2012-2013 The Medical Year in Review

Over the past year, many important medical topics were the focus of presentations and papers at medical conferences and conventions across the country and the world. Pharmacists need to stay up-to-date on findings that may impact disease state management and treatments—and also offer insights into future trends in health care. Here are some of those findings from recent medical meetings in 11 major therapeutic areas.

Pain/Inflammation

American College of Rheumatology 76th Annual Scientific Meeting

• A systematic review of Medline and Embase articles up to November 2011 found no consistent link between weather and rheumatoid arthritis symptoms, including pain and stiffness. A total of 19 articles qualified for the study and covered relationships between symptoms and humidity, temperature, and atmospheric pressure.
• NSAIDs are not associated with a lower risk of gout attacks, although particular formulations or doses of the drugs could prove effective, research from the University of Michigan and Ardea Bioscience shows. Prescription colchicine did effectively prevent the attacks, if taken consistently, the research showed.
• Knee pain is more common among runners and former runners with lower lifetime mileage than in runners with higher lifetime mileage, suggesting an inverse correlation between mileage and knee pain, researchers from Stanford University, Northern California Health Care System, and the University of California Davis Medical Center determined.

American Pain Society 31st Annual Scientific Meeting

• Higher scores on a medication side effect index was associated with lower scores on measures of daily function and ability to work, a sample of 103 patients prescribed analgesics for chronic musculoskeletal pain found.
• A survey of 7601 adults 65 years or older participating in the 2011 National Health and Aging Trend study found a 52.9% prevalence of bothersome pain in the last month, with higher pain prevalence in women and older adults with musculoskeletal conditions and depressive symptoms. A majority of the adults (74.9%) reported multiple sites of pain.
• Older obese patients may have enhanced pain sensitivity in their knees, regardless of whether they have knee osteoarthritis, researchers from the University of Alabama at Birmingham determined.

Ear/Eye/Nose/Throat

Association for Research in Vision and Ophthalmology 2013 Annual Meeting

• Using a province-wide database of physician visits and diagnoses, researchers from the University of British Columbia suggest an association between glaucoma and erectile dysfunction (ED), with a crude rate ratio of 1.34 and an adjusted rate ratio of 1.37 among patients with a current diagnosis of ED with at least 2 separate diagnoses of glaucoma. The researchers noted that further research is necessary to clarify the association as well as determine its potential cause.
• A survey of 128 glaucoma patients found no significant difference in adherence to eye drop therapy between patients who had trabeculectomy surgery and those who had not. Instead, researchers found good adherence to eye drop therapy among participants who kept an eye drop diary.
• A retrospective review of 100 patients diagnosed with diabetic foot ulcer between October 2004 and October 2011 at Seoul National University Bundang Hospital showed 90 patients had diabetic retinopathy, researchers reported. Of the 90 diabetic retinopathy cases, 55 were considered proliferative diabetic retinopathy, although there was no significant association between severity of diabetic retinopathy and diabetic foot ulcer.
• Serum and urine samples from 8 participants with dry age-related macular degeneration (AMD) and 35 participants with wet age-related macular degeneration suggest clear metabolic differences between the patients with the 2 disorders, research from The University of Birmingham and the Royal Wolverhampton Hospitals NHS Trust in the United Kingdom suggest. The overlap of several samples from participants with wet AMD with samples from the dry AMD group suggests common disorder pathways, as well as the potential for dry AMD to develop into wet AMD.

American College of Allergy, Asthma and Immunology 2013 Annual Scientific Meeting

• Pooled data from 2 double-blind randomized trials of participants with ragweed pollen—induced allergic rhinoconjunctivits showed ragweed allergy immunotherapy tablets reduced the need for allergy eye drops, even during peak pollen season.
• Separate scales for measuring allergic conjunctivitis severity and dry eye severity showed a particularly moderate correlation overall. Particularly strong correlation between the 2 questionnaires was observed for males; however, females showed a weak to moderate correlation on the same tests.

Diabetes

Epidemiology and Prevention/ Physical Activity, Nutrition and Metabolism Scientific Sessions

• Men whose spouses have died have an increased risk for developing type 2 diabetes, the results of a study conducted by the Harvard School of Public Health and the Mailman School of Public Health suggest.
• Despite population-based case management programs for cholesterol management, fewer women than men met recommended LDL cholesterol goals 1 year after a type 2 diabetes diagnosis, research from the University of Colorado Aurora suggests. Researchers noted that the results may indicate that more emphasis should be placed on coronary artery disease prevention in men and women with diabetes.
• A study of 73 mothers with a history of gestational diabetes and 73 mothers with no history of gestational diabetes found that those with a history were more likely to be told of future diabetes risk and encouraged to attend postpartum examinations, and believed they were more likely to develop diabetes than their peers. Despite this, participants felt they were equally likely to develop cardiovascular disease and also felt they were less able to change their prognosis.
• An examination of data from the Pittsburgh Epidemiology of Diabetes Complications study of childhood onset type 1 diabetes suggests that diabetes duration among microalbuminuria-positive individuals predicts coronary artery disease in both male and female participants. Among microalbuminuria-negative participants, diabetes duration and pulse rate predicted a coronary artery disease diagnosis in women, whereas non-HDL cholesterol and waist-hip ratio predicted it in men.

American Heart Association Annual Scientific Sessions 2012

• A daily regimen of 80 mg atorvastatin was not associated with an increased risk of new onset diabetes in patients with 0 to 1 risk factors, when compared with low-dose statin therapy. In patients with 2 to 4 risk factors for new onset diabetes, however, a daily regimen of 80 mg atorvastatin was associated with a 24% increase in new onset diabetes.
• An early glucose intolerance test in acute coronary syndrome patients can help identify patients with diabetes mellitus and facilitate appropriate treatment, researchers from Iwakuni Clinical Center in Japan determined. In the cases studied, impaired insulin secretion accounted for many cases of glucose intolerance in acute coronary syndrome patients.

Pediatrics

American Academy of Pediatrics 2012 National Conference and Exhibition

• The amount of sports concussion— related pediatric emergency department visits increased 3-fold since the passage of a Rhode Island law requiring athletes sustaining a head injury to obtain medical clearance to return to play. An analysis of electronic medical records found about 12 visits per month prior to the law passing, and about 42 visits per month after the law was in effect. In addition, emergency departments saw more sports concussion cases during fall sports than during winter or spring, as well as the largest increase in emergency department visits after the law passed, rising from about 40 visits during the season to about 97 visits during the season.
• A study of infants born to opioid- addicted mothers at West Virginia University Hospitals showed an increase from 2009 (5.2% of births) and 2010 (3.4% of births) to 2011 (11.8% of births). Of the total infants born during the 3-year study, researchers also detected an increase in the number infants exposed to buprenorphine in utero, whereas the number of infants exposed to methadone remained constant.
• A trial of infants presenting to the emergency department at Philadelphia Children’s Hospital with bronchiolitis with persistent respiratory distress showed less improvement if they received a nebulized 3% hypertonic saline solution than if they received a nebulized 0.9% normal saline solution. In both cases, the participants were initially treated with albuterol and suctioning.
• An increase in concussion awareness has not elicited increased concern from high school athletes, research from the University of Arkansas suggests. Although recognition of concussion symptoms has improved, an online survey that drew 134 responses found 32% of participants experienced concussion-like symptoms but did not seek medical attention, and 38% reported being concerned about long-term effects. Half of those reporting concussion-like symptoms cited exclusion from play as a reason for not reporting their symptoms.
• Researchers from the University of Utah aiming to determine the frequency of off-label medication prescribing in a pediatric intensive care unit found off-label treatment was ordered in 96% of patients 4 days to 12 years of age, and 100% of 13-to-17 year old patients. A total of 335 medications were prescribed, and 74 of those medications were used off-label 10 or more times.

American College of Allergy, Asthma and Immunology 2013 Annual Scientific Meeting

• Portable spirometer values for 20 children with well-controlled persistent asthma who discontinued controller medications showed that their asthma remained stable at the second, sixth, and 12th week after discontinuing therapy. Spirometric values were recorded before and after administering a bronchodilator; however, researchers noted that the portable spirometers could not differentiate cues for asthma exacerbation.
• Researchers examining 33 children, 7 to 18 years old, with severe atopic dermatitis found that the condition affects psychological welfare, physical, and social activities at both baseline and 3 months after receiving background therapy. The therapy included antihistamines, membrane stabilizers, enterosorbents, gastrointestinal medications, and external local treatment.
• A retrospective cross-sectional analysis of 146 children with obstructive sleep apnea detected chronic rhinitis in 43% of children, although its presence does not affect obstructive sleep apnea severity. Children with obstructive sleep apnea and chronic rhinitis are more likely to have apnea-related events during REM sleep, researchers noted.

First Aid

American Academy of Pediatrics 2012 National Conference and Exhibition

• A study following 413 children and their parents for 2 weeks after admission to an emergency department for minor injuries suggests that injury type, location, age, and pain score upon arrival are potential predictors of poor outcomes following release. Poor outcomes were most commonly associated with fractures, injuries to the lower extremities, and moderate to severe pain during arrival.
• A survey of 112 adolescent athletes suggests that more sleep decreases the likelihood of injury, with athletes who slept 8 or more hours per night being 68% less likely to be injured. As students progressed through grades, however, their likelihood of injury increased 2.3 times, researchers reported.

American College of Allergy, Asthma and Immunology 2013 Annual Scientific Meeting

• Acetaminophen 500 mg is a therapeutic option in patients who have previously had allergic reactions to NSAIDs, even if they have also had a prior reaction to acetaminophen, a study of 86 participants who submitted to drug provocation testing suggests. Researchers reported only 7 reactions to the tests, which included mild urticaria and a single case of pruritis and mild facial angioedema. All reactions were successfully treated with oral antihistamines and corticosteroids, researchers reported.

Vitamins and Supplements

Epidemiology and Prevention/ Physical Activity, Nutrition and Metabolism 2012 Scientific Sessions

• Vitamin D concentration of less than 15 ng/ml was associated with higher odds of self-reported musculoskeletal pain among statin users, according to a population-based survey of 6217 participants that included 1145 statin users.
• Levels of vitamin D had no significant influence on macrovascular events in high-risk participants with type 2 diabetes, as long as participants adhered to treatment guidelines, a study of 936 high-risk veterans suggests.

American Academy of Pediatrics National Conference and Exhibition 2012

• A year-long observational study of 74 pediatric patients presenting to an emergency department with long bone fractures found 51% of patients had insufficient vitamin D levels, and 10% had deficient vitamin D levels.

American Heart Association Annual Scientific Sessions 2012

• An analysis of 407 participants with non-valvular atrial fibrillation receiving oral anticoagulant therapy showed higher average vitamin E levels in those experiencing bleeding events than in those who did not. Serum vitamin E levels increased progressively from participants that experienced no bleeding events, participants experiencing minor bleeding events, and participants experiencing major bleeding events.
• Low beta-carotene levels were associated with elevated insulin and insulin resistance in African Americans, a study of 177 non-smoking adult men and women suggests.
• A multi-ethnic cohort study of 6237 participants 45 to 84 years old showed no association between calcium supplementation and cardiovascular events.

Women's Health

American College of Rheumatology 76th Annual Scientific Meeting

• A survey of 868 patients in Oslo, Norway, suggests that female patients with rheumatoid arthritis are more likely to report sleep disturbances. The sleep disturbances are also associated with pain, fatigue, and negative mental and physical function in those female patients.
• Research from Stanford University showed that menopausal status was not associated with an increase in gout or hyperuricemia prevalence, after offsetting the effect of age.
• African American women with either a high body mass index (BMI) or a large waist circumference are more likely to have negative knee osteoarthritis baseline to 4-year function outcomes than Caucasian women with either high BMIs or a large waist circumference, according to research from Northwestern University.

21st Annual Women’s Health Congress

• Although women are as likely to quit smoking as men, women tend to relapse more frequently and could have a harder time quitting long-term because of the relapses.
• Higher human papillomavirus (HPV) knowledge did not make women more likely to complete the vaccination series for the virus; however, women who incorrectly believed HPV could cause HIV/AIDS were 2.5 times more likely to complete the vaccine series.

60th Annual Meeting of the Society for Gynecologic Investigation

• Patients with suspected or confirmed pre-gestational diabetes mellitus can achieve glycemic control using oral hypoglycemic agents, a study from the University of Medicine and Dentistry New Jersey-Robert Wood Johnson Medical Center suggests.
• Women with endometrial cancer had an improved chance of survival if they had been diagnosed with hyperlipidemia or had used statins to treat hyperlipidemia. Researchers from Montefiore Medical Center noted that further research is needed to determine whether the protection is granted by statins or by hyperlipidemia.

Oral Care

International Association for Dental Research PER Conference 2012

• Straight interdental toothbrushes removed more plaque than angled brushes, particularly on posterior teeth, according to research from Witten/Herdecke University.
• Applications of a highly concentrated fluoride gel can prevent demineralization of tooth enamel and increase in tooth lesion depth, despite factors meant to increase dental caries, research from the University of Freiberg and Ludwig Maximilian University of Munich indicates.

2012 FDI Annual World Dental Congress

• A study conducted at Istanbul Training and Research Hospital evaluated plaque index scores between 41 diabetic participants and 32 participants without diabetes. Researchers found higher plaque index scores and a worse periodontal status in the participants with diabetes than in patients without diabetes.

American College of Rheumatology 76th Annual Scientific Meeting

• Severe periodontitis affected 1 in 3 patients with rheumatoid arthritis, a rate much greater than patient self reports show. Periodontitis was more frequently seen in patients who were either older, male, smoked, or had seropositivity for rheumatoid factor or anti-CCP antibody. In addition, researchers suggested that misclassification and study bias are more likely to occur in studies using patient self-reports to determine periodontitis cases.

Topicals

British Association of Dermatologists 92nd Annual Meeting

• Narrowband ultraviolet shortwave rays therapy was effective at relieving psoriasis and atopic eczema in pediatric patients, according to a retrospective review of 94 patients who received the therapy at a British teaching hospital.

23rd Annual Meeting of the Wound Healing Society

• Researchers from the University of Miami examined 8 methicillin-resistant Staphylococcus aureus and methicillin-sensitive aureus strains to determine sensitivity to prescription and OTC topical antibiotics, including an aminoglycoside antibiotic, a monocarboxylic acid antibiotic, a pleuromutlin antibiotic, an antibiotic containing bacitracin, and a hydrocarbon-based ointment. The monocarboxylix acid had the greatest effect on every strain, and required a lower minimum inhibitory concentration to be effective.

Second Eastern Asia Dermatology Congress

• A preliminary observation conducted at the University of Ulsan College of Medicine in Seoul, Korea, suggests a tranexamic acid solution soak can reduce rosacea symptoms, although additional randomized controlled trials are needed.
• A Seoul National University College of Medicine study assigned either a low glycemic load diet or a control diet to 32 participants with mild to moderate acne for 10 weeks. At the end of the study period, participants on the low glycemic load diet showed improvement in the number of non-inflammatory and inflammatory acne lesions, and a histopathologic examination of skin samples showed smaller sebaceous glands and decreased inflammation.
• A systematic review of random clinical trials on topical herbal medicines to treat psoriasis showed only 6 herbal medicines with promising outcomes of 13 investigated. Hydrolyzed wheat protein in Japanese facial soap led to either contact reactions, wheat anaphylaxis, or wheat-dependent exercise-induced anaphylaxis in 18 patients with no prior symptoms of wheat allergy, leading researchers from Kyoto Prefectural University of Medicine to note the possibility of sensitization from a non-dietary product.

Stomach/GI

Joint International Neurogastroenterology and Motility Meeting

• Researchers from several Italian universities found a graded increase in work productivity losses as participants’ functional constipation severity increased, with the overall productivity losses in patients with severe constipation symptoms compared with patients with mild symptoms amounting to € 4647.
• Once-daily linaclotide therapy led to a greater improvement in abdominal pain and bloating in participants with irritable bowel syndrome with constipation by the second day of therapy and a progressive increase in symptom improvement in the first week of therapy compared with a placebo.
• Patients who are partial responders to proton pump inhibitor (PPI) therapy reported significantly lower scores on quality-of-life factors, including general health, bodily pain, vitality, and mental health, than those who responded to therapy well, researchers from Nagoya City University determined. In addition, researchers found that partial PPI responders who were also taking NSAIDs could also affect quality-of-life scores.
• Web surveys of 5494 participants suggest that overactive bladder is common among patients with functional dyspepsia, with 20% of participants with functional dyspepsia also indicating overactive bladder symptoms.

Cold/Cough/Allergy

American College of Allergy, Asthma & Immunology 2013 Annual Scientific Meeting

• Patients with asthma who receive fluticasone proprionate/salmeterol dry powder were 1.17 times more likely to develop oral candidiasis than patients who received beclomethasone dipropionate hydrofluoroalkane, according to a survey of MarketScan Commerical and Medicare Supplemental database data.
• Measuring canister weight can help determine the number of doses remaining in a metered dose inhaler, although the relationship between doses and weight depends on the product used. The study was conducted by researchers from Prince of Songkla University and Prince Songkhlanagarind Hospital in Thailand, who compared the average weight per actuation of 20 inhalers that were placed in regression equations to find predicted values to the actual number of doses remaining in a metered-dose inhaler.
• Antibiotic use within the first year of life is associated with an increased risk of food allergies, and may be a contributing factor in allergy development, researchers from the University of South Carolina determined. After identifying 1105 participants with food allergies and 6433 participants without food allergies from Medicaid billing data, researchers found participants who received an antibiotic between 180 and 365 days after birth were more likely to have food allergies. Having 3 or more courses of antibiotics also increased the likelihood of developing food allergies, researchers noted.
• Smoking hinders the effect of inhaled corticosteroid therapy in patients with mild to moderate asthma, and also causes more inflammation, a study of 81 asthmatic smokers and 52 non-asthmatic smokers suggests.
• Allergic rhinitis severity directly relates to sleep quality, with patients with worse symptoms reporting more sleep disturbances and worse psychological wellness. In addition, patients with allergic rhinitis and nasal congestion tended to report worse psychological wellness and poorer sleep quality than patients without nasal congestion.
• Detection of either Streptococcus pneumoniae or human rhinovirus in children with asthma’s nasal samples is associated with an increased loss of asthma control, researchers from the University of Wisconsin School of Medicine and Public Health determined. Presence of both pneumoniae and human rhinovirus in nasal samples had an additive effect on loss of asthma control.

Family Planning

21st Annual Women’s Health Congress

• A telemedicine monitoring program for participants with gestational hypertension analyzed neonatal intensive care unit costs between those who were engaged in the program and those who were not. Participants who were engaged in the program saw a cost savings of $16,551 per case, spending about $54,946, whereas participants who were not engaged in the program incurred costs of about $71,496.
• A study conducted by researchers from the University of North Carolina aimed to determine how retrospective recall of oral contraceptive adherence compares with data from daily medication diaries. The survey of 185 participants showed agreement between the 2 sets of data; however, retrospective recall was inconsistent in participants with only a high school education or less and in those who reported feeling sad while taking the medication.
• An immediate counseling session with teenagers who are not using contraception at the time of a self-referred pregnancy test made the teenagers more likely to use an effective form of contraception 3, 6, and 12 months afterwards.

60th Annual Meeting of the Society for Gynecologic Investigation

• Increasing the concentration of ethinyl estradiol in combination oral contraceptives over an 84-day active period and following with lower ethinyl estradiol concentrations in place of placebo pills may provide better protection from unscheduled bleeding and unscheduled spotting in a population pharmacokinetic model.