Thursday, June 28, 2012

Testosterone Does Not Necessarily Wane With Age

For many men, testosterone levels drop as they get older, but new research presented at a conference this week suggests this is not necessarily a consequence of age itself, but more to do with behavior, such as smoking, and changes in health, such as obesity and depression.

In men, the hormone testosterone is made in the testicles and controls the development of their sexual characteristics. It influences wellbeing, sexual function and fertility and also helps maintain a healthy body composition, develop muscle bulk, sufficient levels of red blood cells, and protect bone density.

Study co-author Dr Gary Wittert, professor of medicine at the University of Adelaide, told the press:

"It is critical that doctors understand that declining testosterone levels are not a natural part of aging and that they are most likely due to health-related behaviors or health status itself," he added.

Past research has shown that many men have low levels of testosterone, and some have linked depression and low testosterone, but few population studies have followed the same group of men over time, said Wittert.

For the latest study, the researchers analyzed testosterone measurements in more than 1,500 men who had their hormone levels tested twice, with a five year gap between clinic visits. All the samples were tested at the same point in time before, and then after, the five-year gap, said Wittert.

Wittert and colleagues only included 1,382 men in their analysis because they took out the ones who were on medication or had health conditions that affect hormone levels. The men they included had an average age of 54 (range was 35 to 80 years).

They found that the average testosterone level fell by an insignificant 1% a year between the first sampling and the second, five years later.

However, within subgroups, they found a noticeably different pattern: certain factors appeared to influence more significant drops in hormone levels over the period.

The biggest falls in testosterone were among men who became obese, had stopped smoking, or were depressed at either of the clinic visits, said Wittert, adding that:

"While stopping smoking may be a cause of a slight decrease in testosterone, the benefit of quitting smoking is huge."

The study also showed that of the participants, unmarried men experienced larger drops in testosterone than married men.

Wittert said this finding probably supports that of other studies that suggest married men tend to be happier and in better health than single men. He also said that regular sexual activity tends to raise levels of testosterone.

The study was funded by the National Health and Medical Research Council of Australia.

Dr Andre Araujo, a visiting professor at the University of Adelaide in Australia, and vice president of epidemiology at New England Research Institutes, in Watertown, Massachusetts in the US, is presenting the findings at the Endocrine Society's 94th Annual Meeting in Houston, Texas, USA, this week.
Continue to Read more ...

What Is Water On The Knee (Knee Effusion)? What Causes Water On The Knee?

Knee effusion, colloquially known as water on the knee, occurs when excess fluid accumulates in or around the knee joint. There are many common causes for the swelling, including arthritis, injury to the ligaments or meniscus, or when fluid collects in the bursa. This condition is known as prepatellar bursitis.

According to Medilexicon's medical dictionary:

Knee effusion is a large bursa between the inferior part of the femur and the tendon of the quadriceps femoris muscle. It usually communicates with the cavity of the knee joint and is pathologically distended with blood or synovial fluid in suprapatellar bursitis ("water on the knee").

A small amount of fluid exists in normal joints. When a joint is affected by arthritis, particularly an inflammatory arthritis such as rheumatoid arthritis (RA), increased abnormal amounts of fluid buildup, the knee appears swollen. The fluid is produced by the tissues that are affected by the arthritis and that line the joint.

What are the symptoms of Knee Effusion?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Signs and symptoms of water on the knee depend on the cause of excess fluid build-up in the knee joint. With osteoarthritis, pain occurs when bearing weight. The pain typically subsides with rest and relaxation.

One knee may appear larger than the other. Puffiness around the bony parts of the knee appears prominent when compared with the other knee.

When the knee joint contains excess fluid, it may become difficult to bend or straighten the knee in certain cases.

If an individual has injured his or her knee, he or she may note bruising on the front, sides or rear of the knee. Bearing weight on the knee joint may be impossible and the pain unbearable.

What are the causes of Knee Effusion?

Causes of the swelling can include arthritis, injury to the ligaments of the knee or an accident after which the body's natural reaction is to surround the knee with a protective fluid.

There could also be an underlying disease or condition. The type of fluid that accumulates around the knee depends on the underlying disease, condition or type of traumatic injury that caused the excess fluid. The swelling can, in most cases, be easily cured.

Having osteoarthritis or engaging in high-risk sports that involve rapid cut-and-run movements of the knee, football or tennis for example, means an individual is more likely to develop water on the knee.

In overweight or obese individuals the body places more weight on the knee joint. This causes more wear in the joint. Over time, the body will produce excess joint fluid.

Diagnosing Knee Effusion

An understanding of knee pathoanatomy is an invaluable part of making the correct diagnosis and formulating a treatment plan. Taking a thorough medical history is the key component of the evaluation.

The most common traumatic causes of knee effusion are ligamentous, osseous and meniscal injuries, and overuse syndromes. Atraumatic etiologies include arthritis, infection, crystal deposition and tumor. It is essential to compare the affected knee with the unaffected knee.

Systematic physical examination of the knee, using specific maneuvers, and the appropriate use of diagnostic imaging studies and arthrocentesis establish the correct diagnosis and treatment.

Joint aspiration, also known as arthrocentesis, is a procedure that includes withdrawal of fluid from inside the knee for analysis such as cell count, culture for bacteria, and examination for crystals, such as uric acid or calcium pyrophosphate dihydrate crystals found in gout or pseudogout.

An X-ray is useful to verify that there is no break or dislocation when there is a history of trauma and may show signs of osteoarthritis.

An MRI (Magnetic Resonance Imaging) detects abnormalities of the bone or knee joint, such as a tear in the ligaments, tendons or cartilage.

If the knee is swollen, red and warm to the touch when compared to the other knee, a doctor may be concerned about inflammation due to rheumatoid arthritis or a crystalline arthritis, such as gout or pseudogout, or joint infection. Besides sending the joint fluid to a laboratory for analysis, he or she may request blood tests to determine a white blood cell count, erythrocyte sedimentation rate, and perhaps the level of C-reactive protein or uric acid. If blood tests reveal Lyme's disease antibodies forming, the condition may be attributed to it.

Psoriatic arthritis often undiagnosed cause of joint conditions. Patients with the skin condition psoriasis can also have the related arthritis subtype called psoriatic arthritis. This arthritic condition tends to be overlooked, even in patients with diagnosed psoriasis.

What are the treatment options for Knee Effusion?

Along with any sort of medical care, knee joint effusion responds well to simple self-care measures, such as rest and elevation as well as icing and exercise. As with any sort of injury, ice should be applied to the affected area only for 15 to 20 minutes at a time. With exercise, a series of fitness activities are established by a physical therapist to strengthen the area to support the weakened knee.

Most treatments for knee joint effusion are based on the cause of the condition, making a "standard" approach to care nonexistent. However, many people with water on the knee need to have the excess fluid removed, so one may undergo a procedure known as aspiration.

Finally, one may need a series of corticosteroid injections, non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics to reduce inflammation or treat an infection. For others, knee surgery or even joint replacement may be necessary.

Preventing Knee Effusion

Avoiding sudden jolting movements and rough running surfaces can help prevent knee injuries. Obesity adds pressure to the vulnerable knee joint, so weight reduction may help.

Exercises considered better for the knees include small (not deep) knee bends and straightening motions done while in supination with most weight on the outside of the foot.

Sports that are easier on the knees include walking, swimming (flutter kicks, knees straight), skating, baseball, cross-country skiing, and, depending on the state of the knee, cycling (seat high, low gear, avoiding hills).

Choose activities to suit your own knee strength and capacity, and remember that sports especially hard on the knees include football, sprinting, soccer, rugby, hockey, squash, volleyball, basketball, downhill skiing, tennis and jogging or anything that pounds, jolts, or twists the knees.
Continue to Read more ...

Important Breakthrough In Origins Of Aggressive Breast Cancer

Researchers have made a major breakthrough in finding out how aggressive cancers originate, raising hope of novel targeted therapies for future breast cancer patients, according to a study published in the peer-reviewed journal Cell Stem Cell. The scientists say this is the first study to show that the most aggressive cancers probably arise from intermediary, or progenitor, cells, which may significantly influence future research into fighting breast cancer.

Dr Matt Smalley, head researcher, from the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research, London, said:

These results represent a major advance in our understanding of breast cancer. It means we can now look very closely at where the disease forms and which genes are involved in that process. This knowledge will greatly improve the chance of finding effective new targeted treatments for breast cancer patients in the future.
Dr. Smalley and team gave laboratory mice the faulty BRCA gene, which is known to cause breast cancer. They then introduced the defective genes into the stem cells of one group of mice, and also into the intermediary cells of another group. The cancers which developed from the stem cells were different from those typically seen by those with the defective BRCA gene (inherited breast cancer).

The researchers were amazed to see that the cancer from the intermediary cells were nearly the same as those in triple negative breast cancer and forms of the disease which run in families. They concluded that these types of breast cancer originate in the intermediary cells.

The two most aggressive forms of breast cancer are precisely triple negative breast cancer and breast cancer caused by the defective BRCA genes, representing about 17% of the 46,000 reported breast cancer cases in the United Kingdom each year.

Triple negative breast cancer, for which there is no current targeted treatment, is more commonly found among young women, and women with African ancestry.

A promising targeted treatment for inherited forms of breast cancer, called PARP inhibitors, is undergoing clinical trials at the moment.

Professor Alan Ashworth, Director of the Breakthrough Breast Cancer Research Centre at the ICR, said:

Understanding the biology of breast cancer is essential for the future development of new ways to treat and prevent the disease. Our research gives a considerable new insight into how the disease forms and grows.

Stem cells, Intermediary (progenitor) Cells and Normal, Functional Cells

Adult stem cells replace normal functional cells when they die. Adult stem cells are long-lived cells which can divide many times.

Most cells in the body are usually fixed; they can only carry out specific functions, such as producing milk in the breast. Normal functional cells develop from stem cells - this occurs in stages through a series of intermediary (progenitor) cells. Most cells in the body are limited by the number of times they can divide.

Stem cells, unlike normal functioning cells, are long-lived and can divide many times. These two facts have led scientists to believe that they are the origins of several types of cancer. Many experts also believe that they may play a role in cancer treatment resistance.

What is Breast Cancer?

Breast cancer is a tumor that has developed from the breast cells; the tumor has become malignant. A malignant tumor can spread outside the breast area, to other parts of the body - it has the potential to invade surrounding tissue. When cancer spreads beyond its point of origin, we call it "metastasis".

A female breast consists of lobules - milk-producing glands. The breast is also full of ducts - milk passages that connect the lobules to the nipple. There is also fatty and connective tissue surrounding the ducts and lobules - this is called stroma.

The most common breast cancers start in the cells around the ducts. Others can start in the cells that line the lobules. More rarely, breast cancers can start in other parts of the breast. The human body has two ways of moving fluid about. One is through the blood stream, which carries plasma, red and white blood cells and platelets. Lymphatic vessels carry tissue fluid, waste products and infection fighting cells (immune system cells). Immune system cells are located in the lymph nodes - the nodes are shaped like a bean.

It is common for cancer cells to grow in the lymph nodes. They get there via the lymphatic vessels.

The lymphatic system of the breasts connect to the lymph nodes in three areas: Under the arm (axillary lymph node), in the chest (internal mammary node) and by the collarbone (supra or infraclavicular node).

Doctors guess that if cancer cells are in the lymphatic system, they are most likely to be in the bloodstream and will spread to other organs in the body. It is very hard to test for breast cancer cells in the bloodstream.

If breast cancer cells have got to the nodes under the arm (axillary), it will most likely swell. Whether or not it has swollen there, will decide what type of treatment a patient should have. If cancer cells are found in more lymph nodes, then the likelihood of it turning up in different parts of the body is greater. However, there is no hard and fast rule here. Women have had swellings in many nodes and did not develop metastases, while some women with no swellings in their nodes did.
Continue to Read more ...

What Is Heart Block? What Is AV Bundle? What Is Bundle Branch Block?

Heart block, AV bundle, or Bundle branch block is a disease of the electrical system of the heart, as opposed to coronary artery disease, which is a disease of the blood vessels of the heart. The heart of an individual with heart block beats irregularly and more slowly than normal. In some cases the heart may actually stop for up to 20 seconds, caused by a delay, obstruction or disruption along the pathway that electrical impulses travel through to make the heart beat.

Heart block may affect people who appear healthy. It is frequently a sign of some other underlying heart problem. Electrical impulses that make the heart beat may be slowed or blocked as a result of injury or damage to the heart muscle, or blockage of a blood vessel. Even alterations to impulses that last only a fraction of a second can cause bundle branch block (heart block).

Sometimes heart block can make it more difficult for the heart to pump blood properly through the circulatory system, meaning that muscles and organs, including the brain do not get enough oxygen to function properly.

Heart block itself does not usually require direct treatment. However, the underlying health conditions which generally accompany it, such as coronary heart disease, do.

Heart block typically causes lightheadedness, fainting (syncope) and palpitations. Coronary artery disease, on the other hand, causes chest pain (angina) or heart attack (myocardial infarction).

A healthy human heart beats at approximately 60 to 80 times per minute. A heartbeat is one contraction of the heart muscles, which push blood around the body. Every muscle contraction is controlled by electrical signals that travel between the atria (the upper chambers of the heart) and the ventricles (the lower chambers).
  • Partial heart block - this is when the electrical impulses are delayed or stopped. The heart does not beat regularly.
  • Complete heart block - this is when the electrical signals are completely stopped. The heartbeat will drop to about 40 times per minute.
There are three types of heart block:
  • First degree heart block - generally refers to minor heartbeat disruptions, such as skipped beats. It is the least serious type of heart block and does not generally require treatment.
  • Second degree heart block - some electrical signals never get to the heart, causing drooped beats. The patient commonly experiences dizziness and may need a pacemaker.
  • Third degree or complete heart block - electrical signals do not travel between the atria (upper chambers of the heart) and ventricles (lower chambers of the heart). This type is more common in patients with heart disease. If not treated with a pacemaker there is a serious risk of heart attack.
The terms bundle branch block and AV bundle refer to the Bundle of HIS - a bundle of cardiac muscle fibers that conduct electrical impulses that regulate heartbeat from the right atrium to the ventricles. If there is a signal block on the right bundle branch block (the right side of the heart) it is not usually seen as serious. However, if it occurs in the left bundle branch block (the left side of the heart) it is often linked to an elevated risk of developing coronary artery disease, or some other heart problem.

What are the signs and symptoms of heart block?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. The main signs and symptoms of heart block include:
  • Slow or irregular heartbeats
  • Shortness of breath
  • Irregular heartbeat is felt (palpitations)
  • Lightheadedness
  • Syncope (fainting)
  • Presyncope - a feeling that you are about to faint
  • Possible pain or discomfort in the chest
  • Difficulty in doing exercise, because not enough blood is pumped around the body
Heart block more commonly affects elderly individuals with a history of heart disease or smoking.

What are the causes of heart block?

In a healthy heart electrical impulses that travel inside a heart muscle signal it to contract - to beat. The impulses move along a pathway; from the atria (upper heart chambers), through the AV (atrioventricular) node, to the ventricles (lower heart chambers).

Along this pathway there is a cluster of cardiac fibers - the bundle of His - which divides into two branches; the right and left bundles. Each heart ventricle has a branch. If there is damage to one of these branch bundles the heart may not beat properly. The impulses that tell the heart to beat may be blocked or slowed down, resulting in uncoordinated ventricular contractions. The following may cause a bundle branch block:
  • Cardiomyopathy
  • Coronary thrombosis
  • Myocarditis
  • Valvular heart disease
  • Post-operative development of scar tissue in the heart
Acute (sudden) heart block may also occur after a heart attack or a heart operation. In some cases, the condition may be congenital (the person is born with it).

Diagnosing heart block

A GP (general practitioner, primary care physician) will discuss symptoms with the patient and listen to his/her heart. Based on patients' signs and symptoms, age, as well as medical history, the GP may suspect heart disease. If so, the individual will be referred to a cardiologist (a doctor who specializes in heart conditions).

The following diagnostic tests may be ordered:
  • An ECG (electrocardiogram) - this is the most common test for detecting bundle branch block (heart block). The device records the patient's heart's activity. A technician placed probes on the skin of the chest which reveal the patterns of electric impulses through the heart as wave patterns. Certain wave abnormalities may indicate bundle branch block. This test can also determine which bundle branch is affected (the left or right).
  • Holter tape - the patient wears a portable device which records all their heartbeats. It is worn under the clothing and records information about the electrical activity of the heart while the person goes about his/her normal activities for one or two days. It has a button which can be pressed if symptoms are felt - then the doctor can see what heart rhythms were present at that moment.
  • Echocardiogram - this ultrasound scan allows the doctor to see the heart muscles and valves.
  • Electrophysiology test - tiny electrical shocks are used to determine the cause of the abnormal rhythm (where in the heart).
  • Tilt-table test - the patient is placed on a tilt table bed which changes his/her position. This test may sometimes provoke abnormal heartbeats (arrhythmia).

What are the treatment options for heart block?

There is no heart-block-specific treatment. The majority of people with bundle branch block are symptom free and do not require treatment. However, those with underlying conditions which may be causing the heart block will need to have treatment for the underlying condition.

Because heart block affects the electrical activity of the heart, it may sometimes be more difficult to promptly diagnose other heart conditions, especially heart attacks.

Medication - these will be used to treat underlying conditions, such as hypertension (high blood pressure) or the effects of heart failure.

According to the American Heart Association, people with left bundle branch block who have had a heart attack should receive reperfusion, which is given in an emergency situation. Streptokinase, or a tissue plasminogen activator to dissolve blood clots and raise the flow of blood to the heart are administered. Both medications carry an elevated risk of bleeding.

A pacemaker - if the patient has a history of fainting, doctors may recommend implanting an artificial pacemaker. This is a battery-operated device which is implanted under the skin. It is about the size of a quarter (US coin) and weighs less than an ounce. They are placed near the patient's collarbone during a surgical procedure that lasts from one to two hours. The patient receives a local anesthetic.

Pacemakers today are extremely sophisticated; many can be set to produce an electrical impulse only when one is required. Some modern ones can tell if the heart stops beating and produce an electrical impulse to restart it. These devices can last many years before the generator (battery) needs to be changed.

Pacemakers are not affected by cell phones, personal stereos or household appliances. A person who has a pacemaker should not undergo an MRI (magnetic resonance imaging) scan.

What are the complications of heart block?

People with a left side bundle branch block have a higher risk of complications than those with a right side one. Examples of complications include:
  • Arrhythmia (irregular heart beat)
  • Bradycardia (low heart rate)
  • Cardiac arrest - there is either no contraction or inadequate contraction of the left ventricle of the heart, causing immediate, bodywide circulatory failure
  • Sudden cardiac death - the unexpected death of an individual due to cardiac causes which occurred within 1 hour of symptom onset.
Continue to Read more ...

What Is Tourette Syndrome? What Causes Tourette Syndrome?

Tourette syndrome, also known as Tourette's syndrome, GTS, Tourette's, TS, Tourette's disorder, or Gilles de la Tourette Syndrome, is an inherited tic disorder characterized by multiple motor (physical) tics and at least one vocal tic. Experts believe it is closely linked to damage or abnormalities to the basal ganglia of the brain.

In this text, a tic is an unusual movement or sound over which the person may have little or no control. This may include eye blinking, coughing, throat clearing, sniffing, facial movements, head movements, or limb movements. A tic may also include the utterance of unusual sounds, which may include inappropriate and sometimes offensive words (verbal ticks). Contrary to popular belief, only a small minority of people with Tourette's utter obscene words unintentionally.

Tourette's is part of a spectrum of tic disorders, including transient and chronic tics. The tics may emerge at any age, but do so most commonly between the ages of 6 and 18. They are more common among people with OCD (obsessive-compulsive disorder), an autistic spectrum disorder, or ADHD (attention deficit hyperactivity disorder).

For most people, the frequency and intensity of both minor and major tics tend to wax and wane (fluctuate). A person with Tourette syndrome may experience more frequent and possibly more intense tics when they have an infection, especially a strep (streptococcus) infections. Emotional and mental stress and distress may also exacerbate the tics.

The majority of people with Tourette's have normal intelligence and life expectancies. As the children pass through adolescence and early adulthood the severity of the tics tends to decrease. Extreme Tourette's in adulthood does exist, but it is rare.

According to The Mayo Clinic, USA, approximately 1% to 2% of the American population may have Tourette syndrome. It is much more common among males. The National Health Service, UK, estimates that approximately 1% of the UK population is affected by Tourette syndrome.

Georges Albest Edouard Brutus Gilles de la Tourette (1857-1904), a French physician and neurologist, was the first person to describe the condition and its symptoms. He published an account of nine patients in 1885. Jean Martin Charcot (1825-1893), a French neurologist and Professor of Anatomical Pathology bestowed the eponym "Tourette" on behalf of his resident.

According to Medilexicon's medical dictionary:
    Tourette syndrome is "a tic disorder appearing in childhood, characterized by multiple motor tics and vocal tics present for longer than 1 year. Obsessive-compulsive behavior, attention-deficit disorder, and other psychiatric disorders may be associated; coprolalia and echolalia rarely occur; autosomal dominant inheritance."

What are the signs and symptoms of Tourette syndrome?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

The hallmark sign of Tourette syndrome are tics, which can range from very mild to severe. Some severe tics can be extremely debilitating. A facial tic, such as eye blinking, may be the first sign. However, people may experience so many potential tics that there is not really a typical case (each person is different).

There are two types of tics:
  • Physical tics (motor tics) - motor movements, such as blinking, jerking the head or any part of the body.
  • Phonic tics (vocal tics) - uttering sounds, such as grunts or squeaks, and words or phrases.
There are two main classifications of ticks:
  • Simple ticks - this may involve moving just one muscle, or uttering a single sound. Movements are sudden, short lived, and often repetitive.
  • Complex ticks - the physical movements are more complex, and/or the phonic tics involve a more sophisticated set of utterances, including long phrases. Complex tics involve several muscle groups.
In many cases, a person with Tourette's will have a combination of phonic and physical tics, which may be simple or complex.

Examples of simple physical tics may include:
  • Eye blinking
  • Eye darting
  • Grinding the teeth
  • Head jerking
  • Neck twisting
  • Nose twitching
  • Rolling the eyes
  • Rotating the shoulders
  • Shoulder shrugging
  • Sticking the tongue out
Examples of simple phonic tics may include:
  • Barking
  • Blowing
  • Clearing the throat
  • Coughing
  • Grunting
  • Hiccupping
  • Sniffing
  • Squeaking
  • Yelling and screaming
Examples of complex physical tics may include:
  • Copropraxia - making obscene gestures
  • Echopraxia - miming the movements of other people
  • Flapping
  • Head shaking
  • Hitting things
  • Jumping or hopping
  • Kicking things
  • Shaking
  • Smelling objects
  • Touching oneself
  • Touching others
Examples of complex phonic tics include:
  • Varying one's voice intonation
  • Echolalia - repeating what other people say
  • Paliphrasia - saying the same phrase over and over again
  • Coprolalia - uttering or shouting obscene words or phrases
Advanced warning (premonitory sensations/feelings) - the majority of patients experience unusual or uncomfortable sensations before the onset of a tic. Examples include:
  • The eyes have a burning feeling which is eventually only alleviated by blinking.
  • A gradually growing muscle tension which can only be alleviated by stretching or twitching.
  • The throat starts feeling dry. This sensation is only alleviated by grunting or clearing the throat.
  • A limb or joint becomes itchy; the only relief is achieved by twisting it.
The following situations may cause tics to be worse:
  • Anxiety and/or stress
  • Fatigue (tiredness)
  • Illness (especially a streptococcus infection)
  • Excitement
  • A recent head injury
The following situations may help improve tics:
  • Engaging in competitive sports (in some cases, however, overexcitement may bring on tics)
  • Playing an enjoyable computer game which involves a high level of concentration (in some cases, however, overexcitement may cause tics)
  • Reading an interesting book
  • Acquiring relaxation techniques
Most people can eventually hold the ticks back when they are in public view, such as classrooms. However, the longer they are held back, the harder it becomes. It is not uncommon for schoolchildren to suddenly release tics when they get home from school.

Over time the frequency and severity of tics may vary. A person with Tourette's may develop different tics over time. Experts say that during the teenage years tics tend to be at their worst. In many cases they improve during early adulthood.

What are the risk factors for Tourette syndrome?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

The following factors may increase the risk of developing Tourette's:
  • Genetics - if a close relative, such as a sibling or parent has Tourette's, that person's risk of developing it is significantly higher, compared to other people.
  • Premature birth - babies who are born prematurely have a higher risk of developing Tourette's.

What are the causes of Tourette syndrome?

Experts are not exactly sure what the cause is. However, available evidence indicates that the problem is probably in the basal ganglia.
  • The basal ganglia - this is a group of specialized brain cells deep inside the brain. Basal refers to "the basement of the brain". The basal ganglia consists of three clusters of neurons - the caudate nucleus, putamen, and the globus pallidus - located at the base of the brain. The basal ganglia are responsible for involuntary movements, emotion and learning. The basal ganglia are abnormal in patients with Parkinson disease, Huntington disease, and a number of important neurologic conditions.

    MRI (magnetic resonance imaging) scans have revealed that the structure of the basal ganglia is different in patients with Tourette's. Experts believe that these abnormalities cause an imbalance in brain neurotransmitter levels. Neurotransmitters are messengers of neurologic information from one cell to another - they are messenger chemicals that transmit data between brain cells. Abnormal neurotransmitter levels may disrupt normal brain function, resulting in tics.
  • Childhood infection - recent preliminary research indicates there might be a link between the development of tics and infection. The "theory" is that a childhood streptococcal infection may cause the child's immune system to produce antibodies which interact with brain tissue, affecting normal brain development. This theory remains controversial, and many Tourette experts do not accept it.

Diagnosing Tourette syndrome

There is no current test that can diagnose Tourette's. The health care professional relies on the patient's signs and symptoms, medical history, and family history.

Ruling out any other condition - the doctor needs to rule out the following conditions which may cause similar symptoms:
  • Allergies - if the patient coughs or sniffs
  • Dystonia - a neurological condition which includes involuntary movements and prolonged muscle contraction; the patient experiences twisting body motions, abnormal posture and tremor.
  • Restless leg syndrome - if the patient has leg movements
  • Vision - if the patient blinks a lot
The doctor may also order the following tests in order to rule out other medical conditions or illnesses:
  • Blood test
  • Eye test
  • Imaging test - either MRI (magnetic resonance imaging) or CT (computerized tomography) scans
  • Skin prick test (for allergies)
The patient needs to meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM); a manual published by the American Psychiatric Association. The criteria to diagnose Tourette's must include:
  • Presence of both motor and vocal tics
  • Tics occur several times a day, nearly every day or intermittently. These tics have been occurring for over one year.
  • There must be no remission that lasts over three months.
  • Tics start before the patient is 18 years old.
  • Other possible causes have been ruled out, such as medications, other substances, or another medical condition.
If families and even health care professionals are unfamiliar with the signs and symptoms of Tourette, diagnosis is sometimes delayed. Parents and doctors may put blinking or sniffing down to vision or allergy problems.

What are the treatment options for Tourette syndrome?

A patient with Tourette's has the following treatment options - medication, non-pharmacological treatments, or surgery (rare, only when other treatments have failed) - some of which may be taken in combination:

Medication - this may include antihypertensives, muscle relaxants or neuroleptics. Antihypertensives and/or muscle relaxants are usually prescribed for patients with mild to moderate symptoms, while neuroleptics are more commonly given to those with moderate to severe symptoms.
  • Antihypertensives - this type of medication is used for controlling high blood pressure (hypertension). However, they have been shown to help patients with mild to moderate symptoms of Tourette's. Experts believe that this type of medication helps regulate neurotransmitter levels. An example of such a medication is Clonidine.

    Side effects may include:

    • Constipation
    • Diarrhea
    • Dizziness
    • Dry mouth
    • Headaches
    • Sleepiness (drowsiness)
    • Tiredness
  • Muscle relaxants - is used to overcome spasticity (when muscles become too stiff). They have been shown to help control physical tics. Examples include baclofen and clonazepam. Patients taking muscle relaxants should not consume alcohol.

    Side effects may include:

    • Drowsiness
    • Dizziness
    • Less alertness (if so, avoid driving or operating heavy machinery)
  • Neuroleptics - this type of medication blocks the effects of dopamine on the brain. There are two main types of neuroleptics:

    • Typical neuroleptics - developed during the 1950s. The first generation of neuroleptics.
    • Atypical neuroleptics - developed during the 1990s. A newer generation.
    Atypical neuroleptics have less potential to cause side effects, hence they are usually recommended. Some patients may not be suitable candidates for atypical neuroleptics therapy. The medication is taken orally or as an injection. Some slow release neuroleptics only need to be injected once every two to six weeks.

    Typical neuroleptics side effects may include:

    • Blurred vision
    • Constipation
    • Drowsiness
    • Dry mouth
    • Lack of libido (sex drive)
    • Shaking
    • Spasms
    • Trembling
    • Twitches (muscles)
    • Weight gain

    Atypical neuroleptics side effects may include:

    • Blurred vision
    • Constipation
    • Dry mouth
    • Lack of libido
    • Weight gain

    If side effects are becoming a problem the patients should tell their doctor. There may be other neuroleptics they could take.
Non-pharmacological treatments
  • Behavioral therapy - commonly used to help people with Tourette's. This type of therapy aims to change the pattern of the patient's behavior.

      Habit reversal is a type of behavior therapy that has been shown to be especially effective. According to the National Health Service (NHS), UK, it is based on two main principles:

      • Tourette syndrome patients are unaware of their tics
      • Tics are used to alleviate uncomfortable sensations before they occur
      The therapist helps the patient monitor the pattern and frequency of their tics. Any sensations that are triggering the tics are also identified.

      An alternative and less noticeable way of relieving the premonitory sensations are sought. This alternative response (rather than a tic) is called a competing response. For example, if an unpleasant sensation in the throat is a prelude to grunts or throat clearing noises, the patient learns to alleviate the sensation by taking a series of deep breaths.

      Habit reversal therapy often includes relaxation therapy. Stress or anxiety may exacerbate the severity and frequency of tics. Techniques, such as deep breathing or visualization may help relieve anxiety, often resulting in fewer and less severe tics.
Acupuncture and hypnosis are other possible therapies for Tourette's.


Surgery is usually only considered for adult patients with severe symptoms who have not responded well to other treatments.
  • Limbic leucotomy - an electric current or pulse of radiation is used to burn away a small part of the limbic system. The limbic system is responsible for our higher emotions, behavior and memory. A limbic leucotomy often allows the surgeon to re-wire the brain, partially or completely resolving the patient's condition.
  • Deep brain stimulation (DBS) - electrodes are implanted into parts of the brain known to be linked to Tourette's. The electrodes stay in there. They are connected to small generators which are also implanted inside the patient's body. An electronic pulse is sent from the generator to the electrodes, stimulating different parts of the brain, often controlling the symptoms of Tourette's.

    According to the National Health Service (NHS), UK, although initial DBS results have been encouraging, we do not know about the long-term safety and effectiveness of this relative new therapy. In most cases, access to DBS is through clinical trials.

What are the possible complications of Tourette syndrome?

Although Tourette's itself does not generally affect a person's intelligence, it can cause learning difficulties. As the condition often accompanies ADHD (attention deficit hyperactivity disorder), OCD (obsessive compulsive disorder) and autistic spectrum disorders, learning difficulties are common.

The basal ganglia, part of the brain most linked to Tourette's, is also involved in controlling habit learning. Hence, people with Tourette's commonly have problems learning through habit. Children may have difficulties mastering skills and activities which other children pick up rapidly, such as writing, reading or simple arithmetic.

A child with Tourette's may need additional specialized educational help.
Continue to Read more ...

Placebos Plus Positive Thinking May Be Enough

Placebos, which contain no active ingredients, are typically used as controls for potential new medication clinical trials. It has been confirmed that patients often respond to them based solely on the idea that the act of taking a medication, coupled with a positive mental attitude, may in fact cause the body to heal itself or identify that the original diagnosis was self created .

Associate professor of medicine Ted Kaptchuk at Harvard Medical School says:
    "These findings suggest that rather than mere positive thinking, there may be significant benefit to the very performance of medical ritual. I'm excited about studying this further. Placebo may work even if patients know it is a placebo."
Traditionally in medical research, placebos depend on the use of controlled and measured deception. It is estimated that currently 50 percent of all doctors in the United States administer placebos, or dummy pills, to their patients without them being aware of it. As questionable this practice may be, to most of us, the placebo effect is synonymous with the power of positive thinking. The action works because it fools the mind into believing it is taking true active medications.

The phenomenon of an inert substance resulting in a patient's medical improvement is called the placebo effect. The phenomenon is related to the perception and expectation which the patient has; if the substance is viewed as helpful, it can heal, but if it is viewed as harmful, it can cause negative effects, which is known as the nocebo effect.

However, what if patients knew they were taking a placebo? Would positive thinking be enough? Kaptchuk teamed up with colleagues at Beth Israel Deaconess Medical Center (BIDMC) to find out.

Eighty patients suffering from irritable bowel syndrome (IBS) were divided into two prescribed groups. The controls received no treatment. The second group received placebo cycles which were openly described as such. Subjects were told to take the pills twice per day.

Kaptchuk continues:
    "Not only did we make it absolutely clear that these pills had no active ingredient and were made from inert substances, but we actually had 'placebo' printed on the bottle. We told the patients that they didn't have to even believe in the placebo effect. Just take the pills."
Three weeks passed and almost double of the patients treated with the placebo, 59 percent, reported symptom relief as compared to the control group which was only 39 percent. Additionally, patients taking the placebo increased their rates of improvement by double to a relief threshold achieved by some of the most powerful IBS medications on the market.

Senior study author Anthony Lembo, HMS associate professor of medicine at BIDMC and an expert on IBS stated:
    "I didn't think it would work. I felt awkward asking patients to literally take a placebo. But to my surprise, it seemed to work for many of them."
The authors do make a point that this study was small compared to many investigative studies of this kind, but it does in fact open a dialogue about whether or not placebos are effective even for the fully informed patient. Such a hypothesis will need to be confirmed in larger trials hopefully on a much bigger international scale to take into consideration the differences and relations between traditional and holistic methods of treatment.
Continue to Read more ...

First Dengue Fever Case In Miami Since 1950s

Miami-Dade County health officials announced the first locally acquired case of dengue fever in Miami in nearly sixty years, and urge residents to step up measures to prevent being bitten by mosquitoes. Authorities say the infected individual "made a full recovery from this illness". They added that the diagnosis was made based on signs and symptoms, as well as confirmed laboratory tests. The patient, male, had not travelled outside the county in over two weeks, meaning he was infected locally.

According to the CDC (Centers for Disease Control and Prevention), there have been 28 reported cases of dengue fever this year in Key West - a first outside the US-Mexican border since 1945.

Miami-Dade health officials do not know how the man became infected. They explained that it was not the same strain as the one that infected people in Key West.

Dengue fever, otherwise known as breakbone fever is spread by a the Aedes aegypti mosquito, and more rarely by the Aedes albopictus mosquito which may carry four different viruses that can cause the disease. Dengue fever signs and symptoms can range from mild to severe, including DHF (dengue hemorrhagic fever) and dengue shock syndrome. Those with severe symptoms need to be admitted to hospital.

We have no vaccines to protect against dengue fever. The best way to avoid becoming infected is to take measures that reduce your chances of being bitten by a mosquito.

As long as the infection is treated early, or has not developed into DFH or dengue shock syndrome, the illness is easy to treat.

Approximately 100 million people develop dengue fever worldwide annually. It is more common in the urban and rural parts of subtropical and tropical regions, including South and Central American, some parts of Africa and Asia, the Pacific and the Caribbean. Unlike malaria, another mosquito-borne illness, dengue fever is just as common in urban and rural areas.

The World Health Organization informs that:
  • 40% of the world's population is currently at risk from dengue fever.
  • Dengue fever is widespread in more than 100 countries.
  • In a number of Asian countries, dengue hemorrhagic fever is a leading cause of death and/or serious illness among children.
  • There were more than 890,000 reported cases of dengue fever in the Americas in 2007, 26,000 of them developed into dengue hemorrhagic fever.
  • People who have never been exposed to the virus have a 40% to 50% chance of becoming infected if bitten by a mosquito carrying the virus. In rarer cases the risk may be as high as 80%.
  • About 500,000 patients are hospitalized worldwide each year with dengue hemorrhagic fever, of whom about 2.5% die. A significant proportion of these hospitalized patients are children.
  • If left untreated, dengue hemorrhagic fever has a mortality rate of over 20%. If the patient has access to properly trained medical professionals, the death rate is less than 1%.
Signs and symptoms of mild dengue fever include aching joints and muscles, a rash that can come and go, high fever, a very bad headache, pain behind the eyes, nausea and vomiting. Symptoms usually appear up to seven days after becoming infected.

Signs and symptoms of dengue hemorrhagic fever may start off as mild and gradually get worse over a number of days, and may include (as well as those for mild dengue fever) bleeding gums, clammy skin, nosebleeds, damage to lymph and blood vessels, black vomit and feces (caused by internal bleeding), blood platelet levels drop making it harder for the blood to clot, very sensitive stomach, weak pulse, and small spots under the skin.

Signs and symptoms of dengue shock syndrome, the most severe form of dengue fever, may include (as well as those for mild symptoms) disorientation, rapid drop in blood pressure (hypotension), very bad stomach pain, intense and regular vomiting, and blood vessels leaking fluid.
Continue to Read more ...

MS Activity Varies With The Seasons

A new US study that compared brain scans of people with multiple sclerosis to weather data over a two year period found that disease activity varied with the seasons, with spring and summer months showing predominantly the highest rates of activity, but with increased temperature and solar activity also showing a strong link. The researchers said designers of drug trials that use brain scans to measure results should also consider the possible influence of seasonal effects.

The study, by co-author Dr Dominik Meier, of Brigham and Women's Hospital in Boston, and colleagues, is published in the 31 August issue of Neurology.

Meier told the press that:

"Our results showed that the appearance of lesions on brain scans was two to three times higher in the months of March to August, compared to other months of the year."

For the study, Meier and colleagues used data taken between 1991 and 1993 from 44 people aged 25 to 52 with untreated MS who were living in Boston.

The participants underwent a total of 939 MRI brain scans in that period, with an overall average of 22 scans each. At first, each participant had one scan a week for eight weeks, then eight scans every other week, and after that, one follow up scan every six months.

The researchers used the brain scan results to compare the likelihood and intensity of disease activity to time of year (season) and regional weather data from the same period, including daily temperature, solar radiation and rainfall.

The brain scan results showed that after one year, there was a total of 310 new lesions in 31 of the participants, while scans for the other 13 participants showed no new lesions.

Meier said that not only did they find more new lesions during the spring and sumer seasons, their study also found that warmer temperatures and solar radiation were linked to disease activity, while no such link was found between precipitation and new lesions.

He and his colleagues concluded that:

"The observed seasonality in MS disease activity has implications for trial design and therapy assessment. The observed activity pattern is suggestive of a modulating role of seasonally changing environmental factors or season-dependent metabolic activity."

In an editorial in the same issue of the journal, Dr Anne Cross from the Washington University School of Medicine in St. Louis, and a member of the American Academy of Neurology, stressed this study was important because it used data from the early 1990s, before medications for relapsing MS were approved, so drugs could not account for the results.

"A study like this probably won't be able to be repeated," said Cross.

"Future studies should further explore how and why environmental factors play a role in MS," she added.

This study also raises an important question for research in general: should designers of clinical trials that use MRI brain scans be more aware of seasonal effects?

Clinical trials that use MRI brain scans to assess drug effectiveness often last between 6 and 12 months. If they ran from spring to winter, and the results showed lesions lessening over the period, the investigators might conclude this was because of the drug, whereas it could just be a seasonal effect. Conversely, a trial that ran from winter to spring and summer, might have the opposite pattern, which could also be due to seasonal influences and not necessarily the drug.

"Seasonal prevalence of MS disease activity."
Continue to Read more ...

Bromday Eye Drops (Bromfenac Ophthalmic Solution) Approved For Post-operative Inflammation

Patients with post-operative eye inflammation as well as those who have undergone cataract surgery and experience eye pain may be considered for Bromday once-daily eye-drop treatment, as it was approved for both indications by the FDA (Food and Drug Administration) today. ISTA Pharmaceuticals Inc., the makers and marketers of Bromday, a once-daily ophthalmic nonsteroidal anti-inflammatory drug (NSAID), announced today that the medication will most likely be available by the end of this year.

Vicente Anido, Jr., Ph.D., President and Chief Executive Officer of ISTA, said:

BROMDAY is the only once-daily ophthalmic nonsteroidal anti-inflammatory drug (NSAID) for the treatment of postoperative inflammation and reduction of ocular pain in patients who have undergone cataract extraction. We believe the convenience of a once-daily eye drop will help with treatment compliance and benefit patients recovering from cataract surgery.

BROMDAY is an important addition to our growing prescription eye and allergy product portfolio. Within just a few weeks, our expanded sales force will be ready to promote BROMDAY to U.S.-based ophthalmologists, along with BEPREVE(R), our recently launched eye drop for the treatment of itching associated with allergic conjunctivitis.

Bromday has just been approved for once-daily dosage, to be administered one day before surgery, on surgery day and then for the subsequent 14 days.

Xibrom (bromfenac ophthalmic solution) 0.09% has been available in the USA for the treatment of postoperative inflammation and the reduction of eye pain (ocular pain) for patients who have undergone surgical cataract removal (twice daily administration) since 2005.

Side effects, which historically affect between 2% and 7% of patients, include abnormal sensation in the eye, engorgement of the blood vessels in the eye (conjunctival hyperemia), and eye irritation which may include burning or stinging.

Vicente Anido also said:

Since the BROMDAY approval process required additional clinical investigations beyond those conducted for the original approval of XIBROM(TM) 0.09%, we are seeking a three-year exclusivity period under the Drug Price Competition and Patent Term Restoration Act, commonly known as the Hatch-Waxman Act. BROMDAY represents a significant step in extending our successful bromfenac-based product line established when we launched XIBROM, our twice-daily NSAID for use following cataract surgery, in 2005. In addition, we are evaluating a new formulation and lower concentrations of bromfenac called REMURA(TM) for the potential treatment of dry eye which is now in Phase 3 clinical studies. Beginning in mid-November, we will begin detailing BROMDAY to ophthalmologists; we expect to discontinue the twice-daily XIBROM product in early 2011.

According to The Wall Street Journal, ISTA shares rose sharply today as soon as the FDA approval was announced. There was 12 times its normal share trading volume.

Sources: ISTA, Wall Street Journal
Continue to Read more ...

Similac Infant Formula Tainted With Beetles Lot Numbers Identified By Abbott

Some Similac powder infant formulas were found to be contaminated with small beetles and their larvae, prompting Abbot Labs to issue a voluntary recall. The affected products were distributed to retail outlets and medical facilities in the USA, Puerto Rico, Guam and some Caribbean islands. According to Abbott, a fault was discovered in part of a manufacturing facility.

The beetle or larvae contamination risk is remote, Abbott stresses. The company adds that the FDA (Food and Drug Administration) believes that infant formulas containing these beetles "pose no immediate health risk". However, there is a chance that babies might develop gastrointestinal discomfort. Gastrointestinal symptoms of irritation may also put the baby off eating, Abbot adds.

Should any parent or caregiver detect gastrointestinal symptoms that last more than a couple of days, they should consult a health care professional.

To check if your Similac product is affected by the recall

Click here, and type the product lot number in the box, then click on "search". There is an image to the right of the search box; click on it to locate the lot number on the packaging.

List of all affected products and their lot numbers - Click here (PDF) for a full list of Product Descriptions and their Lot Numbers.

Information for retailers and distributors

Retailers/distributors should immediately check their inventory for any affected products. Their lot numbers can be found at the bottom of each container. Abbot asks retailers/distributors to put affected product lots on hold and return them in the following way:
  • 1-9 cases - the retailer/distributor should complete the form - click here to see the form - to receive FedEx Ground prepaid label and mailer.
  • 10+ cases - the retailer/distributor is asked not to fill in the form, but to contact ABF ByRequest directly at 1-866-643-9477 to organize a pick up.
Distributors are asked to notify their customers of this recall and tell them to check their inventory and place any affected products on hold and contact Abbott at 1-888-376-2054.

Information for healthcare professionals

  • Check inventory for 8-ounce powder can samples that may be affected by the recall.
  • Place affected products on hold. Do not give to patients.
  • Affected products will be removed within four days by an Abbott Nutrition pediatric sales representative.
  • Those who do not know who their sales representative is, or if they have not been contacted, call 1-800-545-5216 (for medical professionals) to arrange for the affected product samples to be picked up.
  • Healthcare professionals who are contacted by parents or caregivers should advise them to discontinue use immediately and either visit or telephone 1-888-376-2054.

Affected and unaffected products

Affected products include all Similac powder formula in rectangular plastic tubs, as well as some formula in cans and other packaging (check list of recalled product numbers).

Unaffected products include powder and liquid specialty formulas, including Similac Expert Care™, Alimentum®, Elecare®, Similac Expert CareTM Neosure®, Similac® Human Milk Fortifier, and metabolic formulas (for inherited disorders).
Continue to Read more ...
Related Posts Plugin for WordPress, Blogger...

Popular Posts