January 18, 2011, 7:54 AM CT
Plasma exchange in severe MS relapses
A new guideline from the American Academy of Neurology recommends using plasma exchange to treat people with severe relapses in multiple sclerosis (MS) and related diseases, as well as those with certain kinds of nerve disorders known as neuropathies. The guideline is reported in the January 18, 2011, print issue of Neurology
�, the medical journal of the American Academy of Neurology.
Plasma exchange, formally known as plasmapheresis, is the process of taking blood out of the body, removing constituents in the blood's plasma believed to be harmful, and then transfusing the rest of the blood (mainly red blood cells) mixed with replacement plasma back into the body.
The guideline recommends doctors consider using plasma exchange as a secondary therapy for severe flares in relapsing forms of MS and related diseases. The therapy was not found to be effective for secondary progressive and chronic progressive forms of MS.
As per the guideline, doctors should offer plasma exchange for therapy of severe forms of Guillain-Barr� syndrome and for temporary therapy of chronic inflammatory demyelinating polyneuropathy. Plasma exchange may also be considered for therapy of some other kinds of inflammatory neuropathies.
"These types of neurologic disorders occur when the body's immune system mistakenly causes damage to the nervous system. Plasma exchange helps because it removes factors in the plasma thought to play a role in these disorders," said guideline main author Irene Cortese, MD, a neurologist with the National Institutes of Health in Bethesda, Md., and a member of the American Academy of Neurology.........
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January 18, 2011, 7:52 AM CT
Binge drinking: Too prevalent and hazardous
Binge drinking, an activity that a number of young people engage in, has associated adverse health risks and we need to do a better job of controlling overall alcohol usage, states an editorial in CMAJ
(Canadian Medical Association Journal
) (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj110029.pdf.
"Given the a number of stakeholders involved in the sale and consumption of alcohol, we need a national strategy for controlling overall alcohol use," write Drs. Ken Flegel, Noni MacDonald and Paul H�bert in the editorial. "Public health agencies, the hospitality industry, liquor manufacturers and control boards, municipalities and major granting agencies should collectively turn their attention to evaluate strategies to curb binge drinking".
"As we await evidence about beneficial interventions, we should strengthen surveillance programs so we can increase public awareness of the high prevalence and known dangers of heavy and binge drinking." Communication and discussion with children and youth about the dangers of intoxication such as rape, violence and risk of death is important as is good role modeling about responsible consumption.........
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January 18, 2011, 7:27 AM CT
Follow-up program helps detect melanoma earlier
A follow-up program for patients at high risk of developing skin cancer may be linked to the detection of melanomas at early stages and with good prognosis, as per a report posted online today that will appear in the May print issue of Archives of Dermatology
, one of the JAMA/Archives journals.
Efforts to improve melanoma prognosis have focused on identifying and closely monitoring individuals at high risk, as per background information in the article. "Fair-skinned persons, persons who tan with difficulty, blond or red-haired persons and persons with blue eyes have more risk of developing melanoma than the general population," the authors write. "The presence of a number of pigmented lesions, including freckles and clinically typical or atypical nevi; intermittent sun exposure and severe sunburns, particularly during childhood; and exposure to artificial UV-A radiation have all been linked to an increased risk of melanoma." Individuals with a personal or family history of melanoma are also at high risk.
Dermoscopy�a noninvasive diagnostic technique in which a physician performs a microscopic assessment of a skin lesion�improves the accuracy of melanoma diagnoses, the authors note. Gabriel Salerni, M.D., of Hospital Clinic of Barcelona, Institut d'Investigacions Biom�diques August Pi I Sunyer, Barcelona, and his colleagues analyzed data from 201 patients diagnosed with melanoma in one specialized unit, including 40 who were in a follow-up program for high-risk individuals and 161 who were referred for assessment by another clinician. All melanomas diagnosed among these patients were reviewed by dermoscopy.........
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January 18, 2011, 7:26 AM CT
Barriers to performing skin cancer exams
Time constraints, other illnesses and patient embarrassment may prevent dermatologists, internists and family practitioners from conducting full-body skin examinations, as per a report in the recent issue of Archives of Dermatology
, one of the JAMA/Archives journals. However, dermatologists are significantly more likely than internists and family practitioners to conduct such screenings.
Skin cancer is the most frequently diagnosed cancer in the United States, as per background information in the article. "It is critical for patients to adhere to primary prevention behaviors and for clinicians to adopt secondary prevention strategies aimed at early detection of skin cancer to reduce its associated morbidity and mortality," the authors write. "Prior studies have suggested that a number of individuals, especially those with established risk factors for melanoma, would benefit from active skin cancer screening and surveillance, and screening by dermatologists in particular may also be cost-effective".
Susan A. Oliveria, Sc.D., M.P.H., of Memorial Sloan-Kettering Cancer Center, New York, and his colleagues surveyed 2,999 physicians randomly selected from the American Medical Association's Medical Marketing Services database in 2005. Of those, 1,669 (59.2 percent) returned surveys, including 559 family practitioners, 431 internists and 679 dermatologists.........
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January 18, 2011, 7:24 AM CT
Heart failure patients admitted to general wards
Heart failure patients admitted to general wards are twice as likely to die as those admitted to cardiology wards, shows a national audit of the therapy of the condition, published online in the journal Heart
Women fared worse than men when it comes to appropriate investigations and therapy, the findings suggest, eventhough death rates were similar.
In 2006/7, heart failure accounted for more than a quarter of a million hospital deaths and discharges in England and Wales, equating to around 2.5 million bed days a year and at an annual cost to the NHS of �563 million.
The authors draw their conclusions from a survey of the first 10 patients admitted each month with a primary diagnosis of heart failure to 86 hospitals across England and Wales between April 2008 and March 2009.
During this period, just over 6,000 patients, with an average age of 78, were admitted with the condition. Almost half of these (43%) were women.
At admission, less than a third (30%) were reported to be breathless at rest and under half (43%) as having swollen feet/ankles. These are both diagnostic features of heart failure.
Appropriate investigations were not always carried out, the survey shows, with those admitted to general medical wards less likely to receive these than those admitted to cardiology wards.........
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January 18, 2011, 7:22 AM CT
Smoking accounts for up to 60 percent of gender gap in deaths
Smoking accounts for up to 60% of the gender gap in death rates across Europe, and kills twice as a number of men as alcohol, reveals research published online in Tobacco Control
The reasons why women have been outliving men in developed European countries since the mid to late 18th century, in some cases, have been hotly contested.
The gender gap in death rates has sometimes been put down to simple biology, or the fact that women seek out health care more readily than men. But the magnitude and variability of the trends suggests a rather more complex picture, say the authors, who set out to explore this discrepancy in more detail.
They used World Health Organisation figures on death rates among men and women from all causes as well as those attributable to smoking and drinking in 30 European countries for the years closest to 2005.
Smoking related deaths included respiratory tract cancers, coronary artery disease, stroke and chronic obstructive pulmonary disease (COPD). Those correlation to alcohol included cancers of the throat and gullet and chronic liver disease as well as alcoholic psychosis and violence.
The 30 countries included Iceland, Greece, Malta, Cyprus, and several in Western and Eastern Europe, excluding the Russian Federation, and Scandinavia.........
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January 18, 2011, 7:20 AM CT
Don't reducing diet early in pregnancy
Eating less during early pregnancy impaired fetal brain development in a nonhuman primate model, scientists from The University of Texas Health Science Center San Antonio reported today.
The scientists found decreased formation of cell-to-cell connections, cell division and amounts of growth factors in the fetuses of mothers fed a reduced diet during the first half of pregnancy. "This is a critical time window when a number of of the neurons as well as the supporting cells in the brain are born," said Peter Nathanielsz, M.D., Ph.D., director of the Center for Pregnancy and Newborn Research in the Health Science Center School of Medicine.
The study included collaborators at the Southwest Foundation for Biomedical Research (SFBR) in San Antonio and Friedrich Schiller University in Jena, Gera number of. The team compared two groups of baboon mothers located at SFBR's Southwest National Primate Research Center. One group ate as much as they wanted during the first half of pregnancy while the other group was fed 30 percent less, a level of nutrition similar to what a number of prospective mothers in the U.S. experience.Hundreds of genes involved
"Our collaboration allowed us to determine that the nutritional environment impacts the fetal brain at both the cellular and molecular levels," said SFBR's Laura Cox, Ph.D. "That is, we found dysregulation of hundreds of genes, a number of of which are known to be key regulators in cell growth and development, indicating that nutrition plays a major role during fetal development by regulating the basic cellular machinery."........
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January 18, 2011, 7:17 AM CT
Kidney gene and heart failure risk
Gerald W. Dorn II, MD is a researcher at Washington University School of Medicine in St. Louis.
Credit: Washington University School of Medicine in St. Louis
Researchers have identified the first DNA sequence variant common in the population that is not only linked to an increased risk of heart failure, but appears to play a role in causing it.
The variant, a change in a single letter of the DNA sequence, impairs channels that control kidney function.
"It's not a heart gene," says Gerald W. Dorn II, MD, the Philip and Sima K. Needleman Professor of Medicine at Washington University School of Medicine in St. Louis and a lead investigator on the study. "It's a kidney gene. This protein is not even expressed in the heart. Nobody has previously considered that kidney-specific gene defects might predispose you to heart failure".
Heart failure is diagnosed when the heart can no longer provide sufficient blood to the body. It can have many causes, including high blood pressure, cancer treatment, viral infections of the heart or heart attack.
"It's a syndrome," Dorn says. "You've had sufficient damage to your heart that it doesn't work very well. You collect fluid in your lungs, you swell up, and you have trouble breathing".
The unexpected results highlight the advantage of performing genome-wide studies to find DNA sequence variants linked to disease.
"I was surprised by the finding," says Thomas P. Cappola, MD, assistant professor of medicine at the University of Pennsylvania School of Medicine, also a lead investigator on the study. "This is a good example of how taking unbiased approaches to study human disease can lead you to unexpected targets".........
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January 18, 2011, 7:16 AM CT
Pollution damage to human airways
Scientists from Duke University Medical Center have identified how nanoparticles from diesel exhaust damage lung airway cells, a finding that could lead to new therapies for people susceptible to airway disease.
The researchers also discovered that the severity of the injury depends on the genetic make-up of the affected individual.
"We gained insight into why some people can remain relatively healthy in polluted areas and why others don't," said main author Wolfgang Liedtke, M.D., Ph.D., assistant professor in the Duke Department of Medicine and an attending doctor in the Duke Clinics for Pain and Palliative Care.
The work was published on-line in the journal Environmental Health Perspectives
on Jan. 18.
Diesel exhaust particles, a major part of urban smog, consist of a carbon core coated with organic chemicals and metals. The Duke team showed that the particle core delivers these organic chemicals onto brush-like surfaces called cilia, which clear mucus from the airway lining.
Contact with these chemicals then triggers a "signaling cascade," as the cells respond.
In some patients, who have a single "letter" difference in their DNA, a circuit called the TRPV4 ion channel signals more strongly in response to the pollutants. Prior research showed that this gene variant makes humans more liable to develop chronic-obstructive disease (COPD), and the current study provides an explanation for this observation.........
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January 18, 2011, 7:14 AM CT
Outcomes following primary HIV infection
Women, nonwhites, and people in the southern United States who were newly infected with HIV and followed for an average of four years experienced greater HIV/AIDS-related morbidity in comparison to men and people of other races living in other regions of the country. The findings, reported in the February 15 issue of The Journal of Infectious Diseases,
underscore the urgent need to improve the health of these populations in order to reduce HIV-related morbidity and mortality in the U.S. (Please see below for a link to the embargoed study online.).
The scientists did not expect women to show the worst health outcomes because their viral loads were lower and CD4+ T cell counts were higher than men's following diagnosis, reported study author Amie L. Meditz, MD, of the University of Colorado- Denver. (The study was part of the Acute Infection and Early Disease Research Program, a multicenter study network funded by the National Institute of Allergy and Infectious Diseases.) However, during the course of the study (1997-2007), the frequency of HIV-related illnesses in women was more than double that of men, with nonwhite women having the most negative outcomes. After eight years of infection, HIV-related events affected 64 percent of nonwhite women, and AIDS-defining events occurred in 22 percent of nonwhite women. In comparison, HIV-related and AIDS-defining events occurred in 21 percent and 6 percent of individuals in other combined race and sex groups, respectively.........
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