eMJA: In Other Journals, 6 July 2009

Intestinal metaplasia of the oesophagus (Barrett’s oesophagus) is associated with an increased risk of oesophageal adenocarcinoma through the development of epithelial dysplasia. In a randomised controlled trial involving 127 patients, researchers in the United States have found that radiofrequency ablation of dysplastic Barrett’s oesophagus was successful in achieving a high rate of eradication of the abnormality, along with a reduced risk of disease progression. The authors caution that the results must be interpreted in relation to the grade of severity of oesophageal dysplasia, which has varying risk of progression to cancer. They also comment on potential side effects, including oesophageal stricture, and suggest the need for cost–benefit analyses.

Depression and chronic pain

Primary care providers are well aware that depression and chronic pain are common causes for presentation to a GP, and that these two problems commonly coexist. A combined pharmacological and behavioural approach appears to improve both depression and pain in patients with musculoskeletal pain and comorbid depression, according to the results of a recent randomised controlled trial. The intervention group was placed on optimised (supervised) antidepressant therapy for 12 weeks, followed by a 12-week pain self-management program, and a further 6 months of assessment and assistance. Significant improvements in both depression severity and level of pain were reported in the treatment group compared with the controls. The authors comment that, although the non-specific effect of care-manager contact is difficult to determine, the results have important clinical and economic implications.

JAMA 2009; 301: 2099-2110

Sleep apnoea damages brain function

The damaging effects of obstructive sleep apnoea (OSA) on brain function may be more serious than previously thought, according to Australian researchers. Using 31P magnetic resonance spectroscopy, a non-invasive tool for measuring the relative intracellular concentrations of several phosphorus metabolites, scientists studied the brains of 13 men with severe OSA during apnoeic episodes occurring during sleep. Oxygen saturation was measured via pulse oximetry throughout scanning. The spectra revealed that moderate oxygen desaturation during sleep resulted in significant effects on brain bioenergetic status. In particular, compensatory protective mechanisms appear to be inactive in the transient hypoxia experienced during sleep apnoea. The authors comment that the effects of new therapeutic agents aimed at protecting brain function in OSA may be measured using this method.

J Cereb Blood Flow Metab 2009; 13 May [Epub ahead of print]

An aspirin a day?

The relative benefits and risks of prophylactic aspirin therapy were the subject of a recent large collaborative meta-analysis. In an advance on previous studies, individual patient data from several randomised controlled trials were included, using data from 95 000 individuals from six randomised controlled trials. This allowed researchers to estimate the magnitude of risk factors such as age, male sex, diabetes and high blood pressure for different outcomes including stroke, myocardial infarction, and vascular death. The risk of major bleeding with aspirin therapy was also assessed in the primary and secondary prevention of these vascular diseases. The investigators concluded that, in primary prevention without previous disease, the use of aspirin is of uncertain net benefit when the risks of occlusive events and major bleeds are weighed up against each other.

Lancet 2009; 373: 1849-1860

Genes for autism

The search for genetic markers of autism spectrum disorders (ASDs) is narrowing, say US scientists who have performed a whole-genome study aimed at identifying genetic variations that confer susceptibility to ASDs. Along with some previously reported ASD candidate genes, several new susceptibility genes were revealed. These genes were found to encode neuronal cell-adhesion molecules which are critical in the development of the nervous system. A second association was identified with genes from the ubiquitin pathway, which is involved in the turnover of synaptic components, and has been linked to other human neurological syndromes, including juvenile Parkinson’s disease and intellectual disability. The authors suggest functional studies need to be carried out to assess the biological effects of abnormalities in these candidate genes.

Nature 2009; 459: 569-573

Dr Tanya Grassi, MJA

mja.com.au | The Medical Journal of Australia

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