Wednesday, May 29, 2013

Improving The Analysis Of Medical Images To Facilitate The Study Of Psychotic Disorders

A team of researchers from the UPNA/NUP-Public University of Navarre has developed new superresolution and segmentation methods for magnetic resonance images so that they can be applied to the structural study of psychosis. The aim is to be able to identify the differences that are produced in specific parts of the brain in psychotic patients with respect to their healthy relatives or other people.

The project, run in coordination with doctors in the Psychiatry and Radiology Service of the Complejo Hospitalario of Navarre, is based on the study of medical images obtained by means of magnetic resonance and has already begun to yield results: "We have seen that in individuals who have suffered a first psychotic episode, the area of the brain of the subcortical ganglia displays certain differences in size with respect to that in healthy individuals," explained the researcher Beatriz del Cerro.To a certain extent this contradicts what the psychiatric scientific literature used to say. So we argued that antipsychotic pharmacological treatment might be a determining factor in these discrepancies, since our patients were evaluated during the first weeks of treatment using medication while the studies in the literature provided data on patients who had been on treatment for a long time."

Today, the delimitation of certain structures of the brain or areas of interest in magnetic resonance imaging is often done manually. From the medical point of view, the promoters of the project consider that it would be desirable to have automatic methods that would increase the quality of the images and calculate the desired sizes in the image analysis.

Comparing psychotic patients with their siblings

In parallel with this project, the researchers attached to the Psychiatry and Radiology service of the Complejo Hospitalario of Navarre are doing a study entitled "Motor alterations in patients with recent psychosis onset and their healthy siblings and controls in Navarre" (Alteracionesmotoras en paciente con psicosis de inicioreciente y sus hermanossanos y controles en Navarra). This research focuses on the clinical aspects of the patients who will have the above-mentioned new methods of superresolution and segmentation inmagnetic resonance imaging applied to them.

The sample in the study comprises people who have had a first psychotic episode, people related to them and a third group without any kinship with the former but who do coincide in parameters like sex, age and educational attainment.They all underwent cerebral magnetic resonance imaging.

Once the magnetic resonance images reach the UPNA, the researchers have two main tasks ahead of them.Firstly, they use mathematical superresolution techniques to reconstruct and enhance the quality of the images acquired by the medical equipment.Secondly, they segment each image by applying artificial intelligence techniques; in other words, they divide it into various parts (groups of pixels with common features) in order to simplify it or to swap its representation for another one that is easier to analyse."To do this, we used commercial software that already exists but we have improved the algorithms and adapted them to our purposes," explained AranzazuJurio.The idea is that although there are various methods of segmentation, the one that best adapts to each type of image has to be determined and then modifications have to be made to adjust it properly to each specific case."In this phase they also have the expertise provided by the doctors.

To validate and determine the quality of this segmentation they have compared the results with other more used segmentation methods and with the manual segmentation done by the doctors."We have been able to see that our new method, based on grouping functions, obtains the best results in all the images in the experiment," they pointed out.

The clinical trial is the third main activity in the project and is handled by the medical team.With the results obtained from the images they will be studying the cerebral size differences in the areas of interest (frontal lobes, the hippocampus and the amygdala as well as the subcortical nuclei) and will be determining the existence or otherwise of significant structural differences among the three groups of people being examined.
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Suicide Can Be Contagious Among Teens

Suicide can be contagious, especially among teenagers, according to a new study published in the Canadian Medical Association Journal (CMAJ).

The research suggests that one person's suicide can influence another person's suicidal thoughts or behavior, and this is particularly seen among younger adolescents.

Additionally, the teens do not have to be personally associated with the suicide victim to start thinking about suicide or to attempt suicide themselves, the investigators discovered.

Dr. Ian Colman, an assistant professor at the Department of Epidemiology and Community Medicine and Canada Research Chair in Mental Health Epidemiology, said:

"When someone dies, particularly a young person, the deceased is described by their loved ones in the media and in social media in glowing, romantic terms, often mentioning how beautiful the child was.

Talk like this is common when any child dies, but it can be dangerous when talking about suicide. When other vulnerable youth are reading or hearing about this, they see the reports about how wonderful the person was and they want their loved ones to feel the same way about them."

A previous study suggested that teens are at the highest risk of attempting suicide within two years after a parent has attempted suicide or has received inpatient care because of a mental disorder.

For the current investigation, the experts gathered and analyzed data from more than 22,000 volunteers between the ages of 12 and 17.

According to the results, 12-to-13 year olds who had been exposed to suicide had a five times higher risk of contemplating suicide themselves or to say that they had attempted suicide.

After factoring in the adolescent's personal knowledge of the person who died, the scientists were surprised to see that there was nearly no difference in these statistics.

As the teenager grows older, the influence seems to decline, the researchers explained. Fourteen-to-fifteen year olds who were exposed to suicide were three times as likely to think about or attempt suicide, while those aged 16-to-17 were twice as likely.

These results have practical implications for experts in the mental health field concerned with prevention.

Dr. Colman said:

"It's clear that these results support the suicide contagion hypothesis, especially among younger adolescents.  It most certainly supports school-based interventions as opposed to high-risk interventions aimed solely at the friends of the deceased."

The report emphasizes the unfortunate consequences that may unintentionally result when the public pays too much attention to individual suicide cases.

It is critical to re-evaluate current strategies that are associated with the support and creation of mental health programs, the authors said.

A study from earlier this year indicated that most suicidal teens being treated still attempt suicide, suggesting that they are not being given the proper treatment.
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Your Feet Are Home To Nearly 200 Types Of Fungi

Researchers have discovered that there are close to 200 different types of fungi species living on our feet - more than any other part of the body.

Although fungi also inhabit other areas of the body - such as behind our ears - the researchers found that most of them are living between our toes.

The study, carried out and published in the journal Nature, is the most extensive analysis of the body's fungal diversity to date.

Although only about half of all types of fungi are harmful, they commonly live on the skin and can be a major cause of infection. This finding is key to discovering new ways to treat skin conditions caused by fungal infection.

If you have a weakened immune system or take antibiotics you are more likely to develop a fungal infection.

Although there are treatment options available for fungal infections, research published in the journal Nature has shown that fungi have a lot of potential for "horizontal" gene transfer, similar to the mechanisms that allow bacteria to evolve so quickly, which may lead to antibiotic resistance.

Common fungal infections include:
  • Yeast infections - a fungus that lives almost everywhere, including in your body. Yeast infections of the skin cause itching and rashes.
  • Athlete's foot - A very common infection caused by fungi. It affects the space between the toes. Symptoms include itching, burning, and cracked, scaly skin between your toes.
  • Ringworm - a red skin rash that forms a ring around normal-looking skin - the condition is not caused be a worm.

The study was led by researchers at the National Human Genome Research Institute in Bethesda, Maryland.

10 healthy adults participated in the study, the scientists sequenced the DNA of fungi living on their skin and other parts of the body.

They took samples from behind their ears, between their toes, their backs, toenails, groin, chest, forearm, nostrils, heel, and palm.

The part of the body with the most fungi was the heel with 80 different types of fungi, followed by toenail clippings (60 types) and the toes (40 types). The head contained the fewest types of fungi (only 10).

Lead researcher of the study, Dr Julia Segre, said:

"The data from our study gives us a baseline about normal individuals that we never had before. The bottom line is your feet are teeming with fungal diversity, so wear your flip flops in locker rooms if you don't want to mix your foot fungi with someone else's fungi."

The researchers believe that an imbalance of microbes may be the reason why harmful ones spread. In conclusion the diversity of fungi living on the human body was much higher than expected.
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Cure For Gray Hair And Vitiligo Found

A modified pseudocatalase, a new compound that reverses oxidative stress may provide a cure for loss of skin or hair color, i.e. gray hair or vitiligo, researchers from the United Kingdom and Germany reported in The FASEB Journal.

The need to use hair dyes to cover up a classic sign of aging - gray hair - may soon be a thing of the past.

Scientists from the Institute for Pigmentary Disorders in association with E.M. Arndt University of Greifswald, Germany and the Centre for Skin Sciences, School of Life Sciences at the University of Bradford, United Kingdom, explained that people's hair goes gray because of massive oxidative stress caused by a build up of hydrogen peroxide in hair follicles. This causes hair to bleach itself from the inside out.

The researchers found that this massive build up of hydrogen peroxide can be reversed with a UVB-activated compound called PC-KUS, a modified pseudocatalase. The research team developed this new proprietary treatment.

PC-KUS restores skin color in patients with vitiligo

The authors added that PC-KUS treatment is also effective for patients with vitiligo. Vitiligo is a long-term skin problem that produces white depigmentation patches that develop and grow in certain sections of skin.

Study author, Karin U. Schallreuter, M.D., said:

"To date, it is beyond any doubt that the sudden loss of the inherited skin and localized hair color can affect those individuals in many fundamental ways. The improvement of quality of life after total and even partial successful repigmentation has been documented."

Schallreuter and team analyzed 2,411 patients from several countries with vitiligo. Fifty-seven (2.4%) of them were diagnosed with SSV (strictly segmental vitiligo) and 76 (3.2%) were diagnosed with mixed vitiligo, which is SSV plus NSV (non-segmental vitiligo).

They discovered that those with SSV with a specific nerval distribution involving eyelashes and skin showed the same oxidative stress found in the much more common general NSV. General NSV is associated with decreased antioxidant capacities, including thioredoxin reductase, catalase, and the repair mechanisms methionine sulfoxide reductases.

They found that PC-KUS treatment led to successful patient outcomes - patients' pigmentation in their skin and eyelashes was restored - i.e. they recovered their original skin and hair color.

Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal, said:

"For generations, numerous remedies have been concocted to hide gray hair. but now, for the first time, an actual treatment that gets to the root of the problem has been developed.

While this is exciting news, what's even more exciting is that this also works for vitiligo. This condition, while technically cosmetic, can have serious socio-emotional effects of people. Developing an effective treatment for this condition has the potential to radically improve many people's lives."

Woman with gray hair
Gray hair is caused by a massive accumulation of hydrogen peroxide in the hair follicles.

This report is a follow-up on a 2009 study that explained why our hair turns gray. Scientists from the Universities of Bradford, England, and Mainz and Luebeck, Germany, explained in The FASEB Journal (March 2009 issue) that graying hair has absolutely nothing to do with wisdom. They wrote that "Going gray is caused by a massive build up of hydrogen peroxide due to wear and tear of our hair follicles."

Hydrogen peroxide eventually blocks the normal production of melanin, the natural pigment responsible for hair color, as well as skin and eye color.
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Bras Make Breasts Sag, 15-Year Study Concludes

Wearing a bra does more harm than good - it does nothing to reduce back pain and weakens the muscles that hold up the breasts, resulting in greater breast sagging, Jean-Denis Rouillon, a sports science expert from the University of Besançon, France, reported after a 15-year study.

Rouillon says that the main conclusion from the preliminary results of his "marathon experiment" is that the bra is a false necessity.

In an interview with France Info (radio), Professor Rouillon said:

"Medically, physiologically, anatomically - breasts gain no benefit from being denied gravity. On the contrary, they get saggier with a bra."

Prof. Rouillon used a slide rule and a caliper (a device used to measure the distance between two opposite sides of an object) to carefully measure changes in breast features of hundreds of women over a 15-year period at the Centre Hospitalier Universitaire, Besançon.

All his volunteers were between 18 and 35 years old. Rouillon emphasized that although his study spanned many years and included hundreds of women, he in no way claims his sample population is representative of the global population of women.

Rouillon found that women who never wore bras had nipples on average seven millimeters higher in relation to their shoulders each year than regular bra users.

In an interview with France Info, a 28-year old female called Capucine says she swears by Rouillon's findings.

Capucine, who was one of the volunteers in Rouillon's study, said:

"There are multiple benefits (to being without a bra): I breathe more easily, I carry myself better, and I have less back pain."

Rouillon warns that some women should not throw their bras away immediately. For example, older women (45 years or more) would derive no benefit from throwing away their bra. In an interview with Reuters, he said "But a middle-aged woman, overweight, with 2.4 children? I'm not at all sure she'd benefit from abandoning bras."

In an interview with The Local, an English-written newspaper in France, Rouillon stressed "These are preliminary results. The small sample of 320 young women is not representative of the entire population - that would require something like 300,000 subjects."

The study did confirm that, according to preliminary data, when young women stop wearing a bra:
  • There is no deterioration in the orientation of their breasts
  • There is widespread improvement in the orientation of their breasts
A previous study by the University of Portsmouth, England, revealed that some women are damaging their breasts because they are wearing the wrong bra size.

Rouillon acknowledged that women wear a bra for a number of reasons, apart from hoping to conserve the shape of their breasts and to prevent sagging. Some find them more comfortable, especially those who live far from the equator during wintertime.

In order for these "preliminary results" to become "definitive", Rouillon says he needs to recruit a much larger sample of women, and to conduct further research on the subject.

John Dixey, former CEO of bra-maker Playtex, explained in a Channel 4 (British TV channel) interview "We have no evidence that wearing a bra could prevent sagging, because the breast itself is not muscle, so keeping it toned up is an impossibility.... There's no permanent effect on the breast from wearing a particular bra. The bra will give you the shape the bra's been designed to give while you're wearing it."
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Beware Of Deadly New Virus, CDC Warns Officials

Coronaviruses 004 lores
Coronaviruses viewed under an electron microscope, with their crown-, or halo-like (corona) appearance
State and health officials have been warned about a deadly virus which has so far killed 8 of 14 infected people in the Middle East and the United Kingdom. The CDC (Centers for Disease Control and Prevention) explained that this virulent coronavirus is part of the same family of viruses as the common cold and SARS.

Experts believe this new coronavirus comes from the Middle East. Of the four confirmed infections in the United Kingdom, three occurred among people who had travelled to the Middle East, one of whom was a family member of an infected person, he had no history of recent travel and had never been to the Middle East. This means that it has become human-transmissible; infected humans can pass it on to other people.

One of the family members, the one who had not travelled, died. According to UK authorities, the patient had an underlying condition that may have increased susceptibility to respiratory infections.

The novel virus is a coronavirus, part of the same virus family as SARS (severe acute respiratory syndrome) and the common cold. During the SARS epidemic of 2003/2004, 10% of infected people were killed. This new coronavirus has a death rate of over 50% (8 out of 14 infected people have died).

"Corona" is Latin for "crown" or "halo". Coronaviruses have halo-like projections on their surfaces.

Scientists working at the Health Protection Agency, UK, say that the new coronavirus (N-CoV) is not the same as SARS-CoV (the virus that causes SARS), but is similar to it. N-CoV is similar to a coronavirus found in bats.

According to the CDC, no cases of infection with the new coronavirus have been reported in the USA.

The first case of the novel coronavirus infection was diagnosed Qatar, the patient was taken to the United Kingdom for treatment in September 2012.

According to Professor John Watson, head of the respiratory diseases department at Britain's Health Protection Agency:

"The routes of transmission to humans of the novel coronavirus have not yet been fully determined, but the recent UK experience provides strong evidence of human-to-human transmission in at least some circumstances.

The three recent cases in the UK represent an important opportunity to obtain more information about the characteristics of this infection in humans and risk factors for its acquisition, particularly in the light of the first ever recorded instance of apparently lower severity of illness in one of the cases. The risk of infection in contacts in most circumstances is still considered to be low and the risk associated with novel coronavirus to the general UK population remains very low. The HPA will continue to work closely with national and international health authorities and will share any further advice with health professionals and the public if and when more information becomes available."

The CDC is advising doctors and health care authorities in the USA to be watchful for any patients who have been to the Middle East during the past 10 days with unexplained respiratory infections.

The CDC has set up a Coronavirus Website with infection updates.

What are the signs and symptoms of novel coronavirus infection?

According to the World Health Organization (WHO), the following signs and symptoms were reported in the confirmed cases of human illness:
  • acute severe respiratory illness
  • breathing problems
  • fever
  • shortness of breath
Virtually all patients develop pneumonia. In some patients there is kidney failure.

WHO and the HPA emphasize that with only 14 cases to go by, the features of the infection may change.

Novel coronavirus less human transmissible than SARS

Experts from the UK and WHO say that although the signs and symptoms of N-CoV are similar to those found in S-CoV (the virus that causes SARS), the novel coronavirus is much less human transmissible.

Nobody knows how widespread N-CoV is. Except for one person - the patient in the UK who caught the infection from a family member - how the others became infected is still a mystery. Health authorities do not know whether N-CoV infection resulted from close contact with infected animals or people.

In an official communiqué in February 2013, WHO asked all Member States to continue their surveillance for severe acute respiratory infections and to carefully review unusual patterns. Patients with unexplained pneumonias should be tested, as should those with unexplained severe, progressive/complicated respiratory illness who do not respond to treatment.

WHO, the HPA and the CDC do not advise screening people at points of entry, or implementing any travel or trade restrictions.

Written by Christian Nordqvist
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First-Ever Enterovirus 71 Vaccine Protects Young Children Against Common And Potentially Deadly Hand, Foot, And Mouth Disease

The first enterovirus 71 (EV71) vaccine candidate to reach phase 3 clinical testing provides young Chinese children with significant protection against disease caused by EV71, a growing public-health threat which has caused over 6 million cases of hand, foot, and mouth disease (HFMD) and 2000 deaths worldwide over the last decade, according new research published Online First in The Lancet.

Since its discovery in 1969, EV71 has caused major outbreaks of HFMD around the world, affecting mostly children. No vaccines currently exist against disease caused by EV71.

The novel inactivated EV71 vaccine was developed for use in the Asia-Pacific region where the greatest number of serious cases, that can cause potentially fatal meningitis and encephalitis, occur.

The randomised trial took place at four sites across China (three in Jiangsu province and one in Beijing), and involved 10245 healthy infants and children aged 6-35 months, who were randomly assigned to receive two doses of placebo (5125) or vaccine (5120) 28 days apart.

The vaccine gave 90% protection against clinical EV71-associated HFMD and 80.4% against EV71-associated disease (including neurological complications) for at least 12 months.

Importantly, the vaccine also demonstrated 100% efficacy against EV71-associated hospitalisation, "suggesting that it could have a significant impact on public health by preventing severe outcomes of EV71 infection"*, say the authors.

The vaccine was well tolerated and had a safety profile similar to inactivated poliovirus vaccines. Frequencies of adverse events were similar between the vaccine and placebo groups. No vaccine-related serious adverse events were recorded.

The investigators propose that a titre of 1:32 is the protective antibody level needed to prevent EV71-associated disease.

However, they caution that there was no evidence that the vaccine had cross-protection against coxsackievirus A (CA) 16 that is frequently found to co-circulate with EV71 and cause HFMD.

Moreover, they point out that there are many viruses that can cause HFMD and the vaccine only has an impact on EV71-related disease, "In the 1-year surveillance period, only a small proportion of cases of HFMD were confirmed as associated with EV71...[Therefore] despite its high efficacy for preventing EV71-associated HFMD, the EV71 vaccine might have little part in reducing the overall incidence of HFMD, even by universal mass immunisation of children."

Writing in a linked Comment, Nigel Crawford and Steve Graham from the University of Melbourne and Murdoch Children's Research Institute in Australia say, "The next step is to assess the appropriateness of including an EV71 vaccine in China's national immunisation programme, including a cost-effectiveness analysis...The gains made in Zhu and colleagues' trial need to be shared internationally, including assessment of any potential cross-protection for other EV71 genogroups [prevalent in other epidemic countries or regions eg, Taiwan, Singapore, Malaysia, and Japan]...Monitoring for epidemiological variations in EV71 will also be crucial to determine whether the vaccine has ongoing efficacy and if any genogroup replacement has occurred."

*Quote direct from authors and cannot be found in text of Article.
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Thursday, May 16, 2013

iPad 2 May Interfere With Heart Implants, Study Suggests

The magnets in iPad 2 tablets and their covers are capable of interfering with heart implants, including pacemakers, suggests a new, small study presented Thursday at Heart Rhythm 2013, the Heart Rhythm Society's 34th Annual Scientific Sessions.

The research was performed by 14-year-old high school freshman Gianna Chien of Stockton, California and her colleagues. They found that magnetic interference could change the settings and even deactivate the technology of implantable cardioverter defibrillators (ICDs).

Chien was helped by her father, a cardiologist. She asked 26 volunteers with ICDs to hold the iPad 2 at reading distance and then, on a separate occasion, to hold the tablets against their chest.

The study showed that magnets imbedded in the iPad 2, as well as its Smart Cover, could interfere and disrupt the workings of ICDs.

Specialized magnets are rooted in the heart devices to allow doctors to adjust their settings on a set schedule. The iPad 2 and its Smart Cover magnets can undermine an ICD's ability to stabilize sudden rapid heart rates, such as fibrillation and tachycardia.

This danger can happen when a person falls asleep with the tablet sitting on their chest. Of the study participants, 30% had interference with their devices when the iPad2 was placed in that position.

However, electromagnetic interference was not seen when the iPad was at a normal reading distance from the chest. The magnetic field falls off rapidly with distance, according to Gianna Chien. Also, larger people who have more fat on their chest - not only in their abdomen - are less sensitive to the interference.

The authors suggest that other devices with imbedded magnets, such as cellphones and magnetic resonance imaging (MRI) could also impact cardiac rhythm devices. These were not examined in this study.

Chien concluded:

"Since tablets are becoming more common, I hope these findings will encourage patients who have or may be a candidate for implantable defibrillators to talk to their doctor about precautions if they use a tablet like the iPad 2."

A previous study conducted in 2006 also by the Heart Rhythm Society, revealed that magnets can pose a serious threat for patients with pacemakers and ICDs
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More Effective Treatment Of Complex Infections Likely With Cutting-Edge Bacteria Research

Bacteria are life forms, which, like all other life forms, struggle for the best living conditions for themselves. Therefore they will try to avoid getting attacked by the human immune system, and therefore they have developed various ways to protect themselves from the human immune system. When safe from the immune system, they can focus on breeding and multiplying, and if they become numerous enough, the human body will experience their presence as an infection. Some bacteria are relatively harmless, while others are fatal. The bacteria avoid being attacked by the human immune system by forming a biofilm - a surface to protect them against the immune system.

"The biofilm contributes to bacterial resistance, and that can cause severe, persistent infections around heart valve implants and in lungs and the urinary tract," explains postdoc. Mikkel Girke Jørgensen from the Department of Biochemistry and Molecular Biology at the University of Southern Denmark. Together with professor Poul Valentin-Hansen from the same institution and scientists from American Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, and Georgetown University Medical Center, Washington DC, he stands behind the new discovery.

The researchers now understand the underlying regulatory mechanisms behind the formation of biofilms. The mechanism involves small RNA molecules, which can affect bacterial gene expression and thus the decision of whether to form biofilm or not.

Bacteria can move by using their so-called flagella to swim with. When they need to form biofilms, they "turn off" the flagella, stop moving and start to form a biofilm.

"We have now established what decides whether they swim or not - and that determines whether they form biofilms or not," explains Mikkel Girke Jørgensen and continues:

"Prospects for the pharmaceutical industry are huge. This increased understanding of biofilm formation may be the first step in creating new ways to treat complicated infections in the future. "
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Androgen Deprivation Therapy For Prostate Cancer Can Cause Osteoporosis

Androgen deprivation therapy is a common and effective treatment for advanced prostate cancer. However, among other side-effects, it can cause significant bone thinning in men on long-term treatment.

A new study¹ by Vahakn Shahinian and Yong-Fang Kuo from the Universities of Michigan and Texas respectively, finds that although bone mineral density testing is carried out on some men receiving this therapy, it is not routine. They did note, however, that men were significantly more likely to be tested when they were being cared for by both a urologist and a primary care physician. Their paper² appears in the Journal of General Internal Medicine, published by Springer.

Androgen deprivation therapy cuts off the production of testosterone by the male testes. This prolongs the life of men with advanced prostate cancer, often by years. However, the therapy can cause osteoporosis which carries an increased risk of fracture. There are treatments available which can help reduce the extent of osteoporosis suffered. Despite recommendations for bone mineral density testing being incorporated into practice guidelines in 2002, it still does not seem to be carried out frequently enough.

In order to ascertain current levels of testing, the researchers looked at the medical records of over 80,000 men with prostate cancer in a Medicare claims database between 1996 and 2008. Although they noted that the levels of bone mineral density testing had increased over those years, only just over 11 percent of men received a test for osteoporosis in the last year studied.

According to the authors, "The absolute rates of bone mineral density testing remain low, but are higher in men who have a primary care physician involved in their care." Levels of testing were lowest in men being cared for by just a urologist alone.

The authors emphasize that bone care is not within the usual remit of most urologists and, as such, may be outside their comfort zone for diagnosis and management. Urologists are not alone in this, though, as breast and colorectal cancer patients also tend to fare better with the involvement of a primary care physician in addition to their oncologist.

It would therefore appear important to derive a system whereby primary care physicians remain involved in the care of men with prostate cancer. In addition, urologists need to be made more aware of the risk to bones and men starting androgen deprivation therapy need to know to ask about the test.
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Erectile Dysfunction Tied To Long Term Painkiller Use

A new study suggests that long term use of opioid prescription painkillers for back pain is tied to a higher risk of erectile dysfunction (ED). The findings are published in the 15 May online issue of the journal Spine.

Lead author Richard A. Deyo, an investigator with the Kaiser Permanente Center for Health Research says in a statement:

"Men who take opioid pain medications for an extended period of time have the highest risk of ED."

With his colleagues, Deyo, who is also Professor of Evidence-based Family Medicine at Oregon Health & Science University, found the link by analyzing electronic health records of over 11,000 men enrolled in a health plan.

They believe theirs is the first study to find such a link using electronic health records.

The reason they did the study was because men with chronic pain sometimes experience erectile dysfunction because of depression, smoking, age, or opioid-related hypogonadism (low testosterone due to painkiller use).

But little is known, they note, about how common ED is in men with back pain, and which risk factors may be important.

So they searched the electronic records to find out if men taking prescription painkillers were also the ones most likely to be prescribed testosterone replacement or medications for ED.

They found 11,327 men in Oregon and Washington enrolled in the Kaiser Permanente health plan who went to see their doctor complaining of back pain in 2004.

For each patient they identified, they looked at his pharmacy records covering six months before and six months after the back pain visit to find out if they had received opioids and testosterone replacement or ED medications.

The analysis showed that over 19% of men who took high-dose opioids (classed as more than 120 mg of morphine-equivalent) for at least four months were also prescribed testosterone replacement or medications for ED. This compared with only 7% who received ED prescriptions but did not take opioids.

Of the men who took low-dose opioids for at least four months, 12% also received prescribed testosterone replacement or medications for ED.

In looking at other factors, Deyo and colleagues found being over 60, having depression or other illnesses, or taking sleeping pills (sedative hypnotics like benzodiazepines), were all independently linked to ED. Age was the biggest factor, with men aged 60 to 69 being 14 times more likely to be receiving prescriptions for ED medications than men aged 18 to 29.

However, when they took out the effects of these factors in the figures, they found patients taking high-dose opioids were still 50% more likely to be given prescriptions for ED than men those who did not take the painkillers.

Deyo says just because they have found this link, it does not necessarily mean that prescription painkillers actually cause ED, but it is "something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain."

Deyo has spent over 30 decades studying treatments for back pain. He says that while there is "no question" that for some patients taking opioids is the right treatment for back pain, "there is also increasing evidence that long-term use can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, reduced hormone production, and now erectile dysfunction".

The US Centers for Disease Control and Prevention (CDC) say prescription opioid use in the United States has grown enormously. Between 1999 and 2010, sales quadrupled.

A survey published in 2008 in the journal Pain, suggested that 4.3 million adult Americans regularly use opioids. The ones most commonly prescribed are hydrocodone, oxycodone, and morphine.

Researchers from the CDC also reported recently that in 30% of deaths from overdosing on opioid painkillers, patients had also taken benzodiazepines.

Written by Catharine Paddock PhD
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Malaria-Carrying Mosquitoes More Strongly Attracted To Smell Of Humans

A new study shows for the first time that infection with the malaria parasite causes mosquitoes to change smell-stimulated behavior so they are more strongly attracted to the smell of humans than uninfected mosquitoes.

The burden of malaria around the world is huge: the parasite infects over 200 million people a year and kills an estimated 770,000, note the researchers.

The infection, which causes fever and headache, and in severe cases can result in coma or death, spreads through human populations because malaria-inducing Plasmodium parasites living in the guts of female Anopheles mosquitoes pass into people's bloodstreams through mosquito bites.

There are different strains of malaria-inducing Plasmodium parasites, and different strains of host Anopheles mosquitoes. One of the deadliest parasites is Plasmodium falciparum, which is predominantly carried by Anopheles gambiae mosquitoes.

Writing in a 15 May online issue of PLOS ONE, researchers from the London School of Hygiene & Tropical Medicine in the UK describe how they showed significantly more A. gambiae mosquitoes infected with P. falciparum "landed and probed" on a fabric matrix emanating human skin odor than uninfected mosquitoes.

Previous studies have already shown that the malaria parasite changes host behavior to help it spread. For example, malaria-infected mosquitoes tend to consume larger, more frequent blood meals than uninfected mosquitoes.

However, this is the first study to show that the parasite changes odor-related behavior in its mosquito host.

(An intriguing example of altering host behavior featured recently in a study published in the journal mBio that describes how the luminous bacterium Vibrio fischeri regulates the daily rhythm of its host, the Hawaiian bobtail squid, by interacting with its clock genes.)

The researchers say their results offer a useful starting point for improving malaria control and eradication. It could help us find out more about how A. gambiae mosquitoes infect humans.

And, by understanding the olfactory changes that underly the altered smell-seeking behavior of the mosquitoes, it may be possible to find compounds to make traps for monitoring or capturing parasite-carrying A. gambiae mosquitoes, they conclude.

In another study published recently in the journal Science, researchers in the US show how they used a bacterium to stop the malaria parasite developing in the mosquito and created a stable population where immunity to the parasite was passed onto new generations.
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Novel Coronavirus Might Spread Between Humans, Says World Health Organization

The Novel Coronavirus (nCoV) is emerging as a major challenge for countries across the world and experts from the various governments that have been affected are desperately looking for some form of guidance. A new report by the World Health Organization (WHO) reveals that the virus may be able to spread by human-to-human contact.

In fact, WHO has just been invited by the The Ministry of Health of the Kingdom of Saudi Arabia to try and help them fully assess nCoV and come up with recommendations and ways to try and tackle it.

Novel Coronavirus infection is a relatively new disease in humans; there are still many questions that remain unanswered, says WHO. It is going to take some time before we fully understand nCoV.

What we know about nCoV so far

Coronaviruses affect the upper respiratory tract of birds and mammals, although they may also affect the gastrointestinal tract. They are quite common and are responsible for about one third of all common colds.

The Novel Coronavirus is a new coronavirus strain that began infecting people in the Middle East last year.

It was first identified around the beginning of 2012 when a man in Saudi Arabia became sick with symptoms that appeared to be very similar to SARS - he died in June 2012.

Three months later, a patient from Qatar became ill after a trip to Saudi Arabia. He was transported to the UK for further treatment. Lab tests were conducted which confirmed that the patients were both infected with nCoV.

Since then, nCoV infection has killed 18 people in the Middle East.

NCoV and it's similarity to SARS

Another well known virus that was similarly caused by a Coronavirus was the famous SARS CoV infection which first emerged in the Guangdong Province in southern China in November 2002.

Even though SARS and nCoV belong to the same family, the effects they have on human cells differ substantially. nCoV disrupts more human genes more aggressively and frequently than the SARS coronavirus did.

NCoV is also proving to have a higher fatality rate than SARS, its 50% death rate is a lot higher than the 9.5% rate during the 2002/2003 SARS pandemic that was responsible for the deaths of 774 out of 8,098 confirmed cases of human infection in 37 countries.

Understanding nCoV

WHO reports that "we know nCoV has infected people since 2012, but we don't know where this virus lives. We know that when people get infected, many of them develop severe pneumonia. What we don't know is how often people might develop mild disease."

Older men with existing medical conditions appear to be particularly vulnerable to nCoV infection. WHO warned that this trend may change over time.

One of the main concerns WHO, other health organizations and government bodies have about the virus is how it is being transmitted. A WHO official recently stated that the nCoV is likely able to spread from human-tohuman.

WHO wrote in an online communique:

"Of most concern, however, is the fact that the different clusters seen in multiple countries increasingly support the hypothesis that when there is close contact this novel coronavirus can transmit from person-to-person.

This pattern of person-to- person transmission has remained limited to some small clusters and so far, there is no evidence that this virus has the capacity to sustain generalized transmission in communities."

WHO praises the Saudi Arabian government for its diligent surveillance system and control measures; this could be why so many cases have been identified in the country.
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Antibiotics May Cure 40% Of Chronic Back Pain Cases

For nearly half of all chronic back pain sufferers, s simple course of antibiotics may cure about 40% of patients with chronic back pain, researchers from the University of Southern Denmark and the University of Birmingham, England, reported in the European Spine Journal. Neurologists are describing this breakthrough as "the stuff of Nobel Prizes".

The scientists demonstrated an association between long-term back pain and infection with Propionibacterium acnes, a bacterium commonly found on human skin that is involved in causing acne.

According to trial evidence, administering antibiotics to clear infection may bring an end to the constant lower back pain and all the misery that comes with it - offering a simpler, better and much cheaper option than surgery.

If the results of the trial can be confirmed in larger studies, millions of people around the world who suffer from long-term back pain could experience a complete change in quality of life.

The Mayo Clinic estimates that approximately 80% of all Americans will have low back pain at least once in their lives, and a significant proportion of these people develop chronic back pain. Back pain is the most common reason for absence from work in the USA.

According to the National Health Service, UK, approximately four million people in the United Kingdom suffer from chronic back pain.

Two studies have been published in the European Spine Journal. In the first study, Hanne B. Albert PT., MPH., Ph.D., from The Back Research Centre, University of Southern Denmark, and team demonstrated how bacteria invade the injury sites of slipped discs and cause painful inflammation, as well as harming surrounding vertebrae.

Experts had previously believed that if bacterial infections played a role in back pain, it was probably only a minor one. However, this trial showed that nearly half of all the patients with slipped discs tested positive for bacterial infection, and mostly by the acne-causing bacterium Propionibacterium acnes.

Dr. Albert and colleagues believe the bacterium is probably the cause of up to 40% of all cases of long-term back pain.

In the second study, the same researchers tried out an antibiotic combination treatment based on their discovery. They recruited 162 volunteers, all of them chronic back pain sufferers. They defined "chronic" as somebody whose back pain has lasted for more than six months. All of the participants had had a slipped disk and had signs of bone swelling.

The patients were divided into two groups:
  • The antibiotic group - they were administered Amoxicillin (amoxicillan) and clavulanate for 100 days

  • The placebo group - they received an inactive placebo (dummy drug)
The antibiotic treatment proved effective in 80% of cases. The authors wrote that patients experienced significant reductions in disability and pain.

Dr. Albert wrote:

"Antibiotics should be considered as a treatment option for this special subgroup of patients with chronic low back pain (CLBD).

More confirmatory work in other populations and studies on improved protocols as well as the background science should be encouraged."

The Daily Telegraph quoted Dr. Peter Hamlyn, an expert neurosurgeon from University College London hospital, who said:

"Make no mistake this is a turning point, a point where we will have to re-write the textbooks. It is the stuff of Nobel prizes."

Nursing Times quoted Professor Laura Piddock, from the University of Birmingham, England, who cautioned that antibiotics should only be considered for chronic lower back pain if a bacterial cause has been identified. Inappropriate use of antibiotics can contribute to the proliferation of resistant bacteria.

Professor Piddock said "For this reason, physicians are encouraged to liaise with their consultant microbiologist colleagues for the most appropriate tests to carry out."
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