Eating high-protein foods is so good for you, it’s like quitting smoking, study finds .


Another reason why amino acids are our very favourite acids.

The dietary benefits of eating the right amount of protein are well known, but new research indicates just how big of an impact different kinds of protein-rich food sources can have on our health.

According to a study by the University of East Anglia in the UK, the high levels of certain amino acids in some foods can boost cardiovascular health in ways comparable to making major changes to your lifestyle, such as getting more exercise or even quitting smoking.

“Results from previous studies have provided evidence that increased dietary protein may be associated with lower blood pressure,” said Amy Jennings, lead author, in a statement. “We wanted to know whether protein from animal sources or plant-based sources was more beneficial – so we drilled down and looked at the different amino acids found in both meat and vegetables.”

The researchers analysed seven different amino acids – arginine, cysteine, glutamic acid, glycine, histidine, leucine, and tyrosine – investigating how each affected the cardiovascular health of women with a healthy BMI.

The data of almost 2,000 women was included in the study, and the findings, published in The Journal of Nutrition, showed that those who consumed the highest amounts of amino acids had lower blood pressure and arterial stiffness.

“The really surprising thing that we found is that amino acid intake has as much of an effect on blood pressure as established lifestyle risk factors such as salt intake, physical activity and alcohol consumption,” said Jennings. “For arterial stiffness, the association was similar to the magnitude of change previously associated with not smoking.”

The researchers found that higher intake of amino acids from animal sources (glutamic acid, leucine, and tyrosine) was most strongly associated with lower levels of arterial stiffness; conversely, while all seven amino acids result in lower blood pressure, those from vegetables reduce blood pressure the most.

Given high blood pressure can lead to developing cardiovascular problems such as stroke or heart disease, getting the right amount of amino acids from both animal and plant-based sources could very well help you live longer.

“Increasing intake from protein-rich foods such as meat, fish, dairy produce, beans, lentils, broccoli, and spinach could be an important and readily achievable way to reduce people’s risk of cardiovascular disease,” said Jennings.

Not that you should just load up on second or third portions of things like T-bone steaks, cheese, prawns, and all that other good stuff winking at you from the buffet. The amount of protein we should actually be eating each day is still pretty small.

“Beneficial daily amounts equate to a 75 g portion of steak, a 100 g salmon fillet, or a 500 ml glass of skimmed milk,” said Jennings.

Not exactly all you can eat! But then again, nobody ever said getting more exercise or quitting smoking was meant to be easy either, so why should this be any different?

How papaya, fenugreek leaves can control dengue .


Giloy is helpful in building the immune system and papaya leaves cure dengue fever, an expert says.

Pankaj Aggarwal, from the capital-based Agrawal Homoe Clinic, has suggested some easy home remedies to control platelet loss and recovery from dengue fever.

Giloy (herb): This is helpful in building the immune system, giloy stem marks immediate recovery when consumed in frequently during the fever. Boil two or three giloy stems for ten minutes and serve the patient for better immunity.

Papaya leaves: The budding leaves of papaya tree cure dengue fever and helps in removing excess toxins from the body. The intake of its juice from crushed leaves can helpin rising the platelet count.

Fenugreek leaves: Fenugreek leaves help in reducing the pain of the patient and help in restful sleep. It reduces the level of fever stabilizing the blood pressure and heartbeat of the patient.

Goldenseal: The herb proves to be an excellent remedy for its ability to clear up the symptoms of the dengue fever. The leaf when consumed in form of juice helps in eliminating the dengue virus from the body strengthening the immunity of the body against its signs.

Boy Born With 3 Penises And No Anus Undergoes Surgery


A 2-year-old boy born with three penises in an incredibly rare occurrence has undergone pioneering surgery to correct the abnormality.

Two-year-old-born-with-three-penises-in-Diphallia-Mumbai-with-his-mother

An Indian mother and her boy who suffers from a rare condition

The 2-year-old boy who was suffering from diphallia, a rare condition where a male is born with two penises, had a third penis considered rudimentary or undeveloped.  In addition, the unnamed boy was born without an anus.

However, a medical report shows that he is in process of a successful recovery at the Sion Hospital in Mumbai, India.

The boy from the Indian state of Uttar Pradesh, was brought by his mother to Mumbai for treatment. Last month he went ‘under the knife’ to correct the physical abnormalities. His family are now hopeful that their child will be able to lead a normal life.

Previously, he was able to pass urine through one of the penises. Only two had erectile tissue, which is responsible for sexual function.

A six-hour surgery was carried out in Mumbai, to correct the malfunctions.

Dr Vishesh Dixit, a paediatric surgeon, said: “There was a huge soft boney mass and tissue to which the penises were attached. However, the anus was absent.”

In detailing how the mass and rudimentary penis were removed, Vishesh said: “The two functional penises were fused into one by wrapping a mass of skin around them.”

He further explained that the boy had already undergone a colostomy, where surgeons made an incision in his stomach, enabling him to get rid of waste.

READ ALSO: Teenager’s Manhood Goes Missing After Shaking Stranger

However, from the  latest operation, an anal path was created through the boy’s rectum to facilitate the passage of excreta.

The doctor assured that so long as the anal path surgery proves successful, the incision in the boy’s stomach will be closed in a separate procedure later this month.

There are other assurances that the boy’s sexual function and his fertility will not be affected.

The boy’s relatives overwhelmed by the surgery, thanked the surgeons: “We want our boy to lead a normal life, and are grateful to the doctors who have conducted a successful surgery.”

Diphallia is a rare abnormal development in which an infant male is born with two penises. The first ever recorded case was that of Johannes Jacob in 1609. The presence of diphalia is usually accompanied by several other anomalies.

There is also a higher risk of spina bifida and infants born with diphilia and its related conditions have a higher death rate from various infections associated with their more complex renal or colorectal systems.

There have been just 100 cases of diphallia reported since 1609.

Tintinalli Reviews ACEP’s Revised tPA Policy


A review of the revised ACEP Clinical Policy – IV tPA downgraded to Level B evidence

Nothing seems to stir the emotions of an emergency physician more than a discussion of tPA for stroke: who, why, and when. Skeptics cite problems in the data, and conflicts of interest of the authors. Supporters trust the literature that passed peer review and became policy of emergency medicine and neurology professional societies around the world.

2012 and 2015
The 2012 ACEP Clinical Policy  on the use of tissue plasminogen activator for acute ischemic stroke [1] raised plenty of questions. It resulted in concerns about the effectiveness of the drug, the magnitude of its effectiveness, the risks of cerebral hemorrhage, effects of the drug on stroke mimics, legal implications of the policy, the policy’s impact in different practice settings, hospital differences in resources for stroke diagnosis and emergency care, and the lack of  tools for patient/family shared decision making [2,3,4,5]. The key question asked was ‘Is IV tPA safe and effective for acute ischemic stroke if given within 3, and within 3-4.5 hours after symptom onset? The level A recommendation stated: IVtPA should be offered …to patients who meet …(NINDS) inclusion/exclusion criteria and can be treated within 3 hours after symptom onset. The level B recommendation stated: IVtPA should be considered in patients who meet…(ECASS III) inclusion/exclusion criteria and can be treated between 3 to 4.5 hours after symptom onset.

Criticism of this policy was swift, in these pages and elsewhere. Level A recommendations imply generally accepted principles of care and as such seemed to ignore or shut down years of well-intentioned, well-reasoned debate on tPA’s safety and efficacy. Subsequently, ACEP took the unprecedented step of reconsidering their policy, which had been co-authored with the American Academy of Neurology.

In June 2015, the ACEP Board approved a revised clinical policy  on the use of tPA for ischemic stroke [6].  The question asked was the same as in 2012 – whether IV tPA is safe and effective within 3 hours of symptom onset, and within 3-4.5 hours of symptom onset.

2015 Recommendations
Is IV tPA safe and effective for patients with acute ischemic stroke if given within 3 hours, and within 3-4.5 hours  of symptom onset? Recommendations for ❤ and 3-4.5 hours are combined below for simplicity.

  • Level A recommendation: None.
    Note that the 2015 policy no longer provides level A recommendations for IVtPA.
  • Level B recommendation for ❤ hr administration: IV tPA should be offered and may be given …within 3 hours after symptom onset at institutions where systems are in place to safely administer the medication. Consider the increased risk of sICH.
  • Level B recommendation for 3-4.5 hr administration: despite the known risk of sICH and the variability in the degree of benefit in functional outcomes, IV tPA may be offered and may be given to carefully selected patients…within 3-4.5 hours after symptom onset at institutions where systems are in place to safely administer the medication.
  • Level C recommendation: When feasible, shared decisionmaking…should include a discussion of potential benefits and harms…

Risks and Benefits
Here are selected comments from Appendix D and text, using the most robust analyses that  were provided for risk-benefit analysis:

IVtPA given < 3 hrs

  • NNT = 8 (95% CI 4-31)  NINDS
  • NNH=17 (95% CI 12-34)  NINDS
  • sICH 5-7% sICH overall  (could be lower with adherence to protocol; sICH definitions also vary with study)
  • Proportion who improved: 13% achieving Rankin Scale 0-1 (NINDS 39% IVtPA vs 26% control)

IVtPA given 3-4.5 hrs

  • NNT = 14  (95% CI 7-244) ECASS III
  • NNH= 23 (95%  31-78)  ECASS III
  • sICH 3-8% and 2-6% depending on NINDS definition of sICH
  • Proportion who improved: 7% achieving Rankin Scale 0-1, ECASS III, 52% for IVtPA vs 45% for control)

Who benefits and when?
Published data is somewhat population-based and not at all individual-based, so we are still in the dark about the patients most likely to benefit from IVtPA. If only 13% benefit from IVtPA if given within 3 hours, or 7% in 3-4.5 hours, what about the rest? What about the cost and resources used?   Who exactly are the ‘carefully-selected’ patients who may receive IVtPA at 3-4.5 hours? The benefits of giving tPA in ❤ hours, or  ≤90 minutes also needs discussion [8].

Who is most at risk for sICH?
Several scoring systems for assessing the likelihood of sICH after IVtPA have been developed [9]. Predictive variables and scoring methods vary with the tool, but typically include early infarct signs on non-contrast CT scan; prestroke Rankin scale score; age;  antithrombotic therapy; hyperglycemia; and NIHSS on admission.

What about the ED, the hospital and the hospital system?
Stroke diagnosis and emergency management is not a one-man emergency physician show. It requires a team to make what is often a difficult diagnosis and treatment plan. All members of the team should use the same unified protocol: indications for activating Code Stroke; NIHSS reporting; imaging protocols; scoring systems for risk-benefit analysis; and well-articulated and well-presented information and consent forms.

What about tools for shared decision-making?
Involving patients and family in decision-making is more complex than asking ‘do you want the clot-buster’? Patients who elect a treatment, whether a stent for STEMI, or IVtPA for stroke, assume they will personally benefit from the treatment. This is not the case with IVtPA where most do not benefit. Only a few do. And a small number are harmed. Graphs and pictorial images are an excellent way to communicate a risk-benefit analysis, but are in various stages of development [10,11]. The challenge for tool developers is to convey information simply, clearly, and quickly given a variety of clinical scenarios.

Summary
The 2015 ACEP clinical policy discussion is detailed. Study deficiencies are noted, the discussion uses updated data, and methodology, case definitions, heterogeneity and outcome differences are noted. IVtPA was lowered from a level A to level B recommendation, and qualifications on the proper environment for drug administration were added. However, these qualifications were not spelled out in any detail and key issues relative to decision-making remain unaddressed. The revised policy reminds us that data on risks and  benefits are still a moving target. What is clear is that the pressure is on for emergency physicians who must be the initiators and leaders of the emergency stroke care team.

REFERENCES

  1. Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department . Annals of Emergency Medicine, 61:2, February 2013, 225- 243
  2. Ellison D, ‘The Lytic Lottery’ Annals of Emergency Medicine, 62:5, October 2013, 432-33
  3. Newman, David, ‘Thrombolytics for Acute Ischemic Stroke’ ,theNNT.com, March 25, 2013 accessed Aug 7, 2015
  4. Hoffman JR and Schriger DL ‘A Graphic Reanalysis of the NINDS Trial’ Annals of Emergency Medicine 54:3 September 2009, 329-336
  5. Klauer, K ‘tPA and the Problems of ‘Indication Creep. Emergency Physicians Monthly, May 29, 2013.
  6. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. http://www.acep.org/workarea/DownloadAsset.aspx?id=102373
  7. Zinsser, William. On Writing Well. The Classic Guide to Writing Nonfiction’. 7e, 2006, HarperCollins, New York.
  8. Miller JB, Heitsch L, Siket M, et al ‘The Emergency Medicine Debate on tPA for Stroke: What is Best for our Patients? Efficacy in the First Three Hours’ Acad Emerg Med 2015 July; 22(7):852-5
  9. Asuzu D, Nystrom K, Amin H et al ‘Comparison of 8 scores for predicting symptomatic intracerebral hemorhage after IV thrombolysis’ NeurocritCare 2015 Apr; 22 (2):229-33. PMID 25168743
  10. Gadhia J, Starkman S, Ovbiagele B, et al ‘Assessment and Immprovement of Figures to Visually Convey Benefit and Risk of Stroke Thrombolysis’ Stroke 2010 February; 41 (2): 300-306
  11. Flynn D, Ford GA, Stobbart L et al ‘A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers. BMC Health Services Research 2013, 13:225

Pregnant in the OR: Potential Hazards


Regardless of your position, occupational hazards exist when working in the operating room. Normally these things aren’t given too much thought, but when my choices suddenly affected another developing life, it caused me to pause and contemplate these hazards on a deeper level. Unfortunately, studies on pregnant healthcare workers (and other occupations) are difficult to interpret due to the fact that they predominantly consist of retrospective cohort data rife with selection and recall bias or animal studies of direct exposure to substances. Nevertheless, here is a list of some things to consider when working pregnant in the operating room or hospital setting:

Anesthetic Gases. While every effort is made to avoid elective surgery during pregnancy, even pregnant women need to have general anesthesia under urgent circumstances; there is no evidence that gases administered at concentrations appropriate for general anesthesia cause fetal harm. Thus, sub-anesthetic levels that would be passively inhaled in an occupational capacity should theoretically be safe as well. That being said, it is generally recommended that pregnant women in the OR avoid inhalation of the gases when possible. We facilitate this by using ventilator circuits with scrubbing systems and taking care to turn off anesthetic gases if the circuit is open to air for a period of time (such as between mask ventilation and intubation). This is mostly routine practice regardless of pregnancy status.

Methylmethacrylate. MMA is a common ingredient in cement mixtures for joint prosthetics. When mixed, it forms a strong scent which dissipates over a number of minutes as the mixture cures. Studies, which have mainly occurred in animal models, reveal mixed results in terms of impact on fetal development. As a pregnant provider, your choices are to not work on cases using MMA, ask the scrub mixing the cement to use a vacuum device to remove the fumes, or temporarily leave the room during the mixing process. In one human study, MMA was not found above a 0.5 ppm level in breast milk of surgeons who utilized vacuum mixing devices. At our institution, the use of these devices is mixed amongst surgery personnel, but local suction can also be easily employed. If I am in a joint room and my patient is stable, I elect to step into the adjacent substerile core (which has a window to the operating room) for a few brief minutes while the mixing occurs. However, I did have a recent case where the patient was very unstable and I could not leave the room or easily turn the case over to another provider temporarily. After that experience, the scheduler changed me to a different OR.

Radiation. Discussed briefly in my previous Pregnant in the OR post, radiation is commonly used during OR procedures such as orthopedic repairs, gastrointestinal explorations, interventional pain management, interventional radiology, angiography, line placement… I could go on. For radiation, potential harmful effects are directly related to the dose of exposure. The CDC website has a table of radiation doses with corresponding maternal/fetal risks at different gestational ages. At doses higher than 50 rads, risks range from failure of implantation and miscarriage at early stages to growth retardation, mental delay, and increased risk of cancer at later stages. As with general anesthesia, pregnant women themselves must occasionally undergo irradiative procedures, but care is always taken to balance risks with benefits. In addition, protective shielding goes a long way to reduce exposure. Even in an occupational capacity we wear protective lead garments during periods of radiation. Wearing these and standing at least 6 feet away from the beam will decrease the exposure by more than 99%. However, the garments must encircle the body and not just cover the front of the body in apron form. This is especially important for anesthesiologists, who often turn their backs to the OR table to gather drugs or supplies, etc. And during my pregnancy, I have actively avoided assignments that involve continuous use of fluoroscopy (such as cath lab, GI lab, and interventional vascular or radiology).

Infection. It goes without saying that universal precautions need to be followed by everyone, but there are wider implications and possible sequelae if a pregnant woman contracts an infectious disease while working in the OR. Discussing the details of this would be beyond the scope of this article, but the gist is that potentially teratogenic effects of certain microbes and their treatments and/or long-term transmission of viral infections to the fetus such as HIV or HCV are considerations that should provide pause and vigilance when employing personal protection.

Stress. This is the most difficult “hazard” to avoid. Theoretically, emotional and physical stress can cause neuroendocrine and cardiovascular alterations that could affect fetal physiology and hence possible outcomes. Limited studies implicate longer working hours, night shift work, prolonged standing, and physical work as risk factors for preterm birth, SGA infants and miscarriage. It must also be mentioned, especially for trainees, that the financial burden of NOT working during pregnancy can cause significant stress in itself. Some women might choose to take a lighter load or less frequent call shifts during pregnancy, if possible.

I have mitigated many of these hazards during my pregnancy by notifying the schedulers early of my status, so that they could avoid giving me assignments with increased exposure as much as possible. In terms of stress, my job has no call duties, so long and tiring hours have usually not been an issue. Not everyone can be as lucky, but vigilance to self-care postcall and adequate hydration during call can help.

For readers who have been pregnant during hospital or OR duties, did you encounter any other hazards at work? What were your experiences trying to avoid them? Share your thoughts with us here!

Rethinking the Placebo Effect: How Our Minds Actually Affect Our Bodies


In 2013, Neil deGrasse Tyson hosted a mind-bending debate on the nature of “nothing” — an inquiry that has occupied thinkers since the dawn of recorded thought and permeates everything from Hamlet’s iconic question to the boldest frontiers of quantum physics. That’s precisely what New Scientist editor-in-chief Jeremy Webb explores with a kaleidoscopic lens in Nothing: Surprising Insights Everywhere from Zero to Oblivion(public library | IndieBound) — a terrific collection of essays and articles exploring everything from vacuum to the birth and death of the universe to how the concept of zero gained wide acceptance in the 17th century after being shunned as a dangerous innovation for 400 years. As Webb elegantly puts it, “nothing becomes a lens through which we can explore the universe around us and even what it is to be human. It reveals past attitudes and present thinking.”

Among the most intensely interesting pieces in the collection is one by science journalist Jo Marchant, who penned the fascinating story of the world’s oldest analog computer. Titled “Heal Thyself,” the piece explores how the way we think about medical treatments shapes their very real, very physical effects on our bodies — an almost Gandhi-like proposition, except rooted in science rather than philosophy. Specifically, Marchant brings to light a striking new dimension of the placebo effect that runs counter to how the phenomenon has been conventionally explained. She writes:

It has always been assumed that the placebo effect only works if people are conned into believing that they are getting an actual active drug. But now it seems this may not be true. Belief in the placebo effect itself — rather than a particular drug — might be enough to encourage our bodies to heal.

She cites a recent study at the Harvard Medical School, in which people with irritable bowel syndrome were given a placebo and informed that the pills were “made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes.” As Marchant notes, this is absolutely true, in a meta kind of way. What the researchers found was startling in its implications for medicine, philosophy, and spirituality — despite being aware they were taking placebos, the participants rated their symptoms as “moderately improved” on average. In other words, they knew what they were taking wasn’t a drug — it was a medical “nothing” — but the very consciousness of takingsomething made them experience fewer symptoms.

Illustration by Marianne Dubuc from ‘The Lion and the Bird.’ Click image for more.

This dovetails into recent research confirming what Helen Keller fervently believed by putting some serious science behind the value of optimism. Marchant sums up the findings:

Realism can be bad for your health. Optimists recover better from medical procedures such as coronary bypass surgery, have healthier immune systems and live longer, both in general and when suffering from conditions such as cancer, heart disease and kidney failure.

It is well accepted that negative thoughts and anxiety can make us ill. Stress — the belief that we are at risk — triggers physiological pathways such as the “fight-or-flight” response, mediated by the sympathetic nervous system. These have evolved to protect us from danger, but if switched on long-term they increase the risk of conditions such as diabetes and dementia.

What researchers are now realizing is that positive beliefs don’t just work by quelling stress. They have a positive effect too — feeling safe and secure, or believing things will turn out fine, seems to help the body maintain and repair itself…

Optimism seems to reduce stress-induced inflammation and levels of stress hormones such as cortisol. It may also reduce susceptibility to disease by dampening sympathetic nervous system activity and stimulating the parasympathetic nervous system. The latter governs what’s called the “rest-and-digest” response — the opposite of fight-or-flight.

Just as helpful as taking a rosy view of the future is having a rosy view of yourself. High “self-enhancers” — people who see themselves in a more positive light than others see them — have lower cardiovascular responses to stress and recover faster, as well as lower baseline cortisol levels.

Marchant notes that it’s as beneficial to amplify the world’s perceived positivity as it is to amplify our own — something known as our “self-enhancement bias,”a type of self-delusion that helps keep us sane. But the same applies to our attitudes toward others as well — they too can impact our physical health. She cites University of Chicago psychologist John Cacioppo, who has dedicated his career to studying how social isolation affects individuals. Though solitude might be essential for great writing, being alone a special form of art, and single living the defining modality of our time, loneliness is a different thing altogether — a thing Cacioppo found to be toxic:

Being lonely increases the risk of everything from heart attacks to dementia, depression and death, whereas people who are satisfied with their social lives sleep better, age more slowly and respond better to vaccines. The effect is so strong that curing loneliness is as good for your health as giving up smoking.

Illustration by Marianne Dubuc from ‘The Lion and the Bird.’ Click image for more.

Marchant quotes another researcher, Charles Raison at Atlanta’s Emory University, who studies mind–body interactions:

It’s probably the single most powerful behavioral finding in the world… People who have rich social lives and warm, open relationships don’t get sick and they live longer.

Marchant points to specific research by Cacioppo, who found that “in lonely people, genes involved in cortisol signaling and the inflammatory response were up-regulated, and that immune cells important in fighting bacteria were more active, too.” Marchant explains the findings and the essential caveat to them:

[Cacioppo] suggests that our bodies may have evolved so that in situations of perceived social isolation, they trigger branches of the immune system involved in wound healing and bacterial infection. An isolated person would be at greater risk of physical trauma, whereas being in a group might favor the immune responses necessary for fighting viruses, which spread easily between people in close contact.

Crucially, these differences relate most strongly to how lonely people think they are, rather than to the actual size of their social network. That also makes sense from an evolutionary point of view, says Cacioppo, because being among hostile strangers can be just as dangerous as being alone. So ending loneliness is not about spending more time with people. Cacioppo thinks it is all about our attitude to others: lonely people become overly sensitive to social threats and come to see others as potentially dangerous. In a review of previous studies … he found that tackling this attitude reduced loneliness more effectively than giving people more opportunities for interaction, or teaching social skills.

Illustration by André François for ‘Little Boy Brown,’ a lovely vintage ode to childhood and loneliness. Click image for more.

Paradoxically, science suggests that one of the most important interventions to offer benefits that counter the ill effects of loneliness has to do with solitude — or, more precisely, regimented solitude in the form of meditation. Marchant notes that trials on the effects of meditation have been small — something I find troublesomely emblematic of the short-sightedness with which we approach mental health as we continue to prioritize the physical in both our clinical subsidies and our everyday lives (how many people have a workout routine compared to those with a meditation practice?); even within the study of mental health, the vast majority of medical research focuses on the effects of a physical substance — a drug of some sort — on the mind, with very little effort directed at understanding the effects of the mind on the physical body.

Still, the modest body of research on meditation is heartening. Marchant writes:

There is some evidence that meditation boosts the immune response in vaccine recipients and people with cancer, protects against a relapse in major depression, soothes skin conditions and even slows the progression of HIV. Meditation might even slow the aging process. Telomeres, the protective caps on the ends of chromosomes, get shorter every time a cell divides and so play a role in aging. Clifford Saron of the Center for Mind and Brain at the University of California, Davis, and colleagues showed in 2011 that levels of an enzyme that builds up telomeres were higher in people who attended a three-month meditation retreat than in a control group.

As with social interaction, meditation probably works largely by influencing stress response pathways. People who meditate have lower cortisol levels, and one study showed they have changes in their amygdala, a brain area involved in fear and the response to threat.

If you’re intimidated by the time investment, take heart — fMRI studies show that as little as 11 hours of total training, or an hour every other day for three weeks, can produce structural changes in the brain. If you’re considering dipping your toes in the practice, I wholeheartedly recommend meditation teacher Tara Brach, who has changed my life.

But perhaps the most striking finding in exploring how our beliefs affect our bodies has to do with finding your purpose and, more than that, finding meaning in life. The most prominent studies in the field have defined purpose rather narrowly, as religious belief, but even so, the findings offer an undeniably intriguing signpost to further exploration. Marchant synthesizes the research, its criticism, and its broader implications:

In a study of 50 people with advanced lung cancer, those judged by their doctors to have high “spiritual faith” responded better to chemotherapy and survived longer. More than 40 percent were still alive after three years, compared with less than 10 percent of those judged to have little faith. Are your hackles rising? You’re not alone. Of all the research into the healing potential of thoughts and beliefs, studies into the effects of religion are the most controversial.

Critics of these studies … point out that many of them don’t adequately tease out other factors. For instance, religious people often have lower-risk lifestyles and churchgoers tend to enjoy strong social support, and seriously ill people are less likely to attend church.

[…]

Others think that what really matters is having a sense of purpose in life, whatever it might be. Having an idea of why you are here and what is important increases our sense of control over events, rendering them less stressful. In Saron’s three-month meditation study, the increase in levels of the enzyme that repairs telomeres correlated with an increased sense of control and an increased sense of purpose in life. In fact, Saron argues, this psychological shift may have been more important than the meditation itself. He points out that the participants were already keen meditators, so the study gave them the chance to spend three months doing something important to them. Spending more time doing what you love, whether it’s gardening or voluntary work, might have a similar effect on health. The big news from the study, Saron says, is “the profound impact of having the opportunity to live your life in a way that you find meaningful.”

Philosopher Daniel Dennett was right all along in asserting that the secret of happiness is to “find something more important than you are and dedicate your life to it.”

Each of the essays in Nothing: Surprising Insights Everywhere from Zero to Oblivion is nothing short of fascinating. Complement them with theoretical physicist Lawrence Krauss on the science of “something” and “nothing.”

Risk of intracranial haemorrhage with combination use of antidepressants and NSAIDs


Concerns emerge over combining antidepressants with non-steroidal anti-inflammatory drugs (NSAIDs) as a study shows an increased risk of intracranial haemorrhage (ICH) in these patients.

Antidepressants and NSAIDs are both associated with gastrointestinal bleeding but not with ICH when used as monotherapy. Evidence now shows that the absolute risk of ICH in the first 30 days of combination treatment with an antidepressant and NSAID is 0.05 percent, with a hazard ratio (HR) of 1.6 vs treatment with an antidepressant alone (p<0.001). [BMJ 2015;351:h3517]

Subgroup analyses found no significant difference in ICH risk between the antidepressant drug classes for tricyclic antidepressants (HR, 1.7), selective serotonin reuptake inhibitors (HR, 1.4), and serotonin-norepinephrine reuptake inhibitors (HR, 0.4) vs all other drug classes. The risk of ICH, however, was greater in men (HR, 2.6) than women (HR, 1.2), but there was no association between ICH risk and patient comorbidities or other co-medications.

The retrospective analysis was performed using data from over 4 million Korean patients, taken from the Korean Health Insurance Review and Assessment Service database. All patients were treated with antidepressants between 2009 and 2013.

The study is the first population-based cohort study to highlight the risk of ICH associated with the combined use of antidepressants and NSAIDs. The potential risk of interaction posed by their concomitant use may be substantial, experts warn, especially with the increasing use of antidepressants and overuse of over-the-counter NSAIDs.

“The availability of over-the-counter analgesics is particularly important, as doctors often fail to consider the risks and potential interactions posed by non-prescribed drugs,” wrote Professor Stewart Mercer and colleagues of the University of Glasgow, Glasgow, UK and the University of Cambridge, Cambridge, UK in an accompanying editorial. [BMJ 2015;351:h3745]

“Most worryingly, conditions requiring NSAIDs and antidepressants commonly coexist; 65 percent of people with major depression also have chronic pain, with both morbidities sharing common psychological risk factors and neurobiological processes,” they wrote.

Vigilance in prescribing and assessment of individual patients’ risks and needs are recommended. According to Mercer and colleagues, knowing the patient and applying an empathic, person-centred approach to care may be “as important as having better guidelines and a better evidence base.”

Further research will be needed to address the risk of ICH with the individual treatments used alone, as well as the risks associated with long-term use of combination treatment.

ACE inhibitors may not protect against pneumonia in older tube-fed patients


Angiotensin-converting enzyme (ACE) inhibitors have no protective effect against pneumonia in older tube-fed patients, a Hong Kong randomized controlled trial (RCT) has shown.

The trial results have refuted evidence from previous studies and meta-analyses, which linked the use of ACE inhibitors to improvement of swallowing reflex as well as reduction of silent aspirations and pneumonia incidence in older patients with dysphagia.

“To our knowledge, this is the first RCT to examine the effect of ACE inhibitors on pneumonia in older patients on tube-feeding, with pneumonia as the primary outcome,” wrote investigators from the Chinese University of Hong Kong, Alice Ho Mui Ming Nethersole Hospital, Shatin Hospital, Tai Po Hospital, Prince of Wales Hospital, Pok Oi Hospital, Ruttonjee Hospital, Buddhist Hospital and Princess Margaret Hospital.

They recruited 71 patients aged ≥60 years who had been on tube-feeding for more than 2 weeks due to neurologic dysphagia secondary to cerebrovascular diseases. The patients were randomized to receive the ACE inhibitor lisinopril 2.5 mg once daily or placebo.

“We hypothesized that ACE inhibitors may reduce the incidence of pneumonia in these patients,” wrote the investigators. To their surprise, however, the rates of pneumonia were comparable between the two groups at 6 months after randomization (57.6 percent in the treatment group vs 47.4 percent in the placebo group; p=0.39).

The study was terminated prematurely due to the unexpectedly high overall mortality rate of 40.8 percent at 6 months. Notably, patients receiving lisinopril had significantly higher risks of 6-month mortality (adjusted odds ratio [OR], 7.79; p=0.018) and the composite endpoint of pneumonia or death (adjusted OR, 7.16; p=0.025).

“The higher mortality rate observed in the treatment group appeared to be attributed to its greater pneumonia-related deaths [14 cases vs 7 cases in the placebo group],” noted the investigators. “However, this might have been a chance finding, because the proportion of deaths due to pneumonia [relative to non-pneumonia causes] was similar between both groups [73 percent in the treatment group vs 70 percent in the placebo group]. In addition, pneumonia-related deaths between the two groups were not significantly different in the multiple logistic regression analysis.”

“Although observational studies in community-based populations suggested a protective or non-significant effect of ACE inhibitors in pneumonia, our results showed that whatever immune-modulating effects ACE inhibitors might have did not benefit these very frail patients,” they concluded.

On a positive note, the investigators observed a trend towards better swallowing function in patients treated with lisinopril (p=0.052). Further studies are warranted to examine this potential effect of ACE inhibitors.

Calmangafodipir reduces oxaliplatin-induced neuropathy


Calmangafodipir, an investigational cytoprotective agent, reduces oxaliplatin-induced neuropathy in patients with metastatic colorectal cancer (mCRC) without affecting chemotherapy efficacy, the phase II PLIANT study has shown.

In 173 mCRC patients on the FOLFOX-6 (oxaliplatin, leucovorin, 5-FU) regimen, administration of calmangafodipir (5 or 10 µmol/kg) 10 minutes prior to each chemotherapy cycle reduced the frequency, onset and duration of grade ≥2 chemotherapy-induced peripheral neuropathy (CIPN) compared with placebo. [Multinational Association of Supportive Care in Cancer Annual Meeting 2015, abstract 27-01-O]

Overall reduction in grade ≥2 CIPN was 43 percent with the 5 µmol/kg dose of calmangafodipir (p=0.146). When patients treated with bevacizumab were excluded, the reduction in grade ≥2 CIPN reached statistical significance for the 5 and 10 µmol/kg doses combined (p=0.025).

Reductions in cold allodynia and paresthesia were also seen with calmangafodipir.

“Importantly, unlike other strategies that have been used to prevent CIPN, calmangafodipir showed no apparent negative impact on the efficacy of chemotherapy,” said principal investigator Dr. Devalingam Mahalingam of the University of Texas Health Science Centre in San Antonio, TX, US. “The objective response rate was 27 in patients who received calmangafodipir 5 µmol/kg and those who received placebo [p=0.49].”

Calmangafodipir was developed as an improvement on the MRI contrast agent, mangafodipir. “While accumulation of manganese in the brain has been a concern with repeated administration of mangafodipir, calmangafodipir was designed to be safe even with repeated dosing,” said Mahalingam.

“Calmangafodipir had a very benign safety profile in the PLIANT study,” he continued. “Neurotoxicity was very low, as was the incidence of grade 3/4 neutropenia.”

While more data are needed to define the benefit of calmangafodipir in CIPN prevention, researchers from the North Central Cancer Treatment Group recently characterized the clinical course of oxaliplatin-induced neuropathy using data from the phase III study NO8CB. [J Clin Oncol 2015, doi:10.1200/JCO.2014.58.8533]

They found that in patients with colon cancer receiving adjuvant FOLFOX, symptoms of acute oxaliplatin-induced neuropathy were only half as severe in cycle 1 compared with subsequent cycles. The acute symptoms, including sensitivity to touching or swallowing cold items (71 percent), throat discomfort (63 percent) or muscle cramps (42 percent), usually peaked at day 3 of each cycle and improved afterwards. However, they did not always resolve completely between cycles.

Symptoms of chronic neurotoxicity, including tingling, numbness and pain, were more prominent in the hands during chemotherapy. By 18 months, however, the symptoms became more severe in the feet.

“Patients with more severe acute neuropathy during the first cycle of therapy experienced more chronic sensory neurotoxicity,” the authors wrote.

rom Fish To Eggs, 6 Ways To Get Vitamin D Without The Sun


http://www.medicaldaily.com/fish-eggs-6-ways-get-vitamin-d-without-sun-349390

 

We’ve all heard it; whether we haven’t been spending enough time in the sun, or our diet has been lacking in healthy options, chances are we’ve been told that we need more vitamin D in our diets. Vitamin D has been known to do many essential things for our body, like regulate calcium, absorb phosphorus, and help our immune system fight disease. But despite this vitamin being essential to our diets, new research is finding that many of us just aren’t getting enough of it. In fact, one study found that the current Recommended Dietary Allowance, or how much we should be eating a day, is 10 times lower than it actually should be.

But for those of us who aren’t going outside as much as we like, where exactly can we find this key nutrient? Even though not many foods naturally contain adequate levels of vitamin D, there are still some out there, especially those that have been fortified, that can help up our daily dose. To see the full list of all the foods that can help you get your vitamin D fix, click “View Slideshow” above.