31 Aug

Medical News Today: Moderate drinking may reduce frailty, cardiovascular disease for seniors

A new paper brings some welcome news for older adults who like a tipple; researchers say drinking moderate amounts of alcohol could reduce frailty and other age-related conditions, including cardiovascular disease.
[An older man drinking red wine]
Researchers say moderate alcohol consumption may have health benefits for seniors by reducing inflammation.

Published in the journal Age and Ageing, the report says there is increasing evidence that moderate alcohol consumption leads to such benefits by reducing inflammation, as determined by levels of C-reactive protein (CRP) – a pro-inflammatory marker.

According to co-author Dr. Luigi Ferrucci, of the National Institute on Aging – part of the National Institutes of Health – and colleagues, previous studies have suggested that levels of inflammation increase as we age, and that it is this that contributes to age-related frailty and illness.

In their paper, Dr. Ferrucci and team respond to a recent study published in the same journal that investigated how alcohol intake influences age-related inflammation.

That study – conducted by researchers from the University of Central Florida (UCF) – assessed the alcohol consumption of more than 3,200 adults aged 65 and older who were part of the 2008 wave of the Health and Retirement Study.

The results revealed that adults who consumed moderate amounts of alcohol had lower levels of inflammation, as determined by CRP levels, and were less frail than those who abstained from alcohol use or were heavy drinkers.

Strong evidence of alcohol-related health benefits, but doubts remain

According to Dr. Ferucci and colleagues, this reduction in inflammation may translate into significant health benefits for older adults.

As an example, the team points to a study conducted by Dr. Luc Djoussé, of Harvard Medical School in Boston, MA, and colleagues, which found a link between moderate alcohol intake and better cardiovascular health.

For that research, Dr. Djoussé and team analyzed the data of more than 26,000 adults who were part of the Women’s Health Study.

Compared with abstainers and heavy drinkers, those who consumed 5-14.9 grams of alcohol daily – the equivalent to a small glass of wine or one bottle of beer – were found to be at much lower risk of cardiovascular disease.

What is more, the study identified a 21 percent reduction in markers of inflammation for moderate drinkers, compared with abstainers and occasional drinkers. Compared with heavy drinkers, moderate drinkers showed a 13 percent reduction in inflammation markers.

In their report, Dr. Ferrucci and colleagues say there is increasing evidence that drinking alcohol in moderation can benefit health in older age by reducing inflammation.

However, that is not to say older adults should take up drinking; the team says further research is warranted to gain a better understanding of how moderate alcohol intake might be beneficial before any public health recommendations are made.

“While evidence is growing that regular consumption of small amounts of alcohol, especially as red wine, may have beneficial effects on health, there are still some doubts that this protective association found in epidemiological study is attributable to abstention for alcohol of individuals who are already ill.

Longitudinal studies are needed to shed further light on this question, which has important public health implications.”

Dr. Luigi Ferrucci

Learn how quitting smoking could reduce alcohol intake.

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31 Aug

Medical News Today: The laser probe, the iKnife, and the cutting edge of surgery

If the thought of going under the knife fills you with fear, be reassured. No longer is surgery the brutal and hazardous experience faced by our ancestors. Thanks to wonders such as laparoscopy, robotic solutions, and, more recently, the iKnife and the laser probe, surgical intervention is getting safer all the time.
[surgery]
Technological advances make surgery safer and more precise all the time.

Archaeologists believe that people have been carrying out surgery for up to 11,000 years. Cranial surgery, known as trephination, probably dates back to the Neolithic era. It involved drilling a hole in the skull of a living person.

Speculation suggests it was done to cure disorders such as convulsions, fractures, headaches, and infections. The Ancient Egyptians used the same operation for “letting out” headaches and migraine.

From 1812 onward, the New England Journal of Medicine offers accounts of procedures that would now be considered gruesome, such as passing a hook through a man’s pupil during the removal of a cataract, and using leeches for bloodletting. Pioneers of their time, both surgeons and patients displayed remarkable courage.

Leap from there to the present, and you have minimally invasive surgery where even a heart transplant is now relatively routine. From January 1988 to July 2016, 64,055 cardiac transplants have taken place in the United States, according to the United Network for Organ Sharing (UNOS).

Advances in minimally invasive surgery

In 1987, a French gynecologist performed the first recognized laparoscopic surgery to remove a gallbladder. From there, the practice has expanded rapidly. According to the U.S. Food and Drug Administration (FDA), over 2 million laparoscopic surgeries are carried out each year in the U.S.

In laparoscopic or “keyhole” surgery, a small tube with a light source and a camera passes through the body until it reaches the relevant part. The areas that need operating show up on a screen, while the surgeon works the tools through small openings.

Minimally invasive procedures mean smaller incisions with less scarring, a lower risk of infection, shorter hospital stays, and reduced convalescence.

Robotic surgery

Next stop, robotic surgery. In 2000, a team of scientists in Germany who were researching techniques for minimally invasive surgery announced that they had developed a system with two robotic arms that are controlled by a surgeon at a control console. They called it ARTEMIS.

[robotic surgery]
In robotic surgery, the surgeon controls the instruments from a console.

In July 2000, the da Vinci system was approved for use in the U.S. for cutting and surgery.

It was the first robotic surgical system to get FDA approval, and its use has become relatively widespread.

The system has three components: a vision cart with a light source and cameras, a master console where the operating surgeon sits, and a moveable cart with two instrument arms and the camera arm.

The camera provides a true 3-D image that is displayed above the surgeon’s hands, so the tips of the instruments seem like an extension of the control grips. Foot pedals control electrocautery, camera focus, instrument and camera arm clutches, and master control grips that drive the servant robotic arms at the patient’s side.

There have been reports of errors and malfunctions, some of them fatal, and not everyone is convinced that robotic surgery really produces better patient outcomes.

What the eye cannot see

The electrosurgical knife was invented in the 1920s. Using an electrical current, it rapidly heats the body tissue, enabling the surgeon to cut through the tissue with minimal blood loss. It is commonly used in cancer surgery.

Image-driven surgery, such as laparoscopy, has reduced the extent of intervention for many operations.

However, when it comes to cancer, images can show where the tumor is, but neither images nor the human eye can readily distinguish between healthy and unhealthy tissues.

Dr. Zoltan Takats, of Imperial College London in the United Kingdom, saw a way for the electrosurgical knife to fill the gap that images cannot.

[MRI brain tumor]
MRI-guided surgery shows where the tumor is, but the iKnife can detect its exact borders.

Enter the iKnife. Based on electrosurgery, the iKnife can detect precisely which tissue needs removing, and which should stay.

Until recently, the only definitive way to know whether tissue is cancerous or not has been to take a biopsy for study, usually under a microscope. The disadvantage is that during surgery, only very few samples can be taken and tested, and it can take 40 minutes to complete each test. This is not a practical way to define the edge of a tumor during surgery.

2013 saw the emergence of the first iKnife, which enables the surgeon to examine biological tissue by pairing up electrosurgery with mass spectrometry. In mass spectrometry, ionized, or charged, particles are passed through electric or magnetic fields.

Mass spectrometry provides measurements of mass-to-charge ratio, and these measurements make it possible to distinguish between tissues of different composition, known as chemical profiling. By analyzing the chemical composition of different samples, it can reveal which tissues are healthy and which are not.

At that time, Dr. Takats told Medical News Today that he expected the iKnife to be applicable to different kinds of surgery and that it would save costs.

How the iKnife works

Cutting with an electroscalpel causes the tissue to vaporize as it is being cut. This creates a smoke that is normally sucked away by extraction systems. But by connecting the iKnife to a mass spectrometer and pumping the smoke toward it, the vapor can be “captured” and analyzed for chemical composition. By matching the results to a reference library, the surgeon can see which type of tissue it is within 3 seconds.

In 2013, Dr. Takats and his team used the iKnife to analyze tissue samples collected from 302 patients who had undergone surgery to remove various kinds of tumor, both cancerous and noncancerous.

They recorded the characteristics of thousands of tissue samples taken from tumors in the brain, lung, breast, stomach, colon, and liver. From these samples, they created a database of 1,624 cancerous and 1,309 noncancerous entries, to which future samples could be matched.

The team then used the iKnife with rapid evaporative ionization mass spectrometry (REIMS) in 81 surgical interventions. Readings were taken during surgery, and tissue was tested afterward in the conventional manner. In each case, the reading matched the postoperative histological diagnosis exactly.

The iKnife was developed for electrosurgery because surgeons saw its potential for removing cancerous tumors, but its applicability to hydro and laser surgery have already been raised. In the future, it could be used to take readings to analyze mucous membranes and the respiratory, urinogenital, or gastrointestinal systems.

The iKnife is already in use at Imperial College London, and it is now being trialed in breast, colon, and ovarian cancer surgery.

Laser detection of brain tumors

More recently, researchers in the United Kingdom and Canada have paired up the iKnife with a laser probe to detect abnormal tissue during surgery to remove a brain tumor.

This technique used a near-infrared laser probe to determine whether tissue was cancerous or healthy by measuring light reflected off the tissue.

Fast facts about advances in surgery

  • The first successful use of ether anesthetic was in 1846
  • Carbolic acid was first used as an antiseptic between 1867 and 1876
  • In 1907, the first man-made antibiotic was created.

When they pointed the beam of light onto the exposed brain, molecules in the cells began to vibrate. As they did so, fiber optics in the probe collected the scattered light that was bouncing off the tissue.

By measuring the frequency of the vibrations, the scientists were able to tell which tissue was healthy and which was not. As with the iKnife, analysis took just seconds.

In cancer surgery, the ability to detect the exact border of an area of malignant tissue can make the difference between life and death, and between having to repeat surgery or not.

Being able to remove the exact tissue not only ensures that the whole tumor is taken away, but it also reduces unnecessary tissue loss, leading to better outcomes for patients.

The researchers note that, particularly with brain tumors, the inability to see the boundary of a tumor, even with a surgical microscope, puts people at a higher risk of additional damage, such as the loss of speech. As technology advances, the risks of surgery gradually decline.

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31 Aug

Medical News Today: Brain blood flow reduces when fit older adults stop exercising

Physically fit, healthy older adults who stopped exercising for only 10 days showed signs of significant decreases in blood flow to parts of the brain that are important for thinking, learning, and memory – such as the hippocampus.
older adults exercising
The researchers found significant reductions in resting brain blood flow in eight brain regions in fit older adults who stopped exercising.

This was the key finding of a new study – led by the University of Maryland (UMD) School of Public Health and recently published in the journal Frontiers in Aging Neuroscience – that adds to growing evidence of links between physical fitness and cognitive health.

In their study paper, the researchers discuss how evidence shows endurance exercise training improves cerebrovascular health and has positive effects on the hippocampus, but what happens to these benefits if exercise ceases is somewhat unclear.

Lead author J. Carson Smith, associate professor of kinesiology at UMD says we know that the hippocampus is important for learning and memory.

He explains that studies of mice and rats have shown exercise increases growth of new blood vessels and brain cells. Also, research shows that in older people, exercise can protect the hippocampus from shrinking. He notes:

“So, it is significant that people who stopped exercising for only 10 days showed a decrease in blood flow to brain regions that are important for maintaining cognitive health.”

Significant reductions in brain blood flow

Using magnetic resonance imaging (MRI) brain scans, the team measured brain blood flow in healthy, physically fit older adults aged from 50-89 years (average 61) before and after a 10-day period during which they stopped all exercise.

Fast facts about the hippocampus

  • Named after its shape, the word “hippocampus” comes from old Greek via Latin for “seahorse”
  • Recent research finds the human brain stores time and place of memories in the hippocampus
  • The hippocampus is one the first parts of the brain to suffer damage in people with Alzheimer’s disease.

From the brain scans, the researchers were able to assess the velocity of blood flow while the participants were at peak fitness and then again after 10 days of no exercise.

The results showed significant reductions in resting brain blood flow in eight brain regions – including the right and left hippocampus.

The other regions included parts of the “default mode network” – a brain structure that is known to deteriorate quickly in people with Alzheimer’s disease.

However, the researchers found no significant change in cognitive function – measured using verbal fluency tests – in the participants from before to after they stopped exercising.

The participants who volunteered for the study were all “master athletes” whom the researchers describe as “a unique population and should not be considered equivalent to older adults who engage in regular moderate to vigorous intensity leisure-time physical activity.”

The researchers were not surprised to find these senior athletes scored high for their age on aerobic fitness. Their VO2 max was in the top 10 percent for their age group (above the 90th percentile). VO2 max is the volume of oxygen a person consumes while exercising at their maximum capacity.

With an average continuous endurance training history of around 29 years, the volunteers regularly took part in national and regional events.

Just before taking part in the study, they were running an average of 59 kilometers a week and training on 5 days a week.

“We know that if you are less physically active, you are more likely to have cognitive problems and dementia as you age. However, we did not find any evidence that cognitive abilities worsened after stopping exercising for just 10 days. But the take home message is simple – if you do stop exercising for 10 days, just as you will quickly lose your cardiovascular fitness, you will also experience a decrease in blood brain flow.”

Prof. J. Carson Smith

The researchers say their findings point to a need for further research to discover how fast the brain blood flow changes occur, what their long-term effects could be, and whether they can be reversed by taking up exercise again.

Learn how any type of exercise appears to dramatically reduce risk of developing Alzheimer’s disease.

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31 Aug

Medical News Today: Deadly strep infection in infants could be prevented with breast milk sugars

Further supporting the widespread notion that “breast is best” when it comes to infant feeding, a new study finds that a type of sugar present in breast milk could protect babies from the life-threatening infection group B streptococcus.
[A mother breast-feeding her baby]
Sugars in breast milk could protect babies from life-threatening group B streptococcus infection, say researchers.

According to the Centers for Disease Control and Prevention (CDC), group B streptococcus (GBS) infection is the most common cause of meningitis and sepsis in a newborn’s first week of life.

Around 1 in 4 expectant mothers carry GBS bacteria in their gastrointestinal tract or vagina. As such, early-onset infection in newborns most commonly occurs as a result of GBS bacteria being passed from mother to child during delivery.

Late-onset GBS infection – infection that occurs between the age of 1 week and 3 months – can arise as a result of the bacteria being passed from the mother, but it is more likely the infant has contracted the infection from elsewhere.

Now, researchers from Imperial College London in the United Kingdom have found that lacto-n-difucohexaose I – a type of naturally occurring sugar believed to be present in the breast milk of around half of women worldwide – could prevent babies from becoming infected with GBS.

Lead author Dr. Nicholas Andreas, of the Department of Medicine at Imperial, and colleagues publish their findings in the journal Clinical & Translational Immunology.

Mothers with breast milk sugars less likely to pass GBS to offspring

The researchers explain that the types of sugar in a woman’s breast milk – known as human milk oligosaccharides – are partly influenced by genetic makeup, primarily the Lewis antigen system, which is involved in producing the A, B, and O blood groups.

For their study, the researchers tested the breast milk of 183 mothers from Gambia for the presence of sugars known to be influenced by the Lewis genes.

Additionally, the mothers were tested for the presence of GBS through vaginal and rectal swabs collected at childbirth. At birth, 6 days after birth, and 60-89 days after birth, nasopharyngeal and rectal swabs were collected from their infants and tested for GBS.

Compared with mothers who did not have Lewis gene-related sugars in their breast milk, those who did had lower levels of GBS in their gut, the researchers report, and they were also less likely to pass the bacteria to their infants during childbirth.

What is more, the team found that infants born to mothers who had the sugar lacto-n-difucohexaose in their breast milk – also associated with the Lewis genes – were more likely to have cleared GBS bacteria from their body by 60-89 days of age.

On testing breast milk containing lacto-n-difucohexaose against GBS bacteria in the lab, the researchers found it was more effective at killing the bacteria than breast milk that did not contain this specific sugar.

Together, the researchers say their findings suggest naturally occurring sugars in breast milk – particularly lacto-n-difucohexaose – could prevent GBS infection in infants by boosting the presence of beneficial gut bacteria.

“Although this is early-stage research, it demonstrates the complexity of breast milk, and the benefits it may have for the baby. Increasingly, research is suggesting these breast milk sugars (human milk oligosaccharides) may protect against infections in the newborn, such as rotavirus and group B streptococcus, as well as boosting a child’s ‘friendly’ gut bacteria.”

Dr. Nicholas Andreas

The results could pave the way for new strategies to prevent GBS infection in mothers and their infants, the team notes. For mothers who do not produce the GBS-protective sugars, breast milk sugar supplements could be an option.

Furthermore, Dr. Andreas says the results also provide a basis for Lewis gene testing in new mothers.

“If we know whether a mother is colonized with group B streptococcus and know if she carries an active copy of the Lewis gene, it may give us an indication of how likely she is to pass the bacteria on to her baby, and more personalized preventive measures could be applied,” he explains.

Learn how breast-feeding could have cognitive benefits for preterm babies.

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31 Aug

Medical News Today: Temporal Arteritis: Causes, Diagnosis, and Treatment

Temporal arteritis is a form of vasculitis, which means blood vessel inflammation. This is the immune system causing and reacting to damaged blood vessel lining.

Blood vessels in the head known as the temporal arteries are affected by temporal arteritis. It causes symptoms that include a lasting headache.

The condition is diagnosed mostly in middle-aged people, after the age of around 50. The chances of temporal arteritis go up with increasingly older age.

Different countries have varying rates of the condition, and temporal arteritis is two or three times more likely to affect women than men.

Medical treatment is important because, without it, some cases lead to loss of vision.

What are the temporal arteries?

[Lady headache]
Severe headaches are one of the main symptoms of temporal arteritis.

There are two temporal arteries, one on each side of the head. Each one runs over the part of the skull that is above and around the ear. The two arteries themselves run up in front of the ear.

The temporal arteries are important ones that branch off from the two main blood supplies to the head from the heart.

While the temporal arteries are usually affected, temporal arteritis is a condition that can also affect other medium and large arteries. These are also usually in the head and neck.

Temporal arteritis is also known as giant cell arteritis. It sometimes gets called cranial arteritis and was once known as Horton disease.

Symptoms of temporal arteritis

The main symptoms of temporal arteritis are:

  • Severe headache
  • Muscle pain in the head

The pain is severe and lasting. It usually occurs around the side of the head where the arteries are.

Further symptoms include:

  • Tender temples
  • General tiredness and weakness
  • Mouth-related pain, especially affecting the jaw
  • Pain affecting the tongue, throat, or face
  • Pain or swelling on top of the head, or scalp
  • Blurry or double vision

Any of these symptoms should be taken to a doctor for diagnosis and treatment. This is important whether the headache and other symptoms turn out to be caused by temporal arteritis or something else.

Complications of temporal arteritis

[blurry vision]
Blurred vision and even blindness could occur as a result of temporal arteritis.

The most serious problem that can be caused by temporal arteritis is blindness. Loss of vision in the eye because of this condition is rare overall, however.

This complication may occur if the vasculitis affects an artery that supplies an eye.

If treatment for temporal arteritis is started before any effect on vision, the risk of blindness happening later is reduced to 1 percent or lower.

Other artery complications such as excessive swelling can also happen on rare occasions.

Diagnosis of temporal arteritis

It is important to see a doctor with any symptoms that could be temporal arteritis.

Doctors start out by following the symptoms described. They ask questions and will explore other possibilities. They will also do a physical examination.

If the doctor thinks it is temporal arteritis, they should start treatment right away.

The diagnosis is made clear by a lab analyzing a sample of the artery wall. A piece of the artery is removed under local anesthetic. Blood tests may also be ordered.

What are giant cells?

Giant cell arteritis is another name for temporal arteritis. This is because of what can happen to the lining of the arteries. In many cases of temporal arteritis, the inflammation of the blood vessel lining shows the formation of “giant cell” lesions.

These giant cells are from numerous immune cells fusing together. These immune cells are a type of white blood cell.

Temporal arteritis involves other immune cells and biological features of inflammation, however. As such, it does not always show these giant cell lesions.

Giant cell lesions form in about half of temporal arteritis cases. As a result, the condition can be diagnosed without giant cells being found.

Causes of temporal arteritis

Why some people develop temporal arteritis is not fully understood. It is also unclear why some groups are more at risk than others.

Aging is a risk factor, although it is not clear why. Geography, seasonal factors, and viruses have been linked, too.

Very few cases are associated with causes like an allergic reaction to drugs or toxins. The National Heart, Lung, and Blood Institute state that this can sometimes be the case, adding that the possibility that a recent or ongoing infection “may prompt the attack.”

Temporal arteritis and polymyalgia rheumatica

Polymyalgia rheumatica is a form of inflammation that affects the whole body. It causes muscle pain. Like temporal arteritis, it is also more common in older people over 50 and affects more women than men.

According to Arthritis Research UK, about 1 in 5 cases of polymyalgia rheumatica are accompanied by temporal arteritis.

Experts also estimate that up to 60 percent of people with temporal arteritis show symptoms of polymyalgia rheumatica.

Temporal arteritis and systemic vasculitis

Systemic vasculitis is related to temporal arteritis simply because the inflammation of head arteries is one form of vasculitis.

Systemic vasculitis is a collection of different disorders. All involve inflammation and damage to blood vessel walls that can lead to tissue death.

The different types are classified and managed according to the blood vessel size affected – large, medium, or small – and the area of effect, such as on an organ.

With temporal arteritis, the arteries affected are medium and the eye is at risk.

The general treatment approach for temporal arteritis is the same for all forms of vasculitis.

Why Minnesotans are more likely have temporal arteritis

People with a northern European background show a higher risk of developing temporal arteritis.

One study into rates of temporal arteritis in the United States looked at where the population is largely made up of that ethnic background – Minnesota.

[damaged blood vessels]
“Giant cells” are formed from numerous immune cells fusing together.

The exact cause of this higher rate for northern European background is not fully understood.

Studying Olmsted County in particular, the researchers found that the rate here was as high as in Sweden, a country with one of the highest rates of temporal arteritis.

Over a 50-year period, the study found that there were almost 20 cases for every 100,000 in people across that time. The authors compared this with the rates in the Mediterranean region, where temporal arteritis is at its very lowest in northern Italy. There, the rate is at 6.9 per every 100,000 people.

The authors wrote that the north-south divide was “evocative of environmental causes, but could also reflect a genetic or ethnic influence.”

The rates of temporal arteritis may be put into perspective, however. Statistics experts who classify what is rare in cancer, for example, use a rate of 6 per 100,000 for rare cancers.

So average rates of temporal arteritis in the population overall are relatively low – although they get considerably higher in older people. While the rate is doubled in populations like Olmsted County’s, this is still twice what is a relatively low level in the first place among the overall population.

Treatment for temporal arteritis

A doctor will usually want to start treatment straight away. High-dose corticosteroid drugs are the treatment for temporal arteritis and they prevent complications such as loss of vision.

The medication should be offered before the diagnosis is confirmed. Primary care doctors are advised to issue the prescription rather than wait for a biopsy to be done.

The management may then be taken on by specialist doctors. Whichever doctors are helping with temporal arteritis, steroid treatment is a long-term one. The once-daily dose of 40 to 60 milligrams, by mouth, is gradually reduced after a number of weeks.

If loss of vision is suspected, a drug called prednisolone is given. Otherwise, a drug called prednisone usually needs to be continued for over 2 years. Daily low-dose aspirin is also recommended as a preventive effort against blood clots.

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31 Aug

Medical News Today: Heart attack: Younger survivors at risk of early heart disease death

The risk of premature death has decreased significantly in heart attack survivors under age 50. However, they are still almost twice as likely to die early – primarily due to heart disease – when compared with the generation population, finds a study published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.
[Young woman having heart attack]
Women were three times more likely to die after a heart attack compared with the general population, whereas men were 1.7 times more likely.

Around 735,000 people in the United States have a heart attack every year.

The leading cause of heart attacks is a condition called coronary heart disease, in which the coronary arteries become obstructed with deposits of cholesterol.

Around 610,000 Americans die of heart disease per year, with coronary artery disease accounting for 370,000 deaths annually.

Key risk factors for heart disease include high blood pressure, high cholesterol, and smoking, and around half of Americans have at least one of these risk factors.

Medical conditions and lifestyle choices can also increase a person’s risk for heart disease, including diabetes, being overweight or obese, a poor diet, physical inactivity, or drinking excessive amounts of alcohol.

The researchers analyzed data from 21,693 people aged 50 or younger who had survived a heart attack and compared them to 216,930 of the general population, with follow-up over an average of 11 years.

Heart attack survivors under age 50 almost twice as likely to die

Of the heart attack survivors, 4 in 5 were men, with a median age of 45 years. Most of the heart attack survivors – 83.6 percent – were aged between 40-49 years, with only 1.8 percent under the age of 30.

Findings from the study indicate that there was a decline in heart attack deaths between 1980-1989 and 2000-2009 from 12.5 percent to 3.2 percent within 30 days, 5.1 percent to 1.6 percent within 31-365 days, and 24.2 percent to 8.9 percent within 1-10 years.

When compared with the general population, the patients who were age 50 and younger and had survived for 1 year were 1.89 times more likely to die. The leading causes of death among these people were heart disease and other smoking-related diseases.

Among 1-year survivors, women had a three times greater risk of death and men a 1.7 times increased risk of death after a heart attack when compared with the general population. The research team notes that the reason for the difference in results between sexes in unclear.

Dr. Morten Schmidt, Ph.D., lead study author and a researcher at the Aarhus University Hospital in Denmark, says that while the 30-day risk of death following a heart attack has significantly decreased in the last 30 years, younger patients should still be concerned about their long-term health.

Long-term risks reduced by quitting smoking, exercising, healthy eating

“It is estimated that half of the decline in deaths from heart attacks since 1980 is attributable to primary prevention and, in particular, the reduction in the number of patients who smoke,” says Dr. Schmidt.

“The other half is likely attributable to a combination of things such as the introduction of early treatments that restore blood flow to the part of the heart muscle damaged during a heart attack, improvement in hospital organization, and better management of high blood pressure and high cholesterol,” he adds.

Dr. Schmidt points out that quitting smoking, regularly exercising, and following a healthy diet can reduce the risk of heart attack. Changing these behaviors can also help prevent a second heart attack.

“Even though you survive a heart attack at an early age, you remain at an increased risk of another attack later in life. For the same reason, it is important that patients make efforts to reduce this long-term risk by adhering to the prescribed medical therapy and by improving their lifestyle, especially by stopping smoking.”

Dr. Morten Schmidt, Ph.D.

Dr. Schmidt and colleagues found that cardiovascular disease risk factors were highest among the group that had survived a heart attack when compared with the general population.

Risk factors included angina (11.7 percent versus 0.4 percent); high blood pressure (10.6 percent versus 1.2 percent); diabetes (7.4 percent versus 1.1 percent); and obesity (4.6 percent versus 0.8 percent).

Learn about whether or not the Paleo diet reduces the risk of cardiovascular disease.

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31 Aug

People With Implanted Defibrillators at Higher Car Accident Risk

News Picture: People With Implanted Defibrillators at Higher Car Accident RiskBy E.J. Mundell
HealthDay Reporter

Latest Heart News

MONDAY, Aug. 29, 2016 (HealthDay News) — People who have an implanted cardiac defibrillator (ICD) to control an irregular heartbeat appear to have more car accidents than similarly aged people without such devices, a new Danish study finds.

Overall, Danish drivers with ICDs were 51 percent more likely to be involved in a traffic accident over the two-and-a-half years of the study.

But the findings aren’t necessarily a reason to tighten restrictions on these drivers, since the absolute risk of any one ICD-using driver being involved in an accident remained very low — around 1 percent a year.

The issue is a tough one, said study lead author Dr. Jenny Bjerre, a physician at Herlev and Gentofte University Hospital in Copenhagen.

“On the one side, as physicians we need to take public road safety into consideration when we assess if these patients are medically fit to drive,” she said. “But we also have to acknowledge that these restrictions have a huge impact on the patient’s quality of life and personal freedom.”

She presented the findings Sunday in Rome at the annual meeting of the European Society of Cardiology. Experts note that findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

Dr. Mary Norine Walsh, president-elect of the American College of Cardiology, reviewed the new findings. She said that whether or not — or when — it’s safe for people with ICDs to drive has been an issue for years.

According to Walsh, if a patient is given an ICD because of a history of passing out due to irregular heartbeat, “then the recommendation to the patient is that they not drive for [the first] 6 months” after implantation.

If the person has a condition such as heart failure, ICDs are often still recommended. Often this type of patient hasn’t had a history of passing out due to irregular heartbeat, so there isn’t a similar prohibition on driving, Walsh explained.

Bjerre said there’s been little new data on the potential risks of driving for people with ICDs, since most studies date from the 1990s.

“In order to have contemporary and real-world data on the subject, we aimed to investigate motor vehicle accidents following ICD implantation in a nationwide cohort of ICD patients, and then compare them to an age- and sex-matched control population,” she explained.

Her team tracked motor vehicle accident rates from early 2008 to mid-2012 for almost 4,900 Danish people with ICDs and almost 9,800 Danes of similar age but without such devices. Average age was 63.

Overall, 280 traffic accidents occurred during the study period.

“We found — after adjustment for age, sex and alcohol abuse — a 51 percent increased risk of motor vehicle accidents in the [ICD-patient] population,” Bjerre said.

However, it’s important to stress that the absolute risk of a traffic accident to any one person in the study was low — a little over 1 percent in the first year after ICD implantation and 0.6 percent a year for people without the devices.

None of the accidents involving ICD users were fatal, Bjerre added.

Does any of this mean that current recommendations on driving after ICD implantation should be changed? Bjerre and Walsh agreed it’s too soon to say.

Bjerre said there’s no evidence the ICDs are “shocking” drivers and causing any accidents. Instead, it’s probably the underlying illnesses that ICD users have that are at play, she said.

Walsh agreed. She also believes more insight could have emerged from the study if both groups had been similarly ill.

“They can’t compare to a group with just the same age, the same sex patients — they have to compare to patients who are equally sick,” Walsh said. “Because with sickness comes frailty — some of the reasons these people [with ICDs] had car accidents was because they were frail possibly, because they were ill.”

And she agreed with Bjerre that barring an older person from driving is never an easy call.

“If the recommendation from this study becomes, ‘Well, if you’ve had a defibrillator, you can’t drive,’ it’s devastating,” Walsh said.

She believes caution — and better evidence — is needed before doctors, insurance companies and policymakers make any changes to driving recommendations.

Bjerre agreed. She believes societies must always balance public safety against personal freedoms.

“We’re never going to achieve a zero percent risk [of accidents], even in the general population,” she said, “so I think it’s up to society to decide which risk we do accept.”

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Jenny Bjerre, M.D., physician, Herlev and Gentofte University Hospital, Copenhagen, Denmark; Mary Norine Walsh, M.D., president-elect, American College of Cardiology, and medical director, Heart Failure and Cardiac Transplantation Programs, St. Vincent Heart Center of Indiana, Indianapolis; Aug. 28, 2016, annual meeting, European Society of Cardiology, Rome

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Source: MediciNet

31 Aug

Many Depressed Adults Not Getting Treatment: Study

News Picture: Many Depressed Adults Not Getting Treatment: StudyBy Steven Reinberg
HealthDay Reporter

Latest Depression News

MONDAY, Aug. 29, 2016 (HealthDay News) — Most American adults who suffer from depression aren’t getting treatment, a new study finds.

After screening survey data on more than 46,000 people, researchers found that 8 percent had depression, but only a third were being treated for the mood disorder.

The reasons why were varied.

“Some adults who experience depressive symptoms do not believe they are significant and require medical attention, or that they could benefit from treatment,” said lead researcher Dr. Mark Olfson.

For others, stigma or shame interferes with a desire to get professional help, said Olfson, a professor of psychiatry at the College of Physicians and Surgeons of Columbia University in New York City.

“In still other cases, the medical visits are oriented around more pressing and urgent medical problems, and the clinical opportunities to detect depression are missed,” he said.

The survey also found that some patients are overtreated with antidepressants. But, the percentage of people who fall into that category couldn’t be determined from the study data, he said.

“Some patients with less prominent, milder forms of depression may request and receive antidepressants, despite evidence that these medications have little or no therapeutic benefit for mild depression,” Olfson said.

While some Americans view antidepressants as stigmatizing, others see them as options to enhance personal and social well-being, and “as providing benefits that are well beyond their clinically approved uses,” Olfson noted.

Also, doctors sometimes keep patients on antidepressants, including those without a history of severe depression, “for years after their depression has resolved,” he said.

Olfson and his colleagues found that among all surveyed patients treated for depression, 30 percent were depressed, based on the results of screening, and 22 percent were suffering from serious psychological distress.

The most common treatments for depression were antidepressants and psychotherapy. Depressed patients were more likely to be treated by a primary care doctor, while those with serious psychological distress were more likely to be treated by a psychiatrist, the researchers found.

“However, over half of Americans with severe psychological distress were not seen by a psychiatrist, psychologist or another mental health professional,” Olfson said.

Patients with Medicare and Medicaid were more likely to be treated for depression, while uninsured patients and minorities were least likely to get treatment, he said.

One expert said the findings highlight shortcomings in how depression is both diagnosed and treated.

“Despite our best efforts, we still have a long way to go when it comes to bridging the gap between our evidence-based treatments for depression and the people who need them most,” said Simon Rego, chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine in New York City.

The new study offers data that can help bridge this gap, he added.

“For example, we should tailor our intervention efforts by focusing on increasing the integration of mental health services into primary care,” Rego said. “This should help improve access to care in disadvantaged populations, as well as improve awareness of treatment options.”

The study was published Aug. 29 in the journal JAMA Internal Medicine. It relied on self-reported information, which can sometimes be inaccurate, the researchers noted.

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCES: Mark Olfson, M.D., M.P.H., professor, psychiatry, College of Physicians and Surgeons of Columbia University, New York City; Simon Rego, Psy.D., chief psychologist, Montefiore Medical Center/Albert Einstein College of Medicine, New York City; Aug. 29, 2016, JAMA Internal Medicine, online

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Source: MediciNet

31 Aug

iPads Calm Surgery-Bound Kids as Well as Sedatives

News Picture: iPads Calm Surgery-Bound Kids as Well as Sedatives

Latest Healthy Kids News

TUESDAY, Aug. 30, 2016 (HealthDay News) — Savvy parents probably already suspect it: iPads work as well as sedative drugs to calm anxious kids before surgery, a new study shows.

Researchers assessed 112 children between 4 and 10 years old in France who had day surgery requiring general anesthesia. Twenty minutes before receiving the anesthesia, 54 kids were given the sedative midazolam and 58 were handed an iPad to distract them.

Anxiety levels in both groups of kids and their parents were similar, but iPads conferred none of the side effects of sedatives, the researchers said. Also, they said the kids given iPads were easier to anesthetize.

“Our study showed that child and parental anxiety before anesthesia are equally blunted by midazolam or use of the iPad,” said Dr. Dominique Chassard and colleagues at Hopital Femme-Mere-Enfant in Bron, France. “However, the quality of induction of anesthesia, as well as parental satisfaction, were judged better in the iPad group.”

The study was to be presented this week at the World Congress of Anaesthesiologists meeting in Hong Kong.

“Use of iPads or other tablet devices is a non-pharmacologic tool which can reduce perioperative stress without any sedative effect in pediatric ambulatory surgery,” the researchers wrote in a congress news release.

Research presented at medical meetings is not subject to the same scrutiny as that in peer-reviewed journals and is typically considered preliminary.

— Robert Preidt

MedicalNews
Copyright © 2016 HealthDay. All rights reserved.

SOURCE: World Congress of Anaesthesiologists, news release, Aug. 28, 2016

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30 Aug

Medical News Today: Early Parkinson's diagnosis moves closer with new protein test

Researchers may be one step closer to a diagnostic test for Parkinson’s disease, after finding that an abnormal protein associated with the illness can be detected in patients’ spinal fluid.
[Definition of Parkinson's disease]
Researchers are closer to a much-needed diagnostic test for Parkinson’s disease.

While it is early days for the test, the team’s results – published in the journal Annals of Clinical and Translational Neurology – have been hailed “hugely promising.”

Parkinson’s disease is a neurological condition whereby production of dopamine in the brain is reduced over time, due to the damage and death of neurons that produce it. Dopamine is a neurotransmitter involved in the regulation of movement and coordination.

As a result, patients with the disease may experience tremors of the hands, arms, legs, jaws, and face, slowed movement, muscle rigidity, impaired posture and balance, and speech problems.

There is currently no definitive test for Parkinson’s. The disease is normally diagnosed through assessment of the patient’s medical history, a medical examination, and physical and neurological tests, but this can take years.

Now, Dr. Alison Green, of the National CJD Research & Surveillance Unit at the University of Edinburgh in the United Kingdom, and colleagues reveal how a test originally developed to detect Creutzfeldt-Jakob disease (CJD) could be adapted to detect Parkinson’s.

Test detected Parkinson’s with 95 percent accuracy

In their study, Dr. Green and team report how the test – called the real-time quaking-induced conversion (RT-QuIC) – accurately detected accumulation of the protein alpha-synuclein in the spinal fluid of patients with the disease.

Fast facts about Parkinson’s

  • Almost 1 million Americans are living with Parkinson’s
  • The precise cause of Parkinson’s remains unclear
  • There is no cure for Parkinson’s, only treatments to help manage symptoms.

Learn more about Parkinson’s

Alpha-synuclein is a protein believed to be associated with onset of both Parkinson’s disease and Lewy body dementia.

In people with Parkinson’s, the protein has been found to form clumps – called Lewy bodies – in neurons that produce dopamine, while in patients with Lewy body dementia, the clumps form in neurons associated with cognitive abilities.

While previous studies have attempted to develop a test to detect alpha-synuclein, these have produced conflicting results. This is because the protein is present in the brains of healthy individuals, only causing problems when it clumps together.

The test from Dr. Green and colleagues, however, has the ability to measure the stickiness and buildup of proteins, an indicator of whether they are likely to cause disease.

For their study, the researchers applied the test to 20 samples of spinal fluid taken from patients with Parkinson’s disease, alongside samples of 15 healthy controls.

They found the test was able to identify 19 out of 20 of samples with 95 percent accuracy and 100 percent specificity. It was also able to detect buildup of the protein in three spinal fluid samples of individuals at high risk for Parkinson’s.

The team also applied the test to samples of patients with Lewy body dementia. Compared with control samples, the test was able to detect the disease with 92 percent accuracy and 100 percent specificity.

A ‘significant development’ toward early test for Parkinson’s

While these results need to be validated in a larger sample of patients, the researchers are hopeful that their findings could lead to much-needed diagnostic tests for both Parkinson’s and Lewy body dementia.

Dr. Green says earlier diagnosis for these patients may mean greater participation in clinical trials of new drugs to prevent disease or slow progression.

Dr. Beckie Port, senior research communications officer at Parkinson’s UK, says the team’s findings could one day meet the need for a simple, accurate test for Parkinson’s.

“Although early days, the fact that researchers have developed a new test that is able to detect abnormal alpha-synuclein in the spinal fluid of people with Parkinson’s with remarkable specificity and sensitivity, is hugely promising.

Further research is needed to test more samples to see if the results continue to hold true, but this could be a significant development towards a future early diagnostic test for Parkinson’s.”

Dr. Beckie Port

Read about the discovery of a mutant gene interaction that could lead to new treatments for Parkinson’s.

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Source: medicalnewstoday