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Ireland’s implementation of a workplace smoking ban in 2004 appears tied to a decline in maternal smoking rates as well as lower risk for preterm births, study findings hint.

Compared with the year prior to the smoking ban, 12 percent fewer women reported smoking during pregnancy in the year after the ban, Dr. Zubair Kabir, of the Tobacco Free Research Institute in Dublin, Ireland, and colleagues report.

Their study, in BJOG: An International Journal of Obstetrics and Gynecology, also revealed “a welcome sign,” Kabir’s team notes. They observed 25 percent lower risk for preterm births in the year after the smoking ban compared with the year prior to the ban.

Kabir and colleagues analyzed records at Coombe Women and Infants University Hospital to assess whether Ireland’s workplace smoking ban altered smoking during pregnancy, a known risk factor for preterm birth and having a low birth weight infant.

Their comparison included 7,593 births in 2003 and 7,648 births in 2005, and allowed for other maternal factors tied to birth risks such as the mother’s age, number of previous births, alcohol intake, blood pressure, and complications during pregnancy.

Overall, babies with the highest birth weights on average were born to former smokers. By contrast, babies with the lowest birth weights had mothers who smoked during pregnancy.

However, in addition to the noted declines in maternal smoking and preterm birth risk, the investigators also identified 43 percent greater risk for low birth weight in the year after the smoking ban compared with the year prior to the ban.

This finding “is intriguing and needs further exploration,” Kabir and colleagues say, particularly in light of evidence that exposures to secondhand smoke during pregnancy may play a role in having babies with low birth weight.

They also call for further exploration of their observed increase in Caesarean delivery rates - from 15.4 in 2003 to 19.5 percent in 2005.

In diabetic patients with blocked coronary arteries, there appears to be no difference in outcomes at one year whether patients undergo bypass surgery or angioplasty with stenting, British researchers report.

Bypass surgery has been the standard treatment for diabetic patients with coronary artery disease. However, less invasive approaches such as angioplasty with stenting — where a thin mesh tube is inserted to open the artery — have emerged. Until now, there’s been little study to see whether the procedure is as effective as bypass in diabetic patients.

“Cardiovascular disease is the leading cause of death among patients with type 2 diabetes, and approximately 25 percent of the patients who undergo revascularization procedures in the United States have type 2 diabetes,” noted Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, who was not involved in the study.

Earlier studies have suggested that bypass surgery provides more effective revascularization (re-opening of blood flow) and better long-term clinical outcomes in patients with type 2 diabetes and multi-vessel coronary artery disease compared to angioplasty/stenting, Fonarow said.

But this new clinical trial in patients with type 2 diabetes and multi-vessel disease suggests that in the first year at least, bypass and angioplasty/stenting produce similar results, he said.

“However, as this study is small and the follow-up period confined only to the first year, additional studies with more patients and longer-term follow-up are required,” Fonarow said.

The report is published in the Nov. 25 online edition of the Journal of the American College of Cardiology. The study was funded by a number of drug companies, including Eli Lilly & Co. and Bristol-Myers Squibb, as well as stent manufacturers such as Boston Scientific and Medtronic.

For the study, a team led by Dr. Kevin J. Beatt from the Mayday University Hospital in London, randomly assigned 510 diabetic patients who participated in the Coronary Artery Revascularization in Diabetes Trial to undergo coronary bypass surgery or angioplasty with stenting.

During one year of follow-up, the rate of deaths, heart attack and stroke was 10.5 percent among patients who had bypass surgery, compared with 13 percent for patients who underwent angioplasty and stenting, the researchers found.

The type of stent used seemed important. The first group of patients in the trial received bare metal stents, but when drug-eluting (emitting) stents became available many of the patients received them instead. The introduction of these stents greatly improved the outcome for the patients who received them, the researchers found.

While rates for death, heart attack and stroke were 12.4 percent among patients who underwent bypass surgery, they were 11.6 percent among patients who received drug-eluting stents, the researchers report.

“When the new drug-eluting stents were used, stenting seemed as good and was possibly better than bypass surgery,” said Dr. Byron Lee, an associate professor of cardiology at the University of California San Francisco. “However, this finding was based only on a subgroup analysis, and definitive proof will have to await the results of other ongoing trials,” he said.

In cardiac bypass surgery, the patient’s chest is opened, exposing the heart. The patient is put on a heart-lung machine that continues to pump blood though the body as the operation is done. The operation itself involves taking vein segments from the patient’s leg and using them to replace blocked coronary arteries.

In contrast, angioplasty, a minimally invasive procedure, involves passing a catheter from the patient’s groin into the blocked heart artery. A balloon at the tip of the catheter opens to expand the blocked artery. To ensure the artery remains open, a stent is placed in the artery. Drug-eluting stents are coated with a drug that promotes healing and helps prevent the stent from becoming blocked again.

- It’s known that eating a lot of salt puts people at greater risk of high blood pressure. Now there’s confirmation of a corollary: High salt intake also translates to significantly greater risk of cardiovascular disease and stroke.

A review published in the Nov. 25 online edition of BMJ found that a difference of just 5 grams of regular daily salt intake spells a 23 percent difference in the rate of stroke and a 17 percent difference in the rate of cardiovascular disease.

According to the review, the World Health Organization recommends that people consume only 5 grams — about a teaspoon — of salt each day. But people in the West typically eat around 10 grams a day, and those in Eastern Europe consume even more.

The review authors analyzed 13 studies, involving more than 170,000 people, that assessed the link between salt and cardiovascular disease and stroke.

The researchers estimated that reducing daily salt intake by 5 grams around the world could prevent more than 1 million stroke deaths and nearly 3 million deaths from cardiovascular disease each year. And because it’s hard to measure salt intake, those numbers could actually be even higher, the authors noted.

A drug commonly used to treat non-Hodgkin’s lymphoma and rheumatoid arthritis now also shows some promise in helping patients newly diagnosed with type 1 diabetes.

The drug, rituximab (Rituxan), helped patients keep producing some of their own insulin, even though the disease had destroyed some of their pancreatic beta cells, which produce the critical hormone, reports a study in the Nov. 26 issue of the New England Journal of Medicine.

The results were on par with those seen in other studies trying experimental immune therapies for type 1 diabetes, said study lead author Dr. Mark D. Pescovitz, professor of surgery and of microbiology/immunology at Indiana University in Indianapolis.

But the findings have to be interpreted with a “little caution,” warned Dr. Vivian Fonseca, professor of internal medicine at Texas A&M Health Science Center College of Medicine and director of the Diabetes Institute at Scott & White in Temple.

“This paper doesn’t appear as if this is a cure for diabetes. Patients did manage to produce more insulin themselves, but it’s not a huge amount more. The insulin dose they used was a little bit less but not hugely less,” he continued. “Even with this data, we’re a long, long way from getting approval for using this kind of treatment. Also, the patients in the study were newly diagnosed so there is virtually no application for people who have had type 1 diabetes for some time.”

But needing less outside insulin does have advantages. “We know that people who produce some of their own insulin tend to have less complications in the long term,” Fonseca said. Those complications can include blindness and heart trouble, although in no way do researchers yet know if rituximab will reduce those problems in type 1 diabetics over the long-term.

Type 1 diabetes is an autoimmune disease in which the body’s own immune system destroys the critical insulin-producing beta cells of the pancreas.

“People have been trying to change the immune system to treat type 1 diabetes, the rationale being that it’s an autoimmune disease where you get antibodies that destroy the cells in the pancreas that produce insulin,” Fonseca explained.

Up to now, much research has focused on the immune cells known as T-lymphocytes, the immune cells that attack the pancreas, but there has been increasing speculation that another type of cell, called B-lymphocytes, may also play a role. B cells work a step back in the process, stimulating the T cells to do their damage, Pescovitz explained. Rituximab targets B-lymphocytes.

“This deals with a whole new clinical pathway to try to deal with type 1 diabetes,” he said.

In this phase 2 trial, 87 patients with newly diagnosed type 1 diabetes were randomly assigned to receive rituximab infusions or a placebo at one-week intervals for four weeks.

After one year, C-peptide levels — an indicator of how much insulin is being produced by the body — were higher in people taking rituximab versus those in the placebo group.

Those in the rituximab group also needed less external insulin and had fewer B cells.

Side effects faded with time, although Pescovitz pointed out that long-term adverse effects from rituximab are not yet known.

It’s also not clear if this treatment would be superior to other immunosuppressive strategies, but it is certainly easier to deliver, he said.

“This [B cell] approach is all done as an outpatient basis whereas the [other agents] are done as inpatients,” said Pescovitz.

And treatment over only three weeks gave a response that lasted a year, Fonseca noted.

Next, researchers need to determine if additional infusions over time will confer added benefits, and they also plan to look into ways to help the beta cells actually grow back or ways to transplant beta cells.

The study was funded by the U.S. National Institutes of Health, the Juvenile Diabetes Research Foundation International and the American Diabetes Association. Genentech and Biogen Idec, which make rituximab, provided the medication for the trial.