Category: General Health

HealthDay Reporter

WEDNESDAY, Jan. 9, 2019 (HealthDay News) — Poor sleep is common among Alzheimer’s patients, and researchers say they’re beginning to understand why.

Scientists studied 119 people aged 60 and older. Eighty percent had no thinking or memory problems, while the rest had only mild problems.

The researchers found that participants with less slow-wave sleep — deep sleep that’s needed to preserve memories and to wake up feeling refreshed — had higher levels of the brain protein tau.

Elevated tau levels are a possible sign of Alzheimer’s disease and have been linked to brain damage and mental decline, the scientists said.

The findings suggest that poor sleep among older adults could be a warning sign of declining brain health, according to the researchers at Washington University School of Medicine in St. Louis.

“We saw this inverse relationship between decreased slow-wave sleep and more tau protein in people who were either cognitively normal or very mildly impaired, meaning that reduced slow-wave activity may be a marker for the transition between normal and impaired,” said first author Dr. Brendan Lucey. He’s an assistant professor of neurology and director of the Washington University Sleep Medicine Center.

“Measuring how people sleep may be a noninvasive way to screen for Alzheimer’s disease before or just as people begin to develop problems with memory and thinking,” Lucey said in a university news release.

He noted that the people with increased tau levels “were actually sleeping more at night and napping more in the day, but they weren’t getting as good quality sleep.”

Lucey doesn’t expect sleep monitoring to replace brain scans or cerebrospinal fluid analysis for identifying early signs of Alzheimer’s disease. “But it could supplement them,” he said. The study only found an association between sleep quality and tau levels.

“It’s something that could be easily followed over time, and if someone’s sleep habits start changing, that could be a sign for doctors to take a closer look at what might be going on in their brains,” Lucey said.

About 5.7 million Americans have Alzheimer’s disease. Brain changes associated with the disease can begin up to two decades before symptoms such as memory loss and confusion appear.

The study findings were published Jan. 9 in the journal Science Translational Medicine.

In diabetes, the pancreas is unable to produce enough insulin, the hormone that is key to regulating levels of blood sugar. New research now asks if we can teach pancreatic cells to address this problem on their own.

The pancreas contains three different types of cells, each of which produces different hormones that contribute to the regulation of blood sugar levels, one way or another.

These cells are alpha-cells that produce glucagon to boost blood sugar, beta-cells that produce insulin to lower levels of glucagon, and delta-cells that produce somatostatin, a hormone that regulates alpha- and beta-cell activity.

In both type 1 and type 2 diabetes, research has linked the lack of insulin with problems in pancreatic beta-cells.

However, a new study by researchers from the University of Bergen in Norway suggests that, with just a small “push,” we may be able to train the body to start producing adequate levels of insulin once more, on its own.

More specifically, the investigators explain, some alpha-cells could turn into beta-cells and release insulin.

“We are possibly facing the start of a totally new form of treatment for diabetes, where the body can produce its own insulin, with some start-up help,” says study co-author Luiza Ghila from the Raeder Research Lab in the Department of Clinical Science at the University of Bergen.

The researchers explain their findings in detail in a study paper in the journal Nature Cell Biology.

Thursday, 10 January 2019

Some hormone replacement therapy (HRT) tablets appear to be associated with a higher risk of rare but serious venous thromboembolism (VTE), suggests a large study* published today in The BMJ.

However, the study found no increased risk of VTE for HRT skin patches, gels or creams, although the vast majority of women choosing HRT are prescribed oral preparations.

Different treatments of HRT used to relieve menopausal symptoms are available depending on the symptoms, such as tablets containing oestrogen only or a combination of oestrogen and progestogen, as well as ‘transdermal’ treatments, such as patches, gels and creams.

Previous trials have shown increased risks of blood clots in menopausal women using HRT, but there is a lack of information on risks associated with different types of HRT.

Therefore, Yana Vinogradova, a member of an epidemiological team at the University of Nottingham led by Julia Hippisley-Cox, set out to assess the association between VTE risk and all available types of HRT in the UK between 1998 and 2017.

The research team used two UK primary care databases (QResearch and CPRD) and compared HRT prescription records of 80,396 women aged 40-79 years who developed blood clots (cases) with those of over 391,494 women who did not (controls).

Other relevant factors, such as lifestyle, family history of blood clots, and underlying conditions linked to blood clots were taken into account.

Analysis showed that most HRT tablets were found to be associated with increased VTE risk (nine extra cases per 10,000 women per year) compared with no HRT.

Tablets containing equine oestrogen, including single and combined preparations, were consistently associated with higher risks than tablets containing synthetic oestrogen.

In addition, higher doses of oestrogen were also associated with higher VTE risk, but there was no increased VTE risk found for skin patches, gels and creams.

This was an observational study so it could not establish cause and the researchers acknowledged some limitations that may have influenced the results.

Nevertheless, they said: “This study has provided a more detailed picture of the VTE risks for different HRT preparations and can help clinicians and women make treatment choices.”

They suggested clinicians should give greater consideration to transdermal HRT, particularly for women already at an increased VTE risk and in line with recent guidelines.

Royal College of General Practitioners chair Professor Helen Stokes-Lampard said the study was interesting but stressed that it showed association and not causation.

“The menopause is a transition stage for every woman and can cause difficulties for many – and for some specific symptoms, such as hot flushes and night sweats, HRT is the only medical treatment that has good evidence of benefit,” she said.

“While this study is certainly interesting and important, as the authors themselves acknowledge, the findings do not prove that tablets cause more DVTs [Deep vein thrombosis] than patches, just that there is an association. As such, it is essential that more research is conducted in this area and taken into account as new clinical guidelines are updated and developed.

“It’s important that patients don’t panic or stop taking HRT as a result of reading about this study, but instead discuss their concerns at their next routine GP appointment, or seek advice from a reputable website like NHS Choices.”

Jan. 7, 2019 — As predictable as post-holiday bills and weight loss resolutions, flu activity is on the rise in the U.S., the CDC reports.
Slideshow
Slideshow: Foods for the Flu

For the week ending Dec. 29, 2018, 19 states and New York City reported high flu activity, compared to 9 states and New York City the previous week. More than 1,000 lab-confirmed cases of influenza-related hospitalizations have been reported, and as of Dec. 29, 13 children have died of flu this season.

Experts hesitate to predict how bad a flu season will be, but they say several points are worth noting about year’s flu season:

A new drug to treat flu, Xofluza, is now available to pharmacies nationwide. It joins Tamiflu, the most commonly prescribed treatment.
It’s not too late to get a flu shot.
While symptoms can make you miserable, preventing complications is most important.

New Drug on the Block

Xofluza (baloxavir marboxil) was approved by the FDA in late October and treats flu symptoms, says Andrew Villani, a spokesperson for Genentech, which distributes the prescription medicine. However, when WebMD checked six pharmacies last week, just one had it in stock, although all offered to order it.

Xofluza is a single dose oral medication, and like other medicines for flu, needs to be taken quickly after symptoms start. The ideal window, doctors say, is to start it within 48 hours after symptoms begin.

Xofluza is approved for people 12 years old and older, based on results of a study that pitted the drug against a placebo. The study found the median time to symptoms improving was 54 hours on the drug and 80 hours on placebo, Villani says. “Xofluza helps you recover from the symptoms of the flu in just over 2 days,” he says.

Xofluza Availability

In a telephone spot check of major drug chains in Los Angeles, Chicago, New York City, Minneapolis, Atlanta, and Kankakee, Il., only the Minneapolis drug store had it in stock.

Staff at the other stores said they could order it, giving various timelines about how long it would take to get it in.
Old Standbys

Tamiflu has been on the market since 1999. In 2016, a generic version was approved. It comes in pill or liquid form and can be taken by people 14 days old and older.

It is typically taken twice daily for 5 days. (It can also be prescribed to prevent flu; that regimen is once a day for 7 days.) Besides Tamiflu and Xofluza, the FDA has approved zanamivir (Relenza) to treat flu in people 7 years old and older. A powder that is inhaled, it is usually taken twice daily for 5 days.

Another drug, peramivir (Rapivab), is given in a vein by a health care professional. The FDA approved it for people 2 years old and older. The one-time dose usually takes less than 30 minutes to administer.

More on Tamiflu, Xofluza

Advocates of Xofluza mention the convenience of the single dose vs. 5 days’ worth of Tamiflu doses. While the drugs require different doses and work differently, they have the same result, according to William Schaffner, MD, medical director of the National Foundation for Infectious Diseases. Both interfere with the flu virus’ ability to reproduce and multiply, he says.
Facts About the Flu Vaccine

No studies have looked at head-to-head comparisons of Xofluza and Tamiflu, says Villani of Genentech, which also markets Tamiflu.

The CDC does not recommend Xofluza for pregnant women or breastfeeding mothers, and it’s also not recommended for flu prevention or patients in the hospital.

Patients don’t seem to know about the newer drug, says Lisa Dabby, MD, an emergency medicine doctor at the UCLA Medical Center in Santa Monica, CA. “Not one person has asked me to prescribe it,” she says of Xofluza. “People know Tamiflu and they ask for it.”

If someone did request the new drug, she would consider prescribing it, she says, but first would want to be sure local pharmacies are stocking it to save patients frustration in finding it. And she reminds them: “These antivirals are not the be-all, end-alls.” They shorten how long symptoms last, but they don’t make them disappear instantly, she reminds patients.

As for side effects, patients on these antivirals most often complain of diarrhea and nausea, she says. Others report headache and common cold symptoms.

In kids, Tamiflu has been linked with some psychiatric side effects, such as irritability and occasional seizures. Those reports have caused some pediatricians to hesitate to prescribe it, Schaffner says. But those symptoms go away once the drug is stopped.
Tamiflu, Xofluza Costs

On a wholesale level, the cost of Xofluza is about $150 and of Tamiflu about $152, Villani says.

Insurance coverage and copays for these two drugs vary. But those who have commercial insurance that covers Xofluza can use a coupon available on the drug’s website and ”may pay as little as $30,” he says. Those without insurance may reduce their costs for it by about $60, with a net cost of about $90, he says.

The generic version of Tamiflu is sold online, without insurance, for about $50.

More Stats on the Flu Season

Usually, flu activity peaks from December through February, the CDC says, and February has been the most common peak month in the past 36 years.

This year, the circulating viruses are predominantly influenza A (H1N1)pdm09 and H3N2, with influenza B viruses also circulating, the CDC says.

The H1N1 viruses have been most prevalent in the United States, but the influenza A (H3) has been most common in the southeastern U.S., the CDC says.

And some good news: Most of the circulating viruses analyzed are similar to the viruses in this season’s vaccine.

Focusing on Complications, Risks

While patients with the flu are eager to feel better and get back to work or family responsibilities, doctors are focused on more than that, Schaffner says. “The main thing we want to do is prevent the serious complications of influenza.”

These include pneumonia, inflammation of the heart, and organ failure. Those at high risk of flu complications include anyone 65 and older, children younger than 5, pregnant women and women who have delivered a baby within the past 2 weeks, Native Americans, Alaska Natives, and nursing home or long-term care home residents. In addition, anyone with health conditions such as asthma, sickle cell disease, lung or heart disease, diabetes, kidney or liver problems, the very obese (BMI of 40 or more), immune system issues such as HIV, or cancer is at high risk of getting complications.

When his patients come back for a follow-up visit after getting through the flu, griping about time off work or flu misery in general, Schaffner says he often tells them: “I’m glad you are [still] here to complain.”

The two hemispheres of our brain — left and right — specialize in different tasks. A recent study asks how this occurs and reaches a surprising conclusion.

Hemispheric dominance, also known as lateralization of brain function, describes the tendency for either the left or the right side of the brain to carry out specific brain activities.

Even though both sides of the brain are almost identical, one hemisphere primarily carries out some functions over others.

For instance, the left hemisphere houses brain regions linked to speech (or the right hemisphere in left-handed people).

Previously, scientists thought humans were the only creatures to exhibit this phenomenon. However, recent research has found lateralized brain function throughout the animal kingdom — from insects, such as honeybees, to aquatic mammals, including killer whales.

The corpus callosum — a thick tract of nerve cells, known as commissural fibers — connects the two hemispheres. Exactly how dominance is produced remains uncertain.

Recently, researchers from Ruhr-Universität Bochum in Germany set out to investigate this question. They chose to study the visual system of pigeons, and they have published their findings in the journal Cell Reports.

Bird brains and old ideas

Previously, scientists have theorized that one side of the brain simply inhibits the other, allowing it to take dominance.

Co-lead author Prof. Onur Güntürkün explains that “[i]n the past, it had been assumed that the dominant hemisphere transmits inhibitory signals to the other hemisphere via the commissures, thus suppressing specific functions in that region.”

In effect, the dominant hemisphere is thought to overpower its neighbor. However, scientists have also noted that excitatory messages run both ways, so there must be more to this interaction.

The researchers decided to use a pigeon model because other studies have described hemispheric dominance in this species in some detail over recent years.

For instance, in pigeon brains, the left hemisphere takes the lead when it comes to visual processing of patterns and colors. Conversely, the right brain more often deals with social or emotionally charged stimuli.

The scientists trained the birds to perform a color differentiation task. In particular, this challenge involves part of the brain that uses visual information to guide motor activity. In this type of task, the left side of the brain is dominant.

To understand how cross-talk between hemispheres influences dominance, Prof. Güntürkün and co-author Dr. Qian Xiao intermittently switched off some of the neurons that run between the two sides of the brain.

Interfering in cross-talk

After blocking specific neurons running from one side, they would observe the activity of the neurons that usually receive their input on the opposite side. In this way, they could pick apart the way in which the dominant hemisphere exerts its control.

The researchers showed that, rather than merely inhibiting the right side of the brain during this task, the left brain could delay the response of the right brain, so preventing it from getting involved.

As Prof. Güntürkün explains, “The right hemisphere simply acts too late to control the response.”

Rather than merely inhibiting the response, the right brain still operates, but its signals are too late to the party to make a difference to the bird’s behavior.

“These results show that hemispheric dominance is based on a sophisticated mechanism. It does not hinge on one general inhibitory or excitatory influence; rather it is caused by minute temporal delays in the activity of nerve cells in the other hemisphere.”

Prof. Onur Güntürkün

The findings provide an entirely new way to look at hemispheric dominance. Research is bound to continue into this rather peculiar phenomenon that evolution has lovingly conserved throughout many branches of life.

However, it is likely to be quite some time before we understand why dividing tasks between the hemispheres is so evolutionarily advantageous.

BEIJING (Reuters) – China’s agriculture ministry on Tuesday reported a new outbreak of African swine fever in the city of Huizhou in the southern province of Guangdong, which has killed 11 pigs on a farm of 90 pigs.

China has already reported more than 90 cases of the incurable disease since it was first detected in the country in early August.

By Maureen Salamon | HealthDay Reporter

TUESDAY, Nov. 27, 2018 (HealthDay News) — An hour or less of weightlifting each week might significantly cut your risk of heart attack or stroke, new research suggests.

Evaluating nearly 12,600 adults over more than a decade, scientists found that small amounts of resistance exercise weekly were linked to between 40 percent and 70 percent fewer cardiovascular events.

But doing more weightlifting didn’t reduce these risks further.

“Strength training is not just to make yourself look good to be shirtless on the beach,” said Dr. Alon Gitig, a cardiologist at Mount Sinai Riverside Medical Group in Yonkers, N.Y.

“It has definite health benefits … and seems to directly impact on cardiovascular health,” added Gitig, who wasn’t involved in the study.

Weightlifting uses muscle resistance to strengthen and build muscles. Other types of resistance exercise include pushups, sit-ups or lunges.

Study author Duck-chul Lee said, “Traditionally, weightlifting was for athletes, and that’s why I think there is less evidence on its health benefits, specifically for the heart.” Lee is an associate professor of kinesiology at Iowa State University.

“People know that running or cardio exercise is good for the cardiovascular system, but there are benefits of weightlifting on the heart that were not [previously] well-studied,” Lee added.

In research published separately, Lee and his colleagues found that less than an hour of weightlifting per week also reduced the risk for high cholesterol and metabolic syndrome, a cluster of conditions linked to diabetes. Those reports are in the journal Mayo Clinic Proceedings.

For the heart and stroke study, the researchers studied nearly 12,600 participants (average age 47) who had undergone at least two clinical examinations between 1987 and 2006. The participants self-reported their levels of resistance exercise, and follow-ups were done about five and 10 years later.

The results indicated that the benefits of resistance exercise on heart and stroke risk were independent of aerobic exercise such as walking or running, Lee said.

Compared with participants who did no resistance exercise, those who took part from one to three times and up to 59 minutes in all each week experienced a risk reduction of up to 70 percent.

The study didn’t prove that weightlifting prevents heart attack or stroke, only that an association exists, however.

“We found benefits of resistance exercise without body mass index [changes],” Lee added. “It means that even though you don’t lose weight, you can still get benefits for the heart. People believe the benefits of exercise are from losing weight, but that’s not true.”

Gitig, however, expressed caution about the findings. He said the cardiovascular benefits “seem to be a lot higher than we would expect from strength training.”

In addition, Gitig noted that most participants were male and white, coming voluntarily to the clinic where the study was held. “The question is if confounding variables made these people healthier to begin with,” he said.

Still, Gitig said he wasn’t as surprised by learning about the cardiovascular benefits linked to weightlifting as he might have been five or 10 years ago.

He and Lee agreed that easing into a weightlifting routine should be safe for anyone who’s healthy overall and doesn’t have symptoms of cardiovascular or kidney disease. If you do, check with your doctor first, they said.

“I would counsel my patients that [the research] is very eye-opening and suggests that strength exercise is definitely a good thing overall and may have more powerful benefits than previously thought,” said Gitig, also an assistant professor of medicine at Icahn School of Medicine at Mount Sinai in New York City.

And what if you don’t have access to free weights or weight-training machines? Digging in the yard and lugging heavy shopping bags provide strength-training benefits, too, Lee noted.

The study was published online recently in the journal Medicine & Science in Sports & Exercise.

Amid the increasing rise of probiotic use in Western society, a recent journal article asks whether we should evaluate the products’ safety with a little more scrutiny.

For millennia, humans have consumed foods rich with live bacteria.

Yogurt, for instance, dates back to at least 5000 B.C., and in Korea, kimchi — fermented vegetables — has also been consumed for thousands of years.

Today, however, live microorganisms are added to a range of products advertised as providing a wide array of medical benefits.

Creative marketing and a general fascination for gut bacteria have combined to create a huge market for probiotics.

Perhaps surprisingly, to sell a product that contains live microorganisms there is no legal requirement to provide evidence that it works or, importantly, that it is safe.

An article published this week in JAMA Internal Medicine argues that this is a dangerous state of affairs. The piece was written by Dr. Pieter A. Cohen from the Cambridge Health Alliance at the Harvard Medical School in Boston, MA.

The state of the evidence

Dr. Cohen begins by outlining the proven benefits of probiotics. For instance, Saccharomyces boulardii has been shown to help treat some types of diarrhea in children and reduce recurrence of Clostridium difficile infections in adults.

In spite of the specific cases mentioned, he argues that the strains used in foods and supplements have not been proven to benefit health and neither have they been shown to be safe.

Manufacturers claim that probiotics help maintain respiratory, cardiovascular, reproductive, and psychological health. However, Dr. Cohen writes that “[d]espite the advertised indications, there are no large, long-term clinical trials proving that probiotics offer clinical benefits for people who are already healthy.” He continues:

“Widespread use, particularly among people who are healthy, has greatly outpaced the science.”

For instance, a comprehensive review of relevant literature published earlier this year concluded that “[t]he feasibility of probiotics consumption to provide benefits in healthy adults requires further investigation.”

In other words, there may be benefits, but the evidence simply does not exist to definitively say either way.

Despite this, manufacturers are legally permitted to tell consumers that their products “support the immune system” or “boost digestive health.” Perhaps even more worryingly, they are not required to add information regarding potential adverse effects.

What are the possible dangers?

Over the years, dozens of case reports have underscored the potential hazards of probiotic supplementation. Risks include fungemia and bacteremia — the presence of fungi or bacteria in the blood, respectively.

Individuals with compromised immune systems are most at risk, including the very young and old. These organisms have evolved to infect, after all.

Because many probiotic trials do not report adverse events sufficiently, the exact scope of this problem is not known.

Aside from the risk of opportunistic infections sparked by probiotic consumption, there is the potential threat of low quality and contaminated products.

Although the United States Food and Drug Administration (FDA) have stringent safety rules for the manufacturing of supplements, these are not always followed.

According to Dr. Cohen, an inspection of 656 facilities in 2017 found “violations in more than half.” He continues:

“These violations were not trivial: Most commonly, companies had failed to establish the identity, purity, strength, or composition of their final product.”

This potential threat is brought into stark focus by the case of an 8-day-old infant who developed a fatal fungal infection following the use of a probiotic supplement that had been contaminated with fungi.

As Dr. Cohen notes, although following FDA regulations more closely would help reduce the risk of product contamination, it would still not ensure that the probiotic itself was entirely safe.

The author ends his article by calling for more stringent controls from the FDA. He writes:

“The agency should […] require manufacturers, as Canadian authorities already do, to provide the specific strain or strains, and the number of live microorganisms per serving, on every bottle of probiotic supplements.”

He also urges them to introduce extra safety testing, focusing especially on “potentially transferable antibiotic resistance genes.” As it stands, we do not know how consuming bacteria with an array of new genes might impact antibiotic resistance now or in the future.

Dr. Cohen’s take-home message is clear and concise:

“Consumers and physicians should not assume that the label on probiotic supplements provides adequate information to determine if consuming the live microorganism is worth the risk.”

Just in time for Thanksgiving, the CDC says don’t eat any romaine lettuce and throw it away if it’s in your house. It could cause an E. coli infection.

The CDC says stores and restaurants should also not serve or sell any until more about the outbreak is known. This investigation is ongoing and the advice will be updated as more information is available.

In this case, romaine lettuce means any kind of romaine: whole heads, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.

If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away, the CDC says.

But don’t stop there. Wash and sanitize drawers or shelves in refrigerators where romaine was stored, the CDC warns.

Thirty-two people have been infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 in 11 states.

Illnesses began Oct. 8, and the most recent was confirmed Oct. 31. Thirteen people have been hospitalized. No deaths have been reported.

Those who became sick from this outbreak were infected with E. coli with the same DNA as the strain responsible for a 2017 outbreak.

But, the CDC says, this particular outbreak is not related to a multistate outbreak earlier this year.

A rare, polio-like condition has sickened 116 people in the United States so far this year, the highest number of cases since 2016, the U.S. Centers for Disease Control and Prevention said on Monday.

CDC officials have said they do not know what causes acute flaccid myelitis or AFM, which affects the nervous system and triggers weakness and even paralysis in one or more limbs. The vast majority of patients are children.

In 2014, when 120 patients were diagnosed, the CDC began investigating cases of the disease, which it estimates affects one out of 1 million people in the United States.

Since 2014, the number of cases has spiked every two years in the United States. Last year, the nation had 33 confirmed cases, while in 2016 it had 149.

“It is pretty concerning that it’s going up and we still haven’t figured out specifically how to prevent this or how to treat it,” Dr. Emmanuelle Tiongson, pediatric neurologist at Children’s Hospital Los Angeles who has evaluated and treated patients with the condition, said in a phone interview.

One phenomenon researchers have observed is the illness is particularly prevalent between August and October, a period when many viruses commonly circulate, according to the CDC.

The disease could be spread through infection, which would explain why there have been clusters of cases in certain states, Tiongson said.

The CDC on Monday provided a state-by-state breakdown of cases for the first time this year.

Colorado reported 15 confirmed cases of the disease and Texas had 14, followed by Pennsylvania, Ohio, Washington state and Minnesota, which each had eight cases, according to the CDC.

States with large populations or good methods for reporting the disease are more likely to have a larger number of cases, according to the CDC.

In some patients, the partial paralysis they suffer due to the illness will be a lifelong condition, Tiongson said.