Internal Medicine World Report, April 2006, Volume 0, Issue 0

Drug-Resistant Influenza Virus Strains Increasing in the United States

Influenza viruses isolated this past winter showed high rates of resistance to the adamantanes amantadine (Sym?metrel) and rimantadine (Flumadine). As part of ongoing surveillance efforts, 209 influenza A (H3N2 and H1N1) viruses isolated from patients in 26 states were tested for drug resistance mutations using pyrosequencing and confirmatory assays. A change at amino acid 31 (serine to asparagine) in the M2 gene, a mutation associated with adamantane resistance, was detected in 92.3% of the H3N2 viruses and 25% of the H1N1 isolates. The discovery prompted experts to recommend that amantadine and rimantadine not be used for influenza treatment or prophylaxis in the United States until susceptibility to adamantanes has been established among circulating influenza A virus strains (JAMA. 2006;295:891-894).

Chocolate Milk Hastens Recovery after Intense Exercise

Chocolate milk may be an effective post?exercise recovery drink. On 3 separate days, 9 en?dur?ance???trained cyclists performed an interval workout followed by 4 hours of recovery and a subsequent endurance trial to exhaustion at 70% maximum oxygen consumption. At 2 hours after the interval workout, the participants drank isovolumic amounts of chocolate milk, a fluid replacement drink, or a carbohydrate replacement drink. The carbohydrate content of chocolate milk and the carbohydrate replacement drink was similar. The time to exhaustion and total work during the endurance trial were significantly greater in those who drank chocolate milk or the fluid replacement drink than the carbohydrate drink (Int J Sport Nutr Exerc Metab. 2006;16:78-91).

H5N1 Virus Not as Easy to Spread among Humans as First Feared

A study of cells in the human respiratory tract has revealed a simple anatomical difference in the cells of the system that makes it difficult for the H5N1 avian influenza virus to transfer from human to human. This finding was discovered by experimenting on human tissue and showed that only cells deep within the respiratory system have the surface molecule or receptor that is the key that permits the avian flu virus to enter the cell. The upshot of these findings, according to the investigators, is that they show that for the virus to be transmitted efficiently, it has to multiply in the upper portion of the respiratory system, so it cannot be transmitted by coughing or sneezing (Nature. 2006; 440:435-436).

Oral Contraceptives May Cause Headache

The use of oral contraceptives (OCs) containing estrogen has been linked to an increased risk of both migraine and nonmigraine headaches. In a case-control, population-based study, 13,994 premenopausal Norwegian women completed questionnaires regarding headache and OC use. The use of OCs containing estrogen correlated with a 40% increased risk of migraine and a 20% increased risk of nonmigraine headache. No association was detected between the risk of headache and the use of OCs containing gestagen. There was no dose-response relationship between headache risk and the amount of estrogen in the OC (Neurology. 2006;66:349-353).

Systolic BP Best Predictor of CV Death in Men

Compared with other blood pressure (BP) parameters, systolic BP is the best predictor of cardiovascular (CV) mortality in men. A group of 53,163 men enrolled in the Physicians’ Health Study were followed prospectively for cause-specific mortality over a median of 5.7 years. A total of 459 CV deaths occurred during follow-up. For each 10-mm Hg increase in systolic BP, the multivariate risk ratio for CV death increased from 1.46 in the youngest age-group (39-49 years) to 1.13 in the oldest age-group (70-84 years). The corresponding risk ratios for diastolic BP were 1.25 and 1.07 in the youngest and oldest age-groups, respectively. Combining systolic BP with pulse pressure and mean arterial pressure did not increase the predictive value of systolic BP in any age-group (Am J Hypertens. 2006;19:47-52).

Psychosocial Stress May Predispose to Bacterial Vaginosis

Increased psychosocial stress is associated with a greater incidence and prevalence of bacterial vaginosis. A group of 3614 nonpregnant women aged 15 to 44 years were interviewed and underwent pelvic examinations and symptom assessment every 3 months for 1 year. Psycho?social stress was associated with an increased overall prevalence (adjusted odds ratio, 1.10) and incidence (adjusted odds ratio, 1.29) of bacterial vaginosis. The association between stress and bacterial vaginosis was not influenced by behavioral or demographic characteristics and was increased (odds ratio, 2.05) in a separate case-crossover analysis (Am J Obstet Gynecol. 2006;194:381-386).

Eating Potatoes Can Lead to Diabetes

Eating potatoes/french fries can in?crea?se the risk of type 2 diabetes in women, based on a study of 84,555 women enrolled in the Nurses’ Health Study who completed food frequency questionnaires and were followed for 20 years. Compared with participants in the lowest quintile of potato consumption, those in the highest quintile had a 14% higher risk of type 2 diabetes (P = .009 for trend). The risk of diabetes increased 18% with 1 daily serving of potatoes and 16% with 2 weekly servings of french fries. Substituting 1 serving of potatoes daily for 1 serving of whole grains daily increased the risk of diabetes by 30%. The association between potato consumption and diabetes risk was stronger in obese women (Am J Clin Nutr. 2006;83:284-290).

RA Patients at Risk of Preclinical Atherosclerosis

Patients with rheumatoid arthritis (RA) are at increased risk of preclinical atherosclerosis independent of traditional cardiovascular (CV) risk factors, according to a study of 98 patients with RA and 98 controls who underwent CV risk factor assessment and carotid ultrasonography. The prevalence of carotid atherosclerotic plaque was 44% in the RA patients and 15% in the controls (P <.001). After adjusting for age, cholesterol level, and other CV risk factors, the predicted prevalence of atherosclerotic plaque was 38.5% in the RA patients and 7.4% in the controls (P <.001). Among the RA patients, atherosclerotic plaque was associated with age, hypertension status, and use of tumor necrosis factor-alfa inhibitors (Ann Intern Med. 2006;144:249-256).

Gender Affects Impact of Alcohol on BP Levels

Some of the effects of alcohol on blood pressure (BP) are greater in women than in men, according to a study of the relationship between BP and lifestyle factors in 248 men and women (mean age, 50.8 years). Increased systolic BP was significantly associated with age (P = .039), male gender (P = .004), and alcohol consumption (P = .033), while lower systolic BP was significantly associated with exercise (P = .037). In all participants, the consumption of &#381;10 alcoholic drinks per week was independently associated with a 4.4-mm Hg increase in systolic BP during 24 hours and a 7.1-mm Hg increase during spousal contact; the corresponding values in women were 8.4 and 11.4 mm Hg, respectively. Gender significantly influenced the relationship between heavy drinking and systolic BP only during spousal contact time (P = .047) (Am J Hypertens. 2006;19:136-139).

Acupuncture as Effective as Drug Therapy for Migraine Prophylaxis

The effects of acupuncture may equal those of standard prophylactic drug treatments for migraine, according to a prospective, randomized, double-blind, controlled clinical study. A group of 960 patients with 2 to 6 migraine attacks per month were randomized to verum (ie, authentic) acupuncture, sham acupuncture, or standard therapy (beta-blockers, calcium channel blockers, or antiepileptic drugs). The patients received 10 sessions of acupuncture in 6 weeks or continuous drug treatment. The mean frequency of migraine between baseline and weeks 23 to 26 after randomization decreased 2.3 days in the verum acupuncture group, 1.5 days in the sham acupuncture group, and 2.1 days in the standard therapy group. The reductions in migraine frequency were significant (P <.001) and similar across the 3 treatment groups (P = .09) (Lancet Neurol. 2006;5:310-316).

Prehypertension Added to CVD Risk Factors

Prehypertension, currently defined as blood pressure (BP) 120/80 to 138/89 mm Hg, is associated with an increased risk of cardiovascular disease (CVD), according to a study of 8960 middle-aged adults. Compared with optimal BP (systolic <120 mm Hg and diastolic <80 mm Hg), the relative risk of CVD (ie, coronary heart disease, cardiac procedure, silent myocardial infarction, or ischemic stroke) was 2.33 for high-normal BP (systolic 130-139 mm Hg or diastolic 85-89 mm Hg) and 1.81 for normal BP (systolic 120-129 mm Hg or diastolic 80-84 mm Hg). The association between prehypertension and CVD risk was stronger in blacks, persons with diabetes, and those with a high body mass index (Am J Med. 2006;119:133-141).