31 Mar

Medical News Today: Daily serving of pulses may aid long-term weight loss

Adding just one serving of pulses a day to the diet could help people lose weight and keep it off, concludes a new study.
[A bowl of chickpeas]
Eating just 130 g of pulses daily could help with weight loss, new research suggests.

In The American Journal of Clinical Nutrition, researchers found that people who ate 130 g of pulses every day for an average of 6 weeks lost weight, compared with those who did not eat pulses daily, even when they made no other notable dietary changes.

A part of the legume family, pulses include dried beans, dried peas, chickpeas and lentils.

Pulses are low in fat and high in protein and fiber, making them an ideal food choice for individuals who do not get protein from meat, fish or dairy products. They are also high in iron, zinc, phosphorus, folate and many other vitamins and minerals.

Numerous studies have documented the heath benefits of pulses. In 2014, for example, Medical News Today reported on a study suggesting a serving of pulses each day may lower “bad” low-density lipoprotein (LDL) cholesterol by 5%.

Now, new research suggests adding a daily serving of pulses to the diet could also help tackle overweight and obesity.

Eating pulses every day led to 0.34-kg weight loss

To reach their findings, lead author Dr. Russell de Souza, of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, Canada, and colleagues conducted a meta-analysis of 21 clinical trials involving 940 participants.

These trials compared the weight-loss effects of diets containing dietary pulses with diets that did not, and each trial was conducted for a minimum of 3 weeks.

Over a median duration of 6 weeks, the team found that individuals who consumed 130 g (3/4 cup) of pulses daily had an average weight loss of 0.34 kg – just over half a pound – compared with people who did not eat pulses daily.

What is more, the team notes that the pulse-consuming individuals who experienced weight loss made no other major changes to their diets.

Previous research from Dr. de Souza and colleagues found that eating pulses can increase the feeling of fullness by around 31%, which they say may explain these latest findings.

Because pulses have a low glycemic index (GI), meaning they are broken down slowly, they make us feel full for longer, which can result in reduced food intake and weight loss.

The US is in the midst of an obesity epidemic, where more than a third of Americans are obese, highlighting the need for effective weight-loss strategies.

Dr. de Souza notes that around 90% of current weight-loss interventions do not work, which he says may be partly down to hunger and food cravings. Could a daily helping of pulses aid long-term weight loss?

Dr. de Souza says:

“Though the weight loss was small, our findings suggest that simply including pulses in your diet may help you lose weight, and we think more importantly, prevent you from gaining it back after you lose it.”

Earlier this year, MNT reported on a study that sheds light on why exercise alone does not aid long-term weight loss.

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31 Mar

Medical News Today: Nightly fasting may help reduce breast cancer risk

Fasting during sleep for more than 13 hours a night may offer protection against recurrence of illness among women with early stage breast cancer, say findings published online in JAMA Oncology.
[breast cancer survivors]
When we eat, as well as what we eat, may help prevent recurrence of breast cancer.

Breast cancer is the number one cause of cancer death among women in developing countries and the second most common cause of cancer death in developed countries.

In the US, 224,147 women and 2,125 men received a breast cancer diagnosis in 2012, and 41,150 women and 405 men died from breast cancer.

Much attention has focused on the positive effects of a healthy diet on breast cancer outcomes. However, the results of research into which foods or food groups and which dietary patterns can help have been mixed.

Recently, a new theory suggested that timing also matters, and that when we eat has an impact on metabolic health and cancer.

Previous mouse studies have shown that rodents who consumed a high-fat diet but repeatedly fasted for at least 16 hours experienced protection against abnormal glucose metabolism, inflammation and weight gain. All of these factors have been linked to poor cancer outcomes.

Ruth E. Patterson, PhD, of the University of California-San Diego, and colleagues have been looking at the potential effects of nightly fasting on breast cancer prognosis.

Health benefits of fasting more than 13 hours a night

They looked at data for 2,413 women who were registered in the Women’s Healthy Eating and Living study from 1995-2007. The average age of the women was 52.4 years. All participants had early stage breast cancer and were aged 27-70 years at the time of diagnosis. None of the women had diabetes.

On average, the participants fasted for 12.5 hours each night.

The study focused on the recurrence of invasive breast cancer and new primary breast tumors during an average follow-up time of 7.3 years, in addition to death from breast cancer or any cause over an average 11.4-year period.

Women who fasted for less than 13 hours a night had a 36% higher risk for breast cancer recurrence, compared with those who fasted for 13 or more hours.

No link emerged between shorter fasting time and death from breast cancer or mortality from any other cause.

Patients with early stage breast cancer who fasted for longer had significantly lower concentrations of HbA1c and longer sleep duration.

Since nightly fasting appears to improve glycemic control and sleep, the researchers propose that, as well as having a positive effect on breast cancer outcomes, longer fasting could help to reduce the risk of type 2 diabetes, cardiovascular disease and other cancers.

One limitation of the study is the use of self-reported dietary data.

Nevertheless, the authors note that the findings have important implications for public health.

They say:

“Our study introduces a novel dietary intervention strategy and indicates that prolonging the length of the nightly fasting interval could be a simple and feasible strategy to reduce breast cancer recurrence.”

They call for further studies, including randomized trials, to test the effectiveness of prolonging nightly fasting in reducing the risk of chronic disease.

Medical News Today has previously reported that adhering to a calorie-restricted diet that mimics fasting for a limited period of time may be good for the health.

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31 Mar

Medical News Today: Zika link to fetal brain abnormalities confirmed in new study

A new study provides additional evidence for the link between infection with Zika virus during early pregnancy and brain abnormalities in the developing fetus.
pregnant woman having an ultrasound scan
The study provides more evidence of a link between infection with Zika virus during early pregnancy and brain abnormalities in the fetus.

The research, by a Finnish-American team and published in the New England Journal of Medicine, is also the first to report isolation of infectious Zika virus in cells cultured from fetal brain tissue.

Plus, it shows that genetic traces of Zika virus can be detected in maternal blood samples during the period when potential fetal brain damage is developing, even weeks after symptoms have subsided.

Zika virus is spread by the same Aedes mosquito that carries dengue and chikungunya. Infection with Zika typically presents as mild illness and a rash.

A suspected link between Zika infection and microcephaly has spurred the World Health Organization (WHO) to declare the virus a “public health emergency of international concern.”

The new study surrounds a single case of a woman who became infected with Zika during the first trimester of pregnancy – during the 11th week of gestation – while she was visiting Central America.

The researchers found genetic traces of Zika virus in samples of the woman’s blood. Her spouse tested negative for the virus.

Evidence may suggest Zika virus adapts to fetal brain

Scans of the brain of the fetus taken part way through the second trimester (at 20th week of gestation) showed severe brain abnormalities in the fetus.

With MRI neuroimaging techniques, it is possible to detect brain abnormalities before the development of the intracranial calcifications and microcephaly previously associated with Zika virus infections.

The authors note that, “Given the grave prognosis, the patient elected to terminate the pregnancy at 21 weeks of gestation.”

For their study, the researchers mapped the entire genome of the Zika virus they isolated and found it differed from strains previously reported in Central America by eight mutations.

Speculating on these genetic differences, senior author Prof. Vapalahti, professor of zoonotic virology at the University of Helsinki, suggests:

“Some of these mutations may be associated with the adaptations of the virus to the fetal brain.”

The researchers found the highest postmortem levels of Zika virus traces in the fetal brain, with substantial presence in the placenta and umbilical cord, and lower levels in fetal muscle, liver and other organs.

The main contribution of the study is that it may help to develop ways to detect fetal damage due to Zika infection during pregnancy, say the authors, while Prof. Vapalahti adds:

“Our research also helps confirm the causal relation between the Zika virus and severe damage to the fetal central nervous system.”

The researchers note that the virus samples they isolated from the fetal brain cells will also be a great help to future Zika virus research.

The finding follows another study Medical News Today recently learned about that found the risk of their fetus or newborn having microcephaly is around 1 in 100 for women infected with Zika in their first trimester.

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31 Mar

Medical News Today: Precision treatment for NF1 steps closer with mutation clues

A new genetic study suggests varying mutations in the NF1 gene may determine which particular disease symptoms arise in the cancer syndrome neurofibromatosis type 1. The finding opens the door to discovering ways to help doctors decide the best treatment for patients born with the disease.
Blue DNA strands
The study investigates mutations that may raise the risk for optic gliomas, one of the most common brain tumors to arise in children with NF1.

The study, from the Washington University School of Medicine in St. Louis, MO, is published in the journal Human Molecular Genetics.

Children born with neurofibromatosis type 1 (NF1) usually develop brain and nerve tumors, in addition to other medical problems, including skin and bone defects, autism and epilepsy.

NF1 is among the world’s most common genetic disorders, occurring in about 1 of every 3,000 births. Although it is caused by a mutation in the gene that bears its name, the symptoms that arise vary widely, making it difficult to determine the best course of treatment.

There are thousands of different mutations that can affect the function of the NF1 gene. By investigating the effect of a particular mutation in mice, the new study suggests specific mutations may give rise to specific clinical features.

The finding brings closer the day when doctors will be able to predict which specific NF1 symptoms are likely to arise in their patients by identifying particular mutations in their NF1 genes.

It suggests it may be possible to use mice genetically engineered with patient-specific NF1 gene mutations to predict which mutations are linked to which symptoms of the disease.

Senior author David H. Gutmann, a professor of neurology, says:

“These early-phase findings bring us one step closer to being able to individually tailor how we monitor and treat people with NF1.”

Increased risk of developing optic gliomas

For their study, the team investigated mutations that may raise the risk of developing optic gliomas, one of the most common brain tumors to arise in children with NF1 and a known cause of vision loss in these patients.

Fast facts about NF

  • Neurofibromatosis (NF) occurs worldwide in men and women of all races and ethnic groups
  • Half of cases arise from spontaneous mutations in the NF gene
  • Most people with NF type 1 have symptoms by the age of 10.

Learn more about NF

The researchers showed that one group of mice carrying one specific NF1 gene mutation from a human patient developed optic gliomas, while a second group of mice with another human NF1 gene mutation did not. The mice that developed the gliomas also developed vision problems.

On further investigation, the team found that the mutations appeared to affect the function of microglia – a type of immune cell in the central nervous system that is part of the first line of defense.

Further experiments revealed that the two mutations had different effects on the number and activity of microglia. The first group of mice had more microglia in their brains and they developed bigger tumors and more damage to the optic nerve. No such findings arose in the second group of mice.

The team is now investigating the underlying mechanism through which microglia may help the growth of optic glioma and lead to vision loss.

Prof. Gutmann says he and his colleagues are very excited by their findings. He notes that they can “now envision using a mini-clinic of mice with different NF1 gene mutations” that could offer a “valuable representation of the spectrum of clinical variability in this very heterogeneous disorder,” and adds:

“Moreover, should specific gene mutations play a major role in determining brain tumor development, families could be better informed about the risk that their children may develop such tumors.”

The researchers are now including the mice in drug evaluations for developing precision treatments for children and adults with NF1.

In September 2014, Medical News Today learned about a study that found learning and memory defects in neurofibromatosis are reversible in a zebrafish model of the genetic disease.

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31 Mar

Medical News Today: Fungicides trigger autism-related gene expression changes in mice

The brain cells of mice exposed to a new class of fungicides showed changes in gene expression similar to those found in individuals with autism, Alzheimer’s disease and other neurological conditions, according to the results of a new study.
[A vehicle spraying crops]
A new class of fungicides led to gene expression changes in mouse brain cells similar to changes seen in people with autism, Alzheimer’s and other neurodegenerative disorders.

While the researchers say the findings – published in Nature Communications – cannot confirm that the chemicals cause such conditions in humans, they believe further investigation is warranted.

The study was conducted by senior author Mark Zylka, PhD, associate professor of cell biology and physiology at the University of North Carolina (UNC) School of Medicine, and colleagues.

To reach their findings, the team exposed the brain cells, or neurons, of mice to around 300 chemicals, including a variety of fungicides.

Fungicides are chemicals that can prevent or kill the growth of fungi, protecting plants and crops from fungi-related damage.

The researchers used RNA sequencing on the mouse neurons in order to pinpoint which genes might be affected by exposure to the chemicals, comparing them with neurons that were not exposed to the chemicals.

Using a series of computer programs, the team was able to establish which chemicals triggered similar changes in gene expression.

Fungicides changed same genes that are altered in some brain disorders

The researchers identified six groups of chemicals that altered gene expression within mouse neurons, including the pesticides rotenone, pyridaben and fenpyroximate, as well as a new class of fungicides called strobilurins.

Strobilurins were only introduced into the US market in the late 1990s. Chemicals in this class include pyraclostrobin, trifloxystrobin, fenamidone and famoxadone.

“We found that chemicals within each group altered expression in a common manner,” says Zylka. “One of these groups of chemicals altered the levels of many of the same genes that are altered in the brains of people with autism or Alzheimer’s disease.”

In detail, the researchers found the chemicals reduced the expression of genes that play a role in brain cell communication, which can interfere with brain functioning. The chemicals also increased expression of genes associated with nervous system inflammation, which is often seen in autism and neurodegenerative disorders.

Furthermore, the team found each group of chemicals boosted the production of free radicals – uncharged molecules that can cause cell damage – and interfered with microtubules within brain cells.

“Disrupting microtubules affects the function of synapses in mature neurons and can impair the movement of cells as the brain develops,” explains Zylka. “We know that deficits in neuron migration can lead to neurodevelopmental abnormalities. We have not yet evaluated whether these chemicals impair brain development in animal models or people.”

Findings ‘should serve as a wake-up call’

According to Zylka, conventionally grown leafy green vegetables – such as spinach, lettuce and kale – have the greatest exposure to strobilurins, though he notes that the chemicals are increasingly being applied to other food crops because they are so effective at protecting against fungi.

The Environmental Protection Agency (EPA) state that the few human studies of strobilurins to date have shown the chemicals are less toxic than many other fungicides, though they have still been associated with short-term eye irritation, upper respiratory tract irritation, dizziness, weakness, skin redness and chest pain.

However, Zylka notes that previous research on the fungicide trifloxystrobin has shown the chemical hampers the motor function of rats for up to several days – a symptom that is common in Parkinson’s disease and other neurological conditions – while a low dose of the fungicide picoxystrobin has also been linked to impaired motor function in rats.

While the authors cannot confirm that strobilurins have the same effect on human brain cells as those of mice, they stress that this is something that should be investigated in future research.

“Virtually nothing is known about how these chemicals impact the developing or adult brain,” says Zylka. “Yet these chemicals are being used at increasing levels on many of the foods we eat.”

Commenting on the findings, Dr. Jeannie T. Lee, professor of genetics at Harvard Medical School and Massachusetts General Hospital – who was not involved in the study – says the results should “serve as a wake-up call to regulatory agencies and the general medical community,” adding:

“The work is timely and has wide-ranging implications not only for diseases like autism, Parkinson’s and cancer, but also for the health of future generations. I suspect that a number of these chemicals will turn out to have effects on transgenerational inheritance.”

Last December, Medical News Today reported on a study suggesting a pesticide used in the US until the 1980s – heptachlor epoxide – may be linked to Parkinson’s.

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31 Mar

Medical News Today: Melanoma: 'intralesional therapy is here to stay'

Melanoma intralesional therapy – whether monotherapy or in combination with checkpoint inhibitors – is clearly here to stay, concluded a recent debate at the HemOnc Melanoma and Cutaneous Malignancies Annual Meeting in New York.
[Melanoma word graphic]
Researchers say intralesional therapy – whether monotherapy or in combination with checkpoint inhibitors – is effective for patients with melanoma.

In the debate Merrick Ross, from MD Anderson Cancer Center in Houston, Texas, spoke for the motion “Intralesional Monotherapy is here to stay”; while Robert Andtbacka, from the Huntsman Cancer Institute at the University of Utah in Salt Lake City, opposed it, making a case for combination therapy.

Reviewing the spectrum of injectable advanced “unresectable” disease, Ross described how intralesional therapy could be used for stage 3 B/C regionally metastatic in-transit disease with or without nodal disease; stage M1a (distant skin, soft tissue and nodal metastases); and Stage M1a with low-volume visceral disease.

The dual treatment goals, he explained, are locally ablative therapy for local disease control (leading to palliation/symptom control) and the induction of systemic host immune anti-tumor activity. “You can deliver high concentrations of drug very easily, providing very good palliation of symptoms – and durable control may be curative,” said Ross.

Ross outlined the three main intralesional therapies:

  • T-VEC (talimogene laherarepvec, Imlygic, OncoVEX): a herpes simplex virus type 1. Phase 3 completed. Already licensed
  • PV-10: a 10% solution of the dye Rose Bengal. Phase 2 trial completed, phase 3 trial ongoing
  • Coxsackie A21 virus [Cavatak, viralytics]: a naturally occurring “common cold” intracellular adhesion molecules 1(ICAM1) targeted RNA virus. Phase 2 trial completed.

Through a variety of mechanisms, each of these agents is able to selectively invade and lyse tumor cells, leading to the release of tumor-derived antigens that ultimately have the ability to potentiate a systemic T cell-mediated anti-tumor response.

The oncolytic immunotherapy concept, Ross explained, is part of the cancer immune cycle. “You start with ablation of the tumor which would express tumor-derived antigens, then when the tumor is destroyed, you prime dendritic cells to express activated T cells that proliferate and migrate to distant tumors.”

T-VEC ‘halts metastasis through a form of immune response’

For the remainder of his presentation Ross focused on T-VEC and PV-10, the two agents for which he had the most clinical experience.

In the phase 2 study of PV-10, which took place in 80 patients, a complete response rate of 24% was achieved in both the injected lesions and the uninjected “bystander lesions,” with a disease control rate (DCR) of 71% for injected lesions and 55% for bystander lesions.

To get a good bystander response, patients need to have a good local response, demonstrated by the CR and PR bystander response being 67% for those patients with a strong local response, compared with 5% for those with a negative local response (P<0.0001).

For T-VEC in the phase 3 OPTiM trial, 436 patients with injectable, unresectable stage 3B-4 melanoma were randomized 2:1 to T-VEC intralesional injections (n=295) or GM-CSF (n=141).

Results showed a durable response rate (defined as an objective response lasting for at least 6 months) was achieved in 16.3% of T-VEC patients vs. 2.1% of GM-CSF patients (P<0.0001).

The objective overall response was 26.4% for T-VEC vs. 5.7% for GM-CSF. Furthermore, the risk of developing visceral or bone metastasis was reduced by 59% in patients treated with T-VEC, compared with GM-CSF controls. “This suggests some sort of systemic immune response has developed preventing clinical visceral metastases,” said Ross.

At 12 months, an interim overall survival analysis showed 73.7% of the T-VEC patients had survived versus 69.4% of the GM-CSF patients, indicating a survival trend favoring T-VEC. A subgroup analysis according to disease stage showed Stage 3B/C, 4 M1a patients (HR 0.57) had markedly improved survival in comparison to stage 4 M1b/c patients (HR 1.07)

Summarizing the data, Ross said that studies in stage 3B/C melanoma patients have shown that response rates were higher for intralesional therapies (T-VEX 52%; PV-10 49%) than approved systemic immunotherapies (ipilimumab <30%; pembrolizumab 27-39%; and nivolumab 34-40%). Grade 3-4 adverse event rates were markedly lower for intralesional therapies (T-VEC<2% in comparison to ipilimumab 19%).

Introducing checkpoint inhibitors, said Ross, would change toxicity to a different category. “I have never seen a pituitary gland disappear or a colon rupture with intralesional therapies, side effects that have been seen with some checkpoint blocking agents,” he said.

Combinations ‘do not add toxicity’

Making the case for the superiority of combining intralesional therapies with checkpoint inhibitors – such as ipilimumab, nivolumab and pembrolizumab – Antbacka said that response rates with combinations are better than with either treatment alone and that combinations do not add toxicity.

In the Checkmate 067 trial of nivolumab plus ipilimumab, the best change from baseline in target lesion volume was 51.9% for the combination, versus -34.5% for nivolumab alone and +5.9% for ipilimumab alone. The 40% grade 3-4 adverse event rate seen with the combination, however, was of concern. “There are clearly patients who are not candidates for this combination,” said Andtbacka.

But recent trials combining intralesional therapies with checkpoint inhibitors have revealed enhanced immune responses and no indications of increased toxicity. Notably, a phase 1b trial of ipilimumab plus T-VEC, which enrolled 18 patients, showed no new safety signals or dose limiting toxicities. The DCR was 72 %, with durable responses in 44% and complete regression of uninjected non-visceral and visceral lesions in 39% (with 52% having greater than 50% regression).

In the ongoing phase 1b MASTERKEY-265 trial of T-VEC plus pembrolizumab an interim analysis of 21 patients at 17 weeks showed an ORR of 56% and DCR of 69% for the combination, with no patients having to discontinue treatment due to adverse events.

The phase 3 MASTERKEY-265 study, comparing T-VEC plus pembrolizumab to placebo plus pembrolizumab, has just been initiated. It is hoped that the study, which plans to recruit 660 patients, will provide a definitive answer as to whether combining a viral oncolytic agent and a checkpoint inhibitor improves outcomes and influences side effects.

Studies show the response rates found in advanced unresectable Stage 2/4 melanoma are markedly better for combination therapies (nivolumab plus ipilimumab 52%; T-VEC plus ipilimumab 50%; T-VEC plus pembrolizumab 56%), compared with monotherapies (ipilimumab 6-15%; pembrolizumab 27-38%; nivolumab 34-40%; T-VEC 26%).

“Where checkpoint inhibitors do not work, this can be due to the lack of lymphocytes. Intralesional therapies can boost checkpoint inhibitors through enhancing levels of lymphocytes,” said Antbacka.

Planned trials exploring other combinations include a phase 2 of pembrolizumab plus IL-12 electroporation (a technique using electrical pulses to improve the therapy reach within the lesion); a phase 1b trial of pembrolizumab plus CVA21; and a phase trial of pembrolizumab plus -PV-10.

“Combination therapy is better than monotherapy in advanced melanoma because there is no added toxicity and therapies enhance the effect of checkpoint inhibitors,” said Antbacka. “Monotherapy is clearly only half as good as the combination.”

Sanjiv Agarwala, the meeting’s chairman and moderator from St. Luke’s Cancer Center in Bethlehem, PA, said:

“We have to realize that intralesional therapy is not going anywhere, it is here to stay. It is a new paradigm for potential combinations, and perhaps in the future the ultimate melanoma regimen is going to be with an intralesional therapy with a systemic, checkpoint inhibitor. Monotherapy also is applicable to specific patients.”

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31 Mar

Medical News Today: Right brain structures may hold clue to language recovery after stroke

Scientists may be able to predict who is more likely to recover from language problems following a stroke by examining structures in the right hemisphere of the brain, according to research published in Neurology.
[stroke on left side]
A stroke on the left side of the brain often affects speech and language.

The brain is divided into two hemispheres, the right and the left. In most people, the left side dominates in language and speech-motor functions. If the left side of the brain is damaged by stroke, aphasia can result.

Aphasia can cause problems with speaking, naming, repeating and understanding language.

Many people recover some of these faculties, but for many, even intense speech therapy does not lead to a full recovery.

Previous studies have shown that levels of injury to gray and white matter in structures in the left side of the brain can predict the potential for recovery

However, the role played by the right hemisphere in regaining speech-language functions has remained unclear.

Dr. Gottfried Schlaug, of Harvard Medical School in Boston, MA, and colleagues studied 33 people with aphasia following a stroke on the left side of the brain.

Speech recovery correlates with levels of structure within the brain

The average age of participants was 58 years, and they all had a stroke around 2.5 years prior to the current research. They had all undergone speech therapy.

In addition, 13 people of similar ages who had not had a stroke were included in the tests as a control group.

All the participants underwent speech fluency tests, and brains scans were carried out using a special magnetic resonance imaging (MRI) technique. The MRI enabled the researchers to examine tissue integrity and connectivity in various regions of the brain.

Fast facts about stroke

  • Stroke kills 130,000 Americans every year
  • 795,000 people have a stroke every year
  • Around 87% of strokes are ischemic, meaning that blood flow to the brain is blocked.

Learn more about stroke

The team hypothesized that where there was better structural integrity, better connections might also exist between different areas of the brain.

Results showed that patients with aphasia and better results in speech-fluency tests were more likely to have higher structural integrity than the control group in three areas of the brain.

The three areas were the right middle temporal gyrus, the right inferior frontal and the right precentral gyrus.

The correlation scores between the amount of injury to the left hemisphere and speech-fluency scores improved when the right hemisphere information was added to the analysis.

When researchers factored information from the right side of the brain into the statistical analysis, the amount of variance explained went from 50% to 62% for words per minute.

On this basis, researchers concluded that these right hemisphere regions contribute to speech fluency.

The study further suggests that the right side of the brain reorganizes itself after a stroke to help language/speech-motor functions recover.

It is possible that those who made a better recovery had better structural integrity and more connectivity in those right hemisphere areas of the brain before their strokes.

In a corresponding editorial, Dr. Anna M. Barrett, of the Kessler Foundation in West Orange, NJ, says:

“This study suggests that a well-wired right brain actively supports recovery from aphasia.”

Dr. Barratt calls for further research to establish whether the differences in structural integrity in the right side of the brain exist before the stroke, develop after it or whether other factors influence it.

The findings could ultimately lead to new therapeutic targets in the right hemisphere and new treatments for aphasia – for example, brain stimulation.

Dr. Schlaug also suggests that melodic intonation therapy, focusing on the right side of the brain, could be another potential target. Melodic intonation therapy is an intonation-based therapy.

Medical News Today recently reported that daylight saving time may lead to a higher risk of stroke.

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31 Mar

Medical News Today: What does a 'good death' really mean?

Although many individuals shy away from contemplating the inevitability of death, most would agree that they would like to die well. A new review of existing literature, published in the American Journal of Geriatric Psychiatry, asks what makes a “good death” according to those involved in the process.
[Old lady on her death bed]
Is it possible to summarize the factors involved in planning a “good death”?

Although dying well is covered thoroughly by lay literature, scientific literature on the matter is much more sparse.

The concept of discovering the meaning of life when one is faced with his or her mortality is a common theme in films, novels and biographies.

But when the end comes, what is the general consensus? What do the dying and the soon-to-be bereaved consider to be a good death?

Some believe that American culture, indeed Western culture at large, is becoming increasingly death-phobic.

In sharp contrast to 100 years ago when seeing a dead body would be commonplace, nowadays, individuals outside of the relevant industries (health, funeral homes) very rarely see a corpse. Consequently, death is less likely to be discussed and considered.

Discussing death

In hospices and palliative care settings, these themes are more often debated. But coming up with a neat definition of a “good death” that fits all viewpoints is challenging, and there is very little research to back up the conversation.

Certain organizations have attempted to sum up the principles of dying well. According to an Institute of Medicine report, a good death is:

“Free from avoidable distress and suffering for patient, family and caregivers, in general accord with the patient’s and family’s wishes, and reasonably consistent with clinical, cultural and ethical standards.”

Few would disagree with most of the points listed above, but what is the split between each facet? What are the primary objectives for someone who is facing imminent death?

A research team from the Sam and Rose Stein Institute for Research on Aging at the University of California-San Diego School of Medicine decided to carry out a review of the existing literature to uncover what a good death entails.

The secret of a ‘good death’

The team, headed up by Dr. Dilip Jeste, focused their research on three sets of individuals: patients, family members (prior to and during bereavement) and health care providers. This is, as far as the authors can tell, the first time that these three groups have been compared and contrasted in such a way. According to Dr. Jeste:

“Death is obviously a controversial topic. People don’t like to talk about it in detail, but we should. It’s important to speak honestly and transparently about what kind of death each of us would prefer.”

The team’s literature search returned 32 relevant papers. From these sources, the team uncovered 11 core elements to consider when contemplating a good death:

  1. Preference for a specific dying process
  2. Religious or spiritual element
  3. Emotional well-being
  4. Life completion
  5. Treatment preferences
  6. Dignity
  7. Family
  8. Quality of life
  9. Relationship with health care provider
  10. Life completion
  11. Other.

Across all three of the groups being studied, the categories considered most important were preferences for a specific dying process (94% of all reports), being pain-free (81%) and emotional well-being (64%).

However, certain discrepancies between the groups came to light. For instance, spirituality and religiosity were deemed more important by patients than family members – 65% compared with 50%, respectively.

Family members were more likely to put emphasis on life completion (80%), quality of life (70%) and dignity (70%). Meanwhile, health care professionals tended to occupy the middle ground between the patients and family members.

The future of death

First author Emily Meier confirms the gist of these findings from her personal experience as a psychologist at Moores Cancer Center, UC-San Diego Health:

“Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life.”

Meier goes on to say that “ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life.”

Dr. Jeste sums up the conclusions to be drawn from the investigation: “ask the patient.”

Although the topic can be uncomfortable for the patient, or, indeed, the family, it is essential to voice concerns and desires and listen to the patient’s wishes. Dr. Jeste hopes that in the future “it may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before.”

Death is certainly not a topic that will be disappearing any time soon. The more open and frank everyone involved can be, the smoother the process will surely become.

Medical News Today recently asked whether it is possible to die from a broken heart.

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Source: medicalnewstoday

31 Mar

Medical News Today: Hepatitis A: Causes, Symptoms and Treatment

Hepatitis A is an infection of the liver caused by the hepatitis A virus (HAV). Spread through contaminated food and water or close person-to-person contact, the infection is a “one time” self-limited disease that rarely results in serious liver disease or death.

The hepatitis A virus is more prevalent in areas of low socioeconomic status where a lack of adequate sanitation and poor hygienic practices are common and children are often transmitters of the virus. Improvements in hygiene, public health policies and water supplies have greatly reduced the number of cases of hepatitis A worldwide.

Immunization against HAV virus has been available since 1995 and is now part of the childhood recommended immunization schedule.

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT‘s news stories. Also look out for links to information about related conditions.

Fast facts on hepatitis A

Here are some key points about hepatitis A. More detail and supporting information can be found in the main article.

  • The hepatitis A virus was first identified in 1973
  • Person-to-person contact is the most common means of transmission and is generally limited to close contacts
  • Hepatitis A rates in the US have declined by 95% since the hepatitis A vaccine first became available in 1995
  • In 2006, HAV vaccination was incorporated into the US routine childhood vaccination schedule
  • Hepatitis A is the most frequent vaccine-preventable disease in travelers
  • HAV is one of the most frequent causes of foodborne infection
  • Virtually any food can be contaminated with HAV, particularly shellfish and vegetables
  • Casual contact among people does not spread the virus
  • Foodborne or waterborne HAV outbreaks are relatively uncommon in the US
  • Improved sanitation and the HAV vaccine are the most effective ways to combat the disease
  • In developing countries with poor sanitary conditions and hygienic practices, 90% of the population have often been infected with HAV before the age of 10 years
  • The single most important factor that determines the severity of illness from HAV is age; those aged 50 and above have a higher chance of adverse events from the infection.

What is hepatitis A?

Description of hepatitis A with a syringe.
Hepatitis A is a virus that affects the liver and is most prevalent in areas with low standards of hygiene.

Hepatitis A is a virus that infects the liver, causing inflammation. The majority of infected adults develop symptoms 2 weeks after exposure.

Unlike hepatitis B and C, HAV infection does not cause chronic liver disease and is rarely fatal. People who have been infected become immune to HAV for the rest of their lives.

Hepatitis A has a worldwide distribution and is most prevalent in resource-poor regions where there is overcrowding, poor sanitation and a lack of reliable clean water resources. The virus survives for extended periods in seawater, fresh water, wastewater and soil.

Residents of Africa, Asia, and South America show nearly universal evidence of past infection. Exposure in early childhood is the norm in these regions, and most children never exhibit symptoms of the disease.

Causes of hepatitis A

The HAV is excreted in the stool (feces) of people with hepatitis A infection. The virus is transmitted from person-to-person through the fecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the feces of an infected person.

For the majority of hepatitis A infections, transmission occurs as a result of close personal contact with an infected household member or sex partner.

There are sporadic cases of foodborne hepatitis A outbreaks scattered across the US and are likely caused by HAV-infected food handlers who prepare food for a large social event (such as a wedding). A single HAV-infected food handler can transmit HAV to dozens or even hundreds of people and cause a substantial economic burden to public health.

HAV can remain infectious on environmental surfaces even after 1 month. The virus is killed by heating to over 185 °F (85 °C) for 1 minute. Adequate chlorination of water, as recommended in the US, kills any HAV that enters the water supply.

Risk factors for hepatitis A

The most common reported risk factor for hepatitis A in the US is international travel (up to 50% of cases), mainly to Mexico and Central and South America. Anyone who has not been vaccinated or previously infected can contract hepatitis A.

Others factors that increase the risk of developing hepatitis A infection include:

  • Sexual and household contact with another person with hepatitis A
  • Being a resident or staff in a small community residence setting
  • Being a child or employee in a daycare center
  • Homosexual activity in men
  • Injectable drug use
  • Exposure to food or waterborne outbreaks.

Routine vaccination of all infants began in 1999. In 2006, the Centers for Disease Control and Prevention (CDC) recommended expanding vaccination for all children in the US aged 12-23 months; this practice resulted in a 90% reduction in the number of cases of HAV infection. Infections will most likely occur in high-risk individuals or adolescents who missed the vaccination implementation.

On the next page, we look at the symptoms of hepatitis A, how hepatitis A is diagnosed, and the available treatment and prevention strategies for the condition.

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Source: medicalnewstoday