Boston Children’s Hospital Researchers Able To Bypass The Lungs By Using Injectable Oxygen

Researchers from the Boston Children’s Hospital managed to sustain life in rabbits with blocked tracheae through the use of oxygen-filled microparticles. They injected the particles into the blood stream of the rabbits and managed to keep them alive for almost 15 minutes without a real breath of air. Researchers say that if the novel method would be used in the emergency room, it would save countless more lives. The research team provides a new way to deliver oxygen to the bloodstream and tissues, by bypassing the lungs through the use of injectable oxygen.

Patients who are unable to breathe through their lungs, due to either lung failure or a type of obstruction, need an alternative way of getting oxygen into their bloodstream. Lack of oxygen can lead to brain injury and cardiac arrest. The research team says their new technique can delay the onset of brain injury, cardiac arrest or other tissue injuries that could be induced due to lack of oxygen.

Most of the previous techniques that were attempted in order to treat hypoxemia (an abnormally low concentration of oxygen in the blood) and cyanosis (a bluish discoloration of the skin caused by lack of oxygen in tissues) have had different success rates. Many of the previous techniques used free oxygen gas injections directly into the bloodstream. This is dangerous because the oxygen bubbles can aggregate and form gas bubbles that lead to pulmonary embolism, a lethal blockage.

oxygen

The current study was published in the journal Science Translational Medicine, reporting a new method that removes the danger of injecting free oxygen gas into the bloodstream.

The lead author of the study, Dr. John Kheir, from the Cardiology department of the Boston Children’s Hospital, and his team of researchers have designed a new microparticle that consists of a small pocket of oxygen gas surrounded by a single layer of lipids. The team explains that  pulmonary embolisms are averted because after the injection in the bloodstream, each gaseous oxygen particle is prevented from aggregating with the other particles, thus no large oxygen bubbles are formed.

According to the journal Nature, Dr. Kheir reports that once in the bloodstream, the oxygen particles mix with circulating red blood cells and the oxygen diffuses into these cells almost immediately after contact. The research team notes that their new microparticle technique is unlike any other type of artificial blood because it does not require oxygen to brought from the lungs. Dr. Kheir also added that after the oxygen dissociates from the fatty molecule, the molecule break off and can be easily reabsorbed by the organism.

The research team injected this new solution in rabbits and discovered that the test animals survived almost 15 minutes without any breaths of air. The blood pressure and heart rate of the animals was also tested and found to be normal. Furthermore, test conducted showed no heart, lung or liver damage, which are signs currently associated with oxygen deprivation. These symptoms can also be caused by the injection of free oxygen into the bloodstream.

“Essentially as soon as we started injecting it, clinically we started to see an effect” said Dr. Kheir. However, Dr. Kheir notes that the oxygen levels drop as quickly as they rise, after the injection is stopped, thus meaning that the microparticles must be continuously injected in order to obtain a prolonged effect.

The research team notes that this new microparticle solution is portable, and more importantly, cheap to make, therefore it can be used in emergency situations to stabilize the patient, thus allowing doctors to perform other urgent therapies.

“This is a short-term oxygen substitute”a way to safely inject oxygen gas to support patients during a critical few minutes. Eventually, this could be stored in syringes on every code cart in a hospital, ambulance or transport helicopter to help stabilize patients who are having difficulty breathing”, said the lead author of the study.

A drawback of the technique is that these microparticles can only be administered for a maximum of 30 minutes. This is due to the fact that the microparticles are injected along with a liquid solution. Administering fluids for longer periods of time would overload the bloodstream.

According to the journal Science, Dr. Kheir said that if the team manages to increase the ration of microparticles to fluid, it would allow doctors to inject the solution for a longer period of time.

Dr. Peter Laussen from the Boston Children’s Hospital says that this potential breakthrough can have many uses across the field of medicine, from emergency rooms and intensive care units, to operating rooms and battlefields.

Sleeplessness As New Breast Cancer Risk Factor

Lack of sleep has been associated with aggressive forms of breast cancer, according to a study. Researchers from University Hospitals Case Medical Center’s Seidman Cancer Center and Case Comprehensive Cancer Center at Case Western Reserve University, conducted a study which shows that there is a link between lack of sleep and cancer aggressiveness. They gathered data from the 412 post-menopausal breast cancer patients who were treated at UH Case Medical Center. They interviewed patients enrolled in the study and found that they slept 6 hours a night (on average) over the past two years. Dr. Thompson, who is Assistant Professor at Case Western Reserve University School of Medicine and lead author, said this is the first study showing the relationship between the number of hours of sleep per night and cancer aggressiveness. She added that a smaller number of hours of sleep per night is associated with cancer recurrence. In addition, she said that more studies are needed to deepen this discovery.

Sleeplessness

Another finding was that the relationship between the number of hours of sleep and cancer aggressiveness is only in post-menopausal women, and not in pre-menopausal women. Therefore, researchers believe that sleep may influence pathways involved in carcinogenesis, especially in post-menopausal women.

There are other lifestyle factors involved in breast cancer. For example, smoking was associated with breast cancer. It is believed that breast cancer risk increases with the number of cigarettes smoked. Also, as earlier started smoking, the cancer risk is higher. Lack of physical activity is also a risk factor. Obesity, fat diet, oral contraceptives have been incriminated as risk factors for breast cancer. Besides lifestyle, there are hereditary factors. The most common mutations are those of the BRCA1 and BRCA2 genes.

Breast cancer is the most common cancer in women, and is responsible for half a million deaths each year. Method of screening are breast examination and mammography. Signs and symptoms of breast cancer are changes in the breast, nipple retraction or skin appearance such as orange peel. The presence of a lump in the breast is an important sign. It is therefore important palpation and visual examination of the breasts.

Short sleep duration is involved not only in cancer but also in other diseases such as diabetes, obesity, heart disease.  Li Li, MD, PhD, a study co-author, pointed out that increasing the number of hours of sleep could be a way to reduce the risk of developing aggressive forms of cancer.

Pain During Intercourse

Pain during intercourse is a problem each day, women from all around the world are forced to deal with. In medical terms, pain during intercourse is called dyspareunia, a condition that can be treated after seeking medical advice. Dyspareunia or pain during intercourse is manifested by different sensations of discomfort or pain, that appear and disappear during intercourse or even after. When the pain is not so intense it only affects the vulva and the opening of the vagina.

Types of pain during intercourse

There are many types of pain  namely:

• Primary pain during itercourse- appears after the first intercourse;
• Secondary pain during intercourse – appears after a certain period, the woman had a sexual relationship but the pain is caused by psychological trauma;
• Superficial pain during intercourse- appears at the beginning of penetration;
• Deep pain during intercourse – occurs when the penetration is complete.

Pain During Intercourse

Superficial pain during intercourse is manifested by early discomfort, at the beginning of the intercourse, discomfort felt  in the vulva, with burning and stinging sensations. The causes are vaginal infections, irritation, trauma, radiation therapy and in most of the cases  insufficient lubrication.

Causes of Pain During Intercourse

There are many possible causes that can leat to pain during intercourse, which vary depending on the nature of the disease.

The superficial causes of pain during intercourse are:

• Lubrication failure – due to a short prelude, for women who have passed to menopause due to the low estrogen levels;
• An inflammation or infection in the genital area – they can affect the vulva or vagina
• Urinary tract infections;
• Genital herpes
• Allergic reactions to latex condoms;
• Surgery;
• Antihistamines (drugs against allergies) – causes temporary dryness of the vagina;
• Menopause – one of the most common causes as vaginal thinning and estrogen level decrease (this phenomenon is called atrophic vaginitis care)

Profound causes of pain during intercourse

• Infection or inflammation of the cervix (cervicitis), uterus or fallopian tubes
• Endometriosis (inflammation of the uterus);
• Pelvic tumors;
• Ovarian cysts;
• Uterine prolapse;
• Radiation – used in cancer treatment.

Psycho-social causes of pain during intercourse

The psycho-social causes of pain during intercourse are special cases, except those specific to each type of dyspareunia. Most women who have been victims of sexual abuse usually suffer from pain during intercourse. Moreover, these women may suffer from vaginismus. Vaginismus is a condition that is manifested by involuntary spasms of the vagina, making penetration painful or impossible. Fear, anxiety, fear of pregnancy, religious considerations – are all factors that may prevent arousal and lubrication, hence the pain that can sometimes be unbearable. Marital and psychological problems such as depression are common causes of pain during intercourse, that of erectile dysfunction. Women whose partners are distant or negligent have a normal reaction by the lack of sexual attraction to partners, while men in similar situations, may experience erectile dysfunction and even impotence.

All these factors must be made aware at first through a personal evaluation of the situation made by the person concerned, then by a discussion with a specialist. Untreated in time, pain during intercourse will make sexual activity to be associated strictly with pain, and interest in intercourse would drop dramatically.

 Pain During Intercouse Treatment

Mild pain during intercourse, which usually occurs during penetration  can be minimized by applying an ointment with anesthetic effect. It is also helpful to apply a water based lubricant before intercourse. Why water-based lubricants? Because oil-based ones can affect the quality of contraceptives such as condoms or diaphragms. For better lubrication of the vagina, enough attention to foreplay and deep pain can be lessened or eliminated by careful choice of positions during intercourse.

Pain during intercourse due to menopause and all that implies it can be treated with estrogen-based creams ( hormone replacement therapy). Inflammation and / or an infection is treated using antibiotics or antifungal drugs. In case of inflammation of the vulva, , wet compresses with aluminum acetate solution are verry effective. Surgery removes cysts or abscesses and can even repair some anatomical abnormalities relieving the pain during intercourse.

Last but not least, couple psychotherapy can be very effective in identifying negative or pessimistic attitudes about intercourse and improve communication between the couple, thus solving the problems that can cause the appearance of pain during intercorse.

Dry And Itchy Skin

Dry and itchy skin occurs along with age when the skin produces less and less oily substances hat help maintain a specific humidity of the skin. The dry room air can cause the skin to become dry and itchy, so as excessive bathing in hot water.

Dry And Itchy Skin Prevention

Dry and itchy skin can be avoided by avoid excessive showers. They remove the oily substances that keep the skin moisturized. Baths have a drying effect on skin much less pronounced than showers. When you take a shower or a bath be sure to use bath oils, soaps with a pH close to that of the skin and also use of lotions or moisturizer after bathing. This way you will not get your skin dry and itchy.

Hand Dry And Itchy Skin

Dry And Itchy Skin Treatment

• Following these steps may be useful for treating dry skin and itching skin. For very dry hands it is recommended that in the evening before going to bed to apply a thin-film of oil and cream and wear thin cotton gloves overnight (this method can be also applied for legs with dry skin and brittle nails). Avoid scratching the skin which defenetly causes damage. In this case we recommend keeping the area moist as when the skin is dry the itching increases. You can also use an oatmeal bath that reduces itching (use one cup of oat that is wrapped in cotton cloth, quantity that is boiled, and this improvised sponge is used for bathing in warm water along with soap. You can also use commercial products). Use 1% hydrocortisone cream, which does not require a prescription and which can be applied to more restricted itchy areas, it is recommended to apply it carefully on the face and the genitals area. If the itchy skin persists or becomes more severe, a cream that is available only on prescription will be recommended by your physician.
• Use of non-prescription antihistamines such as diphenhydramine or chlorpheniramine malate.
• Cutting fingernails short and wear gloves at night to prevent scratching.
• Wear clothes made of cotton or silk and avoid wool or acrylic especially for clothing items that come in contact with the skin.

Cotton Gloves For Itchy Skin

It is recommended for you to see a doctor if the itching of the skin has generalized (whole body) with no apparent cause or a skin rash appears. You must also see a doctor if the itching is severe, preventing you from sleeping and the home treatment is ineffective, serious skin lesions occur due to scratching, signs of skin infection such as pain, swelling, redness, warmth or tenderness, red stripes that start at this level, pus, fever over 37.8 degrees C without any apparent cause, swollen lymph nodes (glands) near the infected area of the neck, axillae (armpit) or groin.

Epilepsy Seizures

Epilepsy is a lifelong and debilitating disease which is characterized by uncontrollable, recurrent and spontaneous seizures.  It is a disease with potential complex consequences (economic, social, psychological) that affect both the patient and its family. Epilepsy is a chronic cerebral disorder characterized by recurrent and spontaneous seizures that are typically unprovoked and unpredicteble. An epilepsy seizure represents a transient episode of supratentorial origin, characterized by an abrupt and temporary alteration of cerebral function, due to an abnormal paroxysmal discharge of cerebral neurons caused by cortical hyperexcitability.

Being a chronic cerebral disorder, its treatment should avoid the causes that may trigger a seizure. This approach include general lifestyle measures including diet, hypoglycemia avoidance and a balanced physical activity. Patient should also avoid sleep deprivation, alcohol intake, drugs or caffeine intake. Potential dangerous activities that may generate accidents during a seizure, such as working at altitude, near thermal sources should also be avoided.

Epilepsy Seizures

Each country has specific legal regulations that include rights and limitations for an epileptic patient regarding professional activity choices, car driving, cost free medication and others.

Epilepsy Seizures Medical Treatment

Epilepsy medical treatment is continuous and consist of drugs which should be chosen according to the type and frequency of crisis. Treatment must be administrated at least 2-3 years after the last seizure and after this period, according to the individual context, the dose can be gradually reduced. In cases where initial therapy correctly chosen is not efficient, an second anticonvulsant drug should be added.

Antiepileptic drugs poses multiple action mechanisms that include blocking the activation of sodium channels, enhancing GABA (gamma aminobutyric acid) receptors, glutamate modulators, calcium channels blockers, carbonic anhydrase inhibitors, neuronal potassium channel openers. In practice, most used antiepileptic drugs are:

Valproic acid

Valproic acid and its salts poses an inhibitory action on voltage dependent sodium channels and an enhancing activity on GABA receptors. Major indication is represented by idiopathic generalized epilepsy, but is effective in partial epilepsy seizures too. Adverse effects are represented by gaining weight and it was proven that poses teratogenic effects (capability of producing fetal malformation).

Carbamazepine

Carbamazepine has a modulator effect on voltage dependent sodium channels and is indicated in partial epilepsy seizures which may become generalized. Is not indicated in idiopathic generalized epilepsy because may worsen the absence epilepsy crisis and myoclonus.

Oxacarbazepine

Oxacarbazepine is a carbamazepine analouge which acts by inhibiting sodium channels and by modulating potassium channels. This drugs has the same indication as carbamazepine, but with considerably less side effects.

Epilepsy Treatment

Fenitoin

Fenitoin is indicated both in generalized and focal epilepsy seizures and presents important side effects such as gum hypertrophy, cardiac rhythm disturbances, cerebellar toxicity and facial hair growth. Injectable form is used in status epilepticus treatment.

Phenobarbital

Phenobarbital is useful in all forms of epilepsy, except typical absence seizures. Currently is more useful as an emergency therapy and side effects are represented by sedation and cognitive impairments.

Ethosuximide

Ethosuximide acts by reducing the calcium influx in thalamic neurons and is indicated exclusively in absence epilepsy seizures.

Lamotrigene

Lamotrigene is indicated all type of epilepsy seizures and presents minimal impact on cognitive functions and minimal teratogenic effect, therefor is indicated in pregnant women.

Epilepsy Seizures Surgical Treatment

Surgical procedures are reserved for cases with refractory epilepsy seizures to any drug combination correctly chosen and in maximal dose and for repeated seizures that influence patient’s life quality.

Epilepsy Surgery

Brain surgery procedure for epilepsy are palliative and potential curative and are represented by:

• Anterior callosotomy, represented until few years ago the most common palliative procedure in patients with intractable atonic seizures with facial and neck injures due to a fall. This procedure was replaced by vagal nerve stimulator.
• Lobectomy and lesionectomy (surgical removal of lesions), because 25% of patients present lesions identified by MRI which can cause seizures. This lesions are represented by: low grade astrocytomas, cortical dysplasias, cavernous angiomas, and areas of focal atrophy.
• Temporal-lobe surgeries are reserved for cases with temporal epilepsy.

Chronic Kidney Disease And  Cellular Inability to Repair Damaged DNA

A new study led by Friedhelm Hildebrandt, from the Howard Hughes Medical Institute, shows that chronic kidney disease can be caused by genetic mutations that hinder the ability of the cell to repair the damaged DNA.

Chronic kidney disease is one of the major health problems in the United States, however, a cure for the disease has not yet been discovered. Dr  Hildebrandt and his team of scientists have discovered a connection between mutations of four DNA repairing genes and the onset of chronic kidney disease.

Due to the fact that the mutations of these genes causes cells to be more sensitive to genetic damage, the team of researchers suggest that environmental toxins are contributing to the higher prevalence of chronic kidney disease. The findings of the team were published in the journal Nature Genetics and Cell. The four genes discovered to be linked to chronic kidney disease are FAN1, MRE11, ZNF423 and CEP164.

In an attempt to find the causes of kidney disease, Dr Hildebrandt  has been gathering genetic information from over 5,000 families for the past 15 years. All of the families had members with kidney disorders beginning in their childhood. After analyzing the gathered data, the research team found that the mutation of a single gene can cause some of the types of kidney disorder. However, most of the chronic kidney disease causes are still unknown.

Several years ago, Dr Hildebrandt started using a new approach for rare mutation searching. This new approach consisted of two technologies. The first technology, called whole exome sequencing, specifically examines the genetic sequence that codes the proteins. Through the use of the whole exome sequencing, scientists avoided the cost and time needed to sequence the rest of the genome.

In order to find the mutations that are more likely to cause kidney failure, Dr Hildebrandt continued the exome sequencing process with a method called homozygosity mapping. For recessively inherited diseases the technique is able to identify the disease-causing mutations. Dr Hildebrandt used this technique in order to reduce the DNA variations that resulted after the exome sequencing, thus being able to identify the single gene that caused kidney failure for each examined patient.

Chronic Kidney Disease

 Researchers investigated the genetic sequence of fifty families over the entire course of a year. They found that mutations in four genes – FAN1, MRE11, ZNF423 and CEP164 – were associated with kidney failure.

The first mutation investigated by the researchers team was that of the FAN1 gene. This mutation was found in the exome sequence of two siblings suffering from karyomegalic interstitial nephritis. This disease causes an early onset of kidney failure. In order to find out if karyomegalic interstitial nephritis was caused by the same mutation in other patients as well, Dr Hildebrandt screened their DNA as well. “In nine out of ten patients, we saw that there were mutations in FAN1”, he reported.

The FAN1 gene was first discovered by Steve Elledge in 2010. It was found then that the gene is involved in the repairing of damaged DNA.

The researchers used a similar method to link the mutations in the CEP164, ZNF423 and MRE11 genes to chronic kidney disease. After testing the genes from laboratory rats and zebra-fish, they found that the mutations of these genes led to the inability of the cells to repair damaged DNA. The team led by doctor Hildebrandt also collaborated with Bruce Hamilton, Rachel Giles and Agata Smogorszewska, from the University of California – San Diego, the University of Utrecht and the Rockefeller University, respectively.

The role of the DNA repair system is to fix minor defects that are the result of either replication or environmental factors. The failure of this system leads to abnormalities in cellular function. This is for the first time that the DNA repair mechanism is associated with chronic kidney disease. However, the connection between them is unclear.  “It can take decades to draw a line from the primary defect to what the disease does to the organism or the human”, said Dr Hildebrandt, whilst adding that a possible explanation is that DNA damage leads to cellular degeneration. His hypothesis could explain chronic organ failure in general, not just chronic kidney failure.

HIV And Arterial Inflammation

Researchers at Massachusetts General Hospital found that there is a high degree of vascular inflammation among patients with HIV without having cardiovascular risk factors. They found that these patients had a degree of inflammation of arteries comparable to those with cardiovascular disease. Steven Grinspoon, MD, director of the MGH Program in Nutritional Metabolism and a member of the Neuroendocrine Unit, the study’s principal investigator, said the new data suggests the mechanisms by which the activation of the immune system leads to a vascular inflammation and an increased cardiovascular risk of complications in patients with HIV. The study will be published in a special issue of JAMA in conjunction with the International AIDS Conference.

Arterial Inflamation

The cardiovascular risk refers to complications that can occur in the heart or the blood vessels. Cardiovascular complications include myocardial infarction, stroke, peripheral arterial disease, angina, heart failure, etc.. It seems that HIV infection increases cardiovascular risk by increasing inflammation in the arteries and increasing cholesterol levels. These changes play an important role in forming plaque lesions that can cause heart attack or stroke. It is known that HIV alters the immune system by infecting helper T lymphocytes. This results in immune suppression and significant increase in the risk of infections and cancer.

Researchers conducted a study on 81 individuals: 27 of them had HIV infection and no cardiovascular disease but were receiving antiretroviral therapy, 27 people were uninfected and without cardiovascular disease, and 27 people were uninfected but with atherosclerosis. All the 81 study participants were examined with PET and CT scans. The results showed that people with HIV infection without known cardiovascular disease had a level of vascular inflammation comparable to those with cardiovascular disease. Following investigations,  researchers found that patients with HIV infection had increased CD163, a marker of inflammation. CD163 is in fact a marker of monocytes activation which are involved in the formation of unstable plaque. These plaques are more susceptible to rupture, and therefore more dangerous. Rupture of these plaques can lead to a heart attack.

Scientists also took into account traditional risk factors for cardiovascular disease, that is abdominal obesity, hypertension, smoking, high cholesterol. Now, besides these risk factors should be taken into account also arterial inflammation. Researchers believe that if investigations such as PET or CT scans cannot be used as screening method, measuring levels of inflammation marker CD163 may be useful for determining cardiovascular risk among HIV positive patients. Grinspoon, professor of Medicine at Harvard Medical School, believes that the new target to reduce inflammation in HIV positive patients could be monocytes activation, namely CD163.

Parkinson Disease Treatment

The goal of medical treatment in Parkinson disease is to control signs and symptoms for as long as possible, while the adverse effects of drugs should be minimized. Medical treatment for Parkinson disease include levodopa, dopamine agonists, anticholinergic medication and other therapeutic agents.

Levodopa

Levodopa is considered the most effective drug for Parkinson disease. Is a precursor of dopamine. The indication of using this drug is represented by the biochemical imbalance produced by depletion of dopamine in the nuhcleus striatum. Levodopa can be combined with peripheral dopa decarboxylase inhibitor such as carbidopa or benserazide, in order to prevent its fast destruction and to achieve a better control of the symptoms with a low doses of levodopa.

Levodopa relieves disease symptoms, but with prolonged use of the drug and the disease progression will appear  the wearing off phenomenon (a gradually decrease in the efficiency of the drug before the administration of the next dose).

Levodopa adverse effects are important,  being represented by involuntary movements, labial dyskinesia, lingual, trunk, neck and limbs dystonia, grimacing and head movements. May also occur orthostatic hypotension, depression and the possibility of worsening a preexisting depression. Other adverse effects are represented by hyperexcitability and aggression.

Parkinson Disease Treatment

Secondary phenomena usually occur at high doses of levodopa, after a long term therapy. If adverse effects appear at low doses, combination with other dopaminergic agents such as amantadine or bromocriptine is recommended. It is believed that long-term evolution of Parkinson disease is not influenced by treatment with levodapa, even administered from the early stages of the disease. Degeneration of substantia ningra cells progresses and after years of  Parkinson disease evolution, drug efficiency is decreasing and in 80% of patients will appear dyskinesias and fluctuations in drug response or on-off phenomenon.  On-off phenomenon is a state in which patient passes within a few minutes from a state of relative mobility to a complete immobility, akinesia, hypotonia, which may last from 30 minutes to several hours, state that is not modified by the next dose of levodopa. The cause is unknown, although it was observed that off phenomena are correlated with low plasma levels of levodopa concentration.

Inhibitors of catechol-O-methyl transferase (COMT)

Inhibitors of catechol-O-methyl transferase (COMT), represented by tolcapone and entacapone are adjuncts for levodopa treatment. Are recommended in patients with Parkinson disease who present wearing off phenomena, in order to prolong the response to levodopa.

Dopamine agonists

Bromocriptine is an ergotamine derivative that stimulates dopamine receptors. It is used in combination with levodopa in Parkinson disease cases associated with dyskinesias or on-off phenomena and allows lower levodopa doses. As side effects were reported nausea, vomiting, hypotension, confusional states and hallucinations.

Pergolide or lisuride is also a ergotamine derivative used as an adjunct drug to cases that do not respond satisfactorily to levodopa. Pramipexole and ropinirole are other dopamine receptor agonist that directly stimulates dopamine receptors. Adverse effects of these drugs are represented by nausea, vomiting, hypotension, hallucinations.

Anticholinergic medication

Are used for a longtime as initial therapy for Parkinson disease in order to counteract the predominance of cholinergic system induced by dopamine deficiency. Synthetic anticholinergics are represented by artane, cogentin and biperiden, being useful in tremor control. Side effects are represented by dry mouth, blurred vision (mydriasis), dizziness, constipation, urinary retention, worsening of an untreated glaucoma, confusional states and hallucinations.

Amantadine

It is an antiviral agent that stimulates dopamine release in the striatum nucleus neurons and also present anticholinergic effects. It is useful in controlling hypokinezia, rigidity and tremor, the beneficial effects of the drug appear immediately after initiation of therapy. It is recommended to be administrated on newly diagnosed cases or on patients who present intolerance on effective doses of levodopa. Amantadine may be associated with levodopa or anticholinergic treatment. Side effects are represented by lower limb edema, congestive heart failure, livedo reticularis, urinary retention and visual hallucinations.

Parkinson Disease Treatment

Selegiline

Is an monoamine oxidase B  inhibitor (IMAO-B), being used in early forms of Parkinson disease. It inhibits the metabolic degradation of intracerebral dopamine. Selegiline can be associated with levodopa treatment, but should not be associated with antidepressant medication. Selegiline also have neuroprotective effect.

Surgical Treatment

Surgery in Parkinson’s disease has two objectives: to suppress certain clinical signs, especially tremor and compensate dopamine deficiency. Surgical options are sterotactic interventions and consists of ablation procedures and chronic stimulation of certain brain structures: the ventral intermediate thalamic nucleus, subthalamic nucleus and globus pallidus.

Pallidototmy (globus pallidus surgical removal) was practiced for dyskinesias and motor fluctuations induced by medical treatment. Thalamotomy (thalamus surgical removal), after certain statistics, improved tremor and reduced rigidity in 90% of patients and has little effect on bradykinesia, rigidity, motor fluctuations or dyskinesia. Bilateral thalamic interventions have a high incidence of speech disorders (dysarthria) and are not recommended.

Neural transplantation could represent a potential treatment for Parkinson disease and consist of  implantation in putamen and caudate nucleus of autologous adrenal medullary cells or of fetal porcine adrenal medullary cells. Investigations on the usefulness of these methods are still in progress.

 Recommendatuions For Unstable Angina

According the new guidelines issued by the American Heart Association  (AHA) and the American College of Cardiology (ACTA) Foundation, an antiplatelet agent, ticagrelor (Brilinta) , should be administered along with clopidogrel or prasugrel. So far ticagrelor was recommended to moderate to high risk patients for ischemic events, even if patients were previously treated with clopidogrel ( which would be stopped at the beginning of ticagrelor).

The new changes that have focused on the treatment of unstable angina and NSTEMI (non ST myocardial infaction) were published in the Journal of the American Heart Association and the Journal of the American College of Cardiology. According to the guidelines, the drug of first choice given to patients with unstable angina (or stable) is aspirin. If aspirin is not tolerated,  prasugrel is recommended for all patients undergoing coronary interventions . If patients receive medical therapy or undergoing invasive surgery, then they can receive either ticagrelor (Brilinta) or clopidogrel. Also an invasive intervention require both aspirin and other antiplatelet agent.

Ticagrelor

Regarding duration of therapy, aspirin should be taken for life and clopidogrel or ticagrelor should be taken 12 months. Hani Jneid, M.D., lead author of the update and an assistant professor of medicine and director of interventional cardiology research at Baylor College of Medicine, and an interventional cardiologist at the Michael E. DeBakey VA Medical Center in Houston, said that these updates in guides are useful for clinicians to make treatment as appropriate and as aggressive to patients in order to improve quality of life and  survival.

Unstable angina and NSTEMI are part of what is called acute coronary syndrome, a condition that is due to decreased oxygen supply to the heart. Diagnosis is based on electrocardiogram and troponin measurements, which are increased in NSTEMI. Stable angina and unstable angina has different features . In unstable angina, unlike stable angina, chest pain may occur at rest, lasts longer than 15-20 minutes, and is more intense. Risk stratification is based on several parameters, such as recurrent chest pain, ECG changes, troponin, age, other diseases (renal failure, diabetes). Treatment that is given to patients with acute coronary syndromes consists of anti-ischemic drugs, anticoagulants, antiplatelet and revascularization. Aspirin, clopidogrel, prasugrel and ticagrelor are drugs with antiplatelet effects. Unlike the last three, aspirin inhibits cyclooxygenase, an enzyme that helps to form thromboxane A2.

Clopidogrel, prasugrel and ticagrelor are inhibitors of ADP receptor (P2Y12), that is inhibits a process that is involved in platelet aggregation. All these drugs are important in the treatment of cardiac patients because they  prevent thrombus formation that can lead to heart attack. Ticagrelor, unlike clopidogrel and prasugrel, is reversible, and active since the time of administration. It takes effect in 30 minutes, duration of effect is 3-4 days and should be removed 5 days before major surgery.

Early Detectable Biological Changes That Precede Alzheimer’s Disease Symptoms Discovered

A study published in The New England Journal of Medicine reveals interesting findings on Alzheimer’s disease.
The study, called Dominantly Inherited Alzheimer Network (DIAN) study  included patients at risk to carry mutations for autosomal dominant form of Alzheimer’s disease. All patients included in the study had a family member with Alzheimer’s disease.  All the 128 patients underwent imaging tests, biochemical, clinical and neuropsychological assessments. Of 128 participants, 88 were carriers of mutations for dominant for of Alzheimer’s disease and 40 participants were noncarriers. It was also observed that participants with autosomal dominant inheritance pattern presented mutations in PSEN1, PSEN2, and APP genes. After analyzing the results of paraclinical assessments, researchers found that 50% of the carriers were asymptomatic at the time of the study.

Alzheimer’s disease is a degenerative neurological disorder that affects  most frequently older people. The disease is manifested by memory loss, behavioral disorders and cognitive impairment. In later stages, patients present depression, hallucinations, they become agitated and hardly recognize their family members. Alzheimer’s disease is a slowly, progressive and irreversible neurological disorder.  Current treatment of the disease slows disease progression and  improve symptoms. Alzheimer’s disease has an impact not only on the person affected but, also on the family members who must take care of the patient.

Alzheimer’s Disease

Alzheimer’s disease present two forms: a form with early-onset and a form with late-onset.  Early-onset form of Alzheimer’s disease has a poor prognosis and a rapid evolution. Patients with early-onset form of the disease present a positive  family history for Alzheimer’s disease. Late-onset form is the most common form of Alzheimer’s disease, being  also called sporadic form of Alzheimer’s disease. However,  Alzheimer’s disease must be differentiated from mild cognitive impairment, which is considered to be a precondition of Alzheimer’s disease. Mild cognitive impairment is a type of forgetfulness  specific to elderly people. It is known that not every patient with mild cognitive impairment will develop Alzheimer’s disease.

In this study, participants were subjected to paraclinical investigations that are targeting directly the specific changes  for Alzheimer’s disease: atrophy of the hippocampus atrophy, amyloid beta protein present in cerebrospinal fluid. Participants cognitive functions were assessed by neurological examination and by using Clinical Dementia Rating  (CDR) scale. Researchers found significant differences between carriers and noncarriers.  This differences were obvious in neuropsychological tests (Mini-Mental State Examination, MMSE) because carriers presented significant cognitive impairment compared with noncarriers. Brain imaging examination revealed  that carriers presented bilateral hippocampal atrophy. It was also observed that carriers presented elevated levels of beta amyloid protein and elevated levels of tau protein (a structural protein of the brain cells)  in cerebrospinal fluid. Other investigations focused on brain glucose metabolism and amyloid deposition with similar results. All this structural and biochemical modifications occur with 15-20 years before disease onset.

With this study, scientists found that the period of time between brain structural modification and the onset of Alzheimer’s disease is prolonged, for example plaques can be seen on brain scans with 15 years before onset of memory problems and for this reason further therapies should target these early changes in order to prevent symptoms emergence.