Prolonged Pregnancy Linked To Behavioural Problems Later In Life

According to a study published in International Journal of Epidemiology, post term  babies are more likely to develop behavioral problems later in life. The study draws attention not only on the importance of calculating the exact age of the baby but also the possible link between prolonged pregnancy and behavioral disorders occurring in post-term babies.

Prolonged pregnancy is considered a pregnancy over 42 weeks. Normal pregnancy lasts 40 weeks, ie 280 days, starting with the first day of the last period (for a normal and regular menstrual cycle). The causes of prolonged pregnancy remain yet unclear. It seems that the factors involved are maternal, fetal and genetic. It was found that women at their first pregnancy have a higher risk of prolonged pregnancy, women also too young or too old have a higher risk of prolonged pregnancy. The longest recorded pregnancy in literature lasted 1 year and 24 days and the baby was born with anencephaly (no brain).

Prolonged Pregnancy

Usually, pregnancies over 42 weeks are associated with infants with malformations or abnormalities of the nervous system. However, prolonged pregnancy involves an increased risk of perinatal mortality.

Recently, researchers have found that babies born over 42 weeks recored a higher incidence of behavior problems than their normal peers born at term. Hanan El Marroun, the author of the study entitled ‘Post-term birth and the risk of Behavioural and emotional problems in early childhood,’ said these children have also a higher risk of having ADHD (attention deficit hyperactivity disorder). It is very important for future studies to establish causal relationship between post-term birth and impaired behaviour.

Scientists conducted a prospective cohort study, that analyzed the cases of women who gave birth between April 2002 and January 2006 in Rotterdam. Of the 5145 babies, 382 (7%) were born post-term and 226 (4%) were born pre-term. Pregnancy age was established by ultrasound, and children were analyzed at 18 and 36 months using a standardized questionnaire completed by parents.

Researchers found that children born preterm and post term had behavioral problems. As Hanan Marroun, the author of the study,  mentions, further studies must be conducted to identify the cause of prolonged pregnancy and the connection between it and behavioral disorders in children. There are several assumptions that were under discussion. One of them is aging of the placenta which may not provide sufficient intake of oxygen and nutrients to the fetus after 42 weeks. Other causes are represented by endocrine disorders or maternal stress in certain key points of fetal development that can result in neuroendocrine abnormalities and may trigger behavioral disorders in children later in life.

Researchers found that patients with atrial fibrillation have a better prognosis when their atrial fibrillation is treated surgically during cardiac surgery. The study was led by Northwestern Medicine and was published in the Journal of Thoracic and Cardiovascular Surgery.

Atrial Fibrillation

Atrial fibrillation is a heart rhythm disorder characterized by absence of the atrial systole (the atria no longer contract as it should). Atrial fibrillation on an electrocardiogram is defined by the complete absence of P waves and irregular rhythm. This condition should not be confused with atrial flutter, which looks similar but shows a regular rhythm. Atrial fibrillation involves the rapid and irregular contraction of atria with a very high rate of 300 beats per minute. However, the ventricles will take fewer pulses due to the atrioventricular node. Installation is completely asymptomatic or patients feel palpitations. Also, an important sign is the pulse deficit. Sometimes, patients complain of dyspnea or pain. Once installed fibrillation can be maintained or the patient can return to normal rhythm spontaneously. There are cases in which the atrial fibrilation fails to resolve spontaneously and then we  speak about permanent atrial fibirlation. There are several conditions that predispose to atrial fibrillation such as mitral stenosis, a valvular heart disease characterized by narrowing of the orifice of mitral valve . Due to a very narrow hole the left atrium can not send the required blood in the left ventricle , therefore the left atrium is dilated, which predisposes to arrhythmias. If the patient reaches the hospital shortly after the onset atrial fibrillation, it can be converted to sinus rhythm by electrical defibrillation. It should be noted that electrical defibrillation is performed only in patients who have no thrombus in the left atrium. Another method is the pharmacological cardioversion using antiarrhythmic drugs.

Heart surgery

Richard Lee, MD, surgical director of the Center for Heart Rhythm Disorders at Northwestern Memorial’s Bluhm Cardiovascular Institute, said that patients with atrial fibrillation should be converted to normal rhythm by surgery. Currently only 38% of patients with atrial fibrillation are treated simultaneously during surgery. “By fixing two issues at once, we can improve Patient outcomes.” Dr. Lee said.

Atrial fibrillation requires chronic treatment with oral anticoagulants. These drugs are necessary for lysis of blood clots formed in the atria. If treatment is not followed, the risk of stroke is very high. Therefore, returning to a normal heart rythm is very important for patients. Brad Knight, MD, medical director for the Center for Heart Rhythm Disorders, notes that since all patients are operated, they should be treated of atrial fibrillation during surgery.

Opioid

Opioids which are extracted from opium are mixture of alkaloids from the poppy plant- Papaver Somniferum. Opiods are very commonly used in anesthesia and in intensive care unites. Their mechanism of actions at cellular level is by activating opoid receptors,these receptors are distributed throughout the central nervous system (CNS)  and there main purpose of use in ICU are relieving pain (analgesic) and to some extend they are also sedatives. They are prescribed for patients in ICU who require strong relief from severe pain for more than a few days. It can become addictive if not administrated correctly. The three commonly used opioids in ICU are morphine, hydromorphine and fentanyl, where as fentanyl is also basically use for induction during general anesthesia.

Morphine

Fentanyl which is a synthetic opioid is hundred times more potent than morphine which means it can act much more faster than morphine and that's why it is also administered in combination with benzodiazepine, such as midazolam , to produce procedural sedation for endoscopy, cardiac catheterization, oral surgery, etc. Fentanyl is often used in the management of chronic pain including cancer pain. Fentanyl dermal patches are also used for treating chronic pain. The patches release fentanyl into the body fat which then slowly releases it into the blood stream over period of 42 to 78 hours. Fentanyl does not detemine the release of histamines, which means they do not produce severe hypotension compared to morphine.

In well developed countries, new methods which are known as patient control analgesia (PCA) are used but these methods are only effective for patients who are conscious. In PCA, patient can administer himself a dose of opioids whenever the intensity of pain is high in a set time frame. The patient cannot exceed a certain dose in that time frame. PCA allows the patient to administer the dose of opioids during acute pain and this has been proven more efficient and successful. The opioids for intravenous use PCA may include morphine, meperidine, hydromorphone, and fentanyl but usually morphine is used more traditionally in PCA. According to research fentanyl has less side effects as compared to morphine (headaches, nausea, vomiting, urinary retention)

The common side effects of opioides are nausea, nose tip itching, , drowsiness , itching, dry mouth, miosis, and constipation but when used in excess and  during abuse can cause adverse effects like respiratory depression,confusion ,hallucinations, delirium , urticaria , hypothermia , bradycardia, orthostatic hypotension, dizziness, headaches, ureteric or biliary spasm, muscle rigidity, myoclonus ,  flushing and addiction.

Sudden Cardiac Death

According to a study published in the April issue of Heart Rhythm, black patients with hypertension are at higher risk of sudden cardiac death than nonblack counterparts.
Sudden cardiac death is natural death due to heart failure, characterized by sudden loss of consciousness that occurs one hour after the onset of cardiac signs and symptoms. Sudden cardiac death is natural, netraumatic, fast and unexpected. The  underlying heart disease may be or may not be known. Sudden cardiac death may be announced by cardiac symptoms such as chest pain, dyspnea, palpitations, the clinical status change comes next, then arrhythmia, hypotension and presyncope. Next event is cardiac arrest, with loss of consciousness and peripheral circulation. However these events precede biological death, characterized by the absence of mechanical and electrical activity of the heart and nervous system. Irreversible brain damage occurring after an interval of 4-6 minutes after the blood circulation is halted in the absence of any interventions. This period may be long if followed by the application of life support measures (8 minutes) or advanced measures (16 minutes), according to resuscitation protocol.

Black patient

Worldwide, hypertension affects approximately 1 billion individuals, and its mortality is about 7 million deaths per year. According to WHO, through its consequences hypertension is the leading cause of mortality worldwide. High blood pressure does not only affect  blood vessels (vascular remodeling, increased vascular stiffness, accelerated atherosclerosis), but also the organs. At heart, hypertension cause left ventricular hypertrophy, heart failure, heart disease and arrhythmias. In the brain can occur cerebral infarction, cerebral hemorrhage and cognitive decline.

Nearly 50% of all cardiac deaths are sudden. Some studies show that sudden cardiac death is more common in older patients and males. Risk factors for sudden cardiac death include coronary atherosclerosis, severe ventricular systolic dysfunction, diabetes mellitus. In addition to these, there are a number of factors such as low socioeconomic status, genetic factors. The Association between sudden cardiac death and history of coronary heart disease in first degree relatives was demonstrated.

In a study of black and nonblack patients, it was demonstrated that the incidence of sudden cardiac death is more common among black people. Important to note that patients enrolled in the study had hypertension and left ventricular hypertrophy. The follow-up period was five years, during which patients received treatment with losartan and atenolol. The researchers found that almost 2% of patients had CSD and the incidence was higher in black patients (3.9 vs. 1.9) Peter M. Okin, MD, from Cornell University in New York City, said that the incidence has remained high even after adjusting sociodemographic and medical variables.

Lymphedema Compression Garment

A new treatment for leg lymphedema is being tested by scientists from Flinders University, Australia. This new treatment is believed to bring new hope for patients that suffer from this condition.

The new treatment is based on the usage of a novel compression outfit that helps the patients organism eliminate toxins and other noxious fluids.

Lymphedema is a medical condition also known as lymphatic obstruction. It’s defined by the fluid retention caused by either a blocked or a damaged lymphatic system. The accumulation of this fluid can be a risk factor for various infections. Congenital disorders, obesity, some infections and even different types of cancer treatments can cause damage to a patients lymphatic system.

The current treatments for lymphedema include the use of compression garments and different types of manual lymphatic therapy but these treatments are either time-consuming for both the therapists and the patients or just too expensive for most patients.

The director of the LRU (Lymphedema Research Unit), professor Neil Piller, says that the new compression garment, called Flexitouch®, has more inflating chambers than the older models and spans from the abdomen down to the foot. The older models of compression garments only focused on the lower legs and had 10 inflating chambers, whilst the new Flexitouch® has 28 of those chambers.

Flexitouch

“This new device puts external pressure on various parts of the leg where the fluid is accumulating, starting in the abdomen and working down, to promote the natural movement of fluid out of the tissues and into the lymph system “ and eventually out of the body”, said professor Piller.

The study conducted by the scientists from Flinders University is also being conducted at two clinics, in the United Kingdom and in the United States. It is a clinical trial that requires the 16 participating patients to wear the device for at least one hour a day, five times a week.

Jan Douglass, one of the coordinators of the study, says that this new device is accessible and cost-effective due to the patients being able to use it at home, instead of having to visit the doctor for each treatment session. This also allows patients, especially those living far away from therapists, to better control their own health.

“Lymphedema needs to be managed on a daily basis so anything patients can do at home is going to be much more effective than going to a therapist once a week, even if you can afford it”, notes Jan Douglass.

The official results of this study will be available later this year, but Jan Douglass already points out that patients participating in the clinical trial have already shown positive reactions. They have reported a visible improvement to their health after using the new Flexitouch® garment.

Researchers at University Hospitals (UH) Case Medical Center’s Seidman Cancer Center and Case Western Reserve University School of Medicine have discovered a new method to detect colon cancer early. The new, non invasive method, which is under research,  refers to DNA testing in stool.

Colon cancer is currently detected by colonoscopy, an invasive method that help visualize the patient’s entire colon. This method is quite reliable but quite painful for the patient because it is an invasive method of exploration. Colonoscopy uses  a tiny, flexible instrument which is attached a camera through which the doctor can view both colon and rectum. With colonoscopy the clinician can find polyps, ulcerated areas, swelling, or bleeding tumors. Also, the doctor may biopsy the lesion found and thus can differentiate between benign or malignant tumors. In addition, the doctor can remove by colonoscopy a superficial lesion.

New method for detecting  colon cancer on early stage was discovered in the laboratory of Sanford Markowitz, MD, Ph.D., oncologist with the UH Seidman Cancer Center and Professor at Case Western Reserve University School of Medicine, and is the recommended screening method  by the American Cancer Society.

Improved methods of screening and early diagnosis of colon cancer is extremely important if we consider that this type of cancer is ranked 2 in U.S. mortality. Moreover, early detection is important because colon cancer is part of cancers that can be  prevented. To date, colonoscopy is considered the method of choice but is underused by patients. Dr. Cooper, who is clinical Primary Investigator for the study, said: “Colonoscopy is truly the best test but it has its limitations and  it is vastly underutilized and by the public”. Therefore, DNA testing is a good alternative for patients who want to use colonoscopy.

Colon Cancer

The new method for screening  is based on changes that occur in the DNA in colon cancer. The team found that by using some sensitive technique that identifies vimentin gene methylation can detect colon cancer in stool. This new screening method is still being researched and is tested on patients with colon polyps (with a high degree of malignancy) to compare the effectiveness of this method with the current standard method, ie colonoscopy. Stanton Gerson, MD, Director, UH Seidman Cancer Center and Case Comprehensive Cancer Center, Case Western Reserve University, said that their goal is to implement a method which bring superior outcomes to the patient and decrease mortality due to colon cancer .

Short Bowel Syndrome

By resection (removal) of a part of the small intestine, fluid and electrolyte imbalances can occur and significant nutrtional deficits, that must be known in order to be treated. The small intestine is represented by the duodenum, jejunum and ileum, with an overall length between 3 and 8 meters. The ileum continues with the cecum(the more dilated part of the colon in which the appendix opens), the transition being made from the ileocecal valve, that prevents colon content reflux back into the small intestine. In various diseases surgical resection of a large or small part of the intestine is required. If the remaining part of intestine is under 2 meters, then the short bowel syndrome occurs characterized by poor absorption of certain nutrients.

Short Bowel Syndrome Causes

The Causes that can lead to short bowel syndrome are:

1. Surgical Resections used for:

• Acute surgical abdomen strangulated hernia, volvulus, intussusception, mesenteric or intestine infarction, abdominal trauma with damage to the small intestine
• Crohn’s disease
• Colorectal cancer or other cancers with invasion at this level ,

2. Bypassing a large portion of the intestine through bypass surgery for morbid obesity (see obesity)

3. Intestine malformation (common cause in children)

The degree of nutritional damage depends on:

• The length of the bowel resection (greater the resection the surface of absorption of nutrients is smaller)
• The segment removed (the duodenum and jejunum of the initial part is absorbed calcium, magnesium, iron, folic acid and secrete water and electrolytes: sodium, potassium, chloride and in the terminal jejunum absorbs B12, bile acids, water and electrolytes)
• The presence or absence of valve ileo-CECA -Ability to adapt to new conditions remaining intestine

Short Bowel Syndrome Symptoms

The most common symptoms of short bowel syndrome are:

• Watery diarrhea with frequent stools and high-normal amounts immediately after surgery and large resections or steatorrhea diarrhea, with pasty and oily stools (see chronic pancreatitis) occurring due to poor absorption (malabsorption) of fats due to the lack of absorption of bile acids (in order to be absorbed from the intestine into the bloodstream, fats require bile acids and salts)
• Gallstones caused by the same bile malabsorption mechanism
• Kidney stones by increasing absorption of excess oxalates
• Peptic esophagitis, gastric or duodenal ulcers  due to acid hypersecretion in extensive resections
• Lack of nutrients: protein, leading to edema, carbohydrates, lipids
• Vitamin deficiency: A, eye damage, D, bone damage, E, K, leading to coagulation disorders, B12, with megaloblastic anemia, folic acid, with the development of anemia similar to that of B12 deficiency;
• Mineral deficiency: iron deficiency anemia, sodium, potassium, calcium, magnesium deficiency with their consequences
• Trace element deficiency : zinc, selenium.

Tests indicated for short bowel syndrome are:

1. Determining the length and any remaining bowel anastomoses performed during surgery
2. Tests to emphasize malabsorption of carbohydrates (D-xylose test), B12 (Schilling test) or fat (steatorrhea)
3. Blood tests that will highlight the above mentioned deficits

Study Finds New Effective Treatment For Pancreatic Cancer

According to new study which was published in today’s issue of Cancer Cell, scientists from Hutchinson Cancer Research Center found a new potential treatment for pancreatic cancer. Pancreatic cancer is one of the deadliest malignancies because it presents symptoms in advance stages, its rapidly spreading to other organs and is very resistant to chemotherapy. The resistance to anti-cancer drugs is explained by the fact that malignant pancreatic tumors build around their self a biological barrier that is impenetrable for chemotherapy drugs. With this study, researchers found a way to penetrate this barrier which can represent a step forward in the treatment of pancreatic cancer.

With this study researchers describe the mechanism which make pancreatic tumors resistant to chemotherapy and a way to break it. This mechanism is represented by a biological barrier that pancreatic cancer builds around its self. After breaking this mechanism, scientists observed that in lab mice models with human pancreatic cancer survival rate has significantly increased. Clinical trials that are using novel chemotherapeutic agents which breake the protection mechanism in pancreatic cancer are conducted  by scientists in a few sites in U.S. and Europe.

For this research scientists used lab mouse models with pancreatic ductal adenocarcinomas that were treated with a combination of gemecitabine, the standard chemotherapeutic agent for pancreatic cancer and an enzyme named PEGPH20. When they injected the combination of gemecitabine and PEGPH20, researchers observed that this mixture broke the barrier build by the pancreatic tumors, thus making the chemotherapeutic agent to penetrate into tumor and to spread throughout the malignant tissue. After administration of combination between gemecitabine and PEGPH20, it was observed an increase of 70 percent in mice survival rate, from 55 to 92 days.

“This represents the largest survival increase we’ve seen in any of the studies done in a preclinical model, and it rivals the very best results reported in humans,” researches said.

Pancreatic Cancer Cell

In their mechanism of acquiring resistance to chemotherapy, pancreatic tumors  use a double defense mechanism. First defense mechanism is represented by the fact that pancreatic cancer has a reduced blood supply and for this reason chemotherapy agents are unable to form an efficient concentration in the malignant tissue. The second defense mechanism is represented by the fact that pancreatic tumors posses the ability to create a strong fibroinflammatory response, which include immune cells, fibroblasts and endothelial cells. This cells form an extracellular barrier around the malignant tissue and it also contains a substance called hyaluronan which is made by glycosaminoglycan and is secreted is high levels by pancreatic malignant cells.

Researchers also observed that the result of fibroinflammatory activity of pancreatic cancerous cells is a high amount of interstitial fluid which increase the pressure into malignant tissue, thus making blood vessels that are supplying the tumor to collapse, preventing the malignant tissue to be penetrated by chemotherapy. The main factor the increase pressure into cancer tissue is hyaluronan.

It was observed that by using the combination between gemecitabine and PEGPH20 the levels of hyaluronan begin to rapidly decrease, leading to a reduction of interstitial pressure of pancreatic malignant tissue. This event made the blood vessels that are supplying the tumor to open, thus allowing the chemotherapy agent to reach high concentrations into the malignant tissue and to be more effective.

“Being able to deliver the drugs effectively into the tumor resulted in improved survival as well as the realization that pancreas cancer may be more sensitive to conventional chemotherapy than we previously thought,” researchers added.

Pancreatic ductal adenocarcinoma is a very aggressive type of cancer, being the fourth cause of cancer-related death. From the moment of diagnosis the median survival rate is four to six months and five-year survival rate is less than five percent.

Missed Birth Control Pill Recommendations

Although contraceptives like all drugs come with instructions on administration and what to do in case you miss to take a pill, sometimes they are difficult to understand and apply. Thus, the new recommendations come with a host of information much simpler and easier to understand.

Hormonal contraception, especially that uses birth control pills, is perhaps the most common method of contraception chosen by women. Unfortunately these birth control pills must be taken daily (except during the break) at fixed intervals therefore one in five women forget to take a pill every month, according to statistics.

The Pill

So, what can be done if you missed to take the birth control pill on time? First of all methods you can use depend strongly on the type of the pill you are taking. Birth control pills may be progestin based (or microprogestative – contain only progesterone) or oestroprogestative (containing progesterone and estrogen).

If you miss a birth control pill or start the pill box a day late 

• Take the missed birth control pill now!
• Continue to take the remaining borth control pills normally
• There is no need for additional emergency contraception (in case of intercourse)
• If you check again and you notice other missed pills in the same box or from a previous box, consult your gynecologist regarding the emergency contraception method.

If you miss two or more birth control pills or start the blister pack with two or more days late:

• Take the missed birth control pill now!
• Continue to take the remaining pills normally
• Dispose the rest of the forgotten pills
• Use an extra contraception method for 7 days in case of intercourse (condom)
• If you had unprotected intercourse in the last 7 days you may need emergency contraception. In this case, consult your gynecologist!

How do I take my pills depending on how many pills are were left in the pack, after i missed a birth control pill?

• If there areseven or more pills remaining in the pack, continue normal administration and take a 7-day break. If the blister also contains placebo pills take them, then start a new pack.
• If there are less than seven pills left, continue the administration and start a new pack without taking a 7 day break. If the blister contains placebo pills, they should not be used, and a new pack of birth control pills should be started.

Study Boosts The Effect Of Chemotherapy

A new study published in the journal Blood shows an innovative new treatment method that boosts the effect of chemotherapy in the treatment of acute myeloid leukemia. The new technique involves the use of a new drug that displaces the affected white blood cells from the bone marrow into the bloodstream, instead of directly attacking them. This new drug increases the effectiveness of chemotherapy.

Cancer Chemotherapy

Researchers from the Washington University, led by Dr. Geoffrey Uy, say that previous treatment schemes have proven useful for clearing the cancerous cells from the blood, but have also proven to be ineffective against cancerous cells that remained in the bone marrow.

Scientists conducted a 2-phase clinical trial on 52 patients with AML (Acute Myeloid Leukemia) that either suffered a relapse or their form of AML wasn’t responding to the treatment scheme. A number of 46 patients received the new drug. After the trial finished, data showed that 21 of the 46 patients (almost 46 percent) were completely cured, having all cancerous cells eradicated from both their bone marrow and their blood. Dr. Geoffrey Uy says that based on clinical data he had gathered from his own patients, only 25 percent of them were completely cured, adding that the results of standard chemotherapy were also dependent on individual characteristics.

Senior author of the study Dr. John DiPersio says that even though recent studies show that acute myeloid leukemia is caused by different genetic mutations in every patient, the increased survivability of the cancerous cells is also a result of the bone marrow’s protective effects.

Dr. DiPersio says that future studies will try to develop new therapies that instead of targeting the cancer itself, will target the environment of the bone marrow, thus effectively destroying the common pathways of the leukemic cancerous cells. He adds that targeting the cancer would probably be ineffective due to the fact that most of the mutations leading to the cancerous proliferation are unique for every patient.

The scientists that conducted this study agree that if the results they have obtained were to be reproduced on a larger scale it would completely change the standard therapy for patients with acute myeloid leukemia. Furthermore, the new approach of targeting the environment found in the bone marrow would aid the development of new treatment for other hematologic malignant tumors.

The leukemic cancerous cells from the bone marrow are protected from the effect of chemotherapy through the inhibiting effect that the bone marrow has on the normal cell-suicide response. The leukemic cells are also protected from drugs due to their own slow cellular division. A standard chemotherapy treatment is useful against the cells found in the bloodstream but some cells still remain in the bone marrow and can later cause a relapse.

The new drug, named plerixafor, has the effect of blocking the attachment of cancerous cells to the bone marrow, thus managing to release them into the bloodstream where they will be destroyed under the effect of chemotherapy.

The United States Food and Drug Administration has already given its approval for plerixafor in 2008 when it was being used, before the stem cell transplant technique appeared, to treat non-Hodgkin’s lymphoma and multiple myeloma. The drug was used to displace the normal stem cells from the bone marrow to the bloodstream, where the stem cells could be collected for a future transplant. After undergoing an aggressive chemotherapy treatment, patients would receive their healthy stem cells, as standard procedure.

“We helped in plerixafor's development for stem cell mobilization, so we thought if it makes normal stem cells leave the bone marrow to circulate, maybe it would do the same with leukemic cells”, said DiPersio.

Back in 2009, Dr. John DiPersio led a study on laboratory mice that suffered from acute myeloid leukemia. The results of the study showed that plerixafor, used with chemotherapy improved the survival rates of the tested mice. Dr. DiPersio says that their clinical trial is the first to show an improved effect of chemotherapy when used in combination with a drug that targets the environment of the bone marrow.