Calcium channel blockers and cancer. . . and other storiesBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2529 (Published 14 June 2018) Cite this as: BMJ 2018;361:k2529
No increased mortality with CCBs
There has been some anxiety that calcium channel blockers might encourage growth of malignant cells by reducing intracellular calcium concentrations and inhibiting apoptotic gene expression. However, the findings of a record linkage study that tracked more than 20 000 breast cancer patients are reassuring. After adjustment for demographics, comorbidities, and the use of other sorts of medication, mortality from breast cancer was no higher in women who had taken calcium channel blockers than in women who had never used them. (Epidemiology doi:10.1097/EDE.0000000000000814)
Fit or faint?
It can be hard to decide whether a patient who presents after a transient episode of loss of consciousness has had a fit or a faint. Although myoclonic jerks are frequently seen in vasovagal syncope, they are often misinterpreted as a sign of epilepsy. Data from a case series of video electroencephalogram recordings among people undergoing tilt-table testing allowed the investigators to formulate a 10/20 rule. Fewer than 10 jerks means syncope, more than 20 means epilepsy. Other useful discriminating features are loss of muscle tone, which is a strong indicator of syncope, and rhythmicity of jerking, which favours epilepsy (Neurol doi:10.1212/WNL.0000000000005301).
The sound of seizures
On the subject of seizures and electroencephalograms, a group of neurologists from Stanford had the bright idea of converting electroencephalogram data into sound, by arranging for the electrophysiological signal to modulate a background voice tone. During a seizure, the epileptic spikes turn into loud speech-like sounds with a strong rhythmic character which are easily distinguished from the quieter, slower, smoother tones of normal brain activity (Epilepsia doi:10.1111/epi.14043). Medical students and nurses without any training in electroencephalography could detect seizures in a sonified electroencephalograms very nearly as well as experts examining the traces visually.
Observational studies suggested that diets rich in insoluble fibre help to prevent type 2 diabetes. But the results of a randomised trial in 180 adults with impaired glucose tolerance make this idea look shaky (Diabetologia doi:10.1007/s00125-018-4582-6). A fibre supplement (15 g of insoluble fibre daily for two years) turned out to be no better than placebo in preventing deterioration in glucose metabolism or progression to diabetes. Neither were there differences in levels of fasting glucose, adipokines, or inflammatory markers between the groups.
Nails can sometimes be a source of useful information. Think of splinter haemorrhages, koilonychia, psoriatic pitting or Mees’ lines. A case report of enormously long toenails in an elderly man adds another example (JAMA Intern Med doi:10.1001/jamainternmed.2018.0099). Toenails grow at a rate of only a couple of millimetres per month, therefore long toenails mean that they haven’t been cut for quite a while. Possible reasons include declining physical function, depression, cognitive impairment, and lack of support from caregivers. Toenails in older people might be considered an indicator of how things have been going over the previous few months.