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Take Note – January 2009


Does ginkgo prevent dementia?   
A recent, randomized, double-blind, placebo-controlled study of more than 3,000 people analyzed the effect of ginkgo biloba on dementia. The participants, who were ages 75 and older, had either normal cognition or mild cognitive impairment at the start of the study.
All participants received ginkgo biloba extract or a placebo twice a day. Every 6 months, the participants’ cognitive function was assessed. The median follow-up was 6 years. In the end, the researchers found no difference in the overall incidence of dementia between the two groups.

Perioperative beta blockers: No clear benefit in noncardiac surgery
Current guidelines recommend beta blockers for intermediate- and high-risk patients having noncardiac surgery. But findings from a meta-analysis are raising questions about this recommendation.
Researchers reviewed 33 randomized trials comparing beta blockers with control therapy in 12,306 surgical patients. Analyses of 30-day outcomes revealed that the risks for all-cause mortality, cardiovascular mortality, and heart failure were similar with beta-blocker therapy and control therapy. With beta-blocker therapy, however, the risks of myocardial ischemia and nonfatal myocardial infarction were lower, and the risks of nonfatal strokes, bradycardia, and hypotension were higher.
The authors concluded that beta blockers have no clear benefit in noncardiac surgery.

HIV: Good news, bad news
Patients may ask about two widely reported findings concerning human immunodeficiency virus (HIV) infection. First, the bad news: In a phase 2 trial, 3,000 high-risk, HIV-negative adults were randomized to receive either a cell-mediated, adenovirus-based vaccine or a placebo. Researchers found that the vaccine didn’t reduce HIV infection rates, and among participants who became infected, it didn’t reduce plasma viral load. In fact, in some subgroups, infection rates were higher with the vaccine.
Now, the good news: The Wall Street Journal reported the case of an HIV-infected man who has been off treatment and free of detectable HIV for more than 600 days—ever since he had a bone marrow transplant for leukemia. The bone marrow donor was homozygous for a genetic mutation (CCR5 delta 32) that made him virtually immune to HIV. Writing in HIV and ID Observations, a Journal Watch blog, Paul Sax concludes: “If ever there were a plausible target for gene therapy, the CCR5 delta 32 mutation seems like a great place to start.”
More resistant bacterium now more common in hospitals
An infectious disease expert says Acinetobacter baumannii, a bacterium found in soil and water, now accounts for 30% of drug-resistant hospital infections. According to Matthew Falagas, director of the Alfa Institute of Biomedical Sciences in Greece, A. baumannii is more resistant than methicillin-resistant Staphylococcus aureus and is a growing problem worldwide. A. baumannii can live on dry surfaces for weeks, and, Falagas explains, the best weapon against its spread is handwashing.

Patient dissatisfaction with U.S. hospitals
About one-third of the patients in a nationwide survey said hospitals do a poor job of managing patient pain. And one-fifth of the respondents thought communication before discharge was inadequate.
Despite such dissatisfaction, nearly two-thirds of the patients would recommend their hospital. Interestingly, facilities with higher nurse-patient ratios received better ratings.

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