Rapid Amigdalitis

One of the frequently encountered infections, especially in children, and during winter time is tonsillitis , also called pharyngitis. Most of the symptoms are caused by viruses, which usually do not require an antibiotic treatment (you should know that antibiotics are ineffective against viruses, only against bacteria), and only will need only symptomatic treatment with fluids and antipyretics. Only a quarter of clinical referrals are caused by bacterial infections, the later being caused by viruses.

The problem is that the symptoms produced by viral infections are very similar to those caused by bacteria, which in practice means it is very difficult to distinguish between the two after examining the patient and evaluating his amigdalitis signs and symptoms . This leads to the fear that the symptoms are produced by bacteria, and many families put pressure on family doctors and pediatricians to prescribe antibiotics to the sick patient, raising the risk that other germs to develop resistance to antibiotics.

The most feared bacteria may be present in these tables is the GABHS A (group A beta-hemolytic streptococcus), which is responsible for more severe infections. Fortunately diagnostic tests that allow rapid and early diagnosis of streptococcal infections are available, easy and safe to use. If these tests are negative, with a reliability close to 98%, the symptoms are not caused by a streptococcus, which avoids having to take antibiotics unnecessarily.

The test is conducted by collecting a sample of exudate present in the tonsils or rear region of the pharynx, using a swab (cotton ball wrapped in sterile gauze, which is placed on the end of a stick) with which the area is rubbed and subsequently introduced into a solution prepared for the test. Once mixed with the solution, a test strip is introduced that reads the results in minutes (from 1 ‘to 5’).

The ease of this test is that it can be done in the pediatrician’s own GP or without a sophisticated apparatus, and also it is a painless test.

The test result can not be accurate, and thus give a false negative if antibiotic treatment has been taken previously. Extra care must also be taken that the sample is not contaminated by contact with other areas of the mouth when removing the swab (eg, teeth). It must not be performed in patients who present no clinical data to guide towards streptococcal pharyngitis or tonsillitis.

Clinical data that guide (though not 100%) are the presence of high fever, absence of cough (most likely atypical cold – upper respiratory tract viral infection), presence of swollen glands, and especially a white exudate on the tonsils observed during pharynx examination.

Short Bowel Syndrome

Short bowel syndrome treatment is aimed to correct nutritional deficiencies, the symptoms and complications after surgery and is modulated mainly by the size of resection:

If the patient remains with the duodenum and jejunum untouched and in place (below 100 cm is resected form the jejunum), then nutrition can be achieved normally through the oral cavity. These patients suffering from short bowel syndrome develop watery diarrhea without steatorrhea which responds well to Imodium (loperamide), Cholestyramine or Sandostatin. The diet will be high in carbohydrates, low in fats. If you B12 deficiency is present, B12 will be administered by muscular injection, once a month or at three months interval. Other deficiencies of vitamins and minerals will be corrected also.

If the resection is extensive, and even includes a part of the colon, as it occurs during surgery for Crohn’s disease, postoperative treatment will be more difficult. Basically, the diet rich in carbohydrates and low in fat is also recommended for this group of patients, fat is more affected regarding the absorption process than carbohydrates and protein. For greater nutritional deficiencies, food consumption will be increased (more meals / day), many patients requiring parenteral nutrition (intravenously) with special solutions containing mixtures of lipids, proteins, carbohydrates and minerals.

Short Bowel Syndrome Parenteral Nutrition

A problem that may occur and contributes to increased nutrient malabsorption is bacterial pollution (see colonic diverticulosis) evidenced by a similar breath test as for Helicobacter pylori.  Antibiotic treatment will often be required (with metronidazole in most cases). Intestinal transplantation is currently the practice in many medical centers, the main indication being the need of total parenteral nutrition (feeding the patient exclusively using infusion solutions due to loss of intestinal absorption) complicated by progressive liver disease (due to this type of diet fatty liver may occur). If the liver damage is advanced, intestinal transplantation can be combined with liver transplantation. Of course, post-transplant complications are multiple, so it is not yet routine practice in most university hospitals.

Latest news: Researchers from Paris recently published follow-up results of 31 children with small bowel transplant, which were followed for an average of 7 years, 27 of them led a normal life post-transplant, with no need for parenteral nutrition and also presenting normal growth and development.

 Breast Cancer Susceptibility Gene

According to a study published in American Journal of Human Genetics, a new gene involved in genetic susceptibility to breast cancer was discovered. According to researchers, XRCC2 gene mutations lead to breast cancer.Breast cancer is the most common malignancy in women. Studies show that 15% of healthy women with at least one first degree relative with breast cancer are at risk. So far, except for BRCA1 and BRCA2 gene mutations and some rare syndromes (such as mutations of TP53, STK11, PTEN, CDH1, NF1 or NBN), familial aggregation could not be proven.

The present study demonstrates the presence of mutations in other genes known so far (BRCA and BRCA2), namely XRCC2. Sean Tavtigian, Ph.D., Huntsman Cancer Institute (HCI) investigator and associate professor in the Department of Oncological Sciences at the University of Utah (U of U), one of Three Co-principal Investigators on the study, highlights the importance of this findings and the potential benefit that this discovery has in treating breast cancer. In addition, this research has an important role diagnose because  healthy women who are  carriers of this mutation can prevent cancer even before it to occur.

Breast Cancer Gene

The discovery was made by tracking families who had a history of breast cancer but not yet discovered any known genes involved in this type of cancer. So far,  familial aggregation of breast cancer was explained by mutations in BRCA1 and BRCA2, which are tumor suppressor genes. In normal cells, these genes have a role in the stability of genetic material (DNA) and prevent uncontrolled cell growth. Women who have a family history of cancer and have mutations in these genes have an increased risk of breast cancer or ovarian cancer. A person can find out if he is  carrier of the mutation by taking blood and conducting genetic tests.

The research was based on the analysis of genes involved in DNA repair and was conducted using a technology called massively parallel sequencing exome capture (exome sequencing). Thus, researchers could investigate the whole human genome by following the exact order of nucleotides that encode proteins genes. Results showed that there are 2 different mutations in the XRCC2 gene involved in breast cancer. Dr. Tavtigian explains that one of the mutations cause an incomplete version of the protein, version that makes it inoperable. The other mutation is characterized by an amino acid change in protein structure.

In terms of therapeutic potential, Dr. Tavtigian said the new discovery could become the target  in breast cancer chemotherapy. People who carry mutations in the gene XRCC2 may be  treated with PARP inhibitors, drugs that kill cells bearing mutations in this gene.

Study Sheds Light On Pregnancy-Induced Hypertension (Preeclampsia)

New research on preeclampsia (pregnancy-induced hypertension), shows that this pregnancy complication could be detected and treated better and faster. According to a study led by Cleveland Clinic’s Lerner Researchers in Research Institute, corin deficiency, an enzyme present in physiological conditions in the heart tissue, is correlated  with the risk of developing preeclampsia.

Researchers at the Cleveland Clinic’s Lerner Research Institute conducted a study on mice and found that corin deficit in the uterus may be the underlying cause of the disease. Furthermore, the study was then extended to patients with preeclampsia, which were found to have low levels of corin in the uterus. Also, these patients were identified to have mutations in the corin gene. Qingyu Wu, MD, Ph.D., a researcher in the Department of Molecular Cardiology at Cleveland Clinic’s Lerner Research Institute and the lead researcher on the study, explained that future research focused on corina will lead to new ways to diagnosis and treat preeclampsia.

Preeclampsia

Pregnancy induced hypertension is a major cause of natal and perinatal mortality and morbidity. An estimated 10% of pregnant women suffer from this complication whose causes are not fully known. This complication usually occurs in late pregnancy but there has been reported that preeclampsia and eclampsia may also occur postpartum. Usually, the disease is manifested by headache, pain in right hypochondrium or epigastrium, edema, neurological deficits, visual field deficits, proteinuria, and tendency to bleeding, such as epistaxis. Eclampsia is the final phase of pre-eclampsia characterized by seizures associated with hypertension. Preeclampsia is associated with HELLP syndrome, low platelets, elevated liver enzymes, and hemolysis.

Risk factors for preeclampsia include hypertension, personal or family history of hypertension, age to 20 years, multiple pregnancy, diabetes, other vascular diseases, hidatiforma mole. There are several theories on the cause of preeclampsia. One of them is endothelial dysfunction, which emphasises the idea that preeclampsia may occur as a result of the increase of anti-angiogenic  factors such as endoglin.

To date, there is no way to prevent preeclampsia, and the only treatment of the disease is the delivery. If the fetus is sufficiently developed, that is under 37 weeks, it is recommended that pregnant rest as much, eat less salt, and constantly monitor blood pressure. Of course, all these should obviously be under medical supervision. If hypertension is severe, the pregnant must take antihipertensive medication. Consequences of untreated preeclampsia may be  on the one hand, death in utero or death to birth, and on the other hand, eclampsia, acute renal failure, massive bleeding and other bleeding disorders.

New FDA Regulations Push PCPs To Improve Their Chronic Pain Management Skills

PCPs, or primary care physicians have to treat numerous patients suffering from chronic pain. Unfortunately they lack the necessary training in assessing and managing patients with chronic pain, most importantly the management of chronic pain through the use of opioid medication. The United States FDA (Food and Drug Administration) has made PCP education one of the most important parts of its REMS (Risk Evaluation and Mitigation Strategy) program. This is being done in attempt to limit the misuse of opioid medication, a misuse that could cause addiction or even death through an overdose.

A research conducted by Inflexxion, a company involved in the observation and research of behavioral health, studied the important issues that concern PCPs and their ability to prescribe opioid drugs to chronic pain patients. The study investigates what kind of training should be considered useful for PCPs in order to make their prescriptions safer and more effective for patients and the type of education found best for clinical practice.

The study, named Identifying Primary Care Skills and Competencies in Opioid Risk Management was published in the JCEHP (Journal of Continuing Education in the Health Professions) in the fall of 2011.

Chronic Pain Management

Sixteen experts in primary care and pain management from around the country were interviewed by scientists from Inflexxion in order to find out what they believed were the best solutions for the safe treatment of chronic pain patients. Questions about competencies and general medical knowledge were included in the investigation. After all the data was collected it was examined and analyzed using a new method that summarizes and prioritizes qualitative data.

The results of the study showed a clear discrepancy between the answers of the primary care physicians and the pain management experts. PCPs believed that monitoring therapy, understanding possible behavioral side effects and a safe prescription of opioid medication are the most important issues. On the other hand, pain management experts said that PCPs should accumulate more knowledge in formulating treatment plants whilst also having a better general understanding of chronic pain management. However, both parts agreed that understanding and managing the pain in patients suffering from co-morbid problems is the most important aspect.

Doctor Kevin Zacharoff, co-author of the study and VP of Medical Affairs from Inflexxion said that  “Primary care physicians treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they could avoid treating these patients, which can lead to an under treatment of pain”. He also added that the new FDA concerns will push both trainers and pharmaceutical companies to develop new programs.

A Link Between Telomeres And Cancer Cells Found By New Study

A new study published on the 11th of March reveals the way human cells recognize the damage suffered by their DNA. The study also reveals that cells can sense even only the possibility of future damage, which could lead to future dividing failure. Scientists have shown that telomeres, which are repetitive nucleotide sequences found at the end of each chromosome, protecting their ends from damage or fusion with neighboring chromosomes, transmit a signal announcing that the respective cell hasn’t divided in the proper time. The study was led by scientists from the Salk Institute for Biological Studies and was published in the journal Nature Structural and Molecular Biology.

The new information found by scientists has a major impact on chemotherapy. It shows how mitotic inhibitors (drugs used to slow the division of cancerous cells and ultimately destroy them) work and provides new ways to create drugs that could have a more potent effect on treating patients undergoing chemotherapy.

Telomere Caps

“How mitotic inhibitors work as cancer therapy has been a 25-year-old question. These drugs are widely used, but it was unclear why they actually kill cancer cells”, says professor Jan Karlseder, also the senior author of the study.

The laboratory that professor Karlseder runs has been studying the role of telomeres in cancer and the process of aging  for a long time. The first thing studied by the researcher team was the presence of specific proteins that would keep telomeres intact whilst going through the process of division. This was done by eliminating different proteins one by one whilst examining the telomeres by using fluorescent microscopy to determine whether or not they were damaged after the process was complete. Their findings were surprising: damaged, unprotected telomeres were observed in every cell that suffered the prolonging of cellular division through the elimination of specific proteins.

Scientist observed the same effect when using mitotic inhibitor drugs on the cells, thus leading them to formulate a new link between cellular death, slowed mitosis and telomere damage.

The study’s first author, Makoto Hayashi, says that telomeres are usually protected  by a protein called TRF2, which seems to disintegrate when the process of mitosis is slowed down due to different causes. He also says that with the help of his researcher team they have  discovered that during the slow down of mitosis, the protein, TRF2, disintegrates from telomeres, therefore exposing them and marking them as damaged DNA, which ultimately triggers the signal that informs about the damaged DNA.

Furthermore, the study revealed that extensive damage suffered by the telomeres leads to the activation of the p53 gene, which stimulates the tumor suppressor proteins. “DNA damage signals occurring during mitotic arrest likely predispose cells to upregulate p53 in the following phase. This then either halts the cell cycle to enable DNA repair to occur or commits cells to a suicide pathway called ‘apoptosis'”, says Makoto Hayashi.

Lead author, professor Karlseder adds that p53 is one of the most frequently found mutated pathways in cancer. Being the first to respond in the case of DNA or telomere damage, a dysfunctional p53 pathway could lead to the loss of genome integrity abnormal cellular mitosis and growth.

This new study suggests that a new approach in cancer chemotherapy should be investigated, an approach that would use the combined effect of two or more drugs in order to achieve better results than by using them alone. Scientists use the “triple cocktail” used to treat AIDS as reference to the powerful effect that the synergy between drugs can have in treating a patient.

Previous to professor Karlseder’s new study, telomeres were known to act as regulators for cell aging. Every time a cell divides, a small part of the telomere cap is also destroyed, eventually leading to the death of the cell. This is the process that ensures that a cell does not become cancerous or undying.

However, a few recent studies show that cancerous cells have the ability to surpass this protective measure and prolong their life by using different pathways that instead of reducing and ultimately destroying the telomere caps, they lengthen it, providing the cells with a longer life, thus leading to more divisions.

Blood-Brain Barrier Mechanism

Researchers at the University of Copenhagen have discovered that the blood-brain barrier plays a key role in maintaining glutamate balance . The study, which has recently been published in the journal GLIA Scientific, uncovers a glutamate balance mechanism unknown until now to scientists.

Researchers have discovered the new mechanism while trying to see how the amino acids enter the brain. Dr. Birger Brodina emphasizes that medical breakthroughs are unintentional and that unexpected results can lead to scientific breakthrough.

Glutamate is a major excitatory neurotransmitter in the brain. Glutamate is involved in various processes such as learning, memory and brain development, neuronal plasticity, long-term potential. Also, it is believed that glutamate is involved in the pathophysiology of schizophrenia. This neurotransmitter mediates information transfer from hippocampus to the anterior cingulate cortex and frontal neocortex. One of glutamate receptors is NMDA (N-methyl D-aspartate).

Blood Brain Barrier

Glutamate is extremely important in the pathophysiology of the nervous system, but in certain concentrations. This neurotransmitter is synthesized from glucose and other precursors in nervous cells, such as astrocytes. If the concentration exceeds a certain limit, glutamate becomes toxic. An imbalance of glutamate concentration can be observed in ischemic strokes, namely excitotoxicity, which occurs due to glutamate accumulation in the brain, leading to nerve cell death. Excitotoxicity leads to an influx of calcium into the cell, with the onset of enzymatic processes that lead to cell death. Neuronal injury can be attenuated by administering glutamate receptors inhibitors. This is one of the mechanisms of action that can be targeted in order to develop new treatment options for stroke.

Until now, it was believed that glutamate balance is maintained by various central nervous system cells, but now researchers have discovered that blood-brain barrier plays an important role in this sense. When glutamate accumulates in excess, the blood-brain barrier dumps the excess into the bloodstream where it has no harmful effects. The blood-brain barrier, which is completely separate from the rest of the blood flow is a barrier between the bloodstream and central nervous system, which helps maintain brain homeostasis. This is basically a filter barrier that prevents the penetration of certain toxic substances into the brain tissue.

Experiments involving blood-brain barrier were also performed in the past. Several years ago, using  nerve cells from mice and calves, researchers at the Faculty of Health and Medical Sciences have created an artificial blood-brain barrier. Nevertheless, the results were not very promising as most drugs tested to treat various nervous disorders could not penetrate that barrier. Therefore, in-depth knowledge of how it works is crucial in order to develop new potentials

Healthcare Reform in America: How It Affects You

The Affordable Care Act (ACA) makes several changes to the way health insurers provide coverage. The act does not provide for government-run health care, but it does have mandates requiring that health insurers provide coverage in certain situations and also makes changes to Medicare coverage for seniors. Key parts of the Affordable Care Act that will affect many Americans are:

• Insurance companies cannot limit or deny care to children under the age of 19 if they have pre-existing conditions. This provision will apply to adults beginning in 2014.
• A parent can keep a child on the parent’s coverage until the child reaches his or her 26th birthday.
• Insurance companies can no longer rescind coverage if a person makes an honest mistake in his or her insurance application. For instance, if a person is diagnosed with cancer, an insurance company cannot rescind coverage because the person forgot to mention a long-ago visit to a counselor on the health insurance application. This provision applies to plan years that began September 23, 2010 or later. An insurance company can still rescind coverage in the case of intentional fraud, however.
• Insurance plans cannot apply lifetime limits to coverage. This provision of applies to any plan or insurance policy issued or renewed on or after September 23, 2010.
• The ACA also phases out annual caps on coverage. By January 1, 2014, no annual caps will be allowed for most covered benefits.
• A new health insurance plan or policy that began on or after September 23, 2010 must provide essential preventive health screenings at no additional cost to members. That means the screenings must be available without plan members having to make a co-pay, co-insurance payment or meet a deductible. Preventive health screenings include mammograms, blood pressure screenings, Type 2 diabetes screenings, cholesterol screenings and many other tests.
• The ACA phases out the “donut hole” gap in prescription drug coverage for seniors who are enrolled in Medicare Part D. The donut hole will be completely closed in 2020. The ACA also provides seniors with free annual wellness exams.
  

  Healthcare Reform

Anyone looking for new health insurance faces a daunting task. Going online to investigate different policies may seem easy, but it can become overwhelming to keep track of all the information from different companies. An online quote service, such as InsuranceQuotes.org, can make shopping for health insurance much easier providing quotes from major insurers in one place.

Substance Abuse During Pregnancy Not Linked To Poor Academic Achievements

The on-line journal of Vulnerable Children and Youth Studies  has recently published the results of a new study conducted by a team of researchers from Boston University Schools of Medicine and Public Health along with Boston Medical center. This study shows that intrauterine exposure to cocaine, tobacco and marijuana does not affect the children’s academic achievement test scores. On the other hand, children exposed to alcohol during their mother’s pregnancy, with no evidence of fetal alcohol syndrome, received lower test scores especially in math, reasoning and spelling.

A+ Control Paper

Intrauterine exposure to cocaine was thought to have harmful effects on the children’s attention, control and abstract reasoning, thus lowering the children’s academic performance. The question was whether this was the result of the cocaine exposure itself, or if the exposure to other drugs which are often associated to cocaine consumption such as alcohol, tobacco and marijuana may independently affect children’s academic abilities.

The study focused on the academic achievement scores of 119 individuals: 11-year-old children in an urban area, with low-income. These children were enrolled in a prospective longitudinal study concerning intrauterine exposure to cocaine.  After comparing the academic achievement scores  (Wechsler Individual 15 Achievement Test-Second Edition, WIAT-II) the result was that the exposure to cocaine, marijuana or tobacco during pregnancy is not correlated with low test scores.  Lead author Ruth Rose-Jacobs, ScD, associate professor of pediatrics at Boston University Schools of Medicine and a research scientist at Boston Medical Center said: “Our results are consistent with growing evidence that intrauterine exposure to cocaine does not independently predict poorer achievement scores in school-age children exposed to multiple other substance exposures and psychosocial stressors.”

Regarding the intrauterine exposure to alcohol, the association with low academic achievement test scores is significant because the analyses had controlled for other substances. Also, all the children enrolled in the study did not have evidence of fetal alcohol syndrome that could have influenced the test scores.

Low test scores in children exposed to alcohol in the fetal period are of potential educational importance. Children’s Depression Inventory explains the relationship between intrauterine alcohol exposure and the achievements scores is this sample: the depressive syndrome in children could be a cause or a result of  achievement difficulties. “Study finding suggest the children with histories of even low-level of intrauterine alcohol exposure who experience school difficulties should be evaluated particularly for arithmetic skills and depressive symptoms and offered enhanced educational methods/interventions tailored to their needs,” added Rose-Jacobs.