Too much of a good thing may be just that: too much. That is the conclusion of yet another study, this time a prospective, longitudinal, population-based cohort of Swedish women, looking at calcium intake and cardiovascular mortality.
In this study, high rates of calcium intake were associated with higher all-cause and cardiovascular death rates but not with deaths from stroke, Karl Michaëlsson, MD, PhD, professor in medical epidemiology and senior consultant in orthopedic surgery at Uppsala University in Sweden, and colleagues report in an article published online February 13 in BMJ.
The study is the latest in a series of contentious analyses linking calcium intake and cardiovascular events. Earlier this month, a National Institutes of Health–sponsored study suggested that a high intake of supplemental calcium increased the risk for cardiovascular disease (CVD) death in men, but not women.
However, a commentator notes that the study results suggest that supplements, rather than the intake level, are the problem.
The Swedish mammography cohort, established between 1987 and 1990, followed up 61,433 women born between 1914 and 1948 for a median of 19 years and used registry data to determine outcomes. During that period, there were 11,944 deaths from all causes, of which 3862 were from CVD, 1932 from ischemic heart disease, and 1100 from stroke.
Dietary assessments from food frequency questionnaires at baseline and in 1997 were available for 38,984 women, from which the researchers estimated intakes of dietary and supplemental calcium.
The highest intakes of calcium (>1400 mg/day) were associated with higher all-cause risk for death (after adjustment for age, total energy, vitamin D, and calcium supplement intake, as well as other dietary, physical, and demographic factors) as compared with intakes of 600 to 1000 mg/day (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.17 - 1.67).
Disease-specific mortality risks were elevated for CVD (HR, 1.49; 95% CI, 1.09 - 2.02) and for ischemic heart disease (HR, 2.14; 95% CI, 1.48 - 3.09) at daily calcium intakes above 1400 mg. At calcium intakes less than 600 mg/day, these same mortality risks were also elevated. None of these patterns was apparent for mortality from stroke.
In an email exchange with Medscape Medical News, Dr. Michaëlsson said the association of calcium intake and all-cause and cardiovascular mortality "was especially strong if a high dietary intake of calcium was combined with calcium supplements."
Women with the highest intake of calcium (>1400 mg/day) and who used supplement tablets had an all-cause risk for death 2.5 times higher than women who had similar total intakes but were not taking a supplement.
The authors explain that serum calcium levels "are under tight homeostatic control" and do not normally correlate with the amount of calcium intake. However, low or very high intakes override this control, "causing changes in blood levels of calcium or calciotropic hormones."
Complex Study Results; Weak Findings?
Dr. Michaëlsson also noted that some previous studies have shown a similar relationship between calcium supplements and a higher risk for CVD but were not powered to look at mortality and did not assess the amount of dietary intake of calcium.
He advised that one should not make recommendations on the basis of a single study, but emerging evidence suggests caution about high calcium intake. He also noted that a meta-analysis of randomized trials has shown that calcium supplementation actually increased the rate of hip fracture. "My present recommendation is to avoid calcium supplement use if you have a normal varied diet," he said.
Commenting to Medscape Medical News by email, John Cleland, MD PhD, professor of cardiology at Hull York Medical School in Kingston-upon-Hull, United Kingdom, called the study results "extremely complex...with rather weak findings." He pointed out that in the study there were few patients or events in the group with high calcium intake (n = 1241; 2%), and the events were confined to those women taking supplements (total events, n = 23, of which 16 occurred among women taking any form of calcium supplement).
Women with calcium intakes greater than 1400 mg/day who were taking calcium tablets had an adjusted all-cause mortality rate of 2.57 (95% CI, 1.19 - 5.55) compared with 1.17 (95% CI, 0.97 - 1.41) among women who had similar daily intakes but were not taking supplements. "So, it's not the diet but the pills that are the problem," Dr. Cleland concluded, which is essentially in agreement with what Dr. Michaëlsson said.
Dr. Cleland raised the issues of what else may have been in the calcium pills and why the women were taking them; for example, if they had chronic kidney disease or osteoporosis. He said the article did not provide such information but just referred to a previous paper.
He also pointed out that calcium tablets "have not been shown to reduce fracture rates or improve any other patient outcome that I know of." He recommended that people stop taking calcium supplements "until efficacy/safety is shown," and that this advice "should definitely include those taking them for osteoporosis and should perhaps include those taking them for [chronic kidney disease]." His recommendation? "Having a healthy balanced diet and avoiding water filters that reduce calcium in drinking water is probably best."
Source: http://www.medscape.com/viewarticle/779541?nlid=28503_1301&src=wnl_edit_dail
Welcome to my collection of health articles. Most of them contain little nuggets of health wisdom that we can easily apply to our daily lives. As you can gather, I've been consuming all sorts of supplements over the years, most of them from iherb. They deliver on time (DHL), and prices are good. If you're a first-time buyer, use my code 'pot089' to enjoy up to $10 off.
Thursday, 21 February 2013
Wednesday, 20 February 2013
Saffron for macular degeneration
Age-related macular degeneration (ARMD) is the primary cause of older age onset partial or sometimes total blindness. Although most common in adults over 50, macular degeneration can occur at any age, though rarely among those under 50.
Macular degeneration mostly affects central vision, forcing people to rely more on less distinct peripheral vision to recognize objects and faces. The macula occupies a small portion of the retina in the back of the eye.
Though small, the macula is the most light sensitive area of the retina, and it permits detailed focus of objects located centrally in the field of vision. There are two classifications of macular degeneration: Dry and wet.
Dry macular degeneration is the most common and least severe. Diminished central vision clarity occurs gradually. It's called dry because there is no capillary leakage in that region of the eye. Wet macular degeneration does involve retina capillary leakage. It's symptoms are usually more severe and worsen rapidly.
Thus far, ophthalmology has little to offer as a remedy for macular degeneration. But ophthalmologists do recommend taking leutin and astaxanthin to slow ARMD's progress or possibly reverse it slightly.
However, recent human clinical research in Italy and Australia has discovered a non-pharmaceutical approach that proved efficacious for improving eyesight with macular degeneration sufferers safely. It is a little pricey though. It's the spice known as saffron.
Saffron is pricier than most other spices because the bulbs must be planted by hand, and the three crimson stigmas or saffron threads have to also be plucked out of each flower by hand.
The Australian clinical trial
Macular degeneration mostly affects central vision, forcing people to rely more on less distinct peripheral vision to recognize objects and faces. The macula occupies a small portion of the retina in the back of the eye.
Though small, the macula is the most light sensitive area of the retina, and it permits detailed focus of objects located centrally in the field of vision. There are two classifications of macular degeneration: Dry and wet.
Dry macular degeneration is the most common and least severe. Diminished central vision clarity occurs gradually. It's called dry because there is no capillary leakage in that region of the eye. Wet macular degeneration does involve retina capillary leakage. It's symptoms are usually more severe and worsen rapidly.
Thus far, ophthalmology has little to offer as a remedy for macular degeneration. But ophthalmologists do recommend taking leutin and astaxanthin to slow ARMD's progress or possibly reverse it slightly.
However, recent human clinical research in Italy and Australia has discovered a non-pharmaceutical approach that proved efficacious for improving eyesight with macular degeneration sufferers safely. It is a little pricey though. It's the spice known as saffron.
Saffron is pricier than most other spices because the bulbs must be planted by hand, and the three crimson stigmas or saffron threads have to also be plucked out of each flower by hand.
The Australian clinical trial
The Australian human study was conducted by Sydney University Professor of Neurology Jonathan Stone. Both this study and the Italian research were similar in scope and dosage. And both conducted a more humane approach to double blind placebo studies with a non-toxic remedy than normally.
The study involved 25 macular degeneration sufferers. Instead of depriving a placebo group from a product that could do something for their ailment, the study switched placebo subjects with saffron subjects half-way through the trial unbeknownst to all involved. The daily dosage was 20 mg of saffron.
The whole study was six months long, so each side of the 25 double blind subjects had three months of improved vision with three months of impaired vision. All 25 were tested for neuron electrical conductivity in the macula and retina, and 23 showed significant improvement. Those 23 also reported they could see much better.
Visual improvement began after only two weeks on saffron. When the saffron group was put onto placebos, they complained that their improved eyesight had begun diminishing again. Conversely, those on placebos for the first half of the trial began seeing better after three months of no improvement.
Professor Stone projects that after a year or more ingesting only 20 mg (milligrams) of saffron daily, vision improvements should stabilize without requiring more saffron dosing.
Stone doesn't know exactly how or why, but he became aware that saffron influences the neuron's genetic code to restore its capacity for healing and protecting neuron cells. Neurons are responsible for transmitting electrical signals or impulses throughout the nervous system.
Professor Stone is looking forward to completing animal studies with saffron for other neurological issues like Parkinson's and Alzheimer's. Then those would go into human clinical trials also.
His results, combined with the Italian study, impressed Professor Stone enough to create his own line of saffron capsules for the market. He qualified it as a safe nutraceutical that shouldn't require any more testing for FDA approval.
Source: http://www.naturalnews.com/039150_saffron_macular_degeneration_cure.html#ixzz2LPB2RnFa
The study involved 25 macular degeneration sufferers. Instead of depriving a placebo group from a product that could do something for their ailment, the study switched placebo subjects with saffron subjects half-way through the trial unbeknownst to all involved. The daily dosage was 20 mg of saffron.
The whole study was six months long, so each side of the 25 double blind subjects had three months of improved vision with three months of impaired vision. All 25 were tested for neuron electrical conductivity in the macula and retina, and 23 showed significant improvement. Those 23 also reported they could see much better.
Visual improvement began after only two weeks on saffron. When the saffron group was put onto placebos, they complained that their improved eyesight had begun diminishing again. Conversely, those on placebos for the first half of the trial began seeing better after three months of no improvement.
Professor Stone projects that after a year or more ingesting only 20 mg (milligrams) of saffron daily, vision improvements should stabilize without requiring more saffron dosing.
Stone doesn't know exactly how or why, but he became aware that saffron influences the neuron's genetic code to restore its capacity for healing and protecting neuron cells. Neurons are responsible for transmitting electrical signals or impulses throughout the nervous system.
Professor Stone is looking forward to completing animal studies with saffron for other neurological issues like Parkinson's and Alzheimer's. Then those would go into human clinical trials also.
His results, combined with the Italian study, impressed Professor Stone enough to create his own line of saffron capsules for the market. He qualified it as a safe nutraceutical that shouldn't require any more testing for FDA approval.
Source: http://www.naturalnews.com/039150_saffron_macular_degeneration_cure.html#ixzz2LPB2RnFa
Tuesday, 19 February 2013
Two antihypertensives plus NSAID ups risk of acute kidney injury
Taking two antihypertensive medications--a diuretic and an ACE inhibitor or angiotensin-receptor blocker (ARB)--along with nonsteroidal anti-inflammatory drugs (NSAIDs) significantly increases the risk of hospitalization for acute kidney injury, particularly in the first 30 days of treatment, a new retrospective case-control study demonstrates [1].
And although the absolute risk for individuals is low, physicians and patients need to be aware of this potential problem, and doctors will need to prescribe alternative anti-inflammatory and/or analgesic agents where warranted, say Dr Francesco Lapi (Jewish General Hospital, Montreal, QC) and colleagues in their report published online January 8, 2013 in BMJ.
"More and more patients, especially the elderly, are taking many medications at the same time, and drug-drug interactions are always important. With the size of the population that we have access to now, we are able to study questions we could not address before," senior author Dr Samy Suissa (McGill University, Montreal, QC) told heartwire . "The message to clinicians is to be vigilant during that early period of treatment," he added.
In an editorial accompanying the paper [2], Drs Dorothea Nitsch and Laurie A Tomlinson (London School of Hygiene and Tropical Medicine, UK) agree. "Clinicians must advise patients who are prescribed diuretics, ACE inhibitors, or ARBs of the risks associated with NSAID use, and they must also be vigilant for signs of drug-associated acute kidney injury in all patients," they observe.
"Triple" Therapy Ups Risk of Kidney Injury by 80% in First 30 Days of Use
Clinicians must advise patients who are prescribed diuretics, ACE inhibitors, or ARBs of the risks associated with NSAID use, and they must also be vigilant for signs of drug associated acute kidney injury.
Lapi and colleagues say that acute kidney injury is a major public-health concern, which has been associated with a mortality rate exceeding 50%. To study the question of how often this occurs with concurrent use of antihypertensives and NSAIDs, they used the UKClinical Practice Research Datalink (previously known as the General Practice Research Database)--which is the world's largest computerized store of primary-care records--to assess a cohort of 487 372 users of antihypertensive drugs between 1997 and 2008. This was linked to the Hospital Episodes Statisticsdatabase to see whether a double therapy combination of a diuretic, ACE inhibitor, or ARB with an NSAID or the triple therapy combination of two of those antihypertensives plus an NSAID was associated with increased risk of hospitalization for acute kidney injury.
During a mean follow-up of almost six years, 2215 cases of acute kidney injury were identified (incidence rate of seven per 10 000 person-years), and each was compared with up to 10 matched controls.
Overall, current use of double therapy was not associated with an increased risk of acute kidney injury, but current use of triple therapy--two antihypertensives plus an NSAID--was associated with an increased rate of this end point (rate ratio 1.31, 95% CI 1.12–1.53). And the highest risk was seen in the first 30 days of use (rate ratio 1.82, 95% CI 1.35–2.46). These results remained consistent after adjustment for potential confounders.
"If you are taking two antihypertensive medications--a diuretic and an ACE inhibitor or ARB--and then you add on an NSAID, the adding of the NSAID increases the risk of acute kidney injury, particularly in the first 30 days, so you are identifying some susceptible patients when you expose them to NSAIDs in that first month," Suissa explains.
He adds that those who get through the 30-day period without any problem will likely be fine, "at least in terms of acute kidney injury"; he noted that the study was not designed to assess the issue of chronic renal problems.
But Is "Double" Therapy Safe?
But Nitsch and Tomlinson go on to question the finding that an NSAID added to one of the three antihypertensives is not associated with acute kidney injury.
I don't think we can say we are absolutely confident that [double therapy] is safe, but it is certainly not a high risk.
The confidence intervals for the estimates of risk for double drug combinations were "wide," they note, so the study "probably underestimates the true burden of drug-associated kidney injury. The jury is still out on whether double drug combinations are indeed safe," they state.
Suissa acknowledges that the number of patients taking this double therapy was small, "so we cannot exclude a small increased risk. I don't think we can say we are absolutely confident that it is safe, but it is certainly not a high risk," he told heartwire .
He adds that the study findings are indicative of how hypertension is now being managed. "It's being controlled with two drugs, not just one, and then if you have pain, we will add an NSAID to that. In our cohort of antihypertensive-drug patients, 11% were treated with this triple therapy, which is quite large. We were surprised."
Source: http://www.medscape.com/viewarticle/777349?src=nldne&uac=129655SZ
And although the absolute risk for individuals is low, physicians and patients need to be aware of this potential problem, and doctors will need to prescribe alternative anti-inflammatory and/or analgesic agents where warranted, say Dr Francesco Lapi (Jewish General Hospital, Montreal, QC) and colleagues in their report published online January 8, 2013 in BMJ.
"More and more patients, especially the elderly, are taking many medications at the same time, and drug-drug interactions are always important. With the size of the population that we have access to now, we are able to study questions we could not address before," senior author Dr Samy Suissa (McGill University, Montreal, QC) told heartwire . "The message to clinicians is to be vigilant during that early period of treatment," he added.
In an editorial accompanying the paper [2], Drs Dorothea Nitsch and Laurie A Tomlinson (London School of Hygiene and Tropical Medicine, UK) agree. "Clinicians must advise patients who are prescribed diuretics, ACE inhibitors, or ARBs of the risks associated with NSAID use, and they must also be vigilant for signs of drug-associated acute kidney injury in all patients," they observe.
"Triple" Therapy Ups Risk of Kidney Injury by 80% in First 30 Days of Use
Clinicians must advise patients who are prescribed diuretics, ACE inhibitors, or ARBs of the risks associated with NSAID use, and they must also be vigilant for signs of drug associated acute kidney injury.
Lapi and colleagues say that acute kidney injury is a major public-health concern, which has been associated with a mortality rate exceeding 50%. To study the question of how often this occurs with concurrent use of antihypertensives and NSAIDs, they used the UKClinical Practice Research Datalink (previously known as the General Practice Research Database)--which is the world's largest computerized store of primary-care records--to assess a cohort of 487 372 users of antihypertensive drugs between 1997 and 2008. This was linked to the Hospital Episodes Statisticsdatabase to see whether a double therapy combination of a diuretic, ACE inhibitor, or ARB with an NSAID or the triple therapy combination of two of those antihypertensives plus an NSAID was associated with increased risk of hospitalization for acute kidney injury.
During a mean follow-up of almost six years, 2215 cases of acute kidney injury were identified (incidence rate of seven per 10 000 person-years), and each was compared with up to 10 matched controls.
Overall, current use of double therapy was not associated with an increased risk of acute kidney injury, but current use of triple therapy--two antihypertensives plus an NSAID--was associated with an increased rate of this end point (rate ratio 1.31, 95% CI 1.12–1.53). And the highest risk was seen in the first 30 days of use (rate ratio 1.82, 95% CI 1.35–2.46). These results remained consistent after adjustment for potential confounders.
"If you are taking two antihypertensive medications--a diuretic and an ACE inhibitor or ARB--and then you add on an NSAID, the adding of the NSAID increases the risk of acute kidney injury, particularly in the first 30 days, so you are identifying some susceptible patients when you expose them to NSAIDs in that first month," Suissa explains.
He adds that those who get through the 30-day period without any problem will likely be fine, "at least in terms of acute kidney injury"; he noted that the study was not designed to assess the issue of chronic renal problems.
But Is "Double" Therapy Safe?
But Nitsch and Tomlinson go on to question the finding that an NSAID added to one of the three antihypertensives is not associated with acute kidney injury.
I don't think we can say we are absolutely confident that [double therapy] is safe, but it is certainly not a high risk.
The confidence intervals for the estimates of risk for double drug combinations were "wide," they note, so the study "probably underestimates the true burden of drug-associated kidney injury. The jury is still out on whether double drug combinations are indeed safe," they state.
Suissa acknowledges that the number of patients taking this double therapy was small, "so we cannot exclude a small increased risk. I don't think we can say we are absolutely confident that it is safe, but it is certainly not a high risk," he told heartwire .
He adds that the study findings are indicative of how hypertension is now being managed. "It's being controlled with two drugs, not just one, and then if you have pain, we will add an NSAID to that. In our cohort of antihypertensive-drug patients, 11% were treated with this triple therapy, which is quite large. We were surprised."
Source: http://www.medscape.com/viewarticle/777349?src=nldne&uac=129655SZ
Flu virus can spread up to 6ft, no cough or sneeze required
The influenza virus can spread up to 6 feet from a patient's head via submicron particles during routine hospital care, according to a study of patients admitted to the emergency department (ED) and throughout a tertiary care hospital with influenza-like illness during the 2010 to 2011 influenza season. It was previously thought that the virus traveled only a short distance via large particle droplets during coughing or sneezing. Submicron particles are released in the air during talking and breathing.
Werner E. Bischoff, MD, PhD, an assistant professor in the Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, and colleagues published their findings online January 31 inClinical Infectious Diseases.
According to the World Health Organization and the Centers for Disease Control and Prevention, transmission mainly occurs when large-particle respiratory droplets travel a short distance, and face masks worn by healthcare professionals block those particles. Fit-tested respirators are only required when aerosol-generating procedures such as bronchoscopy are performed.
Particle size may affect infection risk and severity on the basis of the virus' ability to travel to the lungs instead of being confined to the upper respiratory tract.
"Protecting [healthcare professionals] against influenza virus requires a clear understanding of how this virus is aerosolized and by whom it is emitted," the authors write.
Investigators enrolled 94 patients with influenza-like illness in the study. They obtained patient history and took nasopharyngeal swab specimens. The researchers then collected quantitative impaction air samples 1 foot or less, 3 feet, and 6 feet from the patient's head during routine care. Rapid test and polymerase chain reaction were used to detect influenza virus.
Of the 94 patients, 61 (65%) were influenza-positive (31 influenza A, 30 influenza B). Of those patients, 26 (43%) emitted influenza virus into room air (13 inpatients and 13 ED patients). Of the emitters, 5 (19%) released up to 32 times more virus than other patients. There were no statistical differences in other characteristics or symptoms.
Higher nasopharyngeal viral loads were found in emitters compared with nonemitters. Patients with increased nasopharyngeal viral load were the only patients in whom coughing and sneezing during air sampling was connected with the release of increased virus into room air (P < .05). Emitters exceeded the airborne 50% human infectious dose of influenza virus at all locations sampled.
All emitters in the study were less likely to report chills and more likely to experience higher illness severity and interference with daily living than nonemitter ED patients (P < .05).
As distance from the patient's head increased (from 1 to 6 feet), the viral load decreased significantly (P < .05). The amount of small particles also increased significantly relative to the amount of large particles. Healthcare professionals were primarily exposed to small influenza virus particles (diameter, < 4.7 μm).
There were no detectable differences between influenza virus types, emitters and superemitters, and patient location.
In an accompanying editorial, Caroline Breese Hall, MD, professor in the Department of Pediatrics and the Department of Medicine at the University of Rochester School of Medicine and Dentistry in New York, notes that more advanced forms of personal protection equipment that effectively block small particles (such as N95 respirators) are expensive and that their use in all influenza-positive patients is "usually not feasible."
"[I]nfection control procedures should be commensurate with the concern generated by the clinical observations of the intensity and severity of the community outbreak. The efficacy of the recommended infection control program, however, is less dependent on which specific procedures are included than on the consistent education of healthcare personnel," Dr. Hall noted. "Included in this should be their vaccination, their compliance with the recommended procedures, and their awareness of the risks of nosocomial infection among patients and personnel."
She concludes, "This study not only adds to our understanding of these risks, but helps define the questions that still need answering."
Dr. Hall died on December 10, 2012, at the age of 73 years. She was internationally known for her work in pediatric infectious diseases.
Source: http://www.medscape.com/viewarticle/778674?nlid=28043_1301&src=wnl_edit_dail&uac=129655SZ
Werner E. Bischoff, MD, PhD, an assistant professor in the Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, and colleagues published their findings online January 31 inClinical Infectious Diseases.
According to the World Health Organization and the Centers for Disease Control and Prevention, transmission mainly occurs when large-particle respiratory droplets travel a short distance, and face masks worn by healthcare professionals block those particles. Fit-tested respirators are only required when aerosol-generating procedures such as bronchoscopy are performed.
Particle size may affect infection risk and severity on the basis of the virus' ability to travel to the lungs instead of being confined to the upper respiratory tract.
"Protecting [healthcare professionals] against influenza virus requires a clear understanding of how this virus is aerosolized and by whom it is emitted," the authors write.
Investigators enrolled 94 patients with influenza-like illness in the study. They obtained patient history and took nasopharyngeal swab specimens. The researchers then collected quantitative impaction air samples 1 foot or less, 3 feet, and 6 feet from the patient's head during routine care. Rapid test and polymerase chain reaction were used to detect influenza virus.
Of the 94 patients, 61 (65%) were influenza-positive (31 influenza A, 30 influenza B). Of those patients, 26 (43%) emitted influenza virus into room air (13 inpatients and 13 ED patients). Of the emitters, 5 (19%) released up to 32 times more virus than other patients. There were no statistical differences in other characteristics or symptoms.
Higher nasopharyngeal viral loads were found in emitters compared with nonemitters. Patients with increased nasopharyngeal viral load were the only patients in whom coughing and sneezing during air sampling was connected with the release of increased virus into room air (P < .05). Emitters exceeded the airborne 50% human infectious dose of influenza virus at all locations sampled.
All emitters in the study were less likely to report chills and more likely to experience higher illness severity and interference with daily living than nonemitter ED patients (P < .05).
As distance from the patient's head increased (from 1 to 6 feet), the viral load decreased significantly (P < .05). The amount of small particles also increased significantly relative to the amount of large particles. Healthcare professionals were primarily exposed to small influenza virus particles (diameter, < 4.7 μm).
There were no detectable differences between influenza virus types, emitters and superemitters, and patient location.
In an accompanying editorial, Caroline Breese Hall, MD, professor in the Department of Pediatrics and the Department of Medicine at the University of Rochester School of Medicine and Dentistry in New York, notes that more advanced forms of personal protection equipment that effectively block small particles (such as N95 respirators) are expensive and that their use in all influenza-positive patients is "usually not feasible."
"[I]nfection control procedures should be commensurate with the concern generated by the clinical observations of the intensity and severity of the community outbreak. The efficacy of the recommended infection control program, however, is less dependent on which specific procedures are included than on the consistent education of healthcare personnel," Dr. Hall noted. "Included in this should be their vaccination, their compliance with the recommended procedures, and their awareness of the risks of nosocomial infection among patients and personnel."
She concludes, "This study not only adds to our understanding of these risks, but helps define the questions that still need answering."
Dr. Hall died on December 10, 2012, at the age of 73 years. She was internationally known for her work in pediatric infectious diseases.
Source: http://www.medscape.com/viewarticle/778674?nlid=28043_1301&src=wnl_edit_dail&uac=129655SZ
Tadalafil beneficial for ejaculatory disorders
Tadalafil appears to have wider benefits on sexual function than just improving erections. An integrated analysis of 17 double-blind, randomized, placebo-controlled 12-week trials of the drug as needed in patients with erectile dysfunction showed significant improvements in ejaculatory and orgasmic functions. Benefits were seen across all baseline levels of erectile, ejaculatory, and orgasmic dysfunction severity.
Lead author Darius A. Paduch, MD, PhD, associate professor of urology and reproductive medicine and director of sexual health and medicine at Weill Cornell Medical College in New York City, told Medscape Medical News that men with even mild erectile dysfunction may have disorders of ejaculation and orgasm.
"We need to change our vocabulary in how we think about sexual dysfunction in men, that erection is not the only aspect of sexual dysfunction," he said. "From our study, we actually clearly show that sexual satisfaction is clearly correlated to ability of getting orgasm [and] ability to ejaculate."
In the studies included in this analysis, ejaculatory dysfunction (EjD), orgasmic dysfunction (OD), and satisfaction were determined according to patient responses to specific questions on the International Index of Erectile Function (IIEF), as well as the Sexual Encounter Profile for satisfaction. Of the 3581 participants (mean age, 54.9 years; mean body mass index, 26.8 kg/m2), 1512 had severe EjD, 1812 had severe OD, 50.9% were white, and 39.3% were of Asian descent.
The researchers found that tadalafil is an "extremely powerful modulator" of ejaculatory and orgasmic function, Dr. Paduch said. "Across all the severity of erectile dysfunction...tadalafil was actually able to help with ability to achieve orgasm and ability to ejaculate."
Tadalafil 10 or 20 mg improved ejaculatory function in 66% of men with severe EjD vs 36% of men taking placebo (P < .001). For men with severe OD, 66% taking tadalafil reported improvements vs 35% taking placebo (P < .001). The more severe the EjD or OD, the greater the proportion of men experiencing improvement compared with placebo.
On the basis of this study and another analyzing the efficacy of testosterone for EjD and OD, Dr. Paduch recommends first improving the testosterone level, "and then you can start the patient on 3 months of tadalafil and let them...relax more.... Very often I think that they work so hard [to reach orgasm] that they counteract their arousal because they're all stressed out."
One limitation of the study was the use of the IIEF, which has unknown performance to measure responses to treatment for EjD and OD. Further research is needed to validate the IIEF for these purposes. In addition, Dr. Paduch would like to test tadalafil for these conditions in men who do not have erectile dysfunction.
This study included treatment with tadalafil, so it cannot be determined whether similar effects would occur using the other marketed phosphodiesterase type-5 inhibitors.
"We all see those patients, [but] until the study came [out], nobody really had any proof that anything works," Dr. Paduch concluded.
Asked for independent comment, Joseph Harryhill, MD, assistant clinical professor of urology at the University of Pennsylvania in Philadelphia, told Medscape Medical News, "It is encouraging to see that there has been some progress being made in an area where I think there's been a real lack of research...because we're talking about a condition that is probably underreported." Clinicians, he said, often fail to ask about "disorders of ejaculation such as delay or inability to ejaculate."
He noted that in the study, among men with mild erectile dysfunction, a significant number had ejaculatory problems. "Even in men without erectile dysfunction, the incidence may be greater than 10% of men that have problems with ejaculation," Dr. Harryhill said. "This is definitely a little bit of a breath of fresh air that a medication that we know and we're comfortable with using might also have an indication for treating ejaculatory problems as well."
Source: http://www.medscape.com/viewarticle/778859?nlid=27862_1301&src=wnl_edit_dail&uac=129655SZ
Lead author Darius A. Paduch, MD, PhD, associate professor of urology and reproductive medicine and director of sexual health and medicine at Weill Cornell Medical College in New York City, told Medscape Medical News that men with even mild erectile dysfunction may have disorders of ejaculation and orgasm.
"We need to change our vocabulary in how we think about sexual dysfunction in men, that erection is not the only aspect of sexual dysfunction," he said. "From our study, we actually clearly show that sexual satisfaction is clearly correlated to ability of getting orgasm [and] ability to ejaculate."
In the studies included in this analysis, ejaculatory dysfunction (EjD), orgasmic dysfunction (OD), and satisfaction were determined according to patient responses to specific questions on the International Index of Erectile Function (IIEF), as well as the Sexual Encounter Profile for satisfaction. Of the 3581 participants (mean age, 54.9 years; mean body mass index, 26.8 kg/m2), 1512 had severe EjD, 1812 had severe OD, 50.9% were white, and 39.3% were of Asian descent.
The researchers found that tadalafil is an "extremely powerful modulator" of ejaculatory and orgasmic function, Dr. Paduch said. "Across all the severity of erectile dysfunction...tadalafil was actually able to help with ability to achieve orgasm and ability to ejaculate."
Tadalafil 10 or 20 mg improved ejaculatory function in 66% of men with severe EjD vs 36% of men taking placebo (P < .001). For men with severe OD, 66% taking tadalafil reported improvements vs 35% taking placebo (P < .001). The more severe the EjD or OD, the greater the proportion of men experiencing improvement compared with placebo.
On the basis of this study and another analyzing the efficacy of testosterone for EjD and OD, Dr. Paduch recommends first improving the testosterone level, "and then you can start the patient on 3 months of tadalafil and let them...relax more.... Very often I think that they work so hard [to reach orgasm] that they counteract their arousal because they're all stressed out."
One limitation of the study was the use of the IIEF, which has unknown performance to measure responses to treatment for EjD and OD. Further research is needed to validate the IIEF for these purposes. In addition, Dr. Paduch would like to test tadalafil for these conditions in men who do not have erectile dysfunction.
This study included treatment with tadalafil, so it cannot be determined whether similar effects would occur using the other marketed phosphodiesterase type-5 inhibitors.
"We all see those patients, [but] until the study came [out], nobody really had any proof that anything works," Dr. Paduch concluded.
Asked for independent comment, Joseph Harryhill, MD, assistant clinical professor of urology at the University of Pennsylvania in Philadelphia, told Medscape Medical News, "It is encouraging to see that there has been some progress being made in an area where I think there's been a real lack of research...because we're talking about a condition that is probably underreported." Clinicians, he said, often fail to ask about "disorders of ejaculation such as delay or inability to ejaculate."
He noted that in the study, among men with mild erectile dysfunction, a significant number had ejaculatory problems. "Even in men without erectile dysfunction, the incidence may be greater than 10% of men that have problems with ejaculation," Dr. Harryhill said. "This is definitely a little bit of a breath of fresh air that a medication that we know and we're comfortable with using might also have an indication for treating ejaculatory problems as well."
Source: http://www.medscape.com/viewarticle/778859?nlid=27862_1301&src=wnl_edit_dail&uac=129655SZ
Meditation helps reduce inflammation
Mindfulness meditation techniques designed to reduce emotional reactivity also reduce poststress inflammatory responses and might be useful in chronic inflammatory conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, and asthma, according to a study by Melissa A. Rosenkranz, PhD, and colleagues at the University of Wisconsin-Madison.
In an article published in the January issue ofBrain, Behavior, and Immunity, the authors present a comparison between an 8-week mindfulness-based stress reduction program (MBSR) and an 8-week active control health enhancement program (HEP) that included walking, balance, agility, core strength, nutritional education, and music therapy in 49 community volunteers randomly assigned to 1 of the 2 groups.
The intervention and active-control groups had similar levels of stress-evoked cortisol response and similar reductions in psychological distress, but the group trained in mindfulness-based stress reduction had significantly smaller poststress inflammatory responses.
Dr. Rosenkranz told Medscape Medical News, "Because of the experimental design, we were not able to determine whether both interventions reduced stress-evoked cortisol responses or whether participants simply became habituated to the stressor. It is true to say that the postintervention cortisol responses to the stressor declined an equivalent amount for both groups. The MBSR group had significantly smaller postintervention inflammatory responses compared to the HEP group."
The investigators used the Trier Social Stress Test (TSST) to induce psychological stress and a topical application of capsaicin cream to induce inflammation.
The TSST induces psychological stress by requiring participants to give a 5-minute impromptu speech on a given topic, followed by 5 minutes of mental arithmetic.
According to the authors, "[C]apsaicin-sensitive sensory nerves and the neuropeptides they contain, together with local sympathetic nerves and mast cells, have been identified as important contributors to the relationship between psychological stress and symptom expression in inflammatory skin diseases.... Therefore, in the present study, a capsaicin-induced inflammatory response and an acute laboratory stressor were used as a model in which to investigate psychological stress and neurogenic inflammation in the skin."
Mindfulness-based stress reduction, originally designed for patients with chronic pain, consists of continuously focusing attention on the breath, bodily sensations, and mental content while seated, walking, or practicing yoga. The goal is to focus on the present experience to help change one's relationship to it in a beneficial way.
Although interest in meditation as a means of reducing stress has grown over the years, there has been little evidence to support benefits specific to mindfulness meditation practice. This was the first study designed to control for other therapeutic mechanisms, such as supportive social interaction, expert instruction, or learning new skills.
The researchers measured local inflammation by applying vacuum pressure to the skin of the volar forearm just below the cubital fossa to raise suction blisters. The forearm area, including the acrylic blister template with eight 6-mm holes, was wrapped in a heating pad to facilitate the formation of the blisters, which took an average of 53.6 minutes. The vacuum pressure was removed and fluid was collected from 4 blisters using a tuberculin syringe and immediately frozen for analysis by enzyme-linked immunosorbent assay. The researchers applied capsaicin cream around the perimeter of, but not touching, the remaining 4 blisters for 45 minutes and then extracted and froze fluid from those blisters.
Blister fluid was assayed by enzyme-linked immunosorbent assay for levels of tumor necrosis factor alpha and of interleukin 8 because these cytokines are sensitive to modulation by psychological stress and because neuropeptides released from capsaicin-sensitive nerve endings trigger their release.
Despite the group difference in change in cortisol slope after training, the researchers found no change in cortisol reactivity to the TSST. The researchers were surprised to find that more time spent in MBSR practice was associated with lower blister fluid cytokine levels, whereas more time spent in HEP practice was associated with higher blister fluid cytokine levels.
Dr. Rosenkranz said, "This was not an effect that we predicted, but upon further exploration, it seems that the postintervention potentiation of the flare response in the HEP group was related to increased skin irritability associated with colder, drier winter weather in Wisconsin. The preintervention data collection occurred during warmer months, and the daily temperature on the day of data collection was correlated with the size of the flare response. So you could see this as the MBSR group being protected from that seasonal increase in skin irritability."
Dr. Rosenkranz added, "Key points would be that MBSR may be beneficial to those with chronic inflammatory conditions by changing the way they relate to their condition and their symptoms, and in so doing, may reduce emotional neural reactivity and the contribution of this reactivity to further symptom expression. Our data suggest that those with conditions which have a neurogenic inflammatory component (eg, psoriasis, dermatitis, irritable bowel syndrome, asthma) may benefit more, in terms of decreased inflammatory potential, from this type of intervention."
Alex J. Zautra, PhD, who has studied cognitive behavioral and mindfulness meditation interventions in patients with rheumatoid arthritis, reviewed the study for Medscape Medical News. Dr. Zautra, who was not involved in this inflammation study, is professor of psychology at Arizona State University in Tempe.
Dr. Zautra said, "This is an interesting study, and the authors examine their data thoroughly and with sound understanding of the complexities involved in charting changes in inflammatory responses pre- and postintervention. They are to be commended for using an active treatment group, but missing is a no-contact contract. That absence makes any difference pre- to post- for which the groups do not differ suspect...this is acknowledged, but easily overlooked in their lengthy discussion. The sample size was also small, which makes the chance of chance findings a bit more likely, especially with so many dependent measures. Missing were changes in cytokines and cortisol that could explain the differences in flares between groups pre- to post-. The absence of findings in these putative mechanisms of action casts doubt over the findings that the mindfulness intervention was more beneficial."
Source: http://www.medscape.com/viewarticle/778570?nlid=27864_1301&src=wnl_edit_dail&uac=129655SZ
In an article published in the January issue ofBrain, Behavior, and Immunity, the authors present a comparison between an 8-week mindfulness-based stress reduction program (MBSR) and an 8-week active control health enhancement program (HEP) that included walking, balance, agility, core strength, nutritional education, and music therapy in 49 community volunteers randomly assigned to 1 of the 2 groups.
The intervention and active-control groups had similar levels of stress-evoked cortisol response and similar reductions in psychological distress, but the group trained in mindfulness-based stress reduction had significantly smaller poststress inflammatory responses.
Dr. Rosenkranz told Medscape Medical News, "Because of the experimental design, we were not able to determine whether both interventions reduced stress-evoked cortisol responses or whether participants simply became habituated to the stressor. It is true to say that the postintervention cortisol responses to the stressor declined an equivalent amount for both groups. The MBSR group had significantly smaller postintervention inflammatory responses compared to the HEP group."
The investigators used the Trier Social Stress Test (TSST) to induce psychological stress and a topical application of capsaicin cream to induce inflammation.
The TSST induces psychological stress by requiring participants to give a 5-minute impromptu speech on a given topic, followed by 5 minutes of mental arithmetic.
According to the authors, "[C]apsaicin-sensitive sensory nerves and the neuropeptides they contain, together with local sympathetic nerves and mast cells, have been identified as important contributors to the relationship between psychological stress and symptom expression in inflammatory skin diseases.... Therefore, in the present study, a capsaicin-induced inflammatory response and an acute laboratory stressor were used as a model in which to investigate psychological stress and neurogenic inflammation in the skin."
Mindfulness-based stress reduction, originally designed for patients with chronic pain, consists of continuously focusing attention on the breath, bodily sensations, and mental content while seated, walking, or practicing yoga. The goal is to focus on the present experience to help change one's relationship to it in a beneficial way.
Although interest in meditation as a means of reducing stress has grown over the years, there has been little evidence to support benefits specific to mindfulness meditation practice. This was the first study designed to control for other therapeutic mechanisms, such as supportive social interaction, expert instruction, or learning new skills.
The researchers measured local inflammation by applying vacuum pressure to the skin of the volar forearm just below the cubital fossa to raise suction blisters. The forearm area, including the acrylic blister template with eight 6-mm holes, was wrapped in a heating pad to facilitate the formation of the blisters, which took an average of 53.6 minutes. The vacuum pressure was removed and fluid was collected from 4 blisters using a tuberculin syringe and immediately frozen for analysis by enzyme-linked immunosorbent assay. The researchers applied capsaicin cream around the perimeter of, but not touching, the remaining 4 blisters for 45 minutes and then extracted and froze fluid from those blisters.
Blister fluid was assayed by enzyme-linked immunosorbent assay for levels of tumor necrosis factor alpha and of interleukin 8 because these cytokines are sensitive to modulation by psychological stress and because neuropeptides released from capsaicin-sensitive nerve endings trigger their release.
Despite the group difference in change in cortisol slope after training, the researchers found no change in cortisol reactivity to the TSST. The researchers were surprised to find that more time spent in MBSR practice was associated with lower blister fluid cytokine levels, whereas more time spent in HEP practice was associated with higher blister fluid cytokine levels.
Dr. Rosenkranz said, "This was not an effect that we predicted, but upon further exploration, it seems that the postintervention potentiation of the flare response in the HEP group was related to increased skin irritability associated with colder, drier winter weather in Wisconsin. The preintervention data collection occurred during warmer months, and the daily temperature on the day of data collection was correlated with the size of the flare response. So you could see this as the MBSR group being protected from that seasonal increase in skin irritability."
Dr. Rosenkranz added, "Key points would be that MBSR may be beneficial to those with chronic inflammatory conditions by changing the way they relate to their condition and their symptoms, and in so doing, may reduce emotional neural reactivity and the contribution of this reactivity to further symptom expression. Our data suggest that those with conditions which have a neurogenic inflammatory component (eg, psoriasis, dermatitis, irritable bowel syndrome, asthma) may benefit more, in terms of decreased inflammatory potential, from this type of intervention."
Alex J. Zautra, PhD, who has studied cognitive behavioral and mindfulness meditation interventions in patients with rheumatoid arthritis, reviewed the study for Medscape Medical News. Dr. Zautra, who was not involved in this inflammation study, is professor of psychology at Arizona State University in Tempe.
Dr. Zautra said, "This is an interesting study, and the authors examine their data thoroughly and with sound understanding of the complexities involved in charting changes in inflammatory responses pre- and postintervention. They are to be commended for using an active treatment group, but missing is a no-contact contract. That absence makes any difference pre- to post- for which the groups do not differ suspect...this is acknowledged, but easily overlooked in their lengthy discussion. The sample size was also small, which makes the chance of chance findings a bit more likely, especially with so many dependent measures. Missing were changes in cytokines and cortisol that could explain the differences in flares between groups pre- to post-. The absence of findings in these putative mechanisms of action casts doubt over the findings that the mindfulness intervention was more beneficial."
Source: http://www.medscape.com/viewarticle/778570?nlid=27864_1301&src=wnl_edit_dail&uac=129655SZ
Vitamin C ups kidney stone risk
Men who take ascorbic acid supplements daily (approximately 1000 mg) were at increased risk for first incident cases of kidney stones (rate difference, 147/100,000 compared with men who do not take ascorbic acid supplements). This represents a dose-dependent, 2-fold increased risk for kidney stone formation.
Laura D.K. Thomas, MSc, from the Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden, and colleagues published the results of their large, population-based prospective cohortstudy online February 4 in JAMA Internal Medicine.
The study was performed in the Cohort of Swedish Men and included 48,850 men aged 45 to 79 years. The authors estimated, but were not able to accurately assess, the dose of vitamin C consumed by the men in the study.
The authors controlled for age, education level, body mass index, tea and coffee use, smoking status, hypertension, and diabetes mellitus. They did not control for dehydration, immobilization, use of loop diuretics, corticosteroids, or vitamin D.
They found high-dose (1000 mg) vitamin C to be associated with a single new kidney stone per 680 high-dose users per year. They found no association between multivitamin use and kidney stone risk (relative risk, 0.86; 95% confidence interval, 0.62 - 1.191).
The study included only men, and the authors note that the results may not be generalizable to women.
In an accompanying editorial, Robert H. Fletcher, MD, from Harvard Medical School in Boston, Massachusetts, discussed the benefits and risks of vitamin supplementation. He began his editorial by describing the original purpose of vitamin supplementation, which was to avoid vitamin-deficiency diseases such as pellagra, rickets, and scurvy. Since that time, however, vitamin supplements have been consumed with the intention of preventing or treating chronic diseases.
Treatment with vitamin C, for example, began in the 1700s as a response to the scurvy experienced by sailors who spent months at sea. In the 1900s, the Nobel Laureate Linus Pauling, PhD, proposed that vitamin C was an effective treatment for the common cold, cancer, and cardiovascular disease. Dr. Pauling's enthusiasm for vitamin C inspired numerous clinical trials that were unable to support the use of vitamin D to prevent mortality.
Recently, evidence has been accumulating that vitamin C supplementation may also be unsafe in that it promotes the formation of kidney stones. Results from the current study are consistent with other studies that have linked vitamin C supplementation and kidney stone formation.
Source: http://www.medscape.com/viewarticle/778769?nlid=27860_1301&src=wnl_edit_dail&uac=129655SZ
Laura D.K. Thomas, MSc, from the Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institutet, Stockholm, Sweden, and colleagues published the results of their large, population-based prospective cohortstudy online February 4 in JAMA Internal Medicine.
The study was performed in the Cohort of Swedish Men and included 48,850 men aged 45 to 79 years. The authors estimated, but were not able to accurately assess, the dose of vitamin C consumed by the men in the study.
The authors controlled for age, education level, body mass index, tea and coffee use, smoking status, hypertension, and diabetes mellitus. They did not control for dehydration, immobilization, use of loop diuretics, corticosteroids, or vitamin D.
They found high-dose (1000 mg) vitamin C to be associated with a single new kidney stone per 680 high-dose users per year. They found no association between multivitamin use and kidney stone risk (relative risk, 0.86; 95% confidence interval, 0.62 - 1.191).
The study included only men, and the authors note that the results may not be generalizable to women.
In an accompanying editorial, Robert H. Fletcher, MD, from Harvard Medical School in Boston, Massachusetts, discussed the benefits and risks of vitamin supplementation. He began his editorial by describing the original purpose of vitamin supplementation, which was to avoid vitamin-deficiency diseases such as pellagra, rickets, and scurvy. Since that time, however, vitamin supplements have been consumed with the intention of preventing or treating chronic diseases.
Treatment with vitamin C, for example, began in the 1700s as a response to the scurvy experienced by sailors who spent months at sea. In the 1900s, the Nobel Laureate Linus Pauling, PhD, proposed that vitamin C was an effective treatment for the common cold, cancer, and cardiovascular disease. Dr. Pauling's enthusiasm for vitamin C inspired numerous clinical trials that were unable to support the use of vitamin D to prevent mortality.
Recently, evidence has been accumulating that vitamin C supplementation may also be unsafe in that it promotes the formation of kidney stones. Results from the current study are consistent with other studies that have linked vitamin C supplementation and kidney stone formation.
Source: http://www.medscape.com/viewarticle/778769?nlid=27860_1301&src=wnl_edit_dail&uac=129655SZ
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