Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

The point of this article focused on the impact of long-term aspirin and the risk of cancer. The study stemmed from the recommendation of the US Preventive Services Task Force that aspirin can be used to help prevent colorectal cancer and cardiovascular disease. The study wanted to address the effectiveness of aspirin in other cancers. In the study they took two large US prospective cohort studies that had over 135,000 participants. The studies were long term and done over many years and accessed medical records to evaluate a patient’s different types of cancers. The study was completed over 32 years. By the end of the study it was found that aspirin can reduce the overall risk, especially in GI cancers.

I think this study was important since aspirin is such a widely utilized and recommended medication by doctors and pharmacists. Aspirin is primarily recommended for heart protection and health, but now shows an even added benefit of cancer prevention. As pharmacists this gives another important tool for showing patients the benefit of taking aspirin on a regular basis. While I think this is an important indication, I do no think there is enough evidence to support aspirin therapy simply for cancer prevention. More research should be done to continue to weigh the pros and cons of aspirin therapy for the prevention of cancer.

 

Cao Y, Nishihara R, Wu K, et al. Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer. JAMA Oncol. Published online March 03, 2016. doi:10.1001/jamaoncol.2015.6396.

http://oncology.jamanetwork.com.pitt.idm.oclc.org/article.aspx?articleid=2497878

What Pediatricians and Other Clinicians Should Know About Zika Virus

The Zika virus is a recent epidemic that has been spreading across parts of Africa and much of South America. The virus has begun spreading at increasing alarming rates and is on its way to become a global health crisis. The issue with the virus is that while it may cause some symptoms in newly infected hosts, it has a large impact on those for women who may become pregnant. The virus can cause birth defects which will influence and often hinder a child’s development. Due to easier global travel the virus is able to spread more quickly and is no longer in isolated geographical location. The virus is often transmitted by mosquitos. There is not current cure of vaccine for the Zika virus, the only prevention and recommendations that have been made are to wear DEET or paricardian containing bug repellant along with long sleeves and long pants.

I think the major issue with the Zika virus is that it will be affecting a whole infant population in certain regions and countries. These regions and countries must then begin to develop programs and allocate appropriate resources for these affected infants as they grow and mature. These issues may place even more stress on areas with low levels of medical care and governmental resources. As healthcare providers I believe it is our job to help educate others and help find possible solutions in the battle against the virus. I think pharmacist would be essential in providing information and care for individuals who have infants affected by the virus.

 

 

http://archpedi.jamanetwork.com/article.aspx?articleid=2496286

 

Kline MW, Schutze GE. What Pediatricians and Other Clinicians Should Know About Zika Virus. JAMA Pediatr. Published online February 18, 2016. doi:10.1001/jamapediatrics.2016.0429.

Study finds strong link between Zika virus and Guillain-Barre Syndrome

The Zika virus has been in the headlines quite often recently. It is a disease spread by daytime mosquitoes that leads to symptoms including rash, fever, joint pain and red eyes. Currently, it is concentrated in central and south America. However, the disease is spreading into North America and there have been 107 reported cases of the Zika virus in Americans who have travelled from the infected area.

Between October 2013 and April 2014, French Polynesia experienced the largest Zika virus outbreak ever described to date. A study was conducted once a correlation was noticed between areas with the Zika virus and increased cases of the neurological disorder, Guillain-Barre syndrome. Of those who developed Guillain-Barre, 98% of them had Zika virus antibodies, suggesting the virus could be causing the disease.

Guillain-Barre syndrome results in symptoms starting with weakness and tingling in the feet and legs that spread to the upper body. Paralysis can even occur. Overall, it is a condition in which the immune system attacks the nerves and it is triggered by an acute bacterial or viral infection. Treatment is extensive, and includes plasma exchange and immunoglobulin therapy to relieve symptoms. Physical therapy is needed, too.

This newly discovered risk associated with the Zika virus only stresses the importance of preventing its spread. Strategies should be shared on how to avoid daytime mosquitoes and protect yourself. Pharmacists can play a role in this by educating patients in community pharmacy settings on which products work the best to deter mosquitoes and what to look out for as far as early symptoms of the virus.

 

Read the full study here.

Cao-Lormeau VM, Blake A, Mons S, et.al. Guillain-Barre Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016;(published online):1-9

Efforts in Epilepsy Prevention in the Last 40 Years

This was a study conducted to see if new-onset epilepsy prevention strategies have been identified and successfully implemented.  This was done in Finland from 1973 to 2013 and analyzed first-time inpatients with an epilepsy diagnosis.  “Epilepsy” in this study was defined as two or more “unprovoked” seizures.

Previously, antiepileptic drugs have been proven to subdue epilepsy, but have failed to prevent new-onset epilepsy in individuals at risk for developing it.  They studied three different age groups longitudinally to see if there was an increase, decrease, or lack of change in the rates at which first-time patients were admitted with new-onset epilepsy.

In the last 40 years, the rate at which those 65 and younger were admitted to the hospital and newly diagnosed with epilepsy was constant.  However, the rate at which those 65 and older were diagnosed increase 5-fold over the last four decades.

They concluded that no advances had been made in the prevention of epilepsy.  However, I’d like to pose a question…is there really a way to definitively tell if someone will develop epilepsy in the future?  Often our healthcare is reactive not proactive–meaning we only treat things when there’s a problem.  If there aren’t any health complications, we don’t usually go seeking potential ones.  This can relate back to the study.  Yes, we have not been able to make strides with epilepsy prevention, but is that attainable at this time?

Sillanpaa M, Gissler M, Schmidt D. Efforts in Epilepsy Prevention in the Last 40 Years. JAMA Neurol. doi:10.1001/jamaneurol.2015.4515 (15 February 2016).

Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses

In this article, a collaborative research team from South Korea has developed a diagnostic system for use with smart phone technology that is able to identify viruses such as H5N1, or bird flu. The method for this identification being fluorescence excitation and analysis. All of which were smartphone battery powered. The complete setup includes as smartphone (galaxy S3 +others), an apparatus for the device, and samples on test strips.

In order to improve the optical quality of the smartphone features, an apparatus was created that held the phone in place in alignment with an LED light, excitation fiber, emission filter, and upper and lower reflector (parabolic mirrors). The apparatus had the smart phone facing downward to detect the fluorescence using an application in coordination with the diagnostic apparatus, which relayed information back to the phone. Test strips containing unidentified biological specimens would be placed underneath the phone.

Preliminary tests indicate that this method can be used with great accuracy. Of the 29 patients with H5N1, only 1 of them showed of false negative when subjected to smartphone analysis. This relates to pharmacy because potent viruses like H5N1 are public health concerns that could potentially warrant mass vaccinations. Vaccinations fall under the responsibility of a pharmacist, and we are often the most accessible healthcare professional when it comes to vaccinations on a large scale.

Do you think smartphone technology like this will become more prevalent in the future?

You can view the article here: Smartphone-Based Fluorescent Diagnostic System for Highly Pathogenic H5N1 Viruses.

Yeo S, Choi K, Cuc BT, et al. Smartphone-Based Fluoranalyzeescent Diagnostic System for Highly Pathogenic H5N1 Viruses. Theranostics. 2016 Jan 1;6(2):231-42

 

Preventing infant mortality: Pharmacists’ call to action

The United States has a higher infant mortality rate than many other developed countries.  6.1 of every 1000 babies born in the U.S. dies within their first 12 months of life, not including miscarriages or stillbirths.  The leading causes of death in this country are preterm births (when the baby is born before the 37th week of the pregnancy), sudden infant death syndrome (SIDS), or low birth weight.  These deaths aren’t caused by a single factor, but a multitude of them.  Pharmacists can impact society more than they know by informing the population of the factors that contribute to infant mortality and hopefully reduce their frequency.

For example, tobacco use during pregnancy increases the likelihood of all of the leading causes of infant death in the U.S. in addition to birth defects.  Both smoking and smokeless tobacco have affects on the baby  even after it is born and can lead to complications.  Pharmacists can intervene by providing information and advice on smoking cessation as well as recommend products to help mothers quit.  Alcohol, illicit drugs, and marijuana all can have deleterious affects as well, and pharmacists can spread knowledge about these too.

Vaccines are also highly recommended to pregnant women to prevent infants from susceptibility to those diseases and infections.  The inactive forms are preferred and can range from flu to tetanus.  Pharmacists can educate their pregnant patients as well as administer these immunizations to prevent death from preventable causes.

Pharmacists can also inform the public on the advantages of breastfeeding, for instance babies who are breast fed have a lower risk of death due to SIDS.  Critical vitamins during pregnancy are another counseling point for pharmacists.

Overall, including pharmacists in the education of mothers during and after pregnancy can and should have a profound effect.  Together with their inter-professional health team, they can reduce infant mortality rates by informing the public on preventable actions that cause infant death.

DiPietro Mager N. Preventing infant mortality: Pharmacists’ call to action. JAPhA. 2016;56(1):82-87

HIV drugs give couples ‘ray of hope’

There are many couples in Kenya where one is HIV positive and the other negative, but they still want to have children which leads to 44% of new HIV infections. PrEP is a new way to use anti-HIV drugs that are normally given to HIV positive people, that could mean couples can try and have children risk-free. The study took over 4,700 couples and the HIV negative person took the PrEP course over 36% and found that having the drug in their system reduced rate of transmission my over 90% and if the HIV positive person took antiretroviral drugs as well then the risk reduces to zero to close to zero.

Once HIV is in the body it hides in hard to access places and make reservoirs making it hard to flush out. However, if the PrEP drugs are in the system of an HIV negative person, when the virus enters, it gets killed. This means HIV doesn’t get the chance to find those reservoirs to hide in and be hard to flush out and ultimately infect the person.

This allows couples to resolve some conflicts that come with finding out that your partner is HIV positive and allows them to have a more normal relationship. It also helps greatly reduced the number of new HIV infections. Not mentioned in this is how this affects the children of HIV positive women. Whether this course also prevents transmission of HIV to the fetus and allow for uninfected children in unknown. Children who are born HIV positive due to their mother contributes to the population of new HIV infections as well and is another issue to be addressed.

Pitt, C. HIV drug gives couples ‘ray of hope’. BBC. 2016.

http://www.bbc.com/news/health-35324450

Carroll JJ, Ngure K, H Renee, ect at. Gendered differences in perceived risks and benefits of oral PrEP among HIV-serodiscordant couples in Kenya. AIDS Care. doi: 10.1080/09540121.2015.1131972 (published 11 January 2016)