Doubts over fertility treatments
Friday August 8th, 2008
Some well-established infertility treatments may not be effective, experts warned today.
For a quarter of infertile couples, there is no clear medical explanation for their infertility. These couples have traditionally been offered interventions in line with guidelines from the National Institute for Health and Clinical Excellence (NICE).
But the guidelines should be reviewed following recent evidence, say Professor Siladitya Bhattacharya and colleagues at Aberdeen University, UK. On the website of the British Medical Journal today (August 8), they report on their study comparing of two common interventions.
A total of 580 women who had been unable to conceive for more than two years were split into three groups: no medical intervention; oral clomifene citrate (CC), a drug which may correct subtle ovulatory dysfunction; or unstimulated intra-uterine insemination (IUI) of sperm.
After six months, the birth rate was 17 per cent with no medical help, 14 per cent with oral CC, and 23 per cent with unstimulated IUI. These birth rates represent no significant benefit from either of the interventions, say the authors.
They conclude that in couples with unexplained infertility, these treatments are "unlikely to offer superior live birth rates compared with expectant management".
"These results challenge current practice, as endorsed by a national guideline in the UK," they state.
In an editorial, Dr Tarek El-Toukhy and Dr Yacoub Khalaf of Guy's and St Thomas' NHS Foundation Trust, write that treatment of unexplained infertility should be tailored to the patient's expectations, the centre's experience, and the available resources.
They want to see more high-quality clinical trials of these treatments, taking into account cost-effectiveness and side-effects.
Bhattacharya, S. Research paper: Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. The British Medical Journal, 2008;337:a716.
El-Toukhy, T. A. and Khalaf, Y. Treatment of Unexplained Infertility. The British Medical Journal, 2008;337:a772.
Bid to stop measles epidemic
Thursday August 7th, 2008
A new drive to improve take-up of the MMR vaccine is launched today in a bid to prevent a measles epidemic.
Local health organisations in England are to get extra cash and vaccine doses to help boost numbers.
There have been more than 1,700 cases of measles over the last two years - more than in the previous decade - reflecting growing numbers of children unprotected by the vaccine.
And estimates suggest that as many as three million children are now unprotected.
Experts say this could mean an epidemic could infect as many as 100,000 children.
Professor David Salisbury, director of immunisation at the Department of Health, said: "Parents who have not had their children vaccinated with the MMR vaccine should do so now. The evidence on MMR is absolutely clear - there is no link between the vaccine and autism.
"The MMR vaccine coverage is not high enough to remove the threat of recurrence of measles outbreaks. Measles is serious and in some cases it can be fatal. Delaying immunisation puts children at risk."
Methadone could help fight leukaemia
Wednesday August 6th, 2008
A surprising discovery may prove to be beneficial for leukaemia patients.
Researchers have found evidence that methadone - conventionally used to help overcome addiction to opioid drugs - may destroy leukaemia cells.
Dr Claudia Friesen and colleagues at the University of Ulm, Germany, explain that methadone affects opioid receptors, which are found on the surface of certain cancer cells. Methadone has been shown to destroy lung cancer cells, so the researchers tested it on lymphoblastic leukaemia T-cells and myeloid leukemia cells in laboratory culture.
They discovered that methadone was "as effective as standard chemotherapies and radiation treatments" against non-resistant leukemia cells. They add that healthy blood cells were not affected.
The drug also killed leukaemia cells which were resistant to many types of chemotherapy and radiation. Full details appear in the journal Cancer Research.
Dr Friesen said: "Methadone kills sensitive leukemia cells and also breaks treatment resistance, but without any toxic effects on non-leukemic blood cells. We find this very exciting, because once conventional treatments have failed a patient, which occurs in old and also in young patients, they have no other options."
The team suggest that methadone activates a chemical pathway in leukaemia cells which causes enzymes to trigger programmed cell death, or apoptosis. Methadone therefore "holds promise as a new therapy for leukaemia, especially in patients whose cancer no longer responds to chemotherapy and radiation", they conclude.
Dr Friesen adds that methadone can become slightly addictive, but believes: "Addiction shouldn't be an unsolvable problem if methadone is ever used as an anti-cancer therapy."
Friesen, C. et al. Methadone, Commonly Used as Maintenance Medication for Outpatient Treatment of Opioid Dependence, Kills Leukemia Cells and Overcomes Chemoresistance. Cancer Research, Vol. 68, August 1, 2008, pp. 6059-64.
Fish boosts elderly brains
Tuesday August 5th, 2008
Fish is reputed to be good for the brain - and a new study suggests this applies in old age.
Regular fish eaters seem to enjoy a 26 per cent reduced risk of "silent" brain damage, researchers said.
The findings come from brain scans of more than 3,600 people over the age of 65, conducted in Finland.
Researchers looked for signs of small lesions that can lead to loss of thinking skills, stroke or dementia.
Even eating one helping of fish high in omega three fats weekly reduced the risk of having damage by 13 per cent, according to the study, reported in the journal Neurology.
The findings applied to meals such as broiled or baked tuna - but not to fried fish.
Fish high in omega three fats include salmon, mackerel, herring, sardines and anchovies.
The biggest reduction of risk was enjoyed by those who ate three or more helpings of fish a week - and this reduced it by 26 per cent.
Researcher Dr Jyrki Virtanen, of the University of Kuopio, Finland, said: "Previous findings have shown that fish and fish oil can help prevent stroke, but this is one of the only studies that looks at fish's effect on silent brain infarcts in healthy, older people."
Neurology August 5 2008
Alarm over nurse heart training
Monday August 4th, 2008
A minority of primary care nurses have never undertaken basic training in heart disease care, according to a new survey.
Senior nurses warned that practice nurses were sometimes being asked to work with patients without being "adequately qualified".
A survey of some 800 primary care nurses found that 14 per cent do not have any basic training in cardiovascular disease.
And 28 per cent said they did not feel comfortable working with patients with heart disease.
The 86 per cent who had undertaken training cited in-house training, primary care trust courses and reading and web learning as their main sources of knowledge.
The survey was conducted by the magazine Nursing in Practice.
One community matron from Huddersfield said: "I need more information so that I can offer the correct advice to the patients in my care.
"The changing roles of the community nurse have come along too fast, and many people are now responsible for cardiovascular reviews who are not adequately qualified but are under pressure to still complete reviews with limited knowledge. I believe this is potentially harmful to the patients in our care."
Linda Goldie, clinical director of the Primary Care Training Centre, Bradford, said: "The community matron's comment is so true. They work as autonomous practitioners, generally with prescribing rights, and they really should be doing much more formal training which assesses knowledge and skills."
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