The Internet has become a valuable tool for finding out information about your health. Doctors even use it. But you have to be cautious about the information you are getting and be sure to use a reliable site. And sometimes even then you can be fooled.
Over the past few years I've written and published probably 500 articles about health and the latest medical news. I've been interested in medicine for as long as I can remember. I diagnosed my own diabetes and went to the doctor with a plan to control my blood sugar. I was reading The Journal of the American Medical Association, The Lancet, and The New England Journal when I was sixteen. M y family and friends are always asking me questions about their health. But I always tell them to see a doctor just in case I am wrong, especially if it might be serious.
The researchers found that the more people smoked, the more likely they were to have skin cancer, Rollison said. Men who had basal cell skin cancer were significantly more likely to have smoked for at least 20 years than men with no cancer, the study authors noted.
While the study found an association between smoking and skin cancer risk, it did not prove a cause and effect.
Despite the elevated smoking-related risk among women, men overall are more likely to get skin cancer, Rollison noted. She said that "it is possible men's skin is more sensitive to sun exposure than women's."
But another skin cancer expert suggested that men may be less inclined to use sunscreen or other protection when outdoors.
"Although it could just be a genetic difference (between men and women), men tend to have more unprotected sun exposure in their lives," said Dr. Jeffrey Dover, associate clinical professor of dermatology at Yale University Medical School.
Dover said the study findings weren't surprising because "we know cigarette smoke contains carcinogens" and smokers are "blowing the smoke and ash around their faces all day."
The study is important, he added, because "although we have done well, we can do even better" at eliminating smoking as a cause of disease. "This adds more fuel to the idea that smoking has no place in our society."
Non-melanoma skin cancer is the most common form of cancer in the United States, where about 2 million cases are treated annually, according to the U.S. National Institutes of Health. Squamous cell cancer occurs in the epidermis, the top layer of skin, and can spread to other organs. Basal cell skin cancer occurs in the dermis, the skin layer beneath the epidermis. While it does not spread to other organs, it is far more common than squamous cell cancer, according to the government agency.
More information: To learn more about skin cancer, visit the U.S. National Cancer
When smears from thousands of Dutch women were also checked for the human papillomavirus (HPV) doctors were able to find more cancers at an early stage.
The authors of the Lancet Oncology study are now calling for the test to be included for all women.
Experts said the findings were encouraging.
The UK currently invites women aged between 25 and 65 for smear tests every three to five years.
The test is based on "cytology" - a sample of cells from the neck of the womb is examined under the microscope for subtle changes which may lead to cancer.
HPV, a sexually-transmitted virus, is now known to cause the vast majority of cervical cancers in the developed world.
Most cases of infection with the sexually transmitted virus are cleared naturally by the immune system, but persistent infection with certain HPV strains can lead to cervical cancer.
In recent years, tests for these "high-risk" strains have been developed by companies including Roche and Qiagen.
The new tests are known to work well in detecting HPV, but the Dutch study is the first to show they are better than Pap smears alone over two screening rounds set five years apart.
The researchers, who looked at women aged 29 to 56, said use of HPV tests led to earlier detection of pre-cancerous lesions, allowing for treatment that improved protection against cancer.
Hormuzd Katki and Nicolas Wentzensen from the U.S. National Cancer Institute said the results reinforced earlier findings, and provided "overwhelming evidence" of the benefits of including HPV testing in cervical screening programs.
A preliminary study in the Journal of Infectious Diseases finds that patients hospitalized with influenza were less likely to die if they were taking a statin, compared with their peers who weren't taking one of the drugs. The effect held even after adjusting for heart disease.
But it's far too soon to consider adding statins to the existing anti-flu armamentarium, the authors stated.
"At this point, statins should not become the standard of care for people hospitalized with the flu," cautioned study co-author Dr. Ann Thomas, a public health physician with the Oregon Public Health Division in Portland. "We would like to see more studies, [and] I think it would be worthwhile to do these studies."
With flu season underway, here are some of our latest stories on fighting the flu.
Separate the facts from flu fiction
Don't put off flu shot, there's plenty for all, CDC says
Even healthy kids can succumb to flu, study finds
New flu test helps doctors track circulating strains
Right now, preventive vaccinations and antiviral medications are the best weapons against this wily foe, but both stop far short of perfection.
Statins have piqued the interest of virologists and others because they may have anti-inflammatory properties that might mitigate the damage from the influenza virus.
"There have been a couple of studies that have found an apparent association between statins and improved mortality in patients who've had sepsis [blood infections], who've had community-acquired pneumonia," said Dr. Bruce Hirsch, an attending physician in infectious diseases at North Shore University Hospital in Manhasset, NY.
This is the first observational study to investigate a possible relationship between statins and deaths from the flu.
In conclusion, the authors stress the need for randomized controlled trials to help sort out the value of statins in managing influenza. However, they continue, "[d]espite [these] limitations and the need for [randomized controlled trials] before statins can be widely promoted for the treatment of influenza, our findings suggest that statins are a promising area of exploration and could provide a useful adjunct to antiviral medications and vaccine, particularly in settings where circulating influenza virus strains are not susceptible to antiviral medications or vaccine is in short supply or not well matched to circulating viruses."
In an accompanying editorial , Edward Walsh, MD, from the Infectious Diseases Division, Rochester General Hospital, New York, notes that despite increasing uptake of influenza vaccine among the highest-risk groups, morbidity and mortality from influenza continue to rise in the United States.
"This paradox has stimulated a heated debate regarding the true efficacy of influenza vaccination in older persons," he writes. Some investigators have suggested that efficacy of the vaccine may be only negligible in older people, he notes, adding, " even the most optimistic proponents of immunization concede that the current licensed standard dose of inactivated vaccine is less immunogenic and protective in older persons than in young healthy persons."
He commends Dr. Vandermeer and colleagues on their present research and echoes their call for randomized controlled trials aimed at more precisely evaluating how statins may affect influenza.
"Although not the first study to note such an effect, this article adds significantly to the slowly accumulating evidence that statins may reduce the substantial annual morbidity and mortality from influenza," Dr. Walsh writes.
Other experts concurred with that view.
"This is the largest and most carefully controlled study so far to look at the association of ongoing use of statins and mortality among patients with influenza," said Andrew Pavia, MD, FAAP, FIDSA, chief, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, in an interview with Medscape Medical News. "The authors tried to carefully control for other potential explanations, and statin use still seems to be associated with decreased mortality. It adds to earlier, less-powerful studies that showed similar results."
Dr. Pavia pointed out that statins are known to have complex effects on inflammation, and that inflammation plays an important role in severe influenza, "so it is possible that there is a real beneficial effect of long-term statin use in influenza," he noted.
However, he continued, "[w]e need to be very cautious in trying to interpret what this means for patient care." For example, he pointed out, none of the studies conducted so far have addressed the question of whether initiating statin therapy during a bout of influenza would have any effect on the illness.
Given that unanswered question, along with others, Dr. Pavia said clinicians should not be using statins solely for their possible effect on influenza.
Even so, he concluded, "I think we have enough data now to seriously consider investing in a study where patients with influenza who are getting standard care including antivirals are randomized to receive a statin or placebo. Even more importantly, we need to develop a range of treatments that can reduce the death rate from severe influenza."
This work was supported by the Emerging Infections Program Cooperative Agreement between the 10 study sites and the Centers for Disease Control and Prevention. One of the authors has been an occasional consultant to Sanofi Pasteur, Novartis, Pfizer, Dynavax, and GlaxoSmithKline, and is a member of the Data Safety Monitoring Board for experimental vaccine studies for Merck. The other authors have disclosed no relevant financial relationships. Dr. Walsh serves on a Laboratory Quality Review Panel for Alnylam Pharmaceuticals. Dr. Pavia has disclosed no relevant financial relationships.
Lauren Scruggs is recovering today after undergoing surgery to remove her left eye that was damaged when she accidentally walked into the propeller of a small plane 10 days ago.
Doctors at Dallas' Parkland Hospital, where the model and fashion blogger has been treated since the Dec. 3 accident, successfully replaced her damaged left eye with a prosthesis in the surgery on Wednesday.
"We are thankful for all of the strong and powerful prayers for this and the surgery today," Scruggs' family wrote on the website they created in her name at Caringbridge.com.
"The surgery consisted of removing her left eye, which included nerves. The doctors were excited about the surgery and said everything went as planned and unbelievably well," said the family.
Wednesday's surgery comes amidst of a week of progress for Scruggs, 23, of Plano, Texas, who accidentally walked into the propeller of a small plane after viewing Christmas lights above Dallas Dec. 3. The propeller sliced into her face and shoulder and severed her left hand.
On Monday the family announced that Scruggs had begun eating solid foods, including her favorites like sweet potatoes and hard-boiled eggs, and walking the hospital's hallways.
Her family has been providing updates on the website CaringBridge.org; they posted the news on Wednesday evening, writing that the procedure “consisted of removing her left eye, which included nerves.’’
Though the news is a disappointment — the family had initially hoped the eye could be salvaged — surgery "went as planned" and “unbelievably well,’’ they wrote. Scruggs will now wear a prosthesis, which will be "part of our journey and the healing process," wrote the family, to replace the eye, which was badly damaged in the Dec. 3 accident.
The 23-year-old model and fashion blogger suffered lacerations to her face, a fractured skull and a severed left hand when she walked into a still-spinning propeller at Aero Country Airport, about 30 miles from Dallas. She was moving in the darkness toward the front of the plane — possibly to thank the pilot, who was a friend of hers. Within a week of the accident she was able to walk and talk, but is in severe pain.
Here is the statement in its entirety:
“Over this last week, we have been praying for a miracle for the healing of Lo's left eye.
“We are thankful for all of the strong and powerful prayers for this and the surgery today. The surgery consisted of removing her left eye, which included nerves. The doctors were excited about the surgery and said everything went as planned and unbelievably well.
“We believe Jesus has answered our prayers for this miracle through the prosthesis for her eye, which will be a part of our journey and the healing process.
“Along with the pain she was already experiencing with her arm and shoulder injuries, the removal of the left is also very painful. We are asking again for prayer to relieve this pain, and also, as we have posted previously, pray for Lo to regain her appetite. This is crucial for her body to heal quickly.”
As RadarOnline.com has previously reported, Scruggs suffered serious facial injuries, a fractured skull and a severed left hand when she walked into the spinning propeller of a small plane at Aero Country Airport, some 30 miles from Dallas.
She had just finished viewing Christmas lights at night, and her family believes she may have turned back to thank the pilot.
Although her injuries are severe, Scruggs has been able to walk and talk since the accident; she’s also been eating solid foods.
This week, the Food and Drug Administration (FDA) sent a warning letter to the Southern California marketing company 1-800-GET-THIN for using misleading advertising to promote Lap-Band weight-loss surgery.
The agency says the company’s numerous billboards feature thin models and enticing slogans like “Let Your New Life Begin!” but fail to convey the serious risks carried by weight-loss surgery. The warnings are there, but in font so small as to be illegible, the agency says. The FDA also took issue with 1-800-GET-THIN’s other marketing materials, which similarly do not inform patients about the risks.
The FDA letters — sent to 1-800-GET-THIN and eight other affiliated surgery centers — give the outfits 15 days to figure out how to correct their misleading ads. The agency’s move comes in response to complaints from Los Angeles County’s public health agency and even from Allergan, which manufactures the Lap-Band device used in the gastric banding surgery, saying the risks of the surgery are not properly communicated.
The device, designed for weight loss in obese adults, had been approved by the FDA, which has now issued Warning Letters to the centers.
The clinics include Bakersfield Surgery Institute Inc, Beverly Hills Surgery Center, Palmdale Ambulatory Center, Valley Surgical Center, Top Surgeons LLC, Valencia Ambulatory Center LLC, Cosmopolitan Plastic & Reconstructive Surgery and San Diego Ambulatory Center LLC.
The federal health agency said the Lap-Band is a restricted medical device that has been misbranded as a result of misleading advertising by these groups, reports PR Newswire.
In the letters, the FDA warns that billboards and advertising inserts used by the clinics to promote the Lap-Band fail to provide required risk information.
The FDA announced today that it had issued its warning letters to 1-800-Get-Thin and the surgical centers earlier this month. In those letters, the FDA complains that the Lap-Band advertising omits warnings, precautions, contraindications, and possible side effects of the procedure. The warnings in some of those ads that instruct would-be patients to consult their physicians about risks and to read online safety information "may be so small as to render the information illegible," the agency added.
The risks of the surgery, which include death, are heightened for obese individuals, according to the FDA. Risks after the Lap-Band procedure include nausea and vomiting, difficulty swallowing, gastroesophageal reflux disease, stretching of the stomach pouch, and the need for further surgery when the band shifts position or erodes into the stomach.
"FDA's concern is that these ads glamorize the Lap-Band without communicating any of the risks," Steven Silverman, director of the Office of Compliance in the agency's Center for Devices and Radiological Health, said in a press release.
The warning letters instruct and the 8 surgery centers to immediately cease marketing the Lap-Band with "misleading" ads. If they fail to comply, the agency said it may resort to "product seizure" and civil penalties.
An attorney for 1-800-Get-Thin did not respond to a request to comment on the warning letter as of press time.
Allergan, the maker of the Lap-Band system, did not receive an FDA warning letter. Company spokesperson Caroline Van Hove told Medscape Medical News that Allergan has no financial ties to 1-800-Get-Thin and no control over how Allergan customers — namely bariatric surgeons — promote Lap-Band surgery.
MADISON, Wis. -- People who quit smoking are happier and more satisfied with their health, compared to those who smoke, U.S. researchers say.
Dr. Megan Piper of the University of Wisconsin School of Medicine and Public Health said smokers hold strong beliefs about how stopping smoking will reduce their quality of life.
Piper and colleagues assessed overall quality of life, health-related quality of life, positive vs. negative emotions, relationship satisfaction and occurrence of stressors -- among 1,504 smokers taking part in a U.S. smoking cessation trial. Smoking status and quality of life were assessed at both one year and three years post-smoking cessation.
Quality of life measures included health, self-regard, philosophy of life, standard of living, work, recreation, learning, creativity, social service, love relationship, friendships, relationships with children, relationships with relatives, home, neighborhood and community.
The state loses some “quit-friendly” points with the lack of funding for tobacco-control programs. A year ago, Tennessee ranked dead last in dollars committed to funding tobacco-control programs, but “improved” to 44th in the 2011 report, which measures whether a state meets the recommended funding levels for tobacco prevention programs set by the U.S. Centers for Disease Control and Prevention. Tennessee is expected to spend about $200,000 in fiscal year 2012, or 0.3 percent of the recommended amount for prevention programs, while smoking-related health-care costs registered $2.16 billion.
Frankly, Tennessee must do more to educate and provide services for people to quit, considering that 20 percent of all adults are daily smokers and, even more alarming, there are 7,600 teen-agers who start smoking each year.
Tobacco-control advocates know that cessation programs work. That’s why we are going to be talking to both federal and state officials about comprehensive cessation programs as part of “essential benefit” that must be in any insurance plan sold through the state health insurance exchange when health-care reform begins in 2014.
Despite legal challenges to the Affordable Care Act, the law mandates that the essential benefit for each exchange plan sold include the benefits “typical” in employer-sponsored plans. That should include everything from prenatal care to smoking cessation to a prescription drug benefit that includes branded and generic medications, as well as access to new health innovations.
That is a “quit-friendly” environment that we can all live with.
Those suffering from Obstructive Sleep Apnea (OSA) are four times more prone to suffer from cardiovascular risk factors and metabolic syndrome (MS) such as obesity, hypertension, dyslipidaemia and insulin resistance. Delhi has 9.3% prevalence of OSA which is a highly prevalent but an under-recognized clinical problem. In an urban setting in northern India, the occurrence of OSA is 13.7% and 3.8% in men and women.
However, patients with moderate-to-severe OSA can reverse metabolic abnormalities and lower blood pressure by undergoing three months of continuous positive airway pressure (CPAP) therapy.
These are the findings of two separate studies - one published in the Indian Journal of Medical Research (IJMR) and the other in New England Journal of Medicine - carried out by Dr S K Sharma, who heads the department of medicine at AIIMS.
The study volunteers were randomly assigned to receive CPAP or sham CPAP treatment for three months. CPAP treatment involves wearing a face mask during sleep that continuously delivers air into the airway so it remains open. The sham CPAP had modifications to reduce the airflow, and the mask used had tiny holes that allowed extra air to escape. The modifications were done in such a way that even the researchers couldn't tell who was receiving standard CPAP and who received the sham treatment.
After three months, the study volunteers went one month without treatment, and then switched groups for another three months of therapy with the opposite treatment.
Compared to the sham treatment, people treated with CPAP had an overall drop of 3.9 mm Hg systolic (the top number) blood pressure and 2.5 mm Hg diastolic blood pressure. Total cholesterol levels went down 13.3 milligrams per deciliter (mg/dL), and LDL cholesterol, the bad type, dropped by 9.6 mg/dL in the treatment group. Levels of triglyceride, another important and potentially harmful blood fat, went down by 18.7 mg/dL in those who received treatment, according to the study.
Blood sugar levels went down slightly, as did waist circumference, according to the study.
Eleven patients (13 percent) no longer qualified as having metabolic syndrome after receiving CPAP, compared with just 1 percent receiving sham CPAP.
Sharma said these positive effects likely come from the restoration of normal oxygen levels. When the body becomes oxygen-deprived in obstructive sleep apnea, it causes the body to become distressed, which causes the release of hormones that can cause cell damage that may lead to metabolic syndrome, according to Sharma.
"This study adds to the growing body of knowledge that obstructive sleep apnea has long-term consequences for your health, and that treatment reverses some of those consequences," said Dr. David Rapoport, an associate professor of medicine and director of the Sleep Disorders Program at NYU Langone Medical Center in New York City.
Rapoport said it wasn't clear from this study if any of the benefits seen came solely from weight loss in those on CPAP and weight gain for those on sham treatment.
"This study is thought-provoking and could be really wonderful news that using a breathing machine could have all of these beneficial effects. But, ultimately, we'd want to see clinical end points, such as the incidence of cardiovascular deaths, in order to know if an intervention is appropriate and helpful," said Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City.
The American Cancer Society has revised its process for creating cancer screening guidelines to improve consistency.
Some of the key changes include the creation of a single group of generalist experts to develop all guidelines; the use of systematic reviews as the basis of all guidelines; and clear articulation of benefits and harms of various screening tests, according to Tim Byers, MD, MPH, of the Colorado School of Public Health in Aurora, and colleagues.
Byers is chair of the society's guidelines process work-group. The new process was described in the December 14 issue of the Journal of the American Medical Association.
"This new process should ensure that ACS cancer screening guidelines will continue to be a trustworthy source of information for both healthcare practitioners and the general public to guide clinical practice, personal choice, and public policy about cancer screening," the authors wrote.
Cancer screening guidelines written by different organizations can differ, even when based on the same evidence. That can lead to confusion among healthcare professionals, the general public, and policy makers, and reduce the credibility of the recommendations and the groups that issue them, according to Byers and colleagues.
In March, the Institute of Medicine (IOM) issued two reports to establish a framework for developing more trustworthy guidelines and for conducting systematic evidence reviews.
After the IOM released the reports, the ACS, which had already begun revising its methods for making cancer screening guidelines, ensured that their new process would be consistent with that laid out by the institute.
Futures ACS guidelines will be issued by general health care professionals and patient advocates, rather than cancer subspecialists, whom the ACS said may have financial incentives to recommend more tests.
"The conflict is that they know the most about it, but they also have the most self-interest in it," said Byers.
The U.S. Preventive Services Task Force, another recommending organization, has drawn criticism for recommending healthy men not get blood tests for prostate cancer, and that women in their 40s and 50s not get routine mammograms.
Byers said ACS decisions will be transparent as to their reasons. He said some tests, like mammography or colonoscopy, have saved lives, but they have drawbacks, too, such as increased costs, anxiety, and complications resulting from false alarms. He said specialists will still have an advisory role in the recommendations, but will not make decisions or vote.
However the push and public perception against HIV has waned somewhat since its discovery in the 1980s and its incidence in developed countries, such as the US and UK has not been much reduced in the past decade. Obviously public health efforts need to be stepped up again.
There were uncertainties about the cause-and-effect relationship of heavy drinking and HIV infection. Researchers weren't sure if alcohol consumption caused HIV via unsafe sex, or whether certain personality traits in individuals, such as sensation-seeking or a disposition to risky behavior in general, would lead to both alcohol use and unsafe sex.
The study, published in the January 2012 issue of the journal Addiction, presents the results of 12 experiments that analyzed this cause-and-effect relationship in a more systematic way.
Researchers collated their results and discovered that alcohol consumption affects decision-making, and that this impact rises with the amount of alcohol consumed.
"In other words, the more you drink, the stronger becomes your intention to engage in unsafe sex," editors wrote in a summary published on the journal's website.
Researchers said unprotected sex is the most important pathway to HIV infection and therefore this research about the impact of alcohol should be included in HIV prevention materials.
The study examined the results of 12 experiments that tested the cause-and-effect relationship between unsafe sex and alcohol consumption, the journal's editors wrote. An increase in blood alcohol level of 0.1 mg/mL resulted in a 5% increase in the likelihood of engaging in unprotected sex, the study concluded.
"This result also helps explain why people at risk often show this behaviour despite better knowledge: alcohol is influencing their decision processes," said Dr. J. Rehm, the study's Principal Investigator.
Lot of evidence exists about the use of acupuncture for nausea and vomiting in pregnancy, but not much is known about the efficacy of acupuncture for other dyspepsia complaints. So, researchers João Bosco Guerreiro da Silva and colleagues from Department of Internal Medicine, Rio Preto Medical College, Sao Jose do Rio Preto, Brazil, conducted a study to observe the effects of acupuncture on symptomatic dyspepsia during pregnancy and to compare this with a group of patients undergoing conventional treatment alone. This study was approved by the Research Ethics Committee of the Federal University of São Paulo, Brazil. The results appeared in Acupuncture in Medicine, scientific journal published by the BMJ group.
A total of 42 subjects in the age group of 15 to 39 years at 15 to 30 weeks of pregnancy and dyspepsia symptoms were chosen for the study. These women were randomly placed into ‘to be treated with acupuncture’ and ‘not to be treated with acupuncture’ groups. Six women dropped out - one in the acupuncture group and five in the control group. Acupuncture was performed once a week, (sometimes twice if necessary) during 8 weeks. Traditional acupuncture, using sterilized stainless steel needles of 40 mm in length and 0.2 mm diameter, was performed respecting the classical acupuncture points including depth of insertion.
During the first trimester, the focus of the treatment is to reduce the likelihood of miscarriage and address any early pregnancy symptoms such as nausea, morning sickness and fatigue.
Acupuncture during the second semester aims to maintain the balance and address many of the common complaints of pregnancy mentioned above.
Acupuncture during the third trimester prepares the body for labour and delivery by relaxing and softening ligaments, aiding cervical dilation, nourishing the body’s ‘’Qi’’ and blood, as well as relieving any muscular pain or discomfort. This is also the time where Acupuncture is used to turn breach babies.
It is recommended to start this treatment as soon as you learn that the baby is in breach position (around 33-36 weeks)
During the whole pregnancy, special attention will be given at diet and lifestyle.
Treatment for labour induction can be given any time after 39 weeks if there are no complications with the pregnancy.
Acupuncture for delayed labour has been used in China for at least 2,300 years, but Acupuncture for labour pain was rarely used because, according to Chinese culture and oriental tradition, women were expected to experience the pain of childbirth! The first occurrence in Chinese medical literature was in 1970 in ‘A barefoot doctor’s manual’ (my first book on Acupuncture),
The manual drew on the practical expertise of local health workers, often self-taught, who went from house to house to administer medical attention in the form of Acupuncture and herbal medicine.
It was around the same time the interest in Acupuncture Analgesia became the focus of much research in Europe and the western world in general.
In 1972 Christian Ehrstroem performed the first Acupuncture delivery in the west in Stockholm.
In 1974 Darras in France reported 20 electro-acupuncture deliveries by primiparea and multiparea. Since then, Acupuncture has rapidly become more popular for women in childbirth, mainly because it is a natural pain-reliever with no harmful side effects for mother or baby. Moreover, women like to feel in control during their labour and delivery, a feeling of which they may be deprived by some of the more potent conventional analgesic techniques used in today’s maternity units.
Acupuncture is also used in ‘difficult’ labour. Difficult labour can result from abnormality of the uterine contractions, cephalo-pelvic disproportion (that is imbalance between the size of the maternal pelvis and the baby’s head), or malposition and malpresentation of the baby.
Acupuncture can be of help in the first of these, but not the others. It is important to note that ‘malposition’ of the baby should not be confused with ‘malpresentation’: the latter occurs when the baby’s bottom (breach); shoulder; face or brows present first as opposed to the head - as in normal cephalic presentation. ‘Malposition’ means incorrect positioning of the head, which includes occipito-posterior position and deflection of the head. Acupuncture can help in ‘malpresentation’, but not ‘malposition!’
Women's health research has suggested postpartum women may need to be screened for tuberculosis (TB).
Researchers at the Health Protection Agency (HPA) and the University of East Anglia in the UK analysed data relating to 192,801 women with a total of 264,136 pregnancies from 460 practices across the UK between 1996 and 2008.
They found the TB rate for postpartum women was significantly higher than in the general population, but there did not appear to be any substantial difference in the likelihood of infection among pregnant females.
However, consultant in public health at the HPA's Respiratory Diseases Department Dominik Zenner said that there "is almost certainly" an increased risk for those carrying a child as well.
"Given our results, targeted screening of pregnant and postpartum women in high-risk groups may be warranted, given that delays in treatment initiation are associated with poorer outcomes for both mothers and their children," he stated.
In a joint study between scientists at the Health Protection Agency (HPA) and the University of East Anglia, researchers analysed data on all women with pregnancies between 1996 and 2008 from the General Practice Research Database.
A total of 192,801 women who had a total of 264,136 pregnancies were included in the study and over the 12 year period of study there were 177 TB cases among this group.
After adjusting for age, region and socio-economic status, post natal women had a significantly higher TB risk outside pregnancy, whereas no significant increase during pregnancy was observed. Overall the researchers calculated that the rate of TB among pregnant and post natal women was 15.4 per 100,000 people, which is significantly higher than the rate outside of pregnancy - 9.1 per 100,000.
Lead author Ibrahim Abubakar, head of TB surveillance at the HPA and Professor of infectious disease epidemiology at the University of East Anglia said: “This study clearly shows that future guidance to healthcare workers, especially midwives and health visitors, should take into account that the risk of TB may be increased during pregnancy or shortly after giving birth.
“Those looking after pregnant and post natal women should be encouraged to look out for the signs and symptoms of the disease, particularly among women in high risk groups such as immigrants from countries with a high burden of TB, as early diagnosis and appropriate treatment is essential. TB is a preventable and treatable condition but, if left untreated, can be life threatening.”
There is no rhyme, reason, or way to predict if a woman will experience lymphedema following surgery or radiation to treat breast cancer. Swelling of the arm, breast, or chest may begin shortly after breast cancer surgery or radiation, but some women experience lymphedema months—or even years—later. According to the American Cancer Society, most women who have had breast cancer do not develop lymphedema, but the many who do can take steps to manage the swelling and pain, which can range from mild to severe.
Lymphedema results when lymph nodes and vessels are removed or scarred during breast cancer surgery. With fewer lymph nodes and vessels, it is more difficult for the upper body to drain lymph fluid. When excess lymph fluid builds up, pain and swelling occurs. Radiation for breast cancer also affects the flow of lymph fluid in the arm, chest, and breast area, and can cause lymphedema.
“Lymphedema is always a risk when a woman has had any lymph nodes removed or radiation for breast cancer,” says Monique Tiffany, R.N., nurse navigator at the Total Care Breast Center at Los Alamitos Medical Center. Tiffany advises women about lymphedema not only as a breast cancer care nurse, but also as a breast cancer survivor. She celebrated being cancer-free for 10 years this month.
Tiffany says she remains aware that lymphedema can still occur, even after a decade. “I still have to think about it if I’m going to get on a plane,” she says. Air travel can cause lymphedema to flare up.
Unfortunately, there is no way to prevent lymphedema prior to breast cancer surgery or radiation. Tiffany recommends that women get measured for a compression sleeve right after surgery, so the sleeve is available if needed. However, a woman newly diagnosed with breast cancer may find information about lymphedema overwhelming on top of everything else she is dealing with, so not all women will have the measurement done until lymphedema becomes an issue.
To manage the pain and swelling immediately after surgery, women are advised to raise the affected arm above heart level two to three times a day for 45 minutes, and to open and close their fist gently to help move lymph fluid out of the arm. Physical therapy and special exercises can help regain full range of motion in the weeks after surgery or radiation. A compression sleeve or special bandaging may be needed when pain and swelling persist.
Because cuts, burns, or bug bites on the affected arm make the body respond with extra lymph fluid, causing or worsening lymphedema, it’s important to avoid these injuries. Wearing gloves while cleaning or gardening, a mitt while handling hot foods, and a thimble while sewing can help prevent cuts and burns. Cuts and scratches on the affected arm need to be treated right away with antibiotic ointment.
Heat can make lymphedema worse, so hot tubs, saunas, or heating pads are on the list of things to avoid, along with harsh soaps, which can dry the skin and make it more prone to cracking.
Lymphedema can seem particularly onerous when it begins several years after breast surgery or radiation. Having to deal with compression sleeves and massaging and elevating the arm comes as a newly inconvenient and unwelcome after-effect of breast cancer treatment.
“Lymphedema can occur at any time,” notes Barbara Stone, physical therapist at MemorialCare Todd Cancer Institute at Long Beach Memorial Medical Center. Stone sees patients at the outpatient Lymphedema Program at Memorial, which is part of the MemorialCare Rehabilitation Institute. The Lymphedema Program is open to anyone in the community who needs treatment for lymphedema.
Stone recently encountered a patient who just developed lymphedema, although her mastectomy was 25 years ago. “She recently began using a walker, and the extra strain on that arm may have caused the excess fluid,” she explains. In another case, a breast cancer survivor developed lymphedema three years after her breast cancer surgery while caring for her ill husband. Helping him up and turning him in bed strained her affected arm, and she developed lymphedema. While lymphedema can’t be cured, it can be treated, even when it occurs long after breast cancer surgery or radiation.
The study indicated that there might be common and treatment-specific ways that cancer therapies negatively affect cancer survivors' mental abilities.
Previous research had suggested that chemotherapy could cause problems with memory and concentration in breast cancer survivors.
To compare the effects of different types of cancer treatment on such mental abilities, Paul Jacobsen, PhD, of the Moffitt Cancer Centre and Research Institute in Tampa, and his colleagues examined 62 breast cancer patients treated with chemotherapy plus radiation, 67 patients treated with radiation only, and 184 women with no history of cancer.
Study participants completed neuropsychological assessments six months after completing treatment and again 36 months later.
The study confirmed that chemotherapy could cause cognitive problems in breast cancer survivors that persist for three years after they finish treatment.
In addition, the investigators found that breast cancer survivors who had been treated with radiation (and not chemotherapy) often experienced problems similar to those in breast cancer survivors treated with both chemotherapy and radiation.
They did not find that hormonal therapy (such as tamoxifen) caused cognitive difficulties.
"These findings suggest that the problems some breast cancer survivors have with their mental abilities are not due just to the administration of chemotherapy," said Dr. Jacobsen.
"Our findings also provide a more complete picture of the impact of cancer treatment on mental abilities than studies that did not follow patients as long or look at mental abilities in breast cancer survivors who had not been treated with chemotherapy.
Women treated for breast cancer with radiation with or without chemotherapy had more thinking and memory problems a few years after their treatment ended than women who'd never had cancer, in a new study.
Research has suggested some women experience mental haziness, dubbed "chemo brain," during and soon after chemotherapy treatment. And one recent study found evidence of changes in the activity of certain brain regions in women who'd undergone chemotherapy.
But some researchers have questioned whether those problems are due to the specific drug treatments, or possibly to the cancer itself. In the new report, breast cancer survivors showed certain small mental deficits, regardless of whether or not they'd had chemotherapy.
"It's a very, very subtle thing. We're not talking about patients becoming delirious, demented, amnesic," said Barbara Collins, a neuropsychologist who has studied chemotherapy-related cognitive changes at Ottawa Hospital in Ontario, Canada, but wasn't involved in the new study.
"We're talking about a group of people that are saying, 'I'm pretty much still able to function, but I find it harder...it doesn't come as easily, and I can't do as many things at the same time.'"
The current study involved 129 breast cancer survivors in their fifties, on average. About half of them had been treated with radiation and chemotherapy, while the other women only had radiation.
Six months after finishing treatment, and another three years later, women took a range of thinking and memory tests. Their scores were compared against the performance of 184 women who'd never had cancer, but were a similar age and from the same areas.
A notable finding is the absence of appropriate communication between women and their doctors –that is, a disconnect between what women tell their doctors about side effects and what they actually experience, and/or selective hearing by medical professionals on how treatment is influencing a woman’s quality of life.
“Clinicians consistently underestimate the side effects associated with treatment,” said lead investigator and clinical psychologist Dr. Lynne Wagner.
“They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don’t want to be complainers and don’t want their doctor to discontinue treatment. So no one knew how bad it really was for patients.”
The symptom most likely to cause women to stop using the drugs was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.
The medications — aromatase inhibitors — stop the production of estrogen in postmenopausal women, whose breast cancer cells are stimulated by estrogen.
The research is timely as two-thirds of breast cancers are estrogen sensitive, and aromatase inhibitors reduce the recurrence of cancer in postmenopausal women.
Investigators discovered women at the highest risk of stopping the medications before the recommended five years were those who were still experiencing residual side effects from chemotherapy or radiation therapy when they start the aromatase therapy.
Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren’t taking many other medications, were more likely to keep taking the aromatase medication.
“The more miserable they were before they started, the more likely they were to quit,” Wagner said. “By the time they get through chemotherapy or radiation, they have to face five more years of another medication that will make them feel lousy. They feel like they already lost enough time to cancer and have reached their threshold for feeling bad.”
Wagner called it “a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high. We need to be better at managing the symptoms of our patients to improve their quality of life.”
A significant finding of this study is the discrepancy between medical professionals’ opinion of the medication side effects and a woman’s actual experience.
This disconnect is clearly depicted when comparing previous research – where clinicians reported 5 percent of patients experiencing moderate to severe symptoms – as compared with the current study’s discovery of 36 percent reporting significant side effects.
Researchers found after three months of treatment 33 to 35 percent of women had severe joint pain, 28 to 29 percent had hot flashes, 24 percent had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety. These numbers increased as women were on treatment longer.
Earlier studies also asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.
As a result of the side effects, 36 percent of women ended treatment before an average of 4.1 years. After two years, 10 percent had quit; the remainder quit between 25 months and the 4.1 years.
“These findings can help us identify women at risk for quitting the therapy, counsel them about the importance of staying on it and provide treatment for troubling side effects,” Wagner noted.
Weight gain can be addressed with nutritional counseling, while mood swings and irritability can be treated with cognitive-behavioral therapy or mind-body techniques, Wagner said.
Joint pain can be reduced with nonsteroidal anti-inflammatory drugs, or women may be switched to a different hormonal medication. Nausea can be reduced with medication.
Researchers made a major advance in the decades-old effort to use gene therapy to treat the bleeding disorder hemophilia B, reporting that six patients in a study started to make more of a crucial blood-clotting factor that prevents severe bleeding episodes.
After a single gene-therapy treatment, four of the men started making enough of their own clotting factor that they no longer needed the regular protein injections that are currently used to prevent bleeding episodes. The other two required the protein injections but much less frequently than before, according to the paper, which was published online Saturday in the New England Journal of Medicine.
"The idea of treating hemophilia with gene therapy has been around for 25 years, but the problem was how to do it right," says Ronald G. Crystal, chairman of the department of genetic medicine at Weill Cornell Medical College, who is working on gene-therapy research but was not involved in the trial. "This is an important breakthrough because it is the first success in one of the plasma deficiency disorders and shows gene therapy is feasible."
Hemophilia B is caused by a defect in the gene that makes a protein called Factor IX, which is crucial for normal blood clotting. About 1 in 30,000 individuals, usually men, inherit the mutation. Without enough clotting factor, patients can have frequent, painful bleeding episodes.
With gene therapy, scientists try to correct the problem by delivering a normal gene to the body, using what is known as a vector to insert the gene into cells -- usually a virus that is genetically altered to contain human DNA.
Researchers altered the DNA of a common virus so that it would include the instructions for making FIX.
They then injected the men with the altered virus. They hoped that it would do what all viruses do: infect cells and hijack their operating instructions.
Ordinarily when viruses infect cells, they turn the cells into factories that crank out more copies of the virus. That keeps the infection going.
In this case, the infected cells churned out the missing protein.
After a single treatment, four of the six men in the study have been able to stop their weekly protein injections altogether. Two others have been able to stretch the time between their shots from days to up to two weeks.
"You've got people who are maybe not quite cured," says Ponder, an expert on blood disorders who was not involved in the research.
The study and an editorial by Ponder are published in The New England Journal of Medicine.
The results are also scheduled to be presented at the annual meeting of the American Society of Hematology in San Diego.
Hope on the Horizon for Hemophilia and Other Diseases
So far, researchers have only been able to coax the body to make the protein that helps people with the less common form of the disease, hemophilia B.
But researchers say this approach could work for people who have the more common form, hemophilia A, too. They just need to find the right virus to deliver the genes that would help that disease.
"I think this approach will lead to a cure. I think it's not there yet," says study researcher Andrew M. Davidoff, MD, a pediatric surgeon at St. Jude Children's Research Hospital in Memphis, Tenn.
"We have made a significant impact on the severity of the disease," Davidoff tells WebMD. "We are looking to cure patients, and I think with improvements in the vector and higher doses, we will be able to cure them."
Before they were enrolled in the study, the six men all had levels of FIX protein that were less than 1%. After the gene therapy, their FIX levels improved to 2% to 11%.
That's high enough to prevent spontaneous bleeding events. But it's not enough clotting factor to keep them out of danger during surgery, for example, or in the event of other significant trauma.
Researchers think they may be able to give people with hemophilia B higher doses of the altered virus to help boost FIX levels even more.
Questions Remain
But it's unclear how much people will be able to tolerate.
In this study, patients who got the highest doses made the most FIX. But they also saw their liver enzymes spike, a sign of inflammation.
"We were able to control this inflammation with a very short course of steroids," says study researcher Amit C. Nathwani, MBChB, PhD, a hematologist at University College London.
After steroid treatment, liver enzymes returned to normal. And patients continued to make FIX protein on their own, though their levels dropped slightly.
It's also not clear how long the treatments may last.
All patients who got the gene therapy continue to make FIX protein. Some have been followed for nearly two years.
But as liver cells die, the treatment could wear off. In animal studies, results of gene therapies that target liver cells have lasted for 10 years or more.
Even if it's temporary, the gene therapy is likely to save money. If it is approved by the FDA, the treatment is estimated to cost around $30,000 per patient.
It may also turn out to be safer than injecting blood products. In the 1980s, many hemophiliacs were infected with HIV after being treated with clotting factors that contained the virus.
Nathwani says many people with hemophilia in developing countries continue to face that risk, if they are able to get treatment at all.
"Eighty percent of hemophilia patients around the world have no access to treatment," he says. "This is one of the reasons why we wanted to develop a simple gene transfer approach," which could be delivered in almost any clinical setting, he says. "This is life changing."
