Continued warfarin therapy safe in surgery
PATIENTS who underwent pacemaker or defibrillator surgery without interruption to their warfarin therapy had a “markedly reduced incidence” of clinically significant haematoma compared with patients who were treated with heparin bridging therapy, according to a randomised control trial of 668 patients. The results, published in the New England Journal of Medicine, showed that of the patients who remained on warfarin, significant device-pocket haematoma occurred in 3.5% compared with 16% of patients who were switched to heparin bridging therapy. The researchers also found that continued warfarin therapy was not associated with any major perioperative bleeding events and was associated with greater patient satisfaction. However, they warned that the results of their study could not be applied to patients receiving newer anticoagulants, including dabigatran, as evidence for these drugs was unclear.

“Exciting” treatment for schizophrenia
A SMALL randomised, placebo-controlled trial has demonstrated “exciting” results, with safe, rapid and long-lasting improvements in symptoms for schizophrenia patients after a single intravenous injection of sodium nitroprusside. The research, published in JAMA Psychiatry, assigned 20 inpatients aged 19–40 years in the first 5 years of the disease and taking antipsychotics to sodium nitroprusside or placebo. After infusion of 0.5 µg/kg/min of sodium nitroprusside for 4 hours, symptoms improved within 4 hours, with significant differences in psychiatric rating scores between the two groups persisting for 4 weeks after the infusion. “These findings are important given that the medications currently available to patients are often ineffective in treating an acute psychotic episode in a reasonable time frame (if at all) without significant adverse effects”, the researchers wrote. There did not appear to be any negative interactions with the medications taken by any patients at the time of the study. “Approval of sodium nitroprusside infusions for the treatment of schizophrenia could significantly improve patient care in emergency and acute care settings, and the future development of alternative formulations more conducive to long-term use could be effective for maintenance therapy”, they wrote. However, an accompanying editorial, while welcoming the findings, said “caution must be exercised until sufficiently powered clinical trials of nitroprusside are performed in patients with schizophrenia”.

C. difficile linked to depression
RESEARCHERS have conducted two studies which confirm that adults with depression and those using specific antidepressants are more likely to experience Clostridium difficile infection (CDI). The research, published in BMC Medicine, also found that widowhood and living alone were associated with CDI. The two studies included a longitudinal investigation of 16 781 older Americans, linking data from biennial interviews to physician and health facility visits, and a clinical investigation of 4047 hospitalised adults tested for CDI, with cases testing positive and controls testing negative. The first study found that individuals with major depression had rates of CDI consistently elevated across all age groups, and in people without major depression, the rates increased with age. Results from the clinical study indicated that certain antidepressants could impart an altered risk for CDI, particularly the combination of mirtazapine with trazodone. “We cannot completely discern whether it is the pathophysiology of depression itself or the treatment for depression that is the major driver of these findings”, the researchers wrote. “Clinicians prescribing antimicrobials to patients with depression should be aware of the possible increased risk of CDI in this patient population.”

Huge rise in fall-induced brain injury
THE incidence of fall-induced traumatic brain injury (TBI) in older men and women increased dramatically between 1970 and 2011, according to a research letter published in JAMA. The Finnish population-based research found the incidence of fall-induced TBI in those aged 80 years and older had increased by up to 315%, from 60 women and 25 men in 1970, to 1205 women and 612 men in 2011. The age-adjusted incidence of TBI (per 100 000 persons) increased from 168.2 women in 1970 to 653.6 in 2011 (up 289%) and from 174.6 to 724.0 in men (up 315%). “We do not know whether the increase in fall-induced TBI is related to an increase in falls or to an increase in TBI after a fall”, the researchers wrote. They said older adults may fall more often and more seriously than their predecessors because they live longer and have more chronic disorders. “In addition, some strong external risk factors for falling, such as polypharmacy, may have become more common among older adults”, they said. “Changes in living arrangements, impaired balance and vision, sensory neuropathy, alcohol consumption, and increased use of anticoagulants also may have contributed.”

Supplements don’t help cataracts
A RANDOMISED, placebo-controlled trial published in JAMA Ophthalmology has found supplementation with lutein/zeaxanthin for age-related cataracts had no effect on cataract surgery, cortical or posterior subcapsular cataract lens opacity progression, or vision loss. The researchers followed 3159 people enrolled in the Age-Related Eye Disease Study (AREDS2) with a mean age of 73 years. Of the 6027 “study eyes”, 1389 (23%; 876 participants) underwent cataract surgery during the study. “In AREDS2, we found neither beneficial nor harmful effects on the rates of cataract surgery or moderate vision loss when lutein/zeaxanthin was added to the AREDS formulation”, the authors wrote. However, they noted that AREDS2 volunteers were generally better educated and better nourished than the general population, with higher dietary intake levels of lutein/zeaxanthin and omega-3 fatty acids. “Whether there is a subgroup of persons who are relatively less well nourished that would benefit from lutein/zeaxanthin supplementation to slow the progression of lens opacities remains uncertain”, they wrote.

Don’t shop hungry
A RESEARCH letter published in JAMA Internal Medicine says that even short-term food deprivation can make people choose more high-calorie food options when shopping. The research involved 68 women in a laboratory-based study and a supermarket field-based study of 82 people. The laboratory participants shopped in a simulated online grocery store offering a mix of low- and high-calorie food when they did not feel hungry and after having no food on a following day. The women chose a higher number of high-calorie foods, but there was no difference in low-calorie choices. The field study tracked choices at different times of the day and found those shopping in the “hunger hours” bought less low-calorie food. “Given the prevalence of short-term food deprivation, this has important health implications”, the authors wrote. They said people should make food choices while in less hungry states, such as by eating an appetizer before shopping. An accompanying editorial said “all diet guides include the advice to ‘never go grocery shopping when you are hungry’ — and when I had young children, I added ‘and never with young children’ — because either of these factors seem to lead to less wise food choices”.

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