Open Reading Frame brings together a selection of recent publication highlights from elsewhere in the open access ecosystem. This week we take a look at the past few weeks in medicine.
The burden of adverse drugs in the elderly
Adverse drug reactions (ADRs) have a significant impact on health, causing between five percent and seven percent of all hospitalizations. As older people experience greater overall disease burden than younger people, with a corresponding increase in the use of medicines, they have greater risk of suffering ADRs. A systematic review and meta-analysis has been carried out to define the prevalence of ADR in the elderly, and identify the associated risk factors. Analysis of data from the 14 included studies revealed that the overall prevalence of ADRs in people aged 65 or over is 11 percent; older female patients and those with multiple comorbidities and medications were found to be at increased risk of ADRs. These findings highlight the high burden of ADRs in older people, and should inform future research into minimizing the risk of ADRs in this population.
Alhawassi et al. Clinical Interventions in Aging
Identifying the warning signs of cancer
Cancer is a leading cause of morbidity and mortality worldwide, but research suggests that many people in the UK ignore early warning signs of the disease. In the study, the responses of 1,724 people to a health questionnaire were analyzed. Participants were asked about their experience of 17 symptoms over the last three months, ten of which are categorized as cancer ‘alarm’ symptoms by Cancer Research UK. These alarm symptoms include unexplained bleeding, changes in mole appearance, persistent change in bowel habits and unexplained lumps. Fifty-three percent of study participants had experienced at least one cancer alarm symptom, but only two percent of these people considered cancer to be a potential cause. These findings indicate that such symptoms are rarely attributed to cancer, but that some people are dismissing early warning signs that could result in detecting cancer at an earlier and more treatable stage.
Whitaker et al. PLOS One
Preventing cardiovascular events: which antiplatelet should be used?
Antiplatelets – drugs that reduce the risk of blood clots forming – are widely used in the primary and secondary prevention of heart attack and stroke. While these drugs reduce the risk of cardiovascular and cerebrovascular events, they do not prevent them completely, and some people taking aspirin experience problems such as stroke. In a collaboration between Taiwan and the USA, researchers investigated the best strategy to prevent further complications in patients receiving aspirin who suffered ischemic stroke. The authors analyzed the Taiwan National Health Insurance Research Database and compared outcomes in patients receiving either aspirin or clopidogrel after stroke over a 1-7 year follow-up period. Compared with aspirin, clopidogrel was associated with lower occurrence of future hospitalization due to a major adverse cardiovascular event. These results require validation in prospective studies, but suggest that clopidogrel may be a better long-term option to prevent future cardiovascular events in those experiencing a stroke while taking aspirin.
Lee et al. BMJ Open
A new candidate malaria vaccine
Malaria is present in over 100 countries worldwide, and is responsible for approximately 627,000 deaths annually, with over 90 percent of deaths occurring in African children. While a number of candidate vaccines for malaria are under investigation, there is currently no licensed vaccine. Many candidate vaccines target the pre-erythrocytic stages of the malaria parasite’s lifestyle – the stages before the parasite enters red blood cells of the infected individual, and show great promise for reducing the burden of malaria. Now, researchers have developed a new pre-erythrocytic malaria vaccine candidate containing genetically attenuated parasites. The vaccine candidate, PfΔb9ΔslarpSPZ, makes use of sporozoites – immature forms of the malaria parasite – with deletion of the genes b9 and slarp that render the sporozoites unable to develop. In a mouse model, this new vaccine candidate gave rise to protection against infection with malaria, suggesting it is a promising candidate for a new malaria vaccine, which should undergo further clinical development.
van Schaijk et al. eLife
The global burden of TB during pregnancy
The number of global maternal deaths has declined over the past two decades, and it is important to understand the causes of maternal deaths so that effective strategies to further reduce mortality can be implemented in the future. It is thought that non-obstetric causes, such as infectious diseases, now account for 28 percent of maternal deaths. To better understand the burden of infectious disease in pregnant women, new research has used country-level estimates to determine the incidence of tuberculosis (TB). Analyzing data from 217 countries, the researchers estimated that 216,000 pregnant women suffered from TB infection in 2011, with the greatest disease burden in the World Health Organization African region. These estimates suggest that the burden of TB is substantial among pregnant women, and could contribute to maternal mortality. The authors recommend that maternal care services could represent an important platform for detecting and treating TB in pregnant women.
Sugarman et al. The Lancet Global Health
Can fruit and vegetables protect against bladder cancer?
The benefits of eating fruit and vegetables – from reducing the risk of cardiovascular disease and some types of cancer to improving digestive health – are numerous, and it is recommended that we eat at least five portions a day to stay healthy. Now, authors from the UK and Norway have carried out a systematic review and meta-analysis to assess whether fruit and vegetable intake is linked to bladder cancer risk, an association that has been suggested in previous case-control studies. While the results showed a trend towards decreased bladder cancer incidence with higher fruit and vegetable consumption, total consumption was not significantly associated with lower risk of bladder cancer. The authors conclude that current evidence does not support a protective role of fruit and vegetables against bladder cancer, and suggest that further research into specific types of fruit and vegetables, such as citrus fruits and cruciferous vegetables, should be carried out.
Vieira et al. Cancer Medicine
Written by Claire Barnard, Senior Editor for BMC Medicine.