News in brief: Diabetes drug slows Alzheimer’s disease-related cognitive impairment; Lower stroke risk with DOACs vs warfarin for NVAF patients; Neurosurgeon faces urgent disciplinary hearing

23 Aug 2021

Neurosurgeon faces urgent disciplinary hearing

UPDATE: Since this article was published, AHPRA has announced details of restrictions on Dr Charlie Teo’s registration. These include a requirement for a statement of support from a Medical Council approved neurosurgeon before performing recurrent malignant intracranial tumour and brain stem tumour surgical procedures. The restrictions also require Dr Teo to work under supervision and to submit to audits of outcomes of his procedures. More details here.

Controversial neurosurgeon Charlie Teo has faced an urgent disciplinary hearing of the NSW Medical Council over complaint referred by the state’s Healthcare Complaints Commission (HCCC).

The Council said it was legally unable to comment on the outcome of the   “immediate action panel” relating to Dr Teo’s practice at the Prince of Wales Private Hospital, where he specialises in keyhole surgery for brain cancer considered inoperable by other surgeons.

“The Medical Council will not be making any further statements while it is in discussions with Dr Teo and any potential regulatory action is being considered

However in a statement released on Friday 20 August Dr Teo said he “accepted the Medical Council’s direction to consult with another neurosurgeon on two rare types of surgery and will also have retrospective discussions with a colleague to review outcomes.”

According to the SMH, Dr Teo also claimed that the Medical Council had agreed that he had put in place “an advanced set of advanced office procedures, which are expected to become the benchmark for good administrative practice for surgeons.”


Diabetes drug slows Alzheimer’s disease-related cognitive impairment

Dipeptidyl peptidase-4 inhibitor (DPP-4i) use could help slow Alzheimer’s disease-related cognitive impairment (ACDI) in diabetes patients, a new study has shown.

The review of 282 ADCI patients with positive 18F-florbetaben amyloid PET images revealed diabetic patients on DPP-4is had lower global amyloid burden than diabetics who weren’t on DPP-4is (β: 0.075, SE: 0.024, P = 0.002) and non-diabetic patients (β: 0.054, SE: 0.021, P = 0.010).

They also had lower regional amyloid burden in temporo-parietal areas and slower decreases in longitudinal Mini-Mental State Examination (β = 0.772, SE = 0.272, p = 0.005) score and memory recall sub-score (β = 0.291, SE = 0.116, p = 0.012) than non-DPP4i users and non-diabetics.

“These findings suggest that DPP-4i use is associated with low amyloid burden and favorable long-term cognitive outcome in diabetic patients with ADCI,” the authors wrote in Neurology.


Lower stroke risk with DOACs versus warfarin for NVAF patients

Non-valvular atrial fibrillation (NAVF) patients with high risk of gastrointestinal (GI) bleed appear less likely to suffer stroke or systemic embolism (SE) while on non-vitamin K antagonist oral anticoagulants (DOACs) than warfarin, a study suggests.

Published in JAMA Network Open, the study compared stroke and/or SE and major bleeding risk in 381,054 patients who were newly prescribed apixaban, dabigatran, rivaroxaban or warfarin between 2013 and 2015.

It found that apixaban (HR, 0.60; 95% CI, 0.52–0.68), dabigatran (HR, 0.75; 95% CI, 0.64–0.88) and rivaroxaban (HR, 0.79; 95% CI, 0.73-0.86) were associated with lower risk of stroke and/or SE compared with warfarin.

Apixaban (HR, 0.59; 95% CI, 0.56–0.63) and dabigatran (HR, 0.78; 95% CI, 0.70–0.86) were also associated with a lower risk of major bleeding, while rivaroxaban was associated with a higher risk versus warfarin, the authors wrote.

“This is one of the first real-world studies to compare [DOACs] in the patients with NVAF and high risk of GI bleed; the results may help inform decision-making regarding OACs in this high-risk patient population,” they concluded.

 

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