A Blinding Pill to Swallow?

woman eyesOn Monday we brought you news about the health benefits of sex. Today the news is not so good….and for many women will be extremely concerning.

Research presented earlier this week at the American Academy of Ophthalmology annual meeting, showed that women who have taken oral contraceptive pills for three or more years are twice as likely to suffer from glaucoma.

Glaucoma is one of the leading causes of blindness affecting nearly 60 million worldwide.

glaucomaThe researchers caution gynecologists and ophthalmologists to be aware of the role oral contraceptives might play in glaucomatous diseases, and inform patients to have their eyes screened for glaucoma if they also have other risk factors.

The study – conducted by researchers at University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China – is the first to establish such increased risk.

The researchers utilized 2005-2008 data from the National Health and Nutrition Examination Survey (NHANES). The study group included 3,406 US women aged 40 years or older who completed the survey’s vision and reproductive health questionnaire and underwent eye exams. They found that females who had used oral contraceptives, no matter which kind, for longer than three years are 2.05 times more likely to report that they have glaucoma.

aao posterAlthough the results of the study do not speak directly to the causative effect of oral contraceptives on the development of glaucoma, they indicate that long-term use of oral contraceptives might be a potential risk factor for glaucoma. Certainly, “the pill” needs to , be considered as part of the risk profile. Other risk factor include:  African American- ethnicity, family history of glaucoma, history of increased eye pressure or existing visual field defects. Previous studies in the field have shown that estrogen may play a significant role in the pathogenesis of glaucoma.

This study should be an impetus for future research to prove the cause and effect of oral contraceptives and glaucoma,” said Shan Lin, M.D., lead researcher and professor of clinical ophthalmology at the University of California San Francisco. “At this point, women who have taken oral contraceptives for three or more years should be screened for glaucoma and followed closely by an ophthalmologist, especially if they have any other existing risk factors.”

Given the fact that 28% of all sexually active women in the US are on the pill, that’s a lot of glaucoma screening. You may want to call your ophthalmologist or optometrist now and get a jump on the line. Alternately, you may want to reconsider your birth control.

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Condom Homework Increases Compliance, Comfort and Consistency

condomsA new and successful strategy for combating the spread of sexually transmitted diseases such as HIV was revealed today at the American Public Health Association’s annual meeting in Boston.

The idea is based upon the decades old premise that practice makes perfect!.

In the study entitled “A novel, self-guided, home-based intervention to improve condom use among young men who have sex with men.  The men were given a “ditty bag” full of eight different types of condoms and five different types of  lubricants, taught how to apply the condoms correctly, and then assigned homework. The men were expected to try out at least six condoms solo, paying particular attention to their own pleasure and which condoms they liked best.

The purpose of this study was to test of feasibility and efficacy of this intervention and to promote positive condom attitudes and to reduce risk behaviors.

30 volunteer subjects were recruited from a Midwestern University and its surrounding community. A pre-test questionnaire was administered.  A post-test questionnaire was given at Day 15 and an additional follow-up questionnaire at Day 45.

condom-safe-sexIt’s such a simple idea, but nobody has every structured an approach like this,” said William L. Yarber, professor in the Indiana University School of Public-Health. “These are pilot studies. But even with small samples, the results are really good. Men become more motivated to use condoms; they use them more correctly and consistently. They also appreciate learning that there are different condoms available.”

A pilot study, published in the Journal of Men’s Health in 2011, focused on heterosexual men. The new study, focuses on young men who have sex with men, or MSM.  It will be published in the Journal of American College Health, MSM aged 18 – 29 are diagnosed with HIV more than any other group, according to the Centers for Disease Control and Prevention. In fact, half of all new HIV infections in the U.S. are among MSM between the ages of 13 and 24 years. College-aged MSM are more likely than older MSM and men who only have sex with women to be infected with HIV.

This is an important group of men to reach,” says  Roberta Emetu, who coordinated the research project.  “The men who experienced this intervention became better in their condom use. They not only used them more often but used them correctly. We saw an increase in motivation to use them.”

condom_thumbs_upWhen pre-test and post-test responses were compared, significant post-intervention improvements were found for beliefs and application of condoms, self-efficacy, condom attitude, motivation to use condoms, and consistency of condom use for insertive penile-anal intercourse.

Yarber and his colleagues have documented for more than 10 years how merely wearing a condom is not enough to provide effective protection against STDs and unwanted pregnancies. Condoms need to be used correctly, yet fit-and-feel issues can result in erection difficulty, loss of sensation, removal of condoms before the intercourse episode ends, and other problems that can interfere with their correct use.

These findings suggest that this intervention could be applicable to college-aged MSM, and could be a great resource or model for other public health condom interventions.

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Spit It Out! How saliva may provide the key to sports-related concussion

concussionSRxA’s Word on Health has reported several times on the problems of concussion among football players and cheerleaders. So we couldn’t help but sit up and take notice of an article in our local newspaper about some cutting edge research taking place yards from our front door.

The third floor of Bull Run Hall on George Mason University’s Prince William campus plays host to plenty of mind-bending science projects – laser capture microdissection, protein electronics and high-resolution mass spectrometry to name but a few.

Yet the most complex and potentially influential findings to emerge from the school’s College of Science might come down to a kid spitting in a cup after football practice.

Once a week athletic trainers collect saliva samples from the 12- and 13-year-old kids playing for the Jets, an A-League football team in the Central Loudoun Youth Football League. Then they send them to Dr. Shane Caswell, a George Mason professor and pioneer of the world’s first salivary biobank designed for concussion research in athletes.

Caswell stores the saliva in a freezer he dubs the “spit repository.” He eventually extracts the samples and runs them through sophisticated machinery to determine changes in protein variance. By comparing each kid’s spit samples to previous submissions, he hopes to uncover a handful of proteins that can detect concussions.

George Mason scientistsWorking alongside Caswell is Dr. Chip Petricoin. Long accustomed to studying protein biomarkers for cancer research, Petricoin never imagined he’d wind up plying his trade for studies on traumatic brain injury and concussions.  But the seed was planted six years ago, when he was called up to Fort Detrick to conduct a site review for a company that had been given a grant from the army to do concussion research. Petricoin admired their efforts, but he realized that his own work with cancer biomarkers could reap significant benefits for the concussion research that remained in its nascent stages.

A year later he found himself working in the same building as Caswell, whose extensive background in athletic training was getting him increasingly involved with concussion research. The two discussed their respective endeavors and quickly realized they could join forces.

The university’s College of Science and College of Education and Human Development began funding their efforts last year. Since then, Caswell and Petricoin have begun to explore the vast quantities of information stored in athletes’ salivary biomarkers.

Think about the biomarker content of a sample like an iceberg,” said Petricoin, co-director of the university’s Center for Applied Proteomics and Molecular Medicine. “The concept of what you see is only the tip of the iceberg? That’s kind of like biomarker research. Things that have been seen before are just the tip of what really is there. If we could go all the way down and see everything, you’d see a whole new iceberg. So we’re kind of going a mile deep now in the iceberg biomarker research.”

athlete spittingIndeed, the depth of these largely uncharted waters became apparent when the duo began their work with the Jets this fall using eight saliva samples. A few weeks after collecting those baseline samples, they used the nanotechnology at their disposal to examine new samples from four of the same kids who had recently suffered concussions. After compiling a list of proteins, they found that 60% of their list featured proteins that had never been described.

The process generates an information archive that’s larger than anyone’s ever seen before in saliva,” Petricoin said.

Caswell and Petricoin are currently working on 37 concussion cases, a total that increases every week with new samples arriving from different sources. They’re collaborating with Prince William County Public Schools, as well as intercollegiate athletics at Marymount University and George Mason.

The Jets’ head coach, Rob Scola, says his team has so far adapted nicely to the study. George Mason sends a certified athletic trainer to the field to provide care and to collect data on hits the players endure. The trainer tapes every game and practice, something that allows coaches to see what they’re doing right and wrong in their efforts to teach proper heads-up tackling techniques. Players also wear helmets with sensors that detect the force and location of impacts sustained in practices and games.

It’s all part of an effort to determine what measures coaches should take to minimize players’ risk of head trauma on the football field, where the rate of brain injuries is higher than in any other youth sport.

It’s very hard to get information from a very small team in a very small league and then extrapolate that,” Scola said. “I think that as Mason starts to expand the study, I think there will be some really interesting pieces of information that come from that, which I believe can be helpful to the league and football as a whole. I think it’s a phenomenal first step.”

Part of the project’s appeal lies in its lack of hassle. Biomarker work has traditionally come from blood and spinal fluid samples, which are rooted in far more invasive processes than simply spitting in a cup.

If I were to go out on the field and say, ‘Hold on a second. I want to take your child’s blood or their cerebral spinal fluid.’ That’s game over. We can’t move forward,” Caswell said. “This is a non-invasive tool that is rapidly deployable. There’s no threat of infection, it’s easily done and it provides a great deal of information.”

Caswell and Petricoin’s work with the Jets has opened the door to broader studies that extend to the entire lifespan of an athlete’s career. The hope is that parents will have their children give samples when they begin participating in youth football, ice hockey, soccer, or whatever sport they choose to play. They can then follow that up by giving more samples as they pursue the sport in high school, college and beyond.

“You are then able to track at various time points throughout someone’s career and identify how their marker is changing and then maybe one day compare it to a database that could help inform decisions about whether or not that individual should retire from play, whether that individual is suffering any adverse consequences from their participation,” Caswell said.

blue mouthgardEven more ambitious is their ultimate goal of implementing the biomarkers into a clinical diagnostic device. Petricoin envisions a mouthguard that turns from clear to blue when a concussion is detected. The technology, he says, is there – impregnating the nanoparticles into the mouth guard, binding the biomarkers and producing a color shift are concepts that have already been engineered.

The hard part is nailing down the biomarkers. For the moment, all Caswell and Petricoin are trying to do is identify what’s in the saliva. As the data mounts, they hope to reveal protein distribution patterns that coincide with repeated head trauma.

Caswell, a former hockey player who once returned to the ice minutes after suffering a concussion only to realize minutes later that he wasn’t carrying his stick, believes those patterns will come and that his team is well-positioned to make meaningful discoveries that could impact concussion policies on a greater scale.

If and when they do, we’ll be sure to let you know.

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Doctors “Bending” Ethical Norms to Best Serve Their Patients who can’t Bend their Joints

ethical-medical-dilemmasRheumatic diseases, such as rheumatoid arthritis and lupus, are a common cause of disability. they affect all sectors of the population, diminish quality of life and have a significant social impact.

Yet, despite the benefits of early treatment and effective therapies, access to rheumatologic services may be difficult, involving long wait times, even difficulties finding providers.

C. Ronald MacKenzie, MD, a rheumatologist at Hospital for Special Surgery in New York City conducted a survey among rheumatologists entitled “Bending’ Ethical Norms to Serve Patients’ Interests:Tensions in Medical Professionalism,” to examine the medical, moral and ethical dilemmas doctors face when trying to do what’s best for their patients in the current health care environment.

The study was published in the October issue of the journal Arthritis and Rheumatism. When people receive a diagnosis, the cost of effective treatment may render it unaffordable for many,” says Dr. MacKenzie. “While an optimal or fair system would mitigate these impediments to care, our survey of the American College of Rheumatology members suggests that this is often not the case. In fact, physicians report they frequently find themselves in situations of ethical conflict in an effort to best serve their patients.”

The survey consisted of 14 closed-ended and two open-ended questions and was sent to 5,500 members of the American College of Rheumatology.

Physicians reported ways in which they see themselves as ‘bending’ ethical standards and presented justifications for doing so. Examples included ‘embellishment’ of symptoms to help patients obtain prior authorization from insurance companies; stretching the truth to obtain diagnostic tests and necessary medications and or physical therapy.

rheumatismThe delivery of medical care takes place in a particular social context, and when this context includes conditions that are unfair, healthcare practitioners may be forced to struggle with ethical conflicts, making trade-offs that may go unrecognized or are not adequately discussed.”

Medicine is not merely the scientifically based treatment and care of illness. It also involves ethical issues of right and wrong. In some cases, tough ethical dilemmas force doctors and other health care providers to make difficult decisions, all while upholding the Hippocratic oath to which all doctors are bound.

In today’s health care world, where the number of health care options can be great, medical ethics is of particular concern.Awareness of this problem and its consequences is only the first step in finding solutions to the challenges that physicians face.

Fixing the system in which physicians feel they have to ‘bend’ ethical norms and compromise ethical principles in order to provide the care their patients need, is clearly what’s so desperately needed.

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Snuffing Out Alzheimer’s

confusedHot on the heels of Friday’s blog – Sniffing Out Alzheimer’s, British scientists just announced a major breakthrough that could, one day, result in a treatment for Alzheimer’s, Parkinson’s, Huntington’s and other neurodegenerative diseases.

In tests on mice, researchers from the toxicology unit of the Medical Research Council showed brain cell death from prion disease could be prevented.

Professor Roger Morris, from King’s College London, said: “This finding, I suspect, will be judged by history as a turning point in the search for medicines to control and prevent Alzheimer’s disease.”

It is rare to get cautious scientists keen to describe any study as a turning point in history, let alone a study in mice.

miceNot only is it is early science, a lot can go wrong between a drug for mice and a drug for humans and the only published data is for prion disease, not even Alzheimer’s.

So why the excitement?

It is the first time that any form of neurodegeneration has been completely halted, so it is a significant landmark. It shows that the process being targeted has serious potential.

The research team focused on the natural defense mechanisms built into brain cells. When a virus hijacks a brain cell it leads to a build-up of viral proteins. Cells respond by shutting down nearly all protein production in order to halt the virus’s spread.

neurodegenerative diseaseHowever, many neurodegenerative diseases involve the production of faulty or “misfolded” proteins. These activate the same defenses, but with more severe consequences. The misfolded proteins linger and the brain cells shut down protein production for so long that they eventually starve themselves to death.

This process, repeated in neurons throughout the brain, can destroy movement or memory or even kill, depending on the disease.  It  is thought to take place in many forms of neurodegeneration, so safely disrupting it could treat a wide range of diseases.

The researchers used a compound which prevented those defense mechanisms kicking in and in turn halted neurodegeneration.

The study showed mice with prion disease developed severe memory and movement problems. They died within 12 weeks. However, those given the compound showed no sign of brain tissue wasting away.

Lead researcher Professor Giovanna Mallucci says: “They were absolutely fine, it was extraordinary. What’s really exciting is a compound has completely prevented neurodegeneration and that’s a first. This isn’t the compound you would use in people, but it means we can do it and it’s a start.

She said the compound offered a “new pathway that may well give protective drugs” and the next step was for drug companies to develop a medicine for use in humans.

Side effects are an issue. The compound also acted on the pancreas, meaning the mice developed a mild form of diabetes and lost weight. Any human drug would need to act only on the brain.

David Allsop, professor of neuroscience at Lancaster University described the results as “very dramatic and highly encouraging.”

SRxA’s Word on Health agrees.  We look forward to seeing further research and how these findings could apply to diseases such as Alzheimer’s and Parkinson’s.

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Sniffing Out Alzheimer’s

peanut-butter-memory-400x400A dollop of peanut butter and a ruler might be a way to confirm a diagnosis of early-stage Alzheimer’s disease.

Jennifer Stamps, a graduate student in the McKnight Brain Institute Center for Smell and Taste, came up with the idea of using peanut butter to test for smell sensitivity.  when she was working with Kenneth Heilman MD, a professor of neurology at the University of Florida.

One of the first places in the brain to degenerate in people with Alzheimer’s disease is the front part of the temporal lobe that evolved from the smell system. This portion of the brain is also involved in forming new memories. The ability to smell is associated with the first cranial nerve – the olfactory nerve.

Because peanut butter is a “pure odorant,” it is only detected by the olfactory nerve.

In a small pilot studypatients sat down with a clinician, a tablespoon of peanut butter and a metric ruler.

peanut butter testThe patient closed his or her eyes and mouth and blocked one nostril. The clinician opened the peanut butter container and held the ruler next to the open nostril while the patient breathed normally. The clinician then moved the peanut butter up the ruler one centimeter at a time during the patient’s exhale until the person could detect an odor.

The distance was recorded and the procedure repeated on the other nostril after a 90-second delay.

The clinicians running the test did not know the patients’ diagnoses, which were not usually confirmed until weeks after the initial clinical testing.

Patients in the early stages of Alzheimer’s disease had a dramatic difference in detecting odor between the left and right nostril – their left nostril did not detect the smell until it was an average of 10 centimeters (almost 4 inches) closer to the nose than the right nostril.

This was not the case in patients with other kinds of dementia. These patients had either no differences in odor detection between nostrils or the right nostril was worse at detecting odor than the left one.

Of the 24 patients tested who had mild cognitive impairment, which sometimes signals Alzheimer’s disease and sometimes turns out to be something else, about 10 patients showed a left nostril impairment and 14 patients did not. The researchers said more studies must be conducted to fully understand the implications.

At the moment, we can use this test to confirm diagnosis,” Stamps says. “But we plan to study patients with mild cognitive impairment to see if this test might be used to predict which patients are going to get Alzheimer’s disease.”

Many of the tests used to confirm a diagnosis of Alzheimer’s disease or other dementias can be time-consuming, costly, or invasive.  In contrast, according to the researchers their peanut butter and ruler test could be used by clinics that don’t have access to the personnel or equipment to run other, more elaborate tests required for a specific diagnosis.

peanut-butter-and-jelly-sandwich_0And of course there’s the benefit that you can eat the test afterwards!

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Like this post?  Check back on Monday for more ground breaking Alzheimer’s news.

A Fishy Tale of Lumps and Bumps

boa constrictorWhen you think about potentially dangerous pets,  which animals spring to mind? Alligators? Boa Constrictors? Any of the “big cats”? Pit Bulls? Goldfish?

Goldfish? Really?!?  Well, according to a new study from Henry Ford hospital, fish may not be quite as benign as they seem. To be fair, it’s not the fish killer goldfishthemselves, but the water they swim in that may be harmful to health.

Researchers have shown that contaminated water in home aquariums can lead to a skin infection known as Mycobacterium marinum. The condition is characterized by reddish skin lesions or bumps on the hands or arms.

It’s difficult to diagnose and treat because skin lesions don’t appear for two to four weeks after contact with the bacteria, leading to delayed treatment and unnecessary and ineffective use of antifungal and antibacterial agents.

Complicating matters further is that patients fail to remember or mention the source of the exposure, which is often traced to them cleaning their aquarium. Infection results when bacteria in the non-chlorinated water attacks an open skin wound on the arm or hand.

mycobacterium marinumPeople just don’t know or think about their fish tank harboring this bacterial organism,” says George Alangaden, M.D., a Henry Ford Infectious Diseases physician and the study’s lead author.

And unless they’re directly questioned about it by their physician, who may or may not have adequate knowledge of Mycobacterium marinum and its prolonged incubation period, appropriate treatment often gets delayed.”

During the study, conducted between January 2003 and March 2013, researchers identified five patients ages 43 to 72 treated at Henry Ford for Mycobacterium marinum. Skin biopsies performed on all five patients confirmed the infection.

The incubation period before skin lesions appeared ranged from 11 to 56 days. While all five patients responded effectively to antibiotic treatment, it took on average a staggering 161 days from the time of initial presentation to time of treatment.

“Mycobacterium marinum is not a life-threatening illness, but it remains an unrecognized cause of skin infection,” says Dr. Alangaden. “To accelerate diagnosis and treatment, physicians are encouraged to ask detailed questions about the patient’s history, especially questions about potential exposure to aquariums.”

cleaning aquarium Or better still, may we suggest you wear gloves when cleaning out the tank!

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