Medical Bulletin 06/November/2023

Here are the top medical news of the day:

Is Thalidomide Effective In Treating Recurrent Small-Intestinal Bleeding, Study Insights

A recent multicenter, double-blind, randomized, placebo-controlled trial investigated the efficacy and safety of thalidomide as a potential solution for recurrent bleeding due to small-intestinal angiodysplasia (SIA). Thalidomide treatment significantly reduced recurrent bleeding in patients with small-intestinal angiodysplasia, with an effective response observed in 68.6% of those receiving 100 mg thalidomide and 51.0% of those receiving 50 mg, compared to 16.0% in the placebo group.

In the study, eligible patients with a history of recurrent bleeding, experiencing at least four episodes within the previous year due to SIA, were randomly assigned to receive thalidomide at a daily oral dose of either 100 mg or 50 mg or a placebo for four months. Following the treatment period, patients were monitored for a minimum of one year.

The results were derived from 150 patients who underwent randomization: 51 to the 100-mg thalidomide group, 49 to the 50-mg thalidomide group, and 50 to the placebo group. Notably, the percentages of patients with an effective response in these respective groups were 68.6%, 51.0%, and 16.0%, indicating a highly significant outcome (P<0.001). Moreover, the analysis of secondary endpoints consistently supported the primary results.

However, it is important to acknowledge that adverse events were more frequent in the thalidomide groups compared to the placebo group. These adverse events included constipation, somnolence, limb numbness, peripheral edema, dizziness, and elevated liver enzyme levels.

Ref: N Engl J Med 2023; 389:1649-1659 DOI: 10.1056/NEJMoa2303706

Can Midlife Estrogen Therapy Reduce Dementia Risk, Study Finds

A new study has found that estrogen therapy taken during midlife may reduce the risk of developing dementia later in life. The study, published in the journal Frontiers in Aging Neuroscience, looked at data from over 768,000 women and found that those who took estrogen therapy in their 40s and 50s had a 32% lower risk of developing dementia compared to those who did not take estrogen therapy.

The study also found that the type of estrogen therapy taken made a difference. Women who took estrogen-only therapy had a greater reduction in dementia risk than those who took estrogen-plus-progestogen therapy.

The researchers believe that estrogen therapy may help to protect against dementia by reducing inflammation and improving blood flow to the brain. They also note that estrogen therapy may help to reduce the accumulation of amyloid plaques and tau tangles, which are two of the hallmarks of Alzheimer's disease.

The findings of this study are important because they suggest that estrogen therapy may be a way to prevent dementia in women. However, the researchers caution that more research is needed to confirm the findings and to determine the optimal timing and dosage of estrogen therapy for dementia prevention.

Ref: Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer’s disease and dementia Matilde Nerattini et al, Volume 15 - 2023 | https://doi.org/10.3389/fnagi.2023.1260427

Are Face Masks Effective in Reducing Spread of Respiratory Viruses, Study Finds

In a world still grappling with the ongoing COVID-19 pandemic, the role of face masks in preventing the spread of respiratory pathogens has been a subject of debate. A recent study highlights the strong evidence supporting the use of face masks in the fight against deadly pandemics. As viruses like the influenza virus and SARS-CoV-2 have shown, they can swiftly evolve into global pandemics when transmitted through respiratory routes. Face masks have proven effective in reducing the transmission of these pathogens.

The study draws upon well-designed observational research that has consistently demonstrated the association between mask use and the reduced transmission of SARS-CoV-2 within community settings. Moreover, rigorous evaluations of mask mandates have revealed substantial protection.

The study seeks to address the controversy surrounding the efficacy of face masks by emphasizing the significance of observational studies and real-world evidence. Randomized clinical trials, which have their limitations in this context, should not be the sole focus of the debate. The study argues that many effective public health policies have never been assessed through randomized trials and suggests that such trials should not be considered the gold standard for evaluating the efficacy of all interventions.

Masking within communities has consistently demonstrated its effectiveness in reducing the spread of SARS-CoV-2. This evidence is derived from diverse settings and populations, providing a robust foundation for the promotion of mask use as a preventive measure.

Ref: Cash-Goldwasser S, Reingold AL, Luby SP, Jackson LA, Frieden TR. Masks During Pandemics Caused by Respiratory Pathogens—Evidence and Implications for Action. JAMA Netw Open. 2023;6(10):e2339443. doi:10.1001/jamanetworkopen.2023.39443