Clinical news in brief - from the journals

In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.

Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.

More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.

High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.

People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.

Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.

News in brief: clinical studies from China

Measles is now rare in Guangzhou thanks to vaccination, but complete eradication will require vaccination of transient populations who now account for more than half of cases.

People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.

Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.

More than one in four new mothers in Guangzhou experience post-partum depression.

Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.

In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.

The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.

Low vitamin A levels are linked to eye cysts (chalazia) in south west China

Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.

Chinese medical news from the journals

Almost one in three Staphylococcus aureus strains found in humans by Yangzhou researchers were methicillin-resistant S. aureus (MRSA), with most being hospital-acquired MRSA. The superbugs were also found in food and animal samples. Writing in the journal Foodborne Pathogens and Diseases, the researchers say infection with multidrug-resistant MRSA strains acquired from food, animal, and human sources might also become a significant problem for human medicine.

One in four Chinese people with epilepsy has poor adherence to their anti-epilepsy medication and 70% have only moderate compliance, a new study shows. The reasons for nonadherence included forgetfulness (54%), being seizure-free for a period (49%), and fear of adverse drug effects (28%).
Epilepsy and Behavior.

Rotovirus and norovirus are the two most common causative agents for diarrhoea and vomiting in Chinese infants, a study from southeastren China has found. Rotovirus tended to cause more prolonged, frequent and severe illness and the viruses were seasonal, the study published in Pediatrics Infectious Diseases journal showed.

Smoking is a major risk factor for nonalcoholic fatty liver disease, especially in obese people, a Shanghai study has found. People who smoked and had a high BMI had a nine-fold higher risk of nonalcoholic fatty liver disease, their study in the Journal of Epidemiology showed. Passive smoking was also associated with a  25% increased risk of the disease, say researchers from the Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine.

China has made progress in the prevention and control of major non-communicable diseases but there are still large action gaps in the fight against epidemic non-communicable diseases according to members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China’s Ministry of Health.
Global Health Action.

Chinese people who have a more varied diet and especially a diet rich in fruit have a much reduced risk of bladder cancer, a study in Cancer Causes and Control shows

Type 2 diabetes is associated with the increased risk of  liver cancer within five years after diagnosis in Chinese population, researchers at the State Key Laboratory of Oncogene and Related Genes and the Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine have shown.  Writing in Annals of Oncology, they say the finding suggests that hyperinsulinaemia rather than hyperglycaemia is more likely to be a primary mediator for this association.

Ketogenic diet helps reduce seizures in Chinese children with epilepsy

by Michael Woodhead
One in three Chinese children with epilepsy reduced their rate of seizures when they tried the ketogenic diet, a study conducted in Shenzhen has shown.
Dr Suo Chenqu and co-researchers at the Shenzhen Children's Hospital conducted a trial of the high-fat, low-carbohydrate dietdiet which has been used to treat refractory epilepsy in childhood internationally.
Between 2004 and 2011, the researchers assessed the diet in 317 children with refractory epilepsy and followed them up for at least a year. After 3, 6 and 12 months, 63%, 42% and 24% of children remained on the diet, and at these times 35%, 26% and 19% of children respectively showed at least a 50% seizure reduction.
These improvements included 21%, 14% and 11% of children who remained seizure free while on the diet. The researchers found that the starting age for the diet influenced efficacy. Children aged over ten when they started the ketogenic diet showed a worse response than the under 10 age group. Other variables such as duration of epilepsy at the start of the diet, seizure types and aetiologies showed no significant influence on efficacy. Outcome was measured by seizure frequencies before and after the diet, change in anticonvulsant use and adverse effects. Common complications of the diet included GI disturbance, food refusal and hypoproteinaemia.
"The ketogenic diet is a safe and efficacious therapy for intractable childhood epilepsy in Chinese children," the researchers conclude.
Source: Seizure Journal.

Epilepsy stigma persists in China

Measures are needed to alleviate the stigma of epilepsy

by Michael Woodhead

Epilepsy can bring severe stigma for patients in China and strong measures are needed to alleviate the stigma and change attitudes, say Beijing researchers. 
Clinicians at the Beijing Tiantan Hospital Affiliated to Capital Medical University, did a survey of 106 patients with epilepsy as well as their caregivers, family members and clinical staff.
They found that there was still a strong stigma around epilepsy seen in peoples' understanding of epilepsy and the patients' own perception of epilepsy. There was also a noticeable stigma evident in attitudes of other people t epilepsy, in the social and cultural environment, and in the social support available to patients with epilepsy and in government regulations and policies.
"We found that the stigma of epilepsy is a very negative self-feeling from the patients' perspective, said Dr Guo Wencui and colleagues.
"Hence, we suggest that effective measures to alleviate stigma should be based on ways of eliminating factors that cause institutional stigma. Additionally, a personalized approach to eliminate factors that cause internalized and interpersonal stigma needs to be adopted. Only by addressing impacting factors at each of these three levels can the stigma of epilepsy in China be alleviated or even eliminated."
Read more: Epilepsy and Behaviour

Chinese doctors show "outdated" anti-epilepsy drug may still be the best

Phenobarbital was an effective anti-epileptic drug when used in rural China

by Michael Woodhead
Phenobarbital  should not be dismissed as an out-of-date drug for epilepsy because  it is still highly effective and well tolerated, Chinese researchers have shown.
Researchers from the Beijing Neurosurgical Institute analysed the effects of phenobarbital in a trial that involved almost 2500 people with epilepsy in rural China.
They found that 25% became seizure-free for at least one year while taking phenobarbital, 88% of whom did so at daily doses of 120mg or below. At a follow-up assessment, almost 40% of patients had been seizure free for at least the previous year. People with persistent seizures had significantly longer duration of epilepsy and higher number of seizures in the 12 months before treatment. People who were taking anti-epileptic treatment irregularly before the trial were less likely to become seizure-free. Overall, half the patients continued taking phenobarbital. The most common reasons for stopping phenobarbital were freedom from seizures or substantial seizure reduction and being unable to afford the drug. About 23% of patients reported adverse events, which led to withdrawal of phenobarbital in less than 1%. The most common adverse effects were malaise/somnolence (7%), dizziness (3%), and lethargy (2.6%).
The researchers conclude that there are still long-term benefits of regular treatment with phenobarbital for convulsive epilepsy in rural China.
"One hundred years after the discovery of its antiepileptic effect, phenobarbital is still playing an important role in the management of epilepsy," they say.
"Despite the subsequent availability of more than 20 drugs for the treatment of epilepsy, phenobarbital, introduced in 1912, remains the most widely prescribed AED worldwide. Its propensity for cognitive and behavioral adverse effects are of concern, but it has many potential advantages including reliability of supply, affordable cost, broad spectrum of action, and ease of use
They say their findings "have relevance for the implementation of similar intervention programs in other resource-poor settings where the great majority of people with epilepsy live. O
Read more: Epilepsia