A round-up of happenings in medicine this week

Alcohol and the AF link: India is going through a new epidemic of atrial fibrillation (AF), which is linked to acute attacks of paralysis. Now a study published in the journal Heart Rhythm has shown that regular alcohol intake at moderate levels (8-21 drinks per week) is associated with electrical and structural changes in atrial myocardium.

Moderate alcohol consumption is an independent predictor of the atrial remodeling, characterized by significantly reduced atrial voltage and conduction velocities and increased atrial dimensions. The same was not found for mild alcohol intake levels, defined as two to seven drinks per week.

Screen all new cancer patients for hepatitis: A new study published online on January 17 in JAMA Oncology has found a large reservoir of patients with cancer and undiagnosed hepatitis virus infections and has suggested that all newly diagnosed cancer patients should be screened for hepatitis. They found that 6.5% had previously been infected with hepatitis B virus (HBV), 0.6% had chronic HBV infection, 2.4% had hepatitis C (HCV) infection, and 1.1% were infected with HIV.

Universal screening for HBV, HCV, and HIV infection is not routinely performed in patients diagnosed with cancer. Universal screening could prevent complications from hepatitis, such as liver failure and kidney disease. Immunosuppressive cancer drugs such as rituximab can cause some viruses to reactivate and multiply.

Valsartan and cancer: The US FDA said that some versions of the blood pressure-lowering drug valsartan contained trace amounts of a carcinogen for four years before regulators detected the impurity last summer, triggering a widespread recall of the tainted drugs.

FDA officials said the cancer risk for any person who took valsartan that had the carcinogen nitrosodimethylamine, or NDMA, is small. FDA scientists concluded there would be one more cancer case above average rates for every 8,000 people on the highest dose of valsartan for four years.

And now irbesartan has been recalled: In US, Prinston Pharmaceutical Inc has recalled one consumer-level lot of irbesartan and seven lots of irbesartan hydrochlorothiazide (HCTZ) tablets because of the presence of the probable carcinogen N-nitrosodiethylamine (NDEA), marking the latest recall of tainted sartan products produced in the United States.

This announcement on January 18, stems from the finding of NDEA in the active pharmaceutical ingredient (API) manufactured by China's Zhejiang Huahai Pharmaceuticals (ZHP), the company at the center of the tainted sartan crisis.

The recalled product was distributed nationwide to wholesale, distributor, repackager, and retail customers. It comes in 30- and 90-count bottles, with an expiration date of February 2021 for the one irbesartan lot and March 2021 for the seven irbesartan HCTZ lots.

A new sarcoma drug: Eli Lilly and Co.’s cancer drug Lartruvo should not be started in new patients, and those patients already taking it should ask their doctors if they should continue as a key study that failed to show the medicine prolonged lives. The drug was given accelerated approval by the US FDA in 2016 based on promising data from an early-stage study.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA