Category: health

Adapted from BMJ 14 June 2025

Observational studies have shown that colon cancer patients who increase their physical activity after treatment have a lower risk of recurrence and death compared to those who don’t. Now, a randomised controlled trial, the first of its kind, has shown the same thing.

A three year programme of structured exercise reduced the relative risk of disease recurrence, new primary cancer, or death, by 28% in patients with stage III and high risk stage II colon cancer. The magnitude of the benefit is on a par to many standard drug treatments.

The Challenge Study randomised 889 patients with resected colon cancer and adjuvant chemotherapy to either the structured exercise group or a health education group. The exercise group had face to face coaching sessions and behavioural support every week for the first six months and then once a month. The health education group were given information about healthy eating and exercise but not the personal coaching.

The exercise group managed to get people to do the equivalent of 40-60 minutes brisk walking or 25-30 minutes of jogging, three or four times a week.

After 8 years follow up, disease recurrence, new primary cancer, or death had occurred in 93 of the 445 people in the exercise group, compared with 131 of 444 people in the education group. 90% of the exercise group were still alive, compared to 83% in the education group.

Vicky Coyle, consultant medical oncologist at Queen’s University Belfast, who led the research, hopes that exercise will be embedded in future treatment plans for patients.

It is thought that exercise works by regulating hormone levels, reducing inflammation and strengthening the immune system.

One of the commonest questions patients ask their doctors is what they can do to reduce their risk of a cancer recurrence. A vigorous, structured exercise programme fits the bill.

Adapted from BMJ 14 June 2025

Weight loss drugs have considerable advantages but as use grows unexpected side effects are occurring too.

For the child bearing years, usually 15-45 years of age, weight loss drugs seem to render oral contraceptives less effective.

Therefore, should you wish to delay or prevent conception, it is best to add a barrier method such as condoms or a diaphram to the combined or progestogen only pill.

Should a pregnancy occur, the weight loss drugs need to be stopped because there is insufficient knowledge about how these drugs can affect a developing baby. Animal studies indicate that there could be adverse fetal outcomes.

For those in older age groups, it has been found that people with diabetes have twice the likelihood of developing neovascular age related macular degeneration, than diabetics not on weight loss drugs.

Adapted from BMJ 24 August 2024

Marks and Spencer has partnered with Colostomy UK to launch an underwear line design for people with a stoma.

About 100,000 women in the UK have a stoma, but many find that underwear options were very limited to specialist online retailers.

They have produced a more affordable, accessible panty range that can keep a stoma bag in place by day and night.

Adapted from BMJ 3 Feb 2024

Most doctors agree that taking a medical history from a patient not only improves rapport but is essential to accurate diagnosis.

History taking is a skill that takes time and practice. Part of this is knowing when to delve more deeply and when you can take things at face value or leave parts out. Now, AI assistants have been trained to do it too.

A randomised, controlled, double blind trial was done with actors, simulating the patients, the Articulate Medical Intelligence Explorer, and primary care physicians. To keep everyone blinded as to who was “the doctor”, text chat was used instead of face to face interviewing.

The AI machine was as good as the doctors.

My comment: I could see this being very useful in clinical practice as a way of reducing consultation times and prioritising urgency of appointments.

Adapted from BMJ 17 Feb 2024

Around a third of US adults have impaired glucose tolerance also known as pre-diabetes. Many of the men also have low testosterone levels. This is known to cause fat accumulation, insulin resistance and type two diabetes.

Testosterone therapy is known to improve muscle mass, reduce fat mass, and improve insulin sensitivity. One would imagine that giving men who have low testosterone and pre-diabetes, hormone replacement therapy, would reduce the onset of type two diabetes.

For unknown reasons, doing this didn’t work.

In men over the age of 45 with low testosterone and pre-diabetes, testosterone gel was no more effective than placebo in reducing the onset of type two diabetes after two years. (13.5% in the active group and 15.7% in the placebo group.) Glycaemic control also failed to improve.

The trial also found out that testosterone replacement therapy also didn’t reduce fractures in hypogonadal men, even though skeletal mass is known to improve with testosterone.

My comment: I’m sure the researchers were disappointed to see this result. My practice was to treat these men with TRT and I am baffled as to these results, as treatment is usually very well tolerated.

Adapted from BMJ 17 Feb 2024

A Korean study of more than 7 million people determined at baseline if they had type two diabetes or not, and whether they had a normal liver, a mild fatty liver or severe fatty liver. They then followed them up for over 20 years to see what effects were seen on all cause mortality, or cardiovascular disease (myocardial infarction or ischaemic stroke).

In the non diabetic population 21.2% had mild fatty liver and 10.2% had severe fatty liver. In the type two diabetes population, 34% had mild fatty liver disease and 26.73% had severe fatty liver disease.

They found that even mild fatty liver disease increased cardiovascular mortality and all cause mortality in type two diabetics. As the degree of fatty liver increased, so did the rates of death for all cause and cardiovascular disease.

6.5% of the studied Korean population had type two diabetes. Weight loss through lifestyle modifications (diet and exercise) remains the cornerstone of management of type two diabetes, fatty liver and cardiovascular disease, but is difficult to achieve and even harder to maintain.

Newer weight loss drugs have shown promise in treating type two diabetes and in reducing fatty liver, but are expensive and may need to be continued for many years.

Adapted from BMJ 10 Feb 2024

Alexei A Birkun, associate professor, Simferopol wrote a letter into BMJ:

Walker and colleagues explore whether coffee makers are a source of nosocomial pathogens (Champagne Problems Christmas 2023).

The researchers took swabs from the drip tray outlets, buttons, water tank handle, and inside the water tank of coffee makers. But what about the less accessible interior parts?

A couple of days before reading the article, I cleaned the infuser of our home coffee maker. To my surprise, a round shaped fungal colony was sitting on coffee residues left on the infuser.

While hospital fungal pathogens might invade the interior of coffee makers is unclear, but internal components are probably less commonly cleaned and could be a favourable humid environment for fungi.

Previous research has shown that coffee can be a good medium for fungal growth, and toxigenic fungal genera are well known coffee contaminants.

Fungal species living in the interior of coffee makers should not be overlooked in future research.

My comment: Anyone for tea?

Adapted from BMJ 31 May 2025

An analysis of the medical records of 5 million adults under the age of 50 in the USA found that myocardial infarction was six times more frequent in cannabis users compared to non-users.

Ischaemic stroke was also four times more frequent.

Cannabis is also the most used illicit substance used in pregnancy. Eight new studies found that cannabis use doubled the risk of a baby being born with low birthweight.

Preterm birth and being small for gestational age was also raised.