Stroke Survivors Benefit From Regular, Brisk Outdoor Walks

A new study finds that taking regular brisk walks outdoors can help people recovering from a stroke to improve their physical fitness, enjoy a better quality of life, and increase their mobility.

The researchers, from the University of the West Indies in Jamaica, write about their findings in the 6 March online issue of the journal Stroke.

After experiencing a stroke, many survivors have less energy and walk less because of fear of falling. They also tend to reduce meaningful activity like going to the shops, visiting family and friends, or going to church.

Previous studies have already suggested that exercise that doesn't put undue stress on the body can help stroke survivors increase their quality of life, but these have mainly studied the effect of indoor activities such as walking on a treadmill or using an exercise bike.

"Little is known about the effects of community-based walking programs in persons with chronic stroke," write the authors.

So lead author and physical therapy lecturer Carron Gordon and colleagues decided to carry out a randomized controlled trial to investigate effects of aerobic training, namely walking outdoors, on stroke survivors.

They recruited 128 stroke survivors (70 women and 58 men) from three hospitals in Jamaica and randomly assigned them to the intervention group (64 members) or to the control group (64).

The participants, whose average age was 64, had suffered either an ischemic or hemorrhagic stroke six to 24 months before the study and could walk on their own with or without a cane.

Participants of the intervention group undertook supervised outdoor walking for 30 minutes three times a week for 12 weeks. At first they walked with supervisors, but eventually, friends or family members could walk along instead, until they were confident enough to walk on their own.

The participants in the control group just received massage to the side of their body affected by stroke and did not have supervised walking sessions.

Before and after the study, the participants' quality of life, fitness, mobility, strength and functional status were assessed using a mix of physical tests and standardized questionnaires. Blood pressure and heart rate were also assessed.

The results showed that compared to the controls, the exercisers reported a 16.7% improvement in health-related quality of life, and they walked 17.6% further in a six-minute physical endurance test.

The walking group also had a 1.5% lower resting heart rate at the end of the study than they did at the beginning, while the controls' resting heart rate went up 6.7%.

Gordon says in a press statement:

"Walking is a great way to get active after a stroke. It's familiar, inexpensive, and it's something people could very easily get into."

She explains that walking can help control blood pressure, reduce lipid or fat levels, and keep weight under control. All these are cardiovascular risk factors, "So doctors should encourage it for patients who have had a stroke".

Gordon says while most of the participants in their study were black and living in Jamaica, similar results can be expected in other ethnic groups living in other parts of the world.

But, it would not be reasonable to assume the same would be true of patients more severely affected by stroke or who can't walk independently, she cautions.

The American Heart Association recommends stroke survivors do aerobic exercise for 20 to 60 minutes, three to seven days a week, depending on fitness.

Research presented last month at the American Stroke Association's International Stroke Conference 2013, also suggests that practising Tai Chi may reduce falls among adult stroke survivors.

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People Eat More, Gain Weight With Less Sleep

When people don't get enough sleep they tend to eat more, causing them to gain weight. This was the conclusion of a new study led by University of Colorado Boulder in the US that was published online this week in the Proceedings of the National Academy of Sciences.

The researchers found that volunteers who slept only 5 hours a night during a working week put on nearly two pounds (0.8 kg) in weight if they had unlimited access to food.

There is already a lot of evidence linking insufficient sleep with obesity, write the researchers in their background information, but we know little about how repeated nights of insufficient sleep affect energy balance.

Kenneth Wright, director of the Sleep and Chronobiology Laboratory at the University of Colorado Boulder (CU-Boulder), says in a statement:

"Just getting less sleep, by itself, is not going to lead to weight gain. But when people get insufficient sleep, it leads them to eat more than they actually need."

Weight Loss Programs Should Include Healthy Sleep

In their study, Wright and colleagues found that while staying awake longer requires more energy, the extra calories consumed are more than the extra calories burned.

They suggest encouraging people to get the sleep they need could help fight the obesity epidemic, but emphasize the problem is not that simple:

"I don't think extra sleep by itself is going to lead to weight loss," says Wright, "But I think it could help."

"If we can incorporate healthy sleep into weight-loss and weight-maintenance programs, our findings suggest that it may assist people to obtain a healthier weight," he proposes, although he adds that more research is needed to test that idea.

The Study

For their study, Wright and colleagues invited 16 young, lean, healthy adult volunteers to live in a "sleep suite" at the University of Colorado Hospital for about two weeks.

The "sleep suite" offers a quiet and peaceful setting for sleeping, but it is also a controlled environment. The researchers decide when lights go on and off, and the sealed room allows them to measure the oxygen that participants breathe in and the carbon dioxide they breathe out from which they can work out how much energy they are using.

The first three days were spent establishing the baseline measures. All volunteers had the chance to sleep 9 hours a night and they were given only enough food to maintain weight.

After that they were put into two groups for five days: one group had their sleep opportunity restricted to 5 hours and the other continued with 9 hours. Also, their food provision changed so they could eat larger meals and help themselves outside mealtimes to snacks ranging from yogurt and fruit to potato chips and ice cream.

Then, the researchers switched the groups over for the next five days.

The Findings: Restricted Sleep Followed By Overeating, Weight Gain

The results showed that when their sleep was restricted to 5 hours a night, the volunteers on average burned about 5% more calories than when they could sleep up to 9 hours a night, but they consumed 6% more calories.

Also, while on restricted sleep, they ate smaller breakfasts but ate more snacks after the evening meal, to the extent that the total calories consumed in evening snacks was more than the calories in any one meal.

Moving to a restricted sleep schedule resulted in weight gain of nearly 2 pounds (0.8 kg), and also caused a shift in the biological clock, leading to an "earlier circadian phase of wake time", write the authors.

But moving the other way, from restricted sleep to sufficient sleep, reduced energy intake, especially of fats and carbohydrates, and led to a slight drop in weight.

There were also differences between the male and female volunteers. When they could sleep up to 9 hours a night men tended to put on weight whereas women maintained their weight, "whereas insufficient sleep reduced dietary restraint and led to weight gain in women".

The researchers suggest their findings add to the growing evidence that eating too much at night may lead to weight gain.

Wright says their study shows when people don't get enough sleep they eat at night, when their bodies are not equipped for taking in food.

He and his colleagues are now planning another study that looks at the effect of when people eat, as opposed to what they eat, on weight.

An animal study that has shed some light in this area was published in Nature Medicine in 2012, where scientists described how deleting a clock gene leads to obesity in mice, and also causes a change in the timing of their normal eating schedule.

Grants from the National Institutes of Health, the Colorado Clinical and Translational Sciences Institute, and the Howard Hughes Medical Institute in collaboration with the Biological Sciences Initiative and CU-Boulder's Undergraduate Research Opportunities Program helped finance this latest study.

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Diabetes Costs The US $245 Billion A Year Says New Report

Diagnosed diabetes cost the United States an estimated $245 billion in 2012, according to new research released by the American Diabetes Association (ADA) this week. The new figure represents a 41% rise in five years. In 2007, when the cost were last estimated, it came to $174 billion.

A report on the research, commissioned by the ADA, was published online before print in Diabetes Care on 6 March.

The study examines the increased financial cost, use of health resources and productivity that is lost due to diabetes in 2012, and breaks down the figures by gender, race/ethnicity, for the whole country and state by state.

The $245 billion includes $176 in direct medical costs (such as hospital and emergency care, visits to the doctor, and medications), and an estimated $69 billion resulting from indirect costs like absenteeism, reduced productivity, diabetes-related job loss, and productivity loss due to premature deaths.

The rate of diabetes has reached epidemic proportions in the US, where nearly 26 million adults and children have the serious, life-threatening disease, and another 79 million are estimated to have prediabetes, a cluster of risk factors that puts them at greater risk for developing type 2 diabetes.

Robert Ratner, ADA's Chief Scientific & Medical Officer, says in a statement:

"As the number of people with diabetes grows, so does the economic burden it places on this country."

The study finds that medical expenditure for people with diabetes is about 2.3 times higher than for people who don't have the disease and that the main driver of the increased overall financial burden on the country is the rise in proportion of the population that has the disease.

"The cost of diabetes is rising at a rate higher than overall medical costs with more than one in 10 health care dollars in the country being spent directly on diabetes and its complications, and more than one in five health care dollars in the US going to the care of people with diagnosed diabetes," says Ratner.

He also explains that one of the key factors behind the increase is that there are now many more people being treated for diabetes in the US than ever before.

But, he also points out that while treating the disease is expensive, the main driver of cost is the increase in prevalence and the fact it is rising "dramatically".

The report also shows that:

• 64% of diabetes care in the US is met by government insurance (Medicare, Medicaid and the military).


• The remaining cost is met by private health insurance (34.4%) or uninsured people (3.2%).


• Cost per head in 2007 was $6,649, compared with $7,900 in 2012; an increase of 19% over five years.


• Cost per head is higher for women than for men ($8,331 and $7,458 respectively).


• Cost per head is higher among non-Hispanic blacks ($9,540) than among non-Hispanic whites ($8,101), and lower among Hispanics ($5,930).


• California is the state with largest number of people with diabetes and carries the highest cost burden of $27.6 billion.


• But, even though Florida has a smaller population than California, Texas and New York, at $18.9 billion it has the second highest cost burden for diabetes.

The study concludes that these figures show the "substantial burden that diabetes imposes on society".

However, it points out the disease also imposes other, less obvious burdens on society, such as pain and suffering, the care provided by unpaid caregivers, and the costs associated with undiagnosed diabetes.

Looking to the future, it doesn't look like the figures are going to level off anytime soon.

"Recent estimates project that as many as one in three American adults will have diabetes in 2050," says Ratner.

"These numbers are alarming and further highlight the need for our nation to address this epidemic," he urges.

A study from the NIH and the CDC published in February, finds that the number of Americans meeting their diabetes goals - blood sugar, blood pressure and cholesterol - has increased considerably over a 12-year period.

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IPhone Microscope Helps Diagnose Intestinal Worms

Scientists have developed the camera on an iPhone into a microscope that can detect intestinal worm infections.
Photo Credit: Isaac Bogoch

Smart phones are transforming the way that people communicate throughout the world. Now scientists are using them in an innovative way to help diagnose intestinal worm infections in school children living in rural Tanzania.

The scientists have developed an inexpensive microscope using a glass lens costing $8 USD, a strip of double-sided tape, and a cheap flashlight - altering an iPhone 4s into a device that can detect intestinal worm infections; parasites that infect two billion people and result in malnutrition.

Isaac Bogoch, MD, an infectious disease specialist at Toronto General Hospital and the study's lead author explained:

"There's been a lot of tinkering in the lab with mobile phone microscopes, but this is the first time the technology has been used in the field to diagnose intestinal parasites."

The scientists' findings were published in the American Journal of Tropical Medicine and Hygiene, and evaluated 199 stool samples of children using their unique device.

Along with a standard light microscope the researchers examined the samples with the cell phone microscopes and a regular laboratory slide. The kids participating in the trial on Pemba Island, Tanzania, were undergoing different treatments for eliminating intestinal worms.

Scientists first covered the slide in cellophane, then used the double-sided tape to attach it to the camera, lit it from underneath with the flashlight and finally took a picture.

The iPhone microscope was found to be not as sensitive as a light microscope, however, the scientists believe that with some changes it will come close. Bogoch commented, "We think cell phone microscopes could soon become a valuable diagnostic tool in poor, remote regions where intestinal worms are a serious health problem, particularly in children."

Intestinal Worms - A Global Issue

The cell phone microscope sensitivity was dependent on the type of worm and the strength of the infection.

For example, the cellphone found 81 percent of infections of giant roundworm (A. lumbricoides) and 54 percent of roundworm infections (T. trichiura ). But, it only detected 14 percent of all hookworm infections; the researchers say that this is due to the much smaller number of eggs present than with the other parasites.

"It was quite successful at detecting moderate to heavy infections, but not very good at detecting mild infections where there might be only a few eggs in the sample," Bogoch said.

Worms that infect the intestines, such as roundworms and hookworms - or soil-transmitted helminths - harm nearly two billion people worldwide. In isolated, poor regions of developing nations rates of this disease are particularly high and can result in chronic malnutrition and anemia in kids.

Bogoch and his team aimed to find an alternative tool by taping a 3 millimeter ball lens to the camera of Bogoch's Apple iPhone 4S - one he already owned. However, the researchers noted that any phone that has a camera with a zoom option could work effectively. Ball lenses are normally used in the telecommunications field in couplings for optical fiber cable. They are inexpensive - generally $8 to $10 USD.

Instead of an electric light, they used a small flashlight that just needs a single battery for many hours of operation. The entire set-up can be developed for $15 USD, in addition to the cost of the phone, and can be assembled in five minutes.

Cell Phone Microscope - Several Implications

The authors believe that the "mobile phone microscope would likely be of clinical use when it is sensitive enough to detect 80 percent of infections," and note that even now there are new developments underway to improve the current cell phone microscopes.

Bogoch said, "I'm confident that in the near future we will see cell phone microscopes widely used in low-resource settings. They're easy to make, portable, and today, you can find mobile phones with cameras even in some of the most remote regions in the world."

The cell microscope can be used for treating and diagnosing people with worm infections as well as observing the prevalence of disease amongst the broader population.

One example could be when administering drug treatment to large populations. Cell phone microscopes could serve as cheap and effective tools to calculate the effectiveness of these mass drug administration campaigns.

David H. Walker, MD, president of the American Society of Tropical Medicine and Hygiene said:

"I have nothing but praise for the ingenuity of scientists using all available tools to solve pressing health problems in some of the poorest parts of the world. This study is an illustration of how a modest investment in tropical disease research can help reap enormous health benefits for children."

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FDA Warns Antibiotic Zithromax Can Cause Irregular Heart Activity

The U.S. Food and Drug Administration has issued a warning stating that the commonly prescribed antibiotic azithromycin (Zithromax or Zmax) can cause irregular heart activity and result in a fatal heart rhythm.

Zithromax is widely prescribed to treat a series of infections such as pneumonia, bronchitis, wheezing and COPD.

Patients with preexisting heart problems or low blood levels of potassium or magnesium are at a particularly high risk of developing this side effect of the medication.

The FDA says that doctors should be aware of the risk of fatal heart rhythm associated with azithromycin and consider prescribing alternative antibiotics among their patients with existing heart conditions or low blood-potassium/magnesium levels.

Some other alternative drugs such as fluoroquinolones also increase the risk of QT prolongation.

A revised Warnings and Precautions box on the label of azithromycin will include information about the increased risk of QT interval prolongation and Torsades de Pointes - a rare heart rhythm problem.

The new warning comes following review of a study published in the New England Journal of Medicine conducted by researchers at Vanderbilt University. The study revealed that patients who took the antibiotic were at a higher risk of developing heart problems.

Researchers looked at the health risks of several different antibiotics (azithromycin, amoxicillin, ciprofloxacin ,and levofloxacin) by gathering data from over 540 million prescriptions made between 1992 to 2006. Of all the antibiotics prescribed, Zithromaz was found to cause the most heart problems.

According to the FDA statement:

"The study reported an increase in cardiovascular deaths, and in the risk of death from any cause, in persons treated with a 5-day course of azithromycin (Zithromax) compared to persons treated with amoxicillin, ciprofloxacin, or no drug. The risks of cardiovascular death associated with levofloxacin treatment were similar to those associated with azithromycin treatment."

Azithromycin is currently prescribed for the following conditions:

• Acute bacterial exacerbations of chronic pulmonary disease
• Acute bacterial sinusitis
• Community-acquired pneumonia
• Pharyngitis/tonsillitis
• Uncomplicated skin and skin structure infections
• Urethritis and cervicitis
• Genital ulcer disease

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Sitting Less Reduces Risk Of Type 2 Diabetes

People at high risk of developing type 2 diabetes can reduce the risk by sitting less and moving around more frequently, rather than exercising regularly.

The finding came from a study at the University of Leicester which indicates that decreasing sitting time by 90 minutes in total each day may result in critical health advantages.

Patients at risk for type 2 diabetes are currently told to do moderate-to-vigorous physical activity (MVPA) every week for at least 150 minutes.

However, the new research, published in Diabetologia demonstrates that individuals should actually be told to decrease their sedentary time. This means that they need to reduce the time they spend moving very little or not all, such as when they are lying down or sitting.

The investigation was led by Joseph Henson and a team from the Diabetes Research Unit, University of Leicester and National Institute for Health Research (NIHR) Leicester Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), UK.

The researchers examined patients from 2 reports:

• 153 from project STAND (Sedentary Time and Diabetes study, 29% men, 33 years old on average)
• the Walking Away from Diabetes study (65% men, 64 years old on average)

The degree to which MVPA, total physical activity, sedentary time, and breaks in sedentary time were independently linked to cardiometabolic risk factors were observed in people with recognized risk factors for diabetes type 2.

In order to evaluate MVPA, total physical activity and sedentary time, the experts used accelerometers. Breaks in sedentary time were considered a change from a sedentary to an active state.

According to the results, patients with known risk factors for type 2 diabetes recruited from primary care, sedentary time was harmfully linked to 2 h glucose, HDL-cholesterol, and triacylglycerol, independent of confounders that were evaluated.

After controlling for MVPA and adiposity, the results were still significant.

The results were constant across different age groups, demonstrating that the adverse outcomes of surplus sedentary time prevail among young and old adults.

Henson explained:

"These studies provide preliminary evidence that sedentary behavior may be a more effective way to target the prevention of type 2 diabetes, rather than just solely focusing on MVPA. Moreover, sedentary time occupies large portions of the day, unlike MVPA."

The authors added that sedentary time had a more powerful link to many critical cardiometabolic markers, such as HDL-cholesterol, triacylglycerol, and 2 h glucose, as opposed to total physical activity and MVPA, after controlling for each other and other crucial hidden variables.

The novel findings raise concerns about the potential prescription of optimal daily movement for well-being.

Henson concluded:

"Diabetes and cardiovascular prevention programs concentrating solely on MVPA may overlook an area that is of fundamental importance to cardiometabolic health. Along with messages related to accumulating at least 150 min/week of MVPA, which form the cornerstone of diabetes prevention programs, such interventions may be more effective still if individuals are further encouraged to simply sit less and move more, regardless of the intensity level.

This approach requires a paradigm shift, so that individuals at high risk of developing type 2 diabetes think about the balance of sedentary behavior and physical activity throughout the day."

The results coincide with a different study also published this week which showed that sitting for long hours is linked to an elevated risk of developing chronic diseases, such as diabetes, cancer, and heart disease.

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Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication

Amoxicillin, the antibiotic doctors often prescribe for persistent coughs caused by uncomplicated chest infections such as bronchitis, is no more effective at easing symptoms than no medication at all, even in older patients. This was the finding of the largest randomised placebo controlled trial of antibiotics for lower respiratory tract infections (LRTI) done to date.

The study, which was led by the University of Southampton in the UK, is from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and was funded by the European Community's Sixth Framework Programme.

A paper on the findings appears in the 19 December online issue of The Lancet Infectious Diseases.

First author Paul Little, Professor of Primary Care Research at Southampton, says in a statement:

"Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms."

In fact, he adds, using amoxicillin to treat patients with respiratory infections who don't have pneumonia could not only be ineffective, but might actually harm them.

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash, vomiting and the development of resistance," he explains.

The European Centre for Disease Prevention and Control (ECDC) recently put out a statement saying that antibiotic resistance remains a major threat to public health around the world, and for the large part, the cause is misuse of antibiotics.

Chest infections, also known as lower respiratory tract infections (LRTI), are one of the most common acute illnesses treated in primary care settings in developed countries.

There is a lot of controversy about whether LRTI, especially in older people, should be treated with antibiotics, especially since viruses are thought to cause most of them, and previous studies have shown inconsistent results.

A recent study presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, also suggests antibiotics are not successful in treating cough due to the common cold in children.

For this latest GRACE study, the researchers recruited 2,061 adults attending primary care practices with straightforward mild chest infections. The practices were located in 12 European countries: England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia.

The participants were randomly assigned to be prescribed either amoxicillin or a placebo, to be taken three times a day for seven days.

The prescribing general practitioners (GPs) assessed their patients' symptoms at the start of the study period, and the patients also filled in diaries of their daily symptoms.

When they analyzed this data, the researchers found there was little difference in how severe the symptoms were or how long they lasted for, between the amoxicillin and placebo groups.

Even in those aged 60 and over with no other illnesses, antibiotics seemed to offer little benefit over placebo.

Patients in the antibiotic group reported significantly more side effects, including rash, nausea and diarrhea.

The researchers did conclude, however, that while most people seem to get better on their own, there is a small number of patients who do benefit from antibiotics, and "the challenge remains to identify these individuals," says Little.

In an accompanying commentary, Philipp Schuetz, from the University of Basel in Switzerland, notes:

"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected."

However, the question remains, he says, of whether this "one-size-fits-all approach can be further improved".

He suggests perhaps one way to avoid the "toxic effects and costs" of antibiotics and "the development of resistance in the other patients", is to test for "specific blood biomarkers of bacterial infection", so as to "identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia".

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Father's Mental Health Linked To Child's Behavior

An expectant father's psychological distress may be linked to his toddler's emotional and behavioral development.

The finding came from new research published in the journal Pediatrics which analyzed over 31,000 Norwegian kids and their parents.

Several previous studies have shown that the mental health of a mother, during and after her pregnancy, may have an effect on the health of the child. One study showed that children's early experiences with a mother suffering from a severe mental illness can influence their long-term health and development.

Anne Lise Kvalevaag, leading researcher and a doctoral candidate in psychology at the University of Bergen in Norway, said:

"The results of this study point to the fact that the father's mental health represents a risk factor for child development, whereas the traditional view has been that this risk in large is represented by the mother. The father's mental health should therefore be addressed both in research and clinical practice."

The team of experts interrogated the dads when the moms were 4 to 5 months pregnant. They were asked about their mental health, for instance, whether they felt depressed or afraid.

The mental health of the moms was provided by the mothers themselves, as well as the behavioral, social, and emotional development of their children when they were 3 years old.

Rather than looking at particular diagnoses in kids, the scientists collected information on whether they had experienced frequent mood shifts, got into fights, or had feelings of anxiety, explained Kvalevaag.

High levels of psychological distress were reported by 3% of the dads. The team discovered a link between the mental health of the father and the development of a child.

The children who had the most emotional issues at age 3 were the ones whose dads were the most distressed. The researchers pointed out that this study did not demonstrate a direct cause-and-effect association.

The authors explained that there are various possible means that may account for the relationship. For example, Kvalevaag explained, the fathers may be passing on a genetic risk to the child. The mental health of the soon-to-be mom could also be influenced by the dad's depression, therefore, causing an effect on the unborn baby, suggested another scientist.

"If a father is highly distressed, that could affect the mom's secretion of hormones during pregnancy, it could affect her sleep, her own mental status," said Daniel Armstrong, professor of pediatrics and director of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.

"The prenatal mental state of the father is likely to predict the postnatal mental health of the father and this may also account for some of the associations found," Kvalevaag revealed.

The experts noted that the study had a few limitations, for example, the mental health data was taken from self-reports, which are not always reliable.

Prior studies have indicated that infants are seen as being more troublesome by depressed moms as opposed to more impartial onlookers, explained Michael Rice, associate clinical director of the Behavioral Health Education Center of Nebraska at the University of Nebraska Medical Center in Omaha.

The answer to this problem may be fairly simple, Armstrong said. "When mom comes in for appointments, we should at least be raising the question of how dad's doing. That's probably a question that's never asked."

Rice concluded:

"This study gives a more complete picture. When we talk about preventative mental health and preventing these things in the kids, we really need resources there at the prenatal stage for both the mother and the father."

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Salt May Play Role In Autoimmune Disease

A healthy immune system is a finely balanced system: too little activity and we fall prey to disease, too much, and it attacks our own tissue, triggering autoimmune diseases like multiple sclerosis. Now three studies published online this week in Nature suggest the amount of salt we eat may influence this balance by indirectly encouraging the overproduction of immune cells.

In the three studies the researchers focused on a group of immune cells known as T cells because they play an important role in clearing disease-causing pathogens and also in autoimmune disease. They were particularly interested in how T cells develop.

TH17 Cells Have Been Implicated In a Number of Autoimmune Diseases

Previous research has suggested that some types of autoimmunity may be tied to overproduction of a type of immune cell called TH17, a type of helper T cell that protects against pathogens.

However, Th17 cells have also been implicated in diseases like multiple sclerosis, psoriasis, rheumatoid arthritis, and ankylosing spondylitis. Treatments for some of these diseases, such as psoriasis, involve manipulating T cell function.

Until now, scientists have struggled to pinpoint the molecular machinery behind the overproduction of TH17 cells, partly because the usual way of activating native immune cells in the lab, such as RNA interference (RNAi) to manipulate genes, either harms them or disturbs their development.

First Study: Using Nanowires to Manipulate Genes in TH17 Cells

But, by using a new method based on nanowires to manipulate genes in immune cells without altering the cells' functions, the authors of the first study, led by Aviv Regev, a biologist at the Massachusetts Institute of Technology, in Cambridge, in the US, were able "systematically" to assemble and validate a model of how TH17 cells are controlled in mice.

Regev got the idea for the new approach after attending a lecture given by co-author, Hongkun Park, a physicist at Harvard University, also in Cambridge, on how to use silicone nanowires to disarm single genes in cells without disturbing the way the cells operate.

She says in a report by Nature NEWS that without such a model they would probably have been only "guessing in the dark".

Co-author Vijay Kuchroo, an immunologist at Brigham and Women's Hospital in Boston, Massachusetts, says in a statement that until they got the new technology using the nanowires, every time they downregulated a gene (with the previous technology), the cell would change.

The team identified and validated 39 "regulatory factors" altogether, uncovering the most important points in the network and untangling their biological meaning.

They conclude that their findings highlight "novel drug targets for controlling TH17 cell differentiation".

Second Study: Discovering Key Role of SGK1 Signal

In the second study, Regev and another team, this time led by Kuchroo, took snapshots of how immune cells were produced over a three day period.

One protein in particular grabbed their attention, SGK1 (short for serum glucocorticoid kinase 1), a well-studied signaling protein that had not been described in T cells before, but is known to regulate how salt is absorbed in cells of the gut and in kidneys.

By manipulating salt levels in cultured mouse cells, the researchers found SGK1 expression was stronger the more salt there was, causing more TH17 cells to be produced.

Kuchroo says:

"If you incrementally increase salt, you get generation after generation of these TH17 cells."

Third Study: Confirming Findings in Mouse and Human Cells

In the third study, researchers led by David Hafler, a neurologist at Yale University in New Haven, Connecticut, confirmed the findings in mouse and human cells.

Hafler says this was easy to do, "you just add salt".

They also found that mice fed with a high-salt diet developed a more severe form of experimental autoimmune encephalomyelitis (EAE), "in line with augmented central nervous system infiltrating and peripherally induced antigen-specific TH17 cells".

EAE is an animal model of brain inflammation that is used to study autoimmune disease in the lab.

Hafler and colleagues conclude that " ... increased dietary salt intake might represent an environmental risk factor for the development of autoimmune diseases through the induction of pathogenic TH17 cells".

Implications

The researchers do not wish people to go away from these findings assuming that high salt diets alone cause autoimmune diseases.

In their studies they had to induce autoimmune disease, the salt played an additional role. And there are other factors too, as Kuchroo explains:

"It's not just salt, of course. We have this genetic architecture - genes that have been linked to various forms of autoimmune diseases, and predispose a person to developing autoimmune diseases. But we also suspect that environmental factors - infection, smoking, and lack of sunlight and Vitamin D - may play a role."

"Salt could be one more thing on the list of predisposing environmental factors that may promote the development of autoimmunity," says Kuchroo.

Regev also says it is far too early to say people shouldn't eat salt because it leads to autoimmune disease.

"We're putting forth an interesting hypothesis - a connection between salt and autoimmunity - that now must be tested through careful epidemiological studies in humans," she explains.

Hafler adds, "As a physician, I'm very cautious."

He says people should be on a low-salt diet anyway, for general health reasons.

The researchers now plan to apply the new model and build on the results to identify and follow up on potential drug targets.

Support for the research came from the National Human Genome Research Institute, the National Institutes of Health, National Multiple Sclerosis Society, the Klarman Cell Observatory, Guthy Jackson Foundation, and the Austrian Science Fund.

A study published in 2012 finds that the the prevalence and incidence of autoimmune diseases is on the rise in the US and researchers at the Center for Disease Control and Prevention are unsure why.

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Husbands Who Share Housework Have Less Sex

Husbands who help out with household chores have less sex than men in so-called "traditional" marriages where housework is done exclusively by the wife, researchers from the USA and Spain reported in the journal American Sociological Review.

In faithful relationships, the wife whose husband is involved in housework obviously has less sex too, the authors added.

This latest study contradicts most previous ones, which tended to imply that married men generally have more sex in exchange for doing housework. However, those studies did not take into account which chores the husbands did.

The researchers, all sociologists, said that their study demonstrated that sex is not a bargaining chip in marriage. Rather, it is associated with the kinds of chores each partner completes.

Married couples reported greater sexual frequency if the women did the cooking, cleaning and shopping and the men did the gardening, electrics and plumbing, car maintenance and paid the bills.

Co-author Julie Brines, professor of sociology at the University of Washington, said:

"The results show that gender still organizes quite a bit of everyday life in marriage. In particular, it seems that the gender identities husbands and wives express through the chores they do also help structure sexual behavior."

Lead author, Sabino Kornrich, warned that men should not assume from these findings that they should not become involved in traditionally female household tasks, such as shopping, cleaning or cooking. "Men who refuse to help around the house could increase conflict in their marriage and lower their wives' marital satisfaction."

The researchers gathered and examined data from a national survey of approximately 4,500 heterosexual married couples in the USA who took part in the National Survey of Families and Households. The survey, the largest to measure sexual frequency among married couples, included data from 1992 to 1994.

Brines does not believe that the division of household chores - which in this study did not include child care - and sex have changed much since 1994.

"Traditional female tasks" include shopping, cleaning, looking after the kids, and cooking

According to the study, husbands and wives spent an average of 34 hours each week on traditionally female chores. The men's average age was 46, and the women's 44. The couples spent an extra 17 hours each week on "men's work".

On average, the males were involved in about one-fifth of traditionally female chores, and slightly more than half of male-type work. The researchers found that women tend to be more involved with helping out in traditionally male chores, than men do with female tasks.

The couples reported having sex approximately five times, on average, during the four weeks before the survey. In marriages where the woman carried out all the traditionally female tasks, the couples had sex 1.6 times as often, compared to couples where the man was involved in all the female chores.

Brines says she is not surprised that there was more sex among the traditional couples. "If anything surprised us, it was how robust the connection was between a traditional division of housework and sexual frequency." Brines is an expert in family and household dynamics.

The following possible explanations for their findings were ruled out by the researchers:

• Male coercive behavior played no role, because women reported similar satisfaction levels in their sex lives in both types of households (traditional or "modern")


• In two-income households, the difference in sexual frequency was still driven by male behavior regarding traditional female chores. Also, the wife's income had no impact on sexual frequency.


• The following had no impact on sexual frequency - gender ideology, religion, and happiness in marriage.

Brines said:

"Marriage today isn't what it was 30 or 40 years ago, but there are some things that remain important. Sex and housework are still key aspects of sharing a life, and both are related to marital satisfaction and how spouses express their gender identity."

Recovery from Workload Influenced by Housework and Leisure Activity Balance

How rapidly and effectively male and female spouses recover from the burdens of work is probably influenced by a balance of housework time and leisure time, a study by experts from the University of Southern California reported in the Journal of Family Psychology.

Over half of all married couples in the USA are two-income households. The authors wondered whether the winner was the one who had the most help with the housework.

They found that what seems to be good for the male partner was bad for the female, but what is good for the female does not have enough of an impact on the male.

In another study involving 17,000 people in 28 countries, researchers from George Mason University found that married men did less housework than live-in boyfriends. The study was published in the Journal of Family Issues.

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Type 1 Diabetes Stem Cell Breakthrough Moves Toward Cure

In a breakthrough that signifies a move toward a cure for type 1 diabetes, researchers in Australia have identified stem cells in the pancreas that can be turned into insulin-producing cells. The finding promises to bring closer the day when people with type 1 diabetes will be able to produce their own insulin in their own regenerated insulin-producing pancreatic cells.

The discovery is the work of scientists at the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria. They write about their findings in a paper published online in PLoS ONE on 9 November.

Type 1 Diabetes

Type 1 diabetes is a disease where the body's immune system attacks and destroys the cells in the pancreas that produce insulin. Without insulin the body cannot control blood sugar or glucose, which results in serious damage to organs and potentially fatal levels of blood glucose.

Patients with type 1 diabetes have to have several injections of insulin a day, or use an insulin infusion pump, to control their blood glucose. But these methods are not perfect and patients remain at risk of serious long-term health problems.

Pinpointed Cell of Origin

In their paper, Dr Ilia Banakh and Professor Len Harrison from the Walter and Eliza Hall Institute's division of Molecular Medicine, and colleagues, describe how they identified and isolated stem cells from the adult pancreas, and then developed a way to coax them into insulin-producing cells that can secrete insulin in response to glucose.

This discovery could lead to new treatments that mean daily insulin injections become a thing of the past.

Harrison explains in a separate statement how there have been previous successes at generating insulin-producing cells in the adult pancreas from cells with "stem-like" features, but what excites him about this find is that Banakh has pinpointed "the cell of origin of the insulin-producing cells and shown that the number of these cells and their ability to turn into insulin-producing cells increases in response to pancreas injury".

The researchers worked first with cells in the "test tube", and then tested the method in mice:

"Insulin expression was maintained when tissue was transplanted within vascularised chambers into diabetic mice," they write.

Implications

The researchers believe their discovery provides further evidence that stem cells don't only occur in the embryo and means people with type 1 diabetes may one day be able to regenerate their own insulin-producing cells.

The finding means the potential to regenerate insulin-producing cells is present in all of us, even as adults, says Harrison, a clinician scientist whose work is recognized this month as Diabetes Australia confers the Outstanding Contribution to Diabetes Award on him to mark World Diabetes Day on Thursday 14 November.

"In the long-term, we hope that people with type 1 diabetes might be able to regenerate their own insulin-producing cells. This would mean that they could make their own insulin and regain control of their blood glucose levels, curing their diabetes," declares Harrison, adding the proviso:

"Of course, this strategy will only work if we can devise ways to overcome the immune attack on the insulin-producing cells, that causes diabetes in the first place."

Funds from the JDRF, the National Health and Medical Research Council of Australia and the Victorian Government helped finance the study.

Continue to Read more ...

Modern Diet Is Rotting Our Teeth

A study of the evolution of our teeth over the last 7,500 years shows that humans today have less diverse oral bacteria than historic populations, which scientists believe have contributed to chronic oral diseases in post-industrial lifestyles.

The researchers, from the University of Adelaide's Australian Centre for Ancient DNA (ACAD), the University of Aberdeen (Dept of Archeology), Scotland, and the Wellcome Trust Sanger Institute, Cambridge, England, published their study in Nature Genetics.

The authors say that analyzing the DNA of calcified bacteria on the teeth of humans throughout modern and ancient history "has shed light on the health consequences of the evolving diet and behavior from the Stone Age to modern day".

The scientists explained that there were negative changes in oral bacteria as our diets altered when we moved from being hunter-gatherers to farmers. Further changes were observed when humans started manufacturing food during the Industrial Revolution.

Study leader Professor Alan Cooper, ACAD Director, said, "This is the first record of how our evolution over the last 7500 years has impacted the bacteria we carry with us, and the important health consequences."

The introduction of processed sugar may have completely changed the composition of oral bacteria in humans.

"Oral bacteria in modern man are markedly less diverse than historic populations and this is thought to contribute to chronic oral and other disease in post-industrial lifestyles."

The scientists extracted DNA from calcified dental plaque (tartar) from 34 prehistoric human skeletons from northern Europe. They examined the changes in the nature of oral bacteria that were first present in prehistoric hunter-gatherers, through to the Bronze Age when farming became established, then to Medieval times and finally to the Industrial Revolution and later.

Dr Christina Adler, lead author, who was a PhD student at the University of Adelaide during the study, said "Genetic analysis of plaque can create a powerful new record of dietary impacts, health changes and oral pathogen genomic evolution, deep into the past." Dr. Adler now works at the University of Sydney.

The modern mouth exists in a permanent disease state

Professor Cooper said:

"The composition of oral bacteria changed markedly with the introduction of farming, and again around 150 years ago. With the introduction of processed sugar and flour in the Industrial Revolution, we can see a dramatically decreased diversity in our oral bacteria, allowing domination by caries-causing strains. The modern mouth basically exists in a permanent disease state."

Professor Cooper has been working with Professor Keith Dobney from the University of Aberdeen on this for the last 17 years. Professor Dobney said "I had shown tartar deposits commonly found on ancient teeth were dense masses of solid calcified bacteria and food, but couldn't identify the species of bacteria. Ancient DNA was the obvious answer."

Scientists examined tartar deposits found on ancient teeth in their study. (Photo: Alan Cooper/University of Adelaide)

Prof. Dobney explained that this study provides a completely new window on how human populations lived and died in the past. If we know the real genetic history of diseases humans still suffer from today, scientists might better understand them, and even treat them more effectively. "Being able to track them through time has huge implications for understanding the origins and history of human health - making the archaeological record extremely relevant and important to modern-day medics and geneticists," Dobney added.

In an Abstract in Nature Genetics, the authors wrote that "modern oral microbiotic ecosystems are markedly less diverse than historic populations, which might be contributing to chronic oral (and other) disease in postindustrial lifestyles."

It was not until 2007 that the team could control background levels of bacterial contamination properly. This became possible when ACAD's super-clean labs and stringent decontamination and authentications protocols became available.

The scientists are now expanding their studies geographically and chronologically, and including other species, such as Neanderthals.

There is some evidence that beeswax was used 6,500 ago in dentistry, scientists from Abdus Salam International Centre for Theoretical Physics, Italy, explained in the open access journal PLoS ONE on 19th September, 2012.

Continue to Read more ...

Beware Of Deadly New Virus, CDC Warns Officials

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.

Continue to Read more ...

Bee Venom Destroys HIV And Spares Surrounding Cells

Scientists have discovered a powerful toxin in bee venom that could end up playing a crucial role in preventing the spread of HIV.

Nanoparticles containing bee venom toxin melittin can destroy human immunodeficiency virus (HIV) while at the same time leaving surrounding cells unharmed, scientists from Washington University School of Medicine reported in the March 2013 issue of Antiviral Therapy.

The researchers said that their finding is a major step toward creating a vaginal gel that can prevent HIV spread. HIV is the virus that causes AIDS.

Joshua L. Hood, MD, PhD, a research instructor in medicine, said:

"Our hope is that in places where HIV is running rampant, people could use this gel as a preventive measure to stop the initial infection."

Melittin destroys some viruses and malignant tumor cells

Melittin is a powerful toxin found in bee venom. It can poke holes in the protective viral envelope that surrounds the human immunodeficiency virus, as well as other viruses. Free melittin in large-enough quantities can cause considerable damage.

Senior author, Samuel A. Wickline, MD, the J. Russell Hornsby Professor of Biomedical Sciences, has demonstrated that nanoparticles loaded with melittin have anti-cancer properties and have the capacity to kill tumor cells. Linking bee venom with anticancer therapies is not new, in 2004 Croatian scientists reported in the Journal of the Science of Food and Agriculture that honey-bee products, including venom, could well have applications in cancer treatment and prevention.

Normal cells remain intact - the scientists showed that nanoparticles loaded with melittin do not harm normal, healthy cells. Protective bumpers were added to the nanoparticles surface, so that when they come into contact with normal cells (which tend to be much larger), the nanoparticles bounce off rather than attach themselves.

HIV is much smaller than the nanoparticles and fits in between the bumpers. When HIV comes across a nanoparticle it goes in between the bumpers and comes into direct contact with its surface, which is coated with the bee toxin, which destroys it.

Hood explained "Melittin on the nanoparticles fuses with the viral envelope. The melittin forms little pore-like attack complexes and ruptures the envelope, stripping it off the virus."

While most anti-HIV medications work on inhibiting the virus' ability to replicate, this one attacks a vital part of its structure. The problem with attacking a pathogen's ability to replicate is that it does not stop it from starting an infection. Some HIV strains have found ways to circumvent replication-inhibiting drugs, and reproduce regardless.

Hood said:

"We are attacking an inherent physical property of HIV. Theoretically, there isn't any way for the virus to adapt to that. The virus has to have a protective coat, a double-layered membrane that covers the virus."

Melittin nanoparticles may prevent and treat existing HIV infections

Hood believes that the melittin-loaded nanoparticles have the potential for two types of therapies:

• A vaginal gel to prevent the spread of HIV infection
• Therapy for existing HIV infections, particularly drug-resistant ones

In theory, if the nanoparticles were injected into the patient's bloodstream, they should be able to clear the blood of HIV.

Hood said "The basic particle that we are using in these experiments was developed many years ago as an artificial blood product. It didn't work very well for delivering oxygen, but it circulates safely in the body and gives us a nice platform that we can adapt to fight different kinds of infections."

Melittin attacks double-layered membranes indiscriminately, making it a potential for drug therapies beyond HIV infections. The hepatitis B and C viruses, among several others, rely on the same type of protective envelope and could be targeted and destroyed by administering melittin-loaded nanoparticles.

The gel also has the potential to target sperm, the researchers explained, making it a possible contraceptive medication. The study, however, did not look at contraception.

Hood said "We also are looking at this for couples where only one of the partners has HIV, and they want to have a baby. These particles by themselves are actually very safe for sperm, for the same reason they are safe for vaginal cells."

This study was carried out in cells in a laboratory environment. However, the nanoparticles are easy to produce - enough of them could easily be supplied for future human studies.

Recent research on HIV

Over the last few years, scientists have made strides in improving HIV/AIDS treatments and prevention strategies.

Baby "functionally cured" of HIV infection - researchers from Johns Hopkins Children's Center, the University of Mississippi Medical Center and the University of Massachusetts Medical School reported that a baby who was administered antiretroviral therapy thirty hours after being born was "functionally cured". A functional cure means that there is no detectable viral replication after retroviral therapy has stopped.

Ramping up HIV antiretroviral treatments worth the extra cost - investigators from Harvard University, USA, reported that scaling up HIV antiretroviral treatment in a remote province of South Africa (KwaZulu-Natal) reduced the risk of transmitting HIV to sexual partners by 96%.

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What Is MS? What Is Multiple Sclerosis?

Multiple sclerosis, also known as MS, is a chronic disease that attacks the central nervous system, i.e. the brain, spinal cord and optic nerves. In severe cases the patient becomes paralyzed and/or blind, while in milder cases there may be numbness in the limbs.

Over 350,000 people have MS in the USA. The Cleveland Clinic says that MS-related health care costs are thought to be over $10 billion per year in the United States.

According to the National Health Service, UK, approximately 100,000 people live with multiple sclerosis in Great Britain. Symptoms usually appear initially between 15 and 45 years of age. Women are twice as likely to get MS than men.

The term Multiple Sclerosis comes from the Latin multus plus plica meaning "fold", and the Greek sklerosis meaning "hardening".

According to MediLexicon's medical dictionary, Multiple Sclerosis (MS) is:

"a common demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord; occurs primarily in young adults, and has protean clinical manifestations, depending on the location and size of the plaque; typical symptoms include visual loss, diplopia, nystagmus, dysarthria, weakness, paresthesias, bladder abnormalities, and mood alterations; characteristically, the plaques are "separated in time and space" and clinically the symptoms show exacerbations and remissions".

With MS the central nervous system (CNS) is attacked by the person's own immune system. That is why MS is known as an auto-immune disease.

Nerve fibers are surrounded by myelin, which protects them. Myelin also helps conduct electrical signals (impulses) - i.e. myelin facilitates a good flow of electricity along the nervous system from the brain. Myelin regulates a key protein involved in sending long-distant signals.

The myelin of a patient with MS disappears in multiple areas. This leaves a scar (sclerosis). Multiple Sclerosis means "Scar Tissue in Multiple Areas". The areas where there is either not enough or no myelin are called plaques or lesions. As the lesions get worse the nerve fiber can break or become damaged.

When a nerve fiber has less myelin the electrical impulses received from the brain do not flow smoothly to the target nerve - when there is no myelin the nerve fibers cannot conduct the electrical impulses at all. The electrical impulses are instructions from the brain to carry out actions, such as to move a muscle. With MS, you cannot get your body to do what your brain wants it to do.

Who Can Develop Multiple Sclerosis?

• MS can affect people of all ages.


• It is more common among people aged from 20 to 50 years.


• More women develop MS than men.


• People of European descent are more likely to develop MS, compared to other people. However, people of all ancestries can get it.


• You can inherit a greater susceptibility of getting MS from your parents.


• In 2007 the World Health Organization (WHO) estimated that approximately 2.5 million people had MS.


• Multiple sclerosis rates are higher the further away you live from the equator. This leads many to believe that exposure to sunlight impacts on MS risk.

What Are The Causes Of MS?

Although experts are still uncertain, most of them say that the person's own immune system attacks the myelin as if it were an undesirable foreign body - in the same way our immune system might attack a virus or bacteria.

Why might our immune system attack the myelin?

The reasons could be:

• Genetic - some studies have shown that the genes we inherit from our parents may, in part, impact on our risk of developing MS. If you have a parent, sibling, or grandparent who has/had MS, your risk of developing it yourself is greater than average.
  
  Several genes are most likely involved in influencing multiple sclerosis risk, experts say. Scientists believe that a set of gene variants we are born with, plus exposure to some environmental trigger(s), affect the immune system of some people which eventually leads to MS symptoms.
  
  We are probably not that far from identifying those gene variants. The largest MS genetic study ever undertaken, involving 250 scientists from around the world and led by the Universities of Cambridge and Oxford, reported in the journal Nature in August 2011 that over 50 genes had been identified and associated with MS.


• Environmental - MS prevalence varies according to geographical area and population groups. MS is much more common in northern Europe than southern Europe, northern USA than southern USA. It seems that the more exposure to sunlight we have, the lower our MS risk is. The more sunlight we are exposed to, the less likely we are to have low levels of vitamin D - therefore, long-term vitamin D levels probably play a role in MS risk.
  
  Italian scientists explained in July 2012 at the 22nd Meeting of the European Neurological Society (ENS) in Prague, Czech Republic, that people with high vitamin D levels are less likely to develop MS.
  
  In the USA, Caucasian people have a higher risk of developing MS than other racial groups; regardless of geographical location.
  
  Studies indicate that people who move from a higher-risk area to a lower-risk one only acquire the risk of the new area if they move before they reach adolescence. This means that there is something in the environment we are exposed to early in life which influences risk.
  
  Exposure to a toxic substance, such as a heavy metal or solvent has been suggested, but no clear conclusions have been reached.
  
  People with MS are less likely to suffer from gout. MS patients have lower-than-average levels of uric acid in their system, which leads scientists to believe that uric acid protects from MS.
  
  It is unlikely there is just one trigger, experts say, but rather MS is probably triggered by multiple factors.


• Infections - doctors and researchers have often mentioned viruses, such as Epstein-Barr (mononucleosis), varicella zoster, as possible MS triggers; however, this theory has not been backed up scientifically.


• Too much salt - too much salt may trigger the immune system, causing autoimmune diseases, researchers from the Massachusetts Institute of Technology reported in the journal Nature (March 2013 issue). The excessive consumption of salt might increase our risk of developing multiple sclerosis.

What Are The Signs And Symptoms Of MS?

MS affects the central nervous system, which controls all the actions in the body. When nerve fibers which carry messges to and from the brain are damaged, symptoms may occur in any part of the body.

In most cases, signs and symptoms generally appear between the ages of 20 and 40. For some patients, they are so mild that they do not notice anything until much later in the course of the disease. Others may be aware of them very early on

The most common symptoms are:

• Bladder problems - patients may have difficulty emptying their bladder completely, needing to go to the toilet more frequently. Urge incontinence (suddenly dying to go, or unintentional passing of urine), and Nocturia (needing to go frequently during the night) are also common symptoms.


• Bowel problems - half of all MS patients are frequently affected with constipation, which can sometimes be serious (fecal impaction). If the fecal impaction is not resolved, the problem may lead to bowel incontinence.


• Cognitive Function - according to the Multiple Sclerosis Resource Center, UK, about 50% of people with MS say they experience cognitive problems to some extent, increasing to 80% among the most severe cases. The most commonly reported cognitive abnormalities include problems with memory, abstraction, attention and word finding.
  
  In March 2012, researchers from the Kessler foundation reported on a study they carried out which showed that warmer weather has a negative effect on the cognitive performance of patients with MS.


• Depression - researchers from UCLA say MS patients have a 50% chance of developing depression. They add that depression among MS patients is not psychological, but linked to atrophy in part of the hippocampus.


• Emotional Changes - MS may have a profound emotional effect on the individual when a diagnosis is first made. It may be hard to adjust to the diagnosis of such an unpredictable disorder, which carries a risk of some level of physical disability. Also, demyelination and nerve fiber damage in the brain can cause emotional changes. In short, a person with MS may experience emotional changes for either psychological or physical reasons, or both.
  
  Researchers from the LSU Health Sciences Center New Orleans, USA, showed that stress management treatment reduced the formation of new brain lesions in people with MS considerably.


• Fatigue - this is one of the most common symptoms of MS, and affects approximately 80% of patients. The person's ability to function properly at work and at home may be seriously undermined by fatigue. It is the main reason MS patients leave their jobs.


• Dizziness and Vertigo - people with MS commonly experience dizziness and problems with balance. Vertigo is not the same as dizziness; it is a sensation that the room around you is moving or spinning.


• Head movements may cause electric-shock like sensations.


• Numbness or weakness - usually in one or more limbs, and typically affects just one side of the body at a time, or just the bottom half of the body.


• Pain or tingling in some parts of the body.


• Sexual Dysfunction - loss of interest in sex is common for people with MS. Males commonly find it difficult to reach or maintain an erection; they may also find it takes longer to ejaculate. Females may find achieving orgasm more difficult.


• Spasticity and muscle spasms - damaged nerve fibers in the spinal cord and brain can cause muscles to tightly and painfully contract (spasms). Muscles might get stiff and be resistant to movement (spasticity).


• Tremor - involuntary quivering movements


• Vision Problems - Double vision or blurring vision. There may be partial or total loss of vision, which usually affects one eye at a time. When the eye moves there is pain (optic neuritis, inflammation of the optic nerve)


• Gait - gait can be a problem for people with MS. Gait refers to the way you walk. MS can change the way people walk, because their muscles are weaker, they may have problems with balance and dizziness, plus fatigue.

These symptoms are less common, but also possible:

• Headache
• Hearing Loss
• Itching
• Respiration / Breathing Problems
• Seizures
• Speech Disorders
• Swallowing Problems
• Tremor

As the MS advances these symptoms may appear:

• Alterations in perception and thinking
• Fatigue
• Heat sensitivity
• Muscle spasm
• Sexual dysfunction

MS is an unpredictable disease. Each individual will experience it in different ways.. For some, MS starts with a subtle sensation, and it could take months and even years without any MS progression being noticed. For others, however, symptoms worsen much more rapidly - within weeks or months.

MS is very much an individual disease. People are encouraged not to compare what affects them against what other patients might experience.

The Four Courses Of Multiple Sclerosis

There are 4 courses of the disease. In each case, the MS may be mild, moderate or severe.

Relapsing-Remitting MS (RRMS): Over 80% of patients start off with this type.

• Relapsing - there are acute and unpredictable "exacerbations" (acute attacks, also called "flare-ups"). During this period symptoms get worse.
• Remitting - and then there are periods of full or partial recovery. Sometimes there is no recovery.
• The attacks may evolve over days or even weeks, and recovery can take weeks, or even months. In between the attacks there is calm, and symptoms do not worsen.

Primary-Progressive MS (PPMS): About 15% of patients have this type.

• There are no clear relapses or remissions.
• The progression of the disease is steady.
• It is the most common form of MS in those who develop the disease after 40 years of age.

Secondary-Progressive MS (SPMS):

• Starts off as a relapsing-remitting type of MS. Relapses and partial recoveries occur.
• However, in between cycles the disability does not go away.
• Eventually it becomes a progressive disease with no cycles.
• The progressive stage may start very early on, years, or even decades later.

Progressive-Relapsing MS (PRMS): The least common form.

• Symptoms worsen progressively, steadily
• There are acute attacks. Some recovery may follow, or may not.
• In the early stage, it seems the patient has primary progressive MS.

How Is MS Diagnosed?

It is still not yet possible to diagnose MS by sending samples to a lab or collecting physical findings.

The doctor needs to use several strategies to decide whether a patient meets the criteria for an MS diagnosis. To do this, other possible causes of the symptoms need to be ruled out.

The doctor will talk to the patient, carefully look at his/her medical history, carry out a neurolgic exam, order imaging scans, visual evoked potentials (VEP), spinal fluid analysis, and perhaps some further tests.

The health care professional needs to do the following before diagnosing MS:

• Detect evidence of damage in two or more separate parts of the CNS (central nervous system). The CNS includes the spinal cord, brain and optic nerves.
and

• Have proof that the CNS damage happened at least one month apart
and

• Eliminate other potential diagnoses

In 2001, the International Panel on the Diagnosis of Multiple Sclerosis revised the criteria to include precise instructions for using magnetic resonance imaging (MRI), visual evoked potentials (VEP) and cerebrospinal fluid analysis to hasten the diagnostic process. These tests can be used to look for a second area of damage in a person who has experienced only one episode of MS-like symptoms - referred to as a clinically-isolated syndrome (CIS). A person with CIS might not develop MS. The criteria were revised again in 2005 - it is now known as The Revised McDonald Criteria, and has improved the process.

Gauging MS progression through the patient's eyes

A person's multiple sclerosis progression can be determined by measuring how much their retina has thinned, researchers from Johns Hopkins MS Center reported in Neurology. The authors specified that a layer of the retina in the eyes thins when MS progresses.

The researchers wrote "This study suggests that retinal thinning, measured by in-office eye scans, called OCT, may occur at higher rates in people with earlier and more active MS."

What Are The Treatment Options For MS?

There is no cure for MS yet. Existing treatments focus on suppressing the autoimmune response and managing symptoms. Some MS patients do not need treatment because their symptoms are so mild, while others do.

The most common drugs used for treating MS; plus some new ones and a supplement that apparently does not help

• Corticosteroids - these drugs reduce inflammation. During a MS relapse inflammation can become problematic. Corticosteroids are the most commonly prescribed drugs for MS patients.
  
  Prednisone can be taken orally while methylprednisolone is administered intravenously.
  
  During a relapse there is a breakdown of the blood-brain-barrier (BBB) - harmful substances from the bloodstream might cross this barrier and make their way to the brain and spinal cord.
  
  Steroids stabilize the BBB and help prevent harmful substances leaking through. These drugs are also immunosuppressive - they help stop our body's immune system from attacking itself.


• Interferons - these medicines seem to slow down the progression of worsening MS symptoms. However, they must be used with care as they can also cause liver damage.
  
  Interferon alpha is used for treating some cancers, but has no effect on multiple sclerosis. Interferon gamma was also found to have no beneficial effect on multiple sclerosis. However, interferon beta has shown effectiveness as a multiple sclerosis treatment (A Canadian study contradicts this, see below). While the exact method by which interferon beta 1a achieves its beneficial effects in multiple sclerosis remains unknown, some researchers believe it may reduce inflammation. Studies looking at how interferon beta behaves in the lab suggest it may stop harmful cells from entering the brain. However, this is just a theory.
  
  Canadian scientists reported in JAMA in July 2012 that Interferon Beta may not slow long-term progression of MS. They had carried out a study with participants who had relapsing-remitting MS. They concluded that there was no clear evidence showing that Beta A had any measurable effect on the long-term disability progression of MS.


• Copaxone (Glatiramer) - this drug is aimed at stopping the immune system from attacking myelin. It is a combination of four amino acids (proteins). It is injected once a day, subcutaneously (under the skin). The patient may experience flushing and shortness of breath after receiving the injection.


• Tysabri (Natalizumab) - this drug is used on patients who either cannot tolerate other treatments or did not experience any benefits from them. It increases the patient's chances of developing multifocal leukoencephalopathy, a fatal brain infection. The drug is believed to work by reducing the ability of inflammatory immune cells to attach to and pass through the cell layers lining the intestines and blood-brain barriers.


• Mitoxantrone (Novantrone) - usually used only for patients with advanced MS. It is an immunosuppressant medication that can damage the heart.
  
  Novantrone was approved for the treatment of some cancer about 15 years ago. MS patients may find the idea of using chemotherapy cancer treatment disconcerting. In 2000 the Food and Drug Administration (FDA) approved Novantrone as the "only treatment for worsening MS". The recommended treatment schedule for Novantrone usage in MS is much less intensive than for cancer treatment.
  
  For MS patients whose illness is rapidly progressing and getting worse despite other therapies, Novantrone can help slow down the progression of disability and help preserve the patient's independence.


• Cannabis extract - a Phase III trial found that MS patients who took cannabis extract (tetrahydrocannabinol) had improvements in their symptoms of pain, muscle stiffness and insomnia.


• Aubagio (teriflunomide), a once-daily tablet for adults with relapsing forms of MS was approved by the FDA in September 2012. Clinical trials showed that those on Aubagio had relapse rates 30% lower compared to those on placebo.
• Do omega-3 fatty acid supplements help MS patients? - according to scientists at Haukeland University Hospital in Bergen, Norway, who carried out a double blind, placebo-control trial, omega-3 fatty acids do not help MS patients.

Rehabilitation

Rehabilitation is designed to help the MS patient improve or maintain his/her ability to perform effectively at home and at work. The focus is on general fitness and energy management, while at the same time dealing with the problems related to mobility and accessibility, speech and swallowing, memory, thinking and perception.

For an MS patient to achieve good quality health care, rehabilitation is usually a crucial component.

Rehabilitation programs generally include:

• Physical therapy (UK term is physiotherapy) - aims to provide people with the skills to maintain and restore maximum movement and functional ability.


• Occupational therapy - The therapeutic use of work, self-care, and play activities to increase development and prevent disability. It may include adaptation of task or environment to achieve maximum independence and to enhance the quality of life (American Occupational Therapy Association).


• Speech and swallowing therapy - professionals who are trained to assess speech and language development and to treat speech and language disorders are called Speech Language Pathologists, or Speech Therapists. They are also trained to help people with swallowing disorders.


• Cognitive rehabilitation - assists in the management of specific problems in thinking and perception. The patient learns and practices skills and strategies to improve function and/or make up for deficits that remain.


• Vocational rehabilitation - helps people with disabilities make career plans, learn job skills, get and keep a job.

Plasma exchange (plasmapheresis)

Plasmapheresis involves withdrawing whole blood from the patient. The plasma is removed from the blood and replaced with new plasma. Then the blood, with all its red and white blood cells is transfused back into the patient. This process is effective in treating patients with autoimmune diseases because it takes out the antibodies in the blood that are attacking parts of the patients body they should not be attacking.

However, whether plasmapheresis is of benefit to MS patients is unclear. Studies using plasmapheresis on patients with primary and secondary progressive MS have had mixed results.

Beware of fertility treatment - researchers from the Raúl Carrea Institute for Neurological Research in Buenos Aires, Argentina reported that females with MS who undergo ART (assisted reproduction technology) infertility treatment may risk increased disease activity.

Research Into Multiple Sclerosis

Over the last ten years, there has been a great deal of research into multiple sclerosis. Below are some examples:

Lemtrada (alemtuzumab), a medication used for the treatment of a type of leukemia, was shown to help MS patients in two Phase III trials. Lemtrada appears to "reboot" the immune system in MS cases that had not responded to first-line therapy; it reduced the risk of brain shrinkage and disability. Researchers from the University of Cambridge reported in the November 1, 2012, issue of The Lancet that alemtuzumab helped people with early MS who relapsed on previous treatments, as well as those who were treatment naïve (had not yet received any treatment).

Repairing Multiple Sclerosis Damage May be Possible - researchers at Oregon Health & Science University reported in Annals of Neurology (November 2012 issue) that they may be able to repair the damage to the central nervous system associated with multiple sclerosis by blocking an enzyme in the brain called hyaluronidase.

In animal experiments, the scientists blocked the activity of hyaluronidase in mice with MS-like disease, and found that myelin-forming cell differentiation was restored. In other words, remyelination (myelin repair) started to occur.

The authors added that the drug they used on the mice to block hyaluronidase activity would not work on humans, because of the serious side effects. However, they believe that creating one that is suitable for humans is feasible. Any therapy that promotes remyelination would completely change the lives of millions of MS sufferers around the world.

Nanoparticles to trick the immune system and protect the myelin sheath - researchers from Northwestern University Feinberg School of Medicine successfully used nanoparticles covered with proteins that tricked the immune systems of mice so that they stopped attacking myelin and halting MS progression. The mice had relapsing remitting MS.

The scientists say their breakthrough also has the potential for treatment for patients with type 1 diabetes, asthma, and other auto-immune diseases.

They reported in Nature Biotechnology (November 18th, 2012 issue) that MS relapses were prevented in mice for up to 100 days. In human terms, this is equivalent to several years.

The nanoparticles seem to be as effective as using the human body's own white blood cells to deliver the antigen. Phase I/II trials are currently underway on humans with MS. Nanoparticles are much cheaper and easier to use, the authors added.

BG-12 (dimethyl fumarate) - in September 2012, the results of two Phase III clinical trials that evaluated oral dimethyl fumarate, found that it may reduce relapses and disability progression in patients with relapsing-remitting MS.

Alzheimer's molecule reverses paralysis and inflammation - scientists from Stanford University School of Medicine found that a molecule known as the main culprit in Alzheimer's disease surprisingly reversed paralysis and inflammation in mice with multiple sclerosis.

Sodium accumulation - a French study revealed that sodium buildup is linked to MS disability. MRI scans detected the accumulation of sodium in certain parts of the brain among patients with early-stage MS, and throughout the entire brain in those with advanced MS. The scientists say sodium may be a biomarker for the degeneration of nerve cells that occurs in MS.

High Vitamin D levels protects mother but not baby from MS - pregnant women have a smaller risk of developing MS if their vitamin D levels are high. Scientists from Umeå University Hospital added that the developing fetus does not appear to receive the same protection if the mother's vitamin D levels are high. They reported their findings in the journal Neurology.

Jonatan Salzer, MD., neurologist and study author, said: "In our study, pregnant women and women in general had a lower risk for MS with higher levels of the vitamin, as expected. However, a mother's levels of vitamin D during early pregnancy did not have an effect on MS risk for her baby."

MS And Life Expectancy

The lifespan of a person with MS is usually about the same as a healthy person who does not have MS. In rare cases the MS may be so malignant that it is terminal.

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Giant Mosquitoes Likely To Infest Florida This Summer

Giant mosquitoes, the size of quarters, are likely to infest Florida this summer, according to experts from the University of Florida.

These huge, biting insects, which are called Psorophora ciliata, or more commonly known as gallinippers, invaded the state last year and, according to entomologist Phil Kaufman, there may be another invasion on the way.

"I wouldn't be surprised, given the numbers we saw last year," said Kaufman, an associate professor with UF's Institute of Food and Agricultural Sciences. "When we hit the rainy cycle we may see that again."

Female gallinippers lay their eggs in soil at the borders of water bodies that overflow after heavy rain, such as ponds and streams. Therefore, they are referred to as floodwater mosquitoes.

The eggs can stay dry and inactive for a long time, even years, until waters are high enough to help them hatch.

Florida was hit by Tropical Storm Debbie last june, which resulted in flooding in several areas and the release of great numbers of gallinippers and other floodwater mosquitoes.

The mosquito is native to the whole Eastern side of North America and its body is approximately half an inch long with a black-and-white color pattern, making it look like a super-sized form of the invasive Asian tiger mosquito.

Just like all other biting mosquitoes, the female gallinippers feed on blood and the males feed on flower nectar.

The species is well-known for being aggressive and having a painful bite. "The bite really hurts, I can attest to that," Kaufman said. The pain has been described as similar to being stabbed.

According to the scientists:

"Even in the larval stage, gallinippers are fearsome. Most mosquito larvae are content to subsist on decaying plant matter floating in the waters where they develop, but gallinippers are omnivorous, devouring other mosquito larvae and even tadpoles."

Knowing gallinippers possess that trait, they may be a good option for biological control efforts by using the larvae to decrease populations of other pest mosquitoes.

Unfortunately, that strategy has a deadly flaw - it results in more gallinippers, explained UF/IFAS entomology graduate student Ephraim Ragasa.

"That kind of defeats the purpose of using them for biocontrol," he added.

Repellents consisting of DEET can be used to fend off Gallinippers, however, Kaufman believes that because of their huge size, they might be able to endure the compound more than smaller biting mosquitoes.

Recent research in PLOS ONE indicated that DEET is becoming less effective and mosquitoes are now able to ignore the scent three hours after being exposed to it.

Other ways to avoid these mosquitoes include dressing in long pants and long-sleeved shirts when going into wooded areas, particularly places where standing water gathers after rainfall.

There are, however, a couple of positive things about this insect:

• It is not seen as a notable vector of mosquito-borne diseases impacting humans or animals.
• Human activity does not appear to increase its populations.

Kaufman explained:

"This isn't one where you build a subdivision and start to see more. If anything, there may be fewer of them now than there were in the past."

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