants.

Over an average of about 971 days, 429 patients, or roughly 43 percent, died. An initial analysis that did not factor out potentially confounding variables showed that use of antidepressants was associated with a 32 percent increased risk of dying.

However, "multivariate analysis" controlling for depression and other potentially confounding factors showed that antidepressant use was not associated with poor survival, but depression per se was.

This finding, the researchers say, supports the need for randomized clinical trials that are adequately powered to evaluate whether antidepressant medication may reduce mortality and other heart-related outcomes without raising safety concerns among depressed heart patients.

"The ongoing National Institute of Mental Health-funded Sertraline Antidepressant Heart Attack Randomized Trial-Chronic Heart Failure, a randomized double-blind placebo-controlled study of SSRI therapy in depressed patients with HF, is likely to provide further insight into this issue," they note.

SOURCE: Archives of Internal Medicine, November 10, 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Taking a low-dose oral contraceptive pill can reduce painful periods and non-menstrual pain associated with endometriosis, research shows.

"The present study clearly demonstrated for the first time that oral contraceptive pills could be used to effectively and safely treat pain associated with endometriosis," the study team reports in a paper published this month in the medical journal Fertility and Sterility.

Endometriosis is a painful condition that affects women during their reproductive years. It occurs when tissue that normally lines the uterus grows at other sites within the abdomen, such as the ovaries.

Dr. Tasuka Harada, from Tottori University School of Medicine in Yonago, Japan, and colleagues assessed the outcomes of 100 women with painful periods due to endometriosis who were randomized to receive a low-dose oral contraceptive pill or placebo.

The oral contraceptive was taken for 21 days plus 7 days of placebo, while the control group took identical placebo pills for 28 days. Usual pain medications were allowed. The women were treated for four cycles.

Both groups showed significant improvements in pain-related to their period, Harada and colleagues report. Throughout the treatment period, however, menstrual pain was significantly milder in women on the oral contraceptive. The women on the pill also reported less non-menstrual pain.

Treatment with oral contraceptive was also associated with a significant reduction in the volume of endometrial tissue occurring outside the uterus, an effect not seen with placebo use, the researchers note.

The oral contraceptive pill was generally well tolerated and not associated with any serious side effects.

SOURCE: Fertility and Sterility, November 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - In men with an enlarged prostate who fail to respond to tamsulosin (brand name Flomax), treatment with the drug naftopidil may help alleviate common bothersome symptoms, such as having to make frequent nightly trips to the bathroom to urinate, research shows.

Enlargement of the prostate -- a common condition among older men known as benign prostate hyperplasia (BPH) -- often causes a persistent need or urge to urinate. Nighttime urination is a common symptom, for which doctors may prescribe an "alpha1A blocker" such as tamsulosin. However, these drugs may only help some men.

Naftopidil is an "alpha1D blocker" and recent reports have shown that the alpha1D receptors are the main type found in bladder muscle.

Dr. Hitoshi Oh-oka from Kobe Medical Center, Japan, assessed BPH-related symptoms in 122 men who were treated with naftopidil (75 milligrams) for 6 weeks after experiencing no improvement with tamsulosin. The two treatments were separated by a placebo "washout" period of over 1 week.

Treatment with naftopidil led to significant improvement in daytime and nighttime urinary frequency, urinary flow rate and quality of life, the investigator reports in the medical journal Urology.

Naftopidil was particularly helpful in reducing nighttime trips to the bathroom to urinate. Naftopidil therapy also eliminated overactivity of the detrusor muscle, which controls bladder function, in 31 of 40 patients who had this finding.

Based on predefined criteria for symptoms, quality of life, and maximal urine flow, roughly 70 percent of patients were successfully treated with naftopidil.

SOURCE: Urology, November 2008.

Copyright © 2008 Reuters Limited.

LONDON (Reuters) - The number of measles cases has soared, leading to concern of an epidemic as a result of fears that the MMR vaccine could cause autism, health officials said on Friday.

There were 1,049 confirmed cases of measles in England and Wales up the end of October, already surpassing last year's total of 990 and the largest number since new monitoring methods were introduced in 1995, the Health Protection Agency said.

It said the fears about the MMR jab had led to a rise in parents choosing not to have their children vaccinated.

"This rise is due to relatively low MMR vaccine uptake over the past decade and there are now a large number of children who are not fully vaccinated with MMR," said Dr Mary Ramsay, an immunisation expert at the HPA.

"This means that measles is spreading easily among unvaccinated children. There is now a real risk of a large measles epidemic. These children are susceptible to not only measles but to mumps and rubella as well." In 1998, Dr Andrew Wakefield of Royal Free Hospital in London and colleagues sparked a fierce worldwide debate among scientists by suggesting the MMR jab could cause autism.

Before his comments more than 90 percent of children were given the MMR jab but when his now discredited views were made public that fell to 80 percent.

The largest study into the alleged link reported in February that there was no evidence the vaccination caused the development disorder.

Health bosses are now carrying out an MMR "catch up" programme to try and identify those who have missed out on the jab and offer them another chance to have it.

Evidence suggests there is a real risk of a large measles outbreak of between 30,000 to 100,000 cases in England, mainly centred in London, the HPA said.

"Measles is a very serious infection as it can lead to pneumonia and encephalitis, even in healthy children. It is highly infectious: it can be passed on without direct contact before the rash appears," said Ramsay.

"It is never too late to get vaccinated."

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - In middle-aged adults, gum disease goes hand in hand with the metabolic syndrome, UK researchers report.

"Further studies are required to test whether improvements in oral health could affect the onset/progression of the metabolic syndrome or vice-versa," Dr. Francesco D'Aiuto of the UCL Eastman Dental Institute in London, one of the researchers on the study, told Reuters Health.

Metabolic syndrome is a cluster of risk factors for heart disease, stroke and diabetes -- including high blood pressure, abdominal obesity, high blood sugar, low levels of "good" HDL cholesterol and high triglycerides (another type of blood fat). The syndrome is usually diagnosed when a person has three or more of these traits.

Several studies have suggested links between periodontitis, an infection of the tissue supporting the teeth seen in up to 40 percent of adults, and system-wide problems such as low grade inflammation and a reduced ability to metabolize glucose (sugar), D'Aiuto and his team note in the Journal of Clinical Endocrinology and Metabolism.

People with periodontitis are also at about 20 percent greater risk of heart disease. As both periodontitis and the metabolic syndrome have been linked to inflammation and resistance to insulin, they sought to determine whether the two might be directly related.

To investigate, they looked at 13,994 men and women participating in the Third National Health and Nutrition Examination Survey who had undergone periodontal exams.

Thirty-four percent of people with moderate periodontitis and 37 percent with severe periodontitis had the metabolic syndrome, the researchers found, compared to just 18 percent of people with no gum disease or only mild periodontitis.

The likelihood of being diagnosed with metabolic syndrome rose with the severity of bleeding in the gums, as well as the proportion of periodontal pockets, or abnormally deep spaces between teeth and gums. The relationship was especially strong among people 40 and older.

After adjusting for factors that might influence the results, adults older than age 45 suffering from severe periodontitis were 2.3-times more likely to have metabolic syndrome than unaffected individuals.

It's still not entirely clear how gum disease and heart disease might be related, D'Aiuto and his colleagues at University College London note, although they point out that they recently found treating severe periodontitis resulted in better blood vessel function six months later.

Regardless, D'Aiuto said, the findings underscore the importance of oral health to general well being, adding that everyone should take care of their gums and teeth and be sure to see a dentist regularly.

SOURCE: Journal of Clinical Endocrinology and Metabolism, October 2008.

Copyright © 2008 Reuters Limited.