Pesticides In Fruits and Vegetables May Lower Sperm Count In Men

Jorge E. Chavarro, M.D., Sc.D. Assistant Professor of Nutrition and Epidemiology Harvard T.H. Chan School of Public Health Assistant Professor of Medicine Harvard Medical School Boston, MA 02113MedicalResearch.com Interview with:
Jorge E. Chavarro, M.D., Sc.D.
Assistant Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine
Harvard Medical School Boston, MA 02113

Medical Research: What is the background for this study?

Dr. Chavarro: Previous studies have shown that occupational exposure to pesticides is harmful to sperm production. However, whether the same is true for pesticide residues in our food, the most important source of exposure to pesticides for most people, is unclear.

Medical Research: What are the main findings?

Dr. Chavarro: Bottom line, men who consumed the greatest amounts of fruits and vegetables with large amounts of pesticide residues had significantly lower sperm counts and fewer morphologically normal sperm.

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It’s Time To Stop Blaming the Moon For Hospital Admissions or Births

Dr. Jean-Luc Margot PhD Professor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy, University of California, Los AngelesMedicalResearch.com Interview with:
Dr. Jean-Luc Margot PhD
Professor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy,
University of California, Los Angeles

Medical Research: What is the background for this study? What are the main findings?

Dr. Margot: Some professionals who work in emergency rooms or maternity wards believe that the number of hospital admissions or human births is larger during the full moon than at other times.  This belief is incorrect. Analysis of the data shows conclusively that the moon does not influence the timing of hospital admissions or human births.

Results of a new analysis have been published online in the journal Nursing Research.  The Nursing Research article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none.  It reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Continue reading

Black HIV+ Patients Have Increased Mortality Even When Treated

MedicalResearch.com Interview with:
Catherine R. Lesko, MPH

Department of Epidemiology
UNC School of Global Public Health
Chapel Hill, NC

Medical Research: What is the background for this study? What are the main findings?

Response: There is a lot of evidence out there that HIV-infected minorities, and in particular, African Americans, experience higher morbidity and mortality than do their white, HIV-infected counterparts. This study looked at whether there were still differences in mortality among treated, HIV-infected adults, which was a crude attempt to control for differences in access to HIV-testing, HIV-care, and antiretroviral therapy – all things previously shown to contribute to racial disparities among people infected with HIV. Even among people who had initiated HIV therapy, we still found that black patients had a 10-year risk of mortality that was 8 percentage points greater than white patients. Hispanic patients did marginally better than white patients, but not as much better as their non-HIV-infected counterparts.

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Kidney Stone Risk Affected By Age and Sex

MedicalResearch.com Interview with:
Majuran Perinpam, BsC

Mayo Clinic
Rochester, Minn

MedicalResearch: What is the background for this study?

Response: The four key urinary factors: Calcium, magnesium, oxalate and uric acid are all implicated in kidney stone formation. Age and sex are known to influence kidney stone risk and type (1). However the effects of demographics on excretion of the four key urinary factors are not clear. Since diet alters urinary excretions of the four factors, adjusting for this is important. During metabolic evaluation of kidney stone patients, these urinary factors are often measured in 24-hour urine samples. However, often a single adult reference range is used and the effect of demographics is rarely taken into account during the interpretation of results.

MedicalResearch: What are the main findings?

Response: From a cohort of 709 healthy individuals we found a substantial influence of age and sex on the excretion of urinary calcium. Adjusted models showed that urinary calcium, magnesium, oxalate and uric acid were all less in females, possibly explaining why kidney stones are more dominant in males (1). Also a positive association of urinary uric acid excretion with Cystatin C eGFR, but not eGFR calculated from creatinine, suggests cystatin C to possibly being involved in inflammation and hyperuricemia. But further studies are needed to investigate this.

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COPD Patients On Oxygen Therapy Should Be Warned Of Burn Risks

Gulshan Sharma, MD, MPH Division of Pulmonary Critical Care and Sleep Medicine University of Texas Medical Branch Galveston, TXMedicalResearch.com Interview with:
Gulshan Sharma, MD, MPH
Division of Pulmonary Critical Care and Sleep Medicine
University of Texas Medical Branch
Galveston, TX

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD).

Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke.

Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects.

Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury. Continue reading

Despite Claims, Xylitol May Not Help Prevent Tooth Decay

Xylitol Wikipedia

Xylitol
Wikipedia

MedicalResearch.com Interview with:
Philip Riley
Cochrane Oral Health Group, School of Dentistry
The University of Manchester
Manchester, UK

Medical Research: What is the background for this study? What are the main findings?

Response: As tooth decay is still so prevalent worldwide, despite being entirely preventable, it is worth assessing the evidence for other adjunctive ways for the public to help prevent the disease. Manufacturers of xylitol products commonly make the claim that this natural sweetener prevents tooth decay, and we felt that the public deserved to know if the best quality evidence backs up such claims.

We found that there was a lack of evidence from randomised controlled trials (the best type of study design for testing the effects of interventions) to prove that xylitol products can prevent tooth decay. We found some low quality evidence suggesting that xylitol added to fluoride toothpaste may reduce tooth decay in children’s permanent teeth by 13% over a 3 year period when compared to fluoride toothpaste without xylitol. However, these findings should be interpreted with caution and may or may not be generalizable to other populations. There was insufficient evidence to conclude that xylitol in chewing gums, lozenges, candies/sweets, syrups and wipes can prevent tooth decay in children or adults

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Heart Attack Carries Worse Prognosis In Dialysis Patients

Hemodialysis

Hemodialysis

MedicalResearch.com Interview with:
Tanush Gupta, MD

Department of Medicine, Division of Cardiology
New York Medical College, NY

Medical Research: What is the background for this study? What are the main findings?

Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.

We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.

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Diagnosing TB in Children: Evaluating Xpert Assay

Tuberculosis creates cavities visible in x-rays like this one in the patient's right upper lobe. Wikipedia

Tuberculosis creates cavities visible in x-rays like this one in the patient’s right upper lobe Wikipedia

MedicalResearch.com Interview with:
Dr Anne K Detjen, MD

Child Lung Health Consultant
International Union Against Tuberculosis and Lung Disease

Medical Research: What is the background for this study? What are the main findings?

Dr. Detjen: The bacteriological diagnosis of tuberculosis (TB) in children is challenging due to the difficulty in obtaining specimens such as sputum and the lack of an accurate and accessible diagnostic test. In most cases, diagnosis is made on clinical grounds based on a contact history and a combination of signs and symptoms. We included 15 studies in a systematic review and meta-analysis of Xpert for the diagnosis of pulmonary TB in children.

The accuracy of Xpert for diagnosing TB in children is suboptimal, and the majority of children will still have to be diagnosed clinically. However, in settings where it replaces smear microscopy Xpert will increase the likelihood of bacteriological confirmation of TB as well as MDR TB among children. Xpert does not increase the number of confirmed TB cases among culture-negative children. We also found that smear status highly impacted Xpert results, i.e. a higher yield among smear positive compared to smear negative children. Smear positivity increases with bacillary load and might be a proxy for disease severity. Unfortunately, we were not able to assess the performance among children with different stages of disease severity since this was not classified in any of the studies included.

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Cardiorespiratory Fitness May Decrease Cancer Risk and Improve Survival

cdc-cardiorespiratory-fitness

CDC Image: Cardiorespiratory Fitness

MedicalResearch.com Interview with:

Susan G. Lakoski, M.D.

Assistant Professor of Medicine, Hematology/Oncology DivisionDepartment of Medicine Director, Cardiovascular Prevention Program for Cancer PatientsVermont Cancer Center, Division of Hematology/OncologyUniversity of Vermont, BurlingtonCo-Investigators from Cooper Center Longitudinal Study
Cooper Institute in Dallas, Texas

Medical Research: What is the background for this study? What are the main findings?


Dr. Lakoski:

  • High cardiorespiratory fitness (CRF) is associated with 55% reduction in lung cancer and 44% reduction in colorectal cancer in white men. These results were similar even among non-smokers.
  • High cardiorespiratory fitness is associated with a one-third risk reduction in all cancer-related deaths among men who developed lung, colorectal, or prostate cancer at age 65 years or older compared with low cardiorespiratory fitness.
  • High cardiorespiratory fitness is associated with a two-thirds reduction in cardiovascular death compared with low cardiorespiratory fitness among men who developed cancer at age 65 years or older.
  • There is an strong inverse relationship association between fitness and subsequent diagnosis of incident lung and colorectal cancer, but not prostate cancer, in white men.

MedicalResearch.com: What should patients and clinicians take away from this report:

Dr. Lakoski:

A) The relationship between fitness and prostate cancer risk is controversial. It is possible that men with higher cardiorespiratory fitness may be more likely to undergo more frequent preventive health care screening and/or detection visits and, thus, had greater opportunity to be diagnosed as having localized prostate cancer relative to men of lower cardiorespiratory fitness. Importantly, men who developed prostate cancer in the current study, had a lower risk of ultimately dying of cancer or cardiovascular disease if ‘fit’ prior to disease onset. This speaks to the importance of being ‘fit’ in mid-life to improve survival even if a man ultimately develops lung, prostate, or colorectal cancer later in life.

B). Among the men who developed cancer, those who were more fit at middle age had a lower risk of dying from all the three cancers studied, as well as cardiovascular disease. Even a small improvement in fitness (by 1-MET) made a significant difference in survival ─ reducing the risks of dying from cancer and cardiovascular disease by 10 and 25 percent, respectively.

EXAMPLE of what a 1-MET difference equates to:
Running, 5 mph (12 min/mile)  = 8 METs
Running, 5.2 mph (11.5 min/mile) = 9 MET

C) Our findings indicate that cardiorespiratory fitness provides cancer risk prediction information beyond these established lifestyle risk factors. These findings provide support for the utility of cardiorespiratory fitness assessment (via a maximal exercise treadmill test) in preventive health care settings and possibly following a diagnosis of cancer.

The benefits of measuring fitness include:

1) Provide accurate and stable marker of exercise exposure and dose.

2) Measurements can be reproducibly measured over time.

3) Normative values are available to compare fitness levels of patients to the general population for counseling.

4) Allows clinicians to prescribe personalized exercise training goals for patients.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Lakoski: Future studies are needed to test these results across all major cancers in men and women and also address how much an individual must change their fitness to see cancer prevention benefit.

Citation:

Lakoski SG, Willis BL, Barlow CE, et al. Midlife Cardiorespiratory Fitness, Incident Cancer, and Survival After Cancer in Men: The Cooper Center Longitudinal Study. JAMA Oncol. Published online March 26, 2015. doi:10.1001/jamaoncol.2015.0226.

 

MedicalResearch.com Interview with: Susan G. Lakoski, M.D. (2015). Cardiorespiratory Fitness May Decrease Cancer Risk and Improve Survival

Genetic Fingerprint May Lead To Blood Test For Colon Cancer

MedicalResearch.com Interview with:
Professor Massimiliano Mazzone and Professor Hans Prenen
Lab of Molecular Oncology and Angiogenesis
VIB Vesalius Research Center
University of Leuven Leuven Belgium

Medical Research: What is the background for this study? What are the main findings?

Response: Monocytes are circulating cells with patrolling behaviour. In case of harmful situations, they go to the site of injury rapidly to ensure immune and wound-healing functions. Once in the inflammation site, they differentiate into macrophages which are versatile cells adopting different phenotypes according to the stimuli they are subjected to. We hypothesized that cancer cells might release signals and soluble factors that educate and change monocytes already when in circulation. In this work, we proved our hypothesis and found that soluble molecules released by colorectal cancer cells imprint a specific signature in the circulating monocytes. Now, by collecting these monocytic cells from the blood, we are able to determine if colorectal cancer cells are present in the body, either at the primary site (in the colon) or in distant organs (where cancer cells give rise to metastases). (M. Mazzone).

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Living Past 100 May Be In Your Genes

MedicalResearch.com Interview with: Thomas Perls, MD, MPH Professor Boston University School of MedicineMedicalResearch.com Interview with:
Thomas Perls, MD, MPH Professor
Boston University School of Medicine

Medical Research: What is the background for this study?

Dr. Perls:   For years now, Gerontology scholars continue to state that 25% of what they interchangeably call aging, longevity, life expectancy and life span is genetic and 75% is due to the environment and health-related behaviors. This assertion is based on Scandinavian twins reared apart, but the oldest participants in those studies lived to their 70s and 80s. Part of the problem here is the lack of consistency in what people mean by the terms Aging, Life Span and Longevity.

In fact, the Seventh Day Adventists, who generally have a high prevalence of healthy behaviors (vegetarian, daily exercise, eat in moderation, abstain from tobacco and alcohol, and activities that help manage stress well) have an average live expectancy of approximately 88 years. Yet, 7th Day Adventists are ethnically and racially heterogeneous and thus it appears that those healthy behaviors explain the vast majority of the variation in how old these people live to be. This finding is consistent with the optimistic view of the twin studies, that much of living to one’s 80’s is in our hands. Living to only our 50s-70’s is also in our hands (e.g. 75% behaviors) if we choose to smoke, eat red meat frequently, be obese, not exercise, be exposed to gun violence, have unsafe sex, do IV drugs, etc. So it is safe to say, in my opinion, that 75% of the variation in how old we live to be, is on average due to our behavior and exposure choices. The empowering and important point is that if we all lived like the Seventh Day Adventists, average life expectancy would increase almost 8 years and health costs would markedly decline because we would be getting to these older ages because we are healthier not because we are pouring more resources into more effectively treating diseases.

The New England Centenarian Study, which I direct, and a number of other studies of nonagenarians (people in their 90s) have demonstrated via direct genetic studies as well as studies of family trees where at least some family members get to these very old ages, that with older and older ages of survival beyond age ~95 years, variations in genetic profiles explain a greater and greater proportion of the variation in how old people live to be at these ages. So much so that I believe the findings to date are consistent with the roles of genes and environment being reversed for survival to age 106+ years, that is, 75% genetics and 25% environment/behaviors. This supposition is based upon several observations:

(1) as people reach the age of 105+ years, they become more and more alike in terms of what age-related diseases they get and when they get them. Consistent with Jim Fries; “Compression of Morbidity” hypothesis, people who survive to ages 110+ (called supercentenarians) and who therefore approximate the limit of human lifespan are on average disease and disability-free up until the last 5 or so years of their lives. This increasing homogeneity, especially compared to the increasing heterogeneity in the rates of aging and incidences of age-related diseases at younger percentiles or ages of survival, suggests underlying genetic similarities (similar genetic profiles) amongst groups of these supercentenarians; and

(2) the New England Centenarian Study previously discovered genetic signatures (made up of longevity-associated variations of about 130 genes) that were associated with surviving to age 106+ years with 80% accuracy, but with only 60% accuracy for accurately picking out people living to ~100 years. This increasing accuracy with older and older ages also suggests a stronger and stronger genetic influence upon survival to these rarest percentiles of survival.

With the above background, we set out in this study and subsequent paper, to

(1) assess sibling relative risk using the largest-ever collection of validated pedigrees of centenarians,

(2) to assess the risk of a sibling achieving the same age as their very old sibling (e.g. ages 95, 100, or 105+ years) relative to average people born around the same time, and

(3) to look at how when a person was born (eg before or after 1890) made a difference in these relative risks.

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Psoriasis: Effective Two Year Response to IL-17A Antagonist Cosentyx

Andrew Blauvelt, M.D., M.B.A. President and Investigator Research Excellence & Personalized Patient Care Portland, OR 97223MedicalResearch.com Interview with:
Andrew Blauvelt, M.D., M.B.A.
President and Investigator
Research Excellence & Personalized Patient Care
Portland, OR 97223

Medical Research: What is the background for this study? What are the main findings?

Dr. Blauvelt: A2303E1 is a multicenter, double-blind, randomized withdrawal extension to the FIXTURE and ERASURE pivotal phase III studies.  The purpose of this extension study was to collect additional long term efficacy, safety, and tolerability data on secukinumab (i.e., Cosentyx) in patients who demonstrated a PASI 75 response to Cosentyx at Week 52 of these core studies in moderate-to-severe plaque psoriasis.

In the extension phase, 995 patients who achieved Psoriasis Area Severity Index (PASI) 75 responses after 52 weeks of therapy received either Cosentyx 300 mg, Cosentyx 150 mg, or placebo for an additional year (Week 104).  After two full years of therapy in patients treated with Cosentyx 300 mg, almost 9 out of 10 (88.2%) patients maintained their PASI 75 response, 7 out of 10 (70.6%) had clear or almost clear skin (PASI 90), and 4 out of 10 (43.9) had clear skin (PASI 100) at Week 104.  For patients treated with Cosentyx 150 mg, 75.5% maintained their PASI 75 response, 44.6% had clear or almost clear skin (PASI 90), and 23.5% had clear skin (PASI 100) at Week 104.  In addition, 94.8% of patients who initially received placebo (at the start of the extension), and were switched to receive Cosentyx 300 mg after relapse, were able to achieve PASI 75 and 70.3% achieved PASI 90 within 12 weeks of re-starting Cosentyx. Continue reading

Chronic Rhinosinusitis Varies By Bacterial Microbiome

Vijay R. Ramakrishnan, MD Assistant Professor University of Colorado Department of Otolaryngology Aurora, CO 80045MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045

Medical Research: What is the background for this study? What are the main findings?

Dr.
Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.

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Mobile Health Technologies Will Change Chronic Disease Management

Ryan Jeffrey Shaw, PhD, MS, RN Assistant Professor School of Nursing Center for Health Informatics Center for Precision Medicine Duke University MedicalResearch.com Interview with:
Ryan Jeffrey Shaw, PhD, MS, RN

Assistant Professor School of Nursing
Center for Health Informatics
Center for Precision Medicine
Duke University

Medical Research: What is the background for this study? What are the main findings?

Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.

Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.

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Pediatric Meningococcal Vaccine Immunity May Wane By Adolescence

MedicalResearch.com Interview with:
Dr Fiona McQuaid

Clinical Research Fellow
University of Oxford, United Kingdom

Medical Research: What is the background for this study?

Response: Meningococcal B disease is a common cause of sepsis and meningitis
with significant mortality and morbidity. A multicomponent vaccine
against serogroup B meningococcus has been licensed for use in the
Europe, Australia, Canada and recently the USA (though only in the
10-25 years age group) but questions remain about how long the
bactericidal antibodies induced by infant vaccination persist and the
likely breath of strain coverage. This was a follow on study looking
at a group of children aged 5 years who had been vaccinated as infants
and a different group who were vaccinated for the first time at 5
years of age.

Medical Research: What are the main findings?

Response: The percentage of children with protective antibody levels who had
been immunized as infants fell in the 20 months since their last
immunization but this varied by the strain of meingococcus B tested
and by the different infant/toddler vaccination schedules.

The children who were vaccinated for the first time at 5 years of age
showed a good antibody response, but most reported pain and redness
around the site of vaccination and 4-10% had a fever.

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Study Finds Medicaid Improves Depression But Not Physical Health

Peter Muennig, MD, MPH Columbia University Mailman School of Public Health NYC 10032MedicalResearch.com Interview with:
Peter Muennig, MD, MPH
Columbia University
Mailman School of Public Health
NYC 10032

Medical Research: What is the background for this study? What are the main findings?

Dr. Muennig: The Oregon Health Insurance Experiment (OHIE) is one of just two experimental investigations of the health benefits of medical insurance. The first was the Rand Health Insurance Experiment, which was conducted over 3 decades ago. The OHIE randomly assigned participants to receive Medicaid or their usual care. It found that Medicaid protected families from financial ruin caused by medical illness, that it reduced depression, and that it increased preventive screening tests. However, it produced no medical benefits with respect to high blood pressure, diabetes, or high cholesterol. Medicaid opponents suggested that this meant that we should get rid of Medicaid because Medicaid does not improve physical health. But Medicaid proponents suggested that too few participants enrolled to detect a benefit, and, regardless of the study’s flaws, reduced depression, financial protections, and improved screening were reason enough to continue.

We found that the Medicaid opponents were right. Medicaid actually didn’t produce any meaningful benefits with respect to blood pressure, diabetes, or cholesterol. But we also found that the Medicaid proponents were right. It’s impacts on depression alone rendered it cost-effective even if one does not account for the benefits of financial protections or medical screening.
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Senna May Relieve Itching In Some Dialysis Patients

Mohammad Kazem Fallahzadeh Abarghouei, M.D. Baylor University Medical Center, Dallas, TXMedicalResearch.com Interview with:
Mohammad Kazem Fallahzadeh Abarghouei, M.D.
Baylor University Medical Center, Dallas, TX

Medical Research: What is the background for this study?

Response: Uremic pruritus (itch) is a common problem in hemodialysis patients. No effective treatment exists for uremic pruritus due to its complex pathogenesis. Systemic inflammation and elevated serum levels of interleukin-2 (IL-2) are implicated in the pathogenesis of uremic pruritus. Senna is an herbal drug commonly used for treatment of constipation. Senna also has anti-inflammatory properties. We performed this randomized double-blind placebo-controlled trial to evaluate the effect of senna on reduction of uremic pruritus and serum levels of IL-2 in hemodialysis patients.

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High Fluid Intake Reduces Risk Of New Kidney Stones

Wisit Cheungpasitporn, MD, Nephrology Fellow Program director: Suzanne Norby, MD Project mentors: Stephen B. Erickson, MD and John C. Lieske, MD Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MNMedicalResearch.com Interview with:
Wisit Cheungpasitporn, MD, Nephrology Fellow
Program director: Suzanne Norby, MD
Project mentors: Stephen B. Erickson, MD
and John C. Lieske, MD
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN

 

MedicalResearch: What is the background for this study?

Dr.Cheungpasitporn: Kidney stones are very common urologic problems. In addition, once someone has a kidney stone, the likelihood of having another episode increases to 50% within 5 years. Increased fluid intake has been suggested as a simple strategy for kidney stone prevention. However the data on conclusions regarding the benefit, adherence and safety of high fluid intake for the primary or secondary prevention of stones were limited. Thus, we conducted this meta-analysis to evaluate the treatment effect of high fluid intake on the incidence of kidney stones, and to assess the compliance and safety of high fluid intake to prevent kidney stones. Our data presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings may help improve clinicians’ ability to manage kidney stones.

MedicalResearch: What are the main findings?

Dr.Cheungpasitporn: Our meta-analysis included 9 studies with 273,954 patients. According to the findings of our study, individuals with daily high fluid intake (to achieve a urine volume of at least 2.0‒2.5 L per day) had lower risk of new kidney stones by approximately 50%. High fluid intake provided the same benefit in men and women. In addition, high fluid intake reduced the risk of recurrent kidney stones by 40%. Overall, high fluid intake is safe with low adverse events.

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Low Dose Vitamin C May Improve Iron Deficiency in Dialysis Patients

MedicalResearch.com Interview with:
Dr. Tanjim Sultana MD
Department of Nephrology
Lenox Hill Hospital New York

Medical Research: What is the background for this study? What are the main findings?

Response: Almost all dialysis patients are anemic. One quarter of patients requiring High dose Epogen have functional iron deficiency, which means they have adequate iron store but unable to utilize it. Vitamin C has been shown to mobilize iron from their storage and making it available to use in red blood cell production. Prior studies showed intravenous high dose vitamin C could increase hemoglobin levels and decrease epogen requirement. In our study we used daily low dose oral vitamin C in functional iron deficient patients to achieve the same goals. Patients taking daily low dose vitamin C for 3 months had significant decrease in their epogen dose compared to the control group.

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Vascular Calcification Can Predict Mortality in Predialysis Chronic Kidney Disease

Dr. José L. Górriz Department of Medicine and Nephrology Valencia Hospital Universitario Valencia. SpainMedicalResearch.com Interview with:
Dr. José L. Górriz
Department of Medicine and Nephrology
Valencia Hospital Universitario
Valencia. Spain

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Górriz: The background of the study is that several studies have reported on the high prevalence of vascular calcification in chronic kidney disease (CKD) patients not on dialysis. Vascular calcification (VC) has been associated with high cardiovascular mortality in patients on dialysis, but there are no studies in patients in stages before dialysis which analyse the prognostic significance of the presence of Vascular calcification assessed by simple X-ray.

Vascular calcification can occur in both the intima and media of the vessel wall. Intimal calcification is an indicator of atherosclerosis and is associated with ischemic heart disease and medial calcification is associated with arterial stiffness, systolic hypertension, and left ventricular hypertrophy.

Although Vascular calcification can be assessed by various methods, such as ultrasonography, tomography, and arteriography, simple radiology has the advantages of being simple, inexpensive, and commonly applicable in daily clinical practice.

OSERCE 2 is an observational, multicentre and 3-year prospective study performed in 39 Nephrology centres in Spain, which analyzes the presence of Vascular calcification in CKD patients stages 3 and 4 (eGFR between 15-59 ml/min/1,73 m2) and its effect on morbimortality (death, hospitalization and renal progression).

The main findings of the study were that Vascular calcification is highly prevalent in patients with chronic kidney disease, and Vascular calcification assessment using AS independently predicts death and time to hospitalization.

Therefore, it could be a useful index to identify patients with chronic kidney disease at high risk of death and morbidity as previously reported in patients on dialysis.

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Women, Young Drivers More Likely to Talk or Text While Driving

MedicalResearch.com Interview with:
Michelle Wilkinson, MPH

Doctoral Candidate Epidemiology
The University of Texas Health Science Center at Houston School of Public Health
Houston, TX 77030

Medical Research: What is the background for this study? What are the main findings?

Response: Cell phone use (CPU) while driving impairs visual awareness and reaction time, increasing frequency of near-collisions, collisions, and accidents with injuries. National prevalence estimates of driver cell phone use range from 5-10%. Medical and academic centers have large concentrations of young, ill, or elderly pedestrians and drivers, who are often unfamiliar with the congested environment. Drivers distracted by Cell phone use are a safety threat to pedestrians and drivers in these demanding environments. This study aimed to describe the prevalence and correlates of cell phone use among Texas drivers in major medical and academic centers, 2011-2013. This study found the overall prevalence of cell phone use while driving was 18%. The prevalence of Cell phone useand talking declined, while texting increased during the study period. Cell phone users were more likely to be female, <25 years old, and driving without a passenger.

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Anxiety Symptoms Raised by Air Pollution

Melinda C Power, ScD Post-Doctoral Research Fellow Epidemiology Department, Johns Hopkins Bloomberg School of Public Health Neurology Department, Johns Hopkins School of MedicineMedicalResearch.com Interview with:
Melinda C Power, ScD
Post-Doctoral Research Fellow
Epidemiology Department, Johns Hopkins Bloomberg School of Public Health
Neurology Department, Johns Hopkins School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Power: Air pollution may be related to mental health, particularly anxiety, through effects on oxidative stress and systemic inflammation or through promotion or aggravation of chronic diseases.  However, there has been very little research on the relation between air pollution exposures and anxiety in people.   Our study found that those with higher exposures to fine particulate matter, a type of air pollution, were more likely to experience elevated anxiety symptom levels.  Our study also suggests that recent exposures to find particulate matter air pollution are potentially more relevant to anxiety symptom levels than long-term past exposures.

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Imiquimod Cream May Be Effective In Primary And Adjuvant Treatment Of Lentigo Maligna

Susan Swetter, MD Professor of Dermatology and Director, Pigmented Lesion and Melanoma Program Stanford University Medical Center and Cancer Institute.MedicalResearch.com Interview with:
Susan Swetter, MD

Professor of Dermatology and Director, Pigmented Lesion and Melanoma Program
Stanford University Medical Center and Cancer Institute.

 

Medical Research: What is the background for this study?

Dr. Swetter: This retrospective cohort study sought to explore the role of the topical immunomodular – imiquimod 5% cream – as both primary and adjuvant therapy (following optimal surgery) for patients with the lentigo maligna subtype of melanoma in situ. Assessment of alternative treatments to surgery for this melanoma in situ subtype are warranted given the increasing incidence of lentigo maligna in older, fair-complexioned individuals in the United States. Surgical management of lentigo maligna is complicated by its location on cosmetically sensitive areas such as the face, histologic differentiation between lentigo maligna and actinic melanocytic hyperplasia in chronically sun-damaged skin, and potential surgical complications in the elderly who may have medical co-morbid conditions.

Medical Research: What are the main findings?

Dr. Swetter: We conducted a retrospective review of 63 cases of lentigo maligna in 61 patients (mean age 71.1 years) who used topical 5% imiquimod cream instead of surgery (22 of 63 cases, 34.9%) or as an adjuvant therapy following attempted complete excision (63 cases, 65.1%), in which no clinical residual tumor was present but the histologic margins were transected or deemed narrowly excised. Our study showed overall clinical clearance of 86.2% in the 58 patients analyzed for local recurrence at a mean of 42.1 months of follow-up (standard deviation 27.4 months), with primarily treated cases demonstrating 72.7% clearance at a mean of 39.7 months (standard deviation 23.9 months), and adjuvant cases showing 94.4% clearance at a mean of 39.7 months (standard deviation 23.9 months).  We found a statistically significant association between imiquimod-induced inflammation and clinical or histologic clearance in primary but not adjuvant cases, although this latter finding may be explained by a lack of residual atypical melanocytes or true LM in the adjuvant setting, in which wide local excision had already been performed.

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Prenatal Exposure To Air Pollutants May Produce Structural Brain Abnormalities

Dr. Bradley S. Peterson, M.D Director of the Institute for the Developing Mind The Saban Research Institute of Children’s Hospital Los Angeles Children’s Hospital Los AngelesMedicalResearch.com Interview with:
Dr. Bradley S. Peterson, M.D
Director of the Institute for the Developing Mind
The Saban Research Institute of Children’s Hospital
Los Angeles Children’s Hospital Los Angeles

Medical Research: What is the background for this study?

Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7.

Medical Research: What are the main findings?

Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy.  We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression.  Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability. Continue reading

Air Pollution Linked To Increased Risk Of Stroke

MedicalResearch.com Interview with:
Dr Anoop Shah

Cardiology Research fellow
Centre of Cardiovascular sciences
University Of Edinburgh Edinburgh

Medical Research: What is the background for this study? What are the main findings?

Response: Stroke accounts for five million deaths each year and is a major cause of disability. The incidence of stroke is increasing, particularly in low and middle income countries, where two thirds of all strokes occur. The global burden of stroke related disability is therefore high and continues to rise. This has been primarily attributed to an aging population in high income countries and the accumulation of risk factors for stroke, such as smoking, hypertension, and obesity, in low and middle income countries.  The impact of environmental factors on morbidity and mortality from stroke, however, might be important and is less certain.

From 103 studies and across 6.2 million fatal and non-fatal strokes, our findings suggest a strong association between short term exposure to both gaseous (except ozone) and particulate air pollution, and admissions to hospital for stroke or mortality from stroke. These associations were strongest in low and middle income countries, suggesting the need for policy changes to reduce personal exposure to air pollutants especially in highly polluted regions.
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