Month: November 2011

Is Wilson’s syndrome a legitimate ailment?

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No, Wilson’s syndrome, also referred to as Wilson’s temperature syndrome, isn’t an accepted diagnosis. Rather, Wilson’s syndrome is a label applied to a collection of nonspecific symptoms in people whose thyroid hormone levels are normal.

Proponents of Wilson’s syndrome believe it to be a mild form of thyroid hormone deficiency (hypothyroidism) that responds to treatment with a preparation of a thyroid hormone called triiodothyronine (T3). However, the American Thyroid Association has found no scientific evidence supporting the existence of Wilson’s syndrome.

In a public health statement, the American Thyroid Association concluded:

  • The diagnostic criteria for Wilson’s syndrome — low body temperature and nonspecific signs and symptoms such as fatigue, irritability, hair loss, insomnia, headaches and weight gain — are imprecise.
  • There’s no scientific evidence that T3 performs better than placebo in people with nonspecific symptoms such as those described in Wilson’s syndrome.

Hypothyroidism can be diagnosed by blood tests that detect insufficient levels of thyroid hormone. Wilson’s syndrome shouldn’t be confused with Wilson’s disease — a rare, inherited disorder that causes too much copper to accumulate in certain organs.

Although it’s frustrating to have persistent symptoms your doctor can’t readily explain, it could be worse to accept an unrecognized diagnosis from an unqualified practitioner. Unproven therapies for so-called Wilson’s syndrome may leave you feeling sicker, while a treatable condition — such as fibromyalgia or depression — goes undiagnosed.

source:Mayo Clinic

Can huperzine A prevent memory loss and improve cognitive function in people with Alzheimer’s disease?

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Huperzine (HOOP-ur-zeen) A, a dietary supplement derived from the Chinese club moss Huperzia serrata, has received some interest as a potential treatment for Alzheimer’s disease.

Huperzine A acts as a cholinesterase inhibitor — a type of medication that works by improving the levels of neurotransmitters in the brain. Small early studies suggest that huperzine A may improve memory and protect nerve cells, which could slow the cognitive decline associated with Alzheimer’s. More studies are needed, however, to determine possible benefits and long-term risks of huperzine A.

For now, most doctors don’t recommend taking huperzine A because FDA-approved cholinesterase inhibitor medications are available that have been tested for safety and effectiveness. The Alzheimer’s Association recommends that you not take huperzine A if you’re already taking a prescribed cholinesterase inhibitor, such as donepezil (Aricept), rivastigmine (Exelon) or galantamine (Razadyne). Taking both could cause side effects, such as nausea, vomiting, diarrhea, dizziness and muscle cramps. Consult with your doctor before starting any dietary supplement, including huperzine A.

source: Mayo clinic

Is it safe to take glucosamine supplements in diabetes?

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Even though glucosamine is technically a type of sugar, it doesn’t appear to affect blood glucose levels or insulin sensitivity. Some preliminary research had suggested that glucosamine might worsen insulin resistance, which can contribute to increases in blood sugar in people with type 2 diabetes. But subsequent studies refuted these findings.

Glucosamine is one of the most popular dietary supplements sold in the United States, although study results have been mixed regarding its ability to reduce osteoarthritis pain. While glucosamine doesn’t appear to affect glucose levels or insulin sensitivity, the supplement can interact with other medications you might be taking — such as warfarin (Coumadin), a blood thinner.

source:Mayo Clinic

Hormone therapy: Is it right for you?

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Until 2002, hormone therapy was routinely used to treat menopausal symptoms and protect long-term health. Then a large clinical trial unearthed its health risks. What does this mean to you?

Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy (as it’s now called) was also thought to have the long-term benefits of preventing heart disease and osteoporosis.

Attitudes about hormone therapy changed abruptly in 2002, when a large clinical trial found that the treatment actually posed more health risks than benefits for postmenopausal women. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And most women on hormone therapy discontinued its use, often without talking to their doctors.

What are the benefits of hormone therapy?

Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

  • Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
  • Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
  • Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won’t be completed for several years.

For women who undergo menopause naturally, estrogen is typically prescribed along with progestin, a man-made version of progesterone. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.

What are the risks of hormone therapy?

In the largest clinical trial to date, the combination estrogen-progestin (Prempro) increased the risk of certain serious conditions.

According to the study, over one year, 10,000 women taking estrogen plus progestin might experience:

  • Seven more cases of heart disease than women taking a placebo
  • Eight more cases of breast cancer than women taking a placebo
  • Eight more cases of stroke than women taking a placebo
  • Eighteen more cases of blood clots than women taking a placebo
  • An increase in abnormal mammograms, particularly false positives

The study found no increased risk of breast cancer or heart disease among women taking estrogen without progestin. Over one year, however, 10,000 women taking estrogen alone might experience:

  • Twelve more cases of stroke than women taking a placebo
  • Six more cases of blood clots in the legs than women taking a placebo
  • An increase in mammography abnormalities

The effect of hormone therapy on mammograms is important, because it suggests that women on hormone therapy may need more frequent mammograms and additional testing.

Who should consider hormone therapy?

Despite the health risks, estrogen is still the gold standard for treating menopausal symptoms. The absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms.

The benefits of short-term hormone therapy may outweigh the risks if you:

  • Experience moderate to severe hot flashes or other menopausal symptoms
  • Have lost bone mass and either aren’t able to tolerate other treatments or aren’t benefitting from other treatments
  • Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure)

Women who experience premature menopause or premature ovarian failure have a different set of health risks compared with women who reach menopause near the average age of about 50, including:

  • A lower risk of breast cancer
  • A higher risk of osteoporosis
  • A higher risk of coronary heart disease (CHD)

In addition, hormone therapy appears to reduce the risk of osteoporosis and CHD when started soon after menopause in young women. For women who reach menopause prematurely, the protective benefits of hormone therapy may outweigh the risks.

Talk with your doctor about your personal risks.

Who should avoid hormone therapy?

Women with breast cancer, heart disease or a history of blood clots should probably not take hormone therapy for relief of menopause symptoms. Women who aren’t bothered by menopause symptoms should not take hormone therapy for prevention of memory loss or strokes. Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.

If you take hormone replacement therapy, how can you protect yourself from the added risks?

Talk to your doctor about these strategies:

  • Time it right. The risk of hormone therapy causing heart disease is not significantly raised in women under age 60. In fact, some studies suggest that estrogen may protect the heart when taken early in your menopausal years.
  • Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms. If you have lasting, debilitating menopausal symptoms, your doctor may recommend longer term treatment, but will follow up regularly to ensure that the benefits of hormone therapy continue to outweigh the risks.
  • Find the best delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That’s because estrogen applied directly to your vagina is more effective at a lower dose than is estrogen given in pill or skin patch form.

If you haven’t had a hysterectomy and are using oral or skin patch hormone therapy, you will also need progestin, which is available in a pill, combination pill, vaginal gel, intrauterine device or combination skin patch. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

What can you do if you can’t take hormone therapy?

Women shouldn’t have to struggle through menopause. You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you change your exercise or eating habits before you try medication. If lifestyle changes aren’t providing enough relief from bothersome symptoms, there are many medications besides hormone therapy to relieve discomfort.

The bottom line: Hormone therapy isn’t all good or all bad

Clearly, hormone replacement therapy hasn’t lived up to its billing as a panacea for age-related disease. But the news isn’t all doom and gloom either.

The best way to determine if hormone replacement therapy is a good treatment option for you is to talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. Review your current treatments with your doctor on a regular basis to make sure they’re still your best option.

Source:Mayo Clinic

Erectile dysfunction herbs: A natural treatment for ED?

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A number of erectile dysfunction herbs claim to help erectile dysfunction. Find out the facts before trying one.

 

Erectile dysfunction — difficulty maintaining an erection sufficient for sex — is a common problem. You’ve likely seen advertisements on the Internet or in magazines for erectile dysfunction herbs or supplements, and you may wonder whether they might work for you.

Erectile dysfunction herbs and other natural remedies have been used in Chinese, African and other traditional medicines for many years. But finding out whether erectile dysfunction herbs or supplements work, and if they’re safe, can be tricky. Unlike prescription medications for erectile dysfunction such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), most erectile dysfunction herbs and supplements haven’t been well studied or tested. Some can cause side effects or interact with other medications.

Here’s what’s known about some of these erectile dysfunction remedies.

Herbal remedy or supplement Does it work? Dangers and possible side effects
DHEA Dehydroepiandrosterone (DHEA) is a building block for sex hormones. It may help some men if they have low testosterone (hypogonadism). DHEA can interfere with your natural balance of sex hormones. It can cause acne and may lower “good” high-density lipoprotein (HDL) cholesterol.
Epimedium (horny goat weed) This traditional Chinese medicine may help erectile dysfunction. There’s little evidence about the safety or side effects of epimedium. It may cause blood thinning and lower blood pressure.
Folic acid and vitamin E In some men taking sildenafil (Viagra), these vitamins seemed to help with erectile dysfunction. But more studies are needed to determine whether there’s a clear benefit. Except in high doses, there’s little risk of side effects from these vitamins.
Ginkgo Ginkgo may help erectile dysfunction by increasing blood flow to the penis. It may also help ease sexual side effects caused by antidepressants. Ginkgo may increase your risk of bleeding. This could be dangerous if you’re going to have surgery or you take a blood-thinning medication.
Ginseng Asian (Panax) ginseng has been used for centuries in traditional Chinese medicine for a number of conditions. A few studies show that ginseng may help with erectile dysfunction. This herb is generally considered safe. However, it may lower blood sugar levels, so use caution when taking ginseng if you have diabetes. In rare cases, ginseng has been linked to mania when taken with certain antidepressants.
Yohimbe Yohimbe is derived from the bark of the African yohimbe tree. A prescription form (yohimbine) may help with erectile dysfunction — especially if it’s due to psychological causes. The prescription form of this herb has been linked to a number of side effects, including increased blood pressure, fast or irregular heartbeat and anxiety.
Zinc Zinc may improve erectile function in men who have a zinc deficiency. Don’t take zinc in high doses. Too much zinc can harm your immune system and cause other health problems.

Be wary of ‘herbal Viagra’

After the medication Viagra was introduced in the late ’90s, it quickly gained a reputation as an effective treatment for the erectile dysfunction. A number of nonprescription products claiming to be herbal forms of Viagra soon followed. Some of these products contain unknown quantities of potent ingredients similar to those in prescription medications, which can cause dangerous side effects. Some actually contain the real drug that should be given by prescription only. Although the Food and Drug Administration has banned many of these products, some potentially dangerous erectile dysfunction remedies remain on the market.

source: Mayo Clinic

Increasing contraceptive options:depo-subQ provera 104™ in the Uniject™ injection

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Using the Uniject prefilled injection system to deliver injectable contraception may help to increase women’s access to family planning services in developing countries. Currently, about 200 million women worldwide can’t get these services.

Lack of access to family planning options—and especially woman-initiated methods—in poor countries means that women are more likely to die from problems related to pregnancy and childbirth. In sub-Saharan Africa, where health services are especially scarce, a woman’s lifetime risk of dying as a result of getting pregnant is 1 in 22. The good news is that about one in three maternal deaths can be avoided by delaying motherhood, spacing births, preventing unintended pregnancy, and avoiding unsafely performed abortions.

Improving access to contraception

Injectable contraceptives such as Depo-Provera® are increasingly popular with women around the globe. One injection every three months provides a safe, effective, reversible, and discreet method to prevent pregnancy. Many women, however, cannot routinely get to clinics that offer this form of contraception, while others start using the method but stop because they cannot return to the clinic.

Depo-subQ provera 104™, a new subcutaneous formulation that will soon be available in the Uniject injection system, promises to help improve women’s access to injectable contraceptives. Administering the contraceptive via the Uniject injection system may not only strengthen clinics’ injection services but also make it easier for injectable contraceptives to be given safely and effectively outside the clinics. Because the prefilled Uniject injection system is so easy to use, lower-level health workers will be better able to give injections in convenient community locations or in clients’ homes.

Introducing new technologies

Pfizer, the drug’s manufacturer, has registered the new formulation in the United States and expects product registration in developing countries beginning in 2012. In anticipation of product availability, PATH is assisting the US Agency for International Development to coordinate planning among a range of partners for possible global rollout of the product. PATH has also begun country-specific planning for product introduction in Kenya, Malawi, Rwanda, Senegal, and Pakistan.

Uniject is a trademark of BD. Depo-Provera and depo-subQ provera 104 are trademarks of Pfizer.

source:PATH

Extended schedule, escalated dose temozolomide versus dacarbazine in stage IV melanoma: Final results of a randomised phase III study (EORTC 18032)

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Purpose

To compare the efficacy of an extended schedule escalated dose of temozolomide versus standard dose dacarbazine in a large population of patients with stage IV melanoma.

Patients and methods

A total of 859 patients were randomised to receive oral temozolomide at 150mg/m2/day for seven consecutive days every 2weeks or dacarbazine, administered as an intravenous infusion at 1000mg/m2/day on day 1 every 3weeks. The primary endpoint was overall survival (OS), using an intent-to-treat principle. EudraCT number 2004-000654-23 NCI registration number NCT00005052.

Results

Median OS was 9.1months in the temozolomide arm and 9.4months in the dacarbazine arm, with a hazard ratio (HR) of 1.00 (95%confidence interval [CI]: 0.86, 1.17; P=0.99). Median progression-free survival (PFS) was 2.3months in the temozolomide arm and 2.2months in the dacarbazine arm, with a HR of 0.92 (95%CI: 0.80, 1.06; P=0.27). In patients with measurable disease, overall response rate was higher in the temozolomide arm than in the dacarbazine arm (14.5% versus 9.8%, respectively), but the median duration of response was longer for dacarbazine. The extended schedule, escalated dose temozolomide arm showed more toxicity than the standard dose, single agent dacarbazine arm. The most common non-haematological treatment emergent adverse events reported in both treatment arms were nausea, fatigue and vomiting and constipation.

Conclusion

Extended schedule escalated dose Temozolomide (7days on 7days off) is feasible and has an acceptable safety profile, but does not improve OS and PFS in metastatic melanoma when compared to standard dose dacarbazine

 

PATH’s woman’s condom

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 it.

Building protection against unintended pregnancy and HIV

Condoms offer contraception and protection against HIV in one inexpensive, simple-to-use package. But the most commonly used condoms worldwide are male condoms, which means women who want to use this method depend entirely on their partners’ cooperation.

A female condom equalizes control by a small but significant amount. Unfortunately, the currently available female condoms are more expensive than male condoms (they cost ten times as much!) and can be less comfortable and more difficult to use.

In 1996, two PATH employees who were working together on new reproductive health technologies came up with an exciting idea: What if PATH could refine the female condom, with the cooperation of women and their partners, and come up with a design that would be easy to use, affordable, and as or more comfortable than a male condom? The brainstorming sessions that followed brought PATH’s reproductive health and technology experts together on the first incarnation of the Woman’s Condom project, dedicated to producing a female condom that would serve women better through a user-driven design.

Why a new condom?

Cost is not the only factor that restricts developing-world use of the female condoms that are already on the market. As we started to research the problem, we realized that women wanted a number of things that they weren’t getting. They wanted a female condom that was easier to insert, use, and remove; that was more stable, so they didn’t have to worry that it would be dislodged or move out of place during use; that was more comfortable for both partners (in particular, less noisy); that interfered less with sensation.

Going to the source

To achieve a truly user-driven product design meant establishing testing sites around the world with populations that varied widely in physical and cultural needs. We gathered input from couples in Khon Kaen, Thailand; Cuernavaca, Mexico; Durban, South Africa; and Seattle throughout the design process. Our researchers observed clinical fittings of prototype condoms and interviewed the couples to find out how they responded to each new design.

The birth of the final design came after more than four years of hard work—spent in assessment, research and development of new materials, and evaluation of hundreds of prototypes. By the end, we had developed and tested more than 50 design generations in more than 300 unique prototypes. It was a stark contrast to the energy of the original brainstorming session—where anything seemed possible. But the result was a female condom that is easy to insert and remove, is very stable during sex, and feels good for both partners.

What did we change?

The most widely available female condom is shaped like an oversized male condom, with a semiflexible ring at the open end that rests outside the woman’s body and a loose ring inside that helps with insertion and holds the condom in place.

We refined the material from which the condom is made until we had something much softer and thinner, which got high marks from female testers. The inner ring was painful for some women, so we replaced it with four small dots of soft, absorbent foam. These foam dots adhere gently to the interior of the vagina, holding the condom securely in place during use and releasing easily from the vaginal walls on removal. To make insertion easier, we added a rounded cap to the end of the condom, which gathers the condom pouch together until after insertion. Once the condom is inserted, the tip quickly dissolves (in less than a minute, for most women).

From the lab to the market

After extensive evaluation and testing, the Woman’s Condom is ready for a combined Phase 2/3 clinical trial, the last step before US Food and Drug Administration approval. But while approval is the last step in design, it’s only the first step in making the condom available to women in the developing world—which requires finding a manufacturer and making the condom affordable.

PATH has spent more than a year designing and building machines that can manufacture thousands of these condoms, in the process solving some critical technical problems in production. Our new pilot production line, already up and running, is a significant cost-saver for potential manufacturers—bringing us closer to making the final price of the condom affordable to families with little money and many competing needs.

source:PATH

Site-specific recombinases (SSRs)

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Site-specific recombinases (SSRs) enable novel tag-and-target as well as tag-and-exchange strategies for tailoring mammalian genomes. If used in combination with homologous recombination, which per se is inefficient but can serve to introduce SSR sites, the tagged locus lends itself to repeated modification at largely increased efficiency and specificity. The more conventional SSR-based genetic modifications enable straightforward integration of a transgene with efficiencies depending on both the target locus and the vector composition. Only the more recent tag-and-exchange strategies in conjunction with advanced selection principles enable the clean replacement of a genomically anchored cassette by a donor cassette with the related architecture. Meanwhile this recombinase-mediated cassette exchange (RMCE) concept could be verified for two classes of SSRs, belonging to either the Tyr or the Ser family. Certain members of these open different fields of application that will be discussed with reference to the molecular properties of the respective enzymes. A major aim of our review is to characterize the RMCE-relevant components and describe their optimal utilization in the fields of gene therapy and molecular genomics. Early contributions to the field of experimental animal models will be mentioned considering in vivo modifications enabled by microinjection into oocytes..

Source: FASEB

Niacin plus simvastatin was no better than simvastatin alone.

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Physicians sometimes prescribe niacin for statin-treated patients to raise HDL cholesterol levels or to manipulate lipid subfractions detected by more elaborate lipid testing. However, the clinical effect of this practice is unclear. In the NIH-sponsored AIM-HIGH study, 3414 patients with established cardiovascular disease were randomized to receive simvastatin plus either extended-release niacin or placebo. Enrollment criteria included HDL cholesterol levels <40 mg/dL for men and <50 mg/dL for women, and triglyceride levels between 150 and 400 mg/dL. Patients were selected for randomization only after completing an open-label run-in phase, during which they demonstrated that they could tolerate high niacin doses (1500–2000 mg daily). During the trial, most patients took 40-mg or 80-mg simvastatin daily; the LDL cholesterol target was <80 mg/dL. Most patients also received aspirin, β-blockers, and angiotensin-converting–enzyme inhibitors.

Compared with placebo, niacin therapy induced significant changes in LDL cholesterol, HDL cholesterol, and triglyceride levels. Nevertheless, the trial was stopped after average follow-up of 3 years when no hint of cardiovascular benefits and a trend toward more strokes with niacin were reported. The primary outcome (a composite of adverse coronary events, strokes, and revascularization) occurred in 16% of patients in each group; the incidence of stroke was 1.7% with niacin and 1.1% with placebo (P=0.09).

Comment: These results — first announced in May 2011 (JW Gen Med Jun 7 2011) — are straightforward: Extended-release niacin doesn’t benefit patients with known cardiovascular disease who achieve low LDL cholesterol levels with statin monotherapy (the average LDL cholesterol level in this study’s statin-plus-placebo group was about 70 mg/dL). Note that this study was purely a secondary prevention trial; we also have no evidence that niacin improves outcomes in contemporary primary prevention.


source: Journal Watch General Medicine