Diseases & Conditions Archive

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In the journals

It is often assumed that appendicitis means automatic surgery to relieve the pain and avoid complications. Yet, a study published online Sept. 25, 2018, by JAMA found that many people with uncomplicated acute appendicitis may be safely treated with antibiotics and avoid an appendectomy.

About 70% to 80% of acute appendicitis cases are uncomplicated, which means the appendix hasn't ruptured or formed an abscess. In the study, researchers had 530 people with uncomplicated acute appendicitis either undergo an appendectomy or receive 10 days of antibiotic therapy. After five years, 61% of the antibiotic group had no recurrences of appendicitis and no appendectomies.

Certain eye conditions offer clues to your chances of developing dementia.

It's long been said that the eyes are the windows to the soul, but can they also provide a view of your brain's future? Researchers increasingly say yes. Studies have identified links between common eye conditions and Alzheimer's disease and other forms of dementia.

One study, published in the July 2018 issue of Alzheimer's & Dementia, appeared to validate past findings that linked three eye diseases — glaucoma, age-related macular degeneration, and diabetic retinopathy — to an increased risk of Alzheimer's disease.

Ask the doctors

Q. I had a nosebleed the other night. I've heard that this can be more common in the winter. Is this true?

A. Yes, you could be more likely to get a nosebleed in the winter because the heated indoor air may dry out your nasal passages and make the tiny blood vessels inside them more fragile. Nosebleeds occur when these tiny vessels rupture. Sometimes the bleeding happens at the back of the nose, called a posterior bleed. Or it may develop at the front of the nose — an anterior bleed.

What can you do about this mysterious ailment?

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Leaky gut has not received the attention it deserves, in large part because it remains a medical mystery.

"Part of the reason is that the gut is such a complex system, and science continues to find new ways that the gut can influence everything from heart health to keeping our brains young," says Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment with Harvard-affiliated Massachusetts General Hospital. "There is much we know about leaky gut in terms of how it affects people's health, but there is still so much that is unknown."

Ask the doctors

Q. I was recently diagnosed with hidradenitis suppurativa. What could have caused this condition, and can it be cured? What are the usual treatments?

A. Hidradenitis suppurativa is an uncommon skin condition that starts out as pimple-like lesions on the skin. If left untreated, it can grow deeper into the tissue and over time can lead to painful fluid-filled lumps or thick scars. The condition is most common on parts of the body where skin presses up against skin, such as the groin, the underarms, the thighs, or the buttocks. Hidradenitis suppurativa most often affects younger people, particularly women, and most often happens after puberty. It's less common in people over age 55. Other risk factors include smoking and being overweight or obese, and it seems to run in families. Experts aren't really sure what causes hidradenitis suppurativa, but hormones and the immune system may play a role. Some experts believe that an ordinary blockage in the skin triggers an overzealous immune system reaction, which leads to symptoms. The good news is that you can't spread the condition to other people, and it is treatable. Catching the problem early can minimize problems. There are numerous treatment options for hidradenitis suppurativa, including antibiotics, hormonal medications and skin treatments, such as acne washes or special bleach baths. In more severe cases, your doctor might also recommend biologic therapy to dampen the immune response or surgery to remove or drain the affected skin. Even after treatment, the condition may require ongoing monitoring to treat or prevent recurrences.

But use is primarily a concern for people who take them over a long period or who have certain health risks.

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Numerous studies in recent years have raised concerns that common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiovascular problems, such as heart attack and stroke.

A study published September 4 in The BMJ seems to confirm the risks associated with NSAIDs and notes that one medication in particular — diclofenac (Voltaren) — is associated with even higher risks to cardiovascular health than others in the same category.

Research we're watching

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Taking a low-dose aspirin every day could bring more risks than health benefits to healthy older adults, according to three papers from a single study, published online September 16 by The New England Journal of Medicine. The study, which began in 2010, included more than 19,000 adults ages 65 and older in the United States and Australia, who were free of cardiovascular disease, dementia, or disability, and followed participants for 4.7 years on average. Researchers found that treatment with a daily low-dose aspirin did not prevent dementia or disability. And rates of cardiovascular events (such as heart attacks and stroke) were similar between participants who took low-dose aspirin therapy and the comparison group that did not. While health outcomes were largely the same, people in the aspirin group were more likely than those who were not taking daily aspirin to experience significant bleeding, both in the gastrointestinal tract and the brain — a known risk of aspirin therapy.

While low-dose aspirin does not appear to benefit healthy older adults, this does not apply to people with known cardiovascular disease. For them, aspirin therapy significantly decreases risk of heart attack and stroke.

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Research we're watching

Eating a Mediterranean-style diet, which is rich in fruits and vegetables, lean meats, and nuts, may help women over 40 reduce the risk of stroke, according to a study published in the journal Stroke.

The study enrolled more than 20,000 adults, ages 40 to 77, who were asked to record what they ate in a seven-day diet diary. Researchers then compared their diet and their stroke risk over a 17-year period.

Ask the doctor

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Q. Is there something stronger than aspirin I can take for peripheral artery disease in my legs?

A. People with peripheral artery disease (PAD) in the legs have blockages (plaques of atherosclerosis) in the arteries that impair the flow of blood. Based on large scientific studies involving over 5,000 people with PAD, authorities recommend taking a daily aspirin tablet. For people with PAD, smoking cessation, regular exercise, and often other medicines such as statins, can help prevent further plaque buildup and decrease symptoms.

Common mental health disorders are linked to a higher risk of heart attack and stroke. Learn to spot the warning signs.

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Heart disease and mental health issues are both common. So it's not surprising that these problems often occur together. But are people with depression or anxiety more prone to developing cardiovascular disease?

Teasing out the answer to that question has proved tricky. Some factors known to contribute to a higher risk of heart disease (for example, an unhealthy diet, lack of exercise, and smoking) are also common in people with mental health issues. Now, new research that adjusts for those potentially confounding factors suggests the answer is yes.