What is Diabetic Retinopathy (diabetic blindness)

Introduction

Retina is the part of the eye that is responsible for receiving images and transmitting them to the brain through optic nerve. Diabetic retinopathy refers to the retinal changes in patients with diabetes mellitus. It is a common complication of diabetes mellitus, which can eventually lead to blindness. It is an ocular manifestation (involves the eye) of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more. With the increase in life expectancy of people with diabetes, the incidence of retinoparht is on the rise. It is the leading cause of blindness in the developed nations. Research indicates that at least 90% of these new cases of diabetic retinonathy could be reduced if there was proper and vigilant treatment and monitoring of the eyes.




Diabetic retinopathy can be proliferative (growing) or nonproliferative (not growing), referring to the growth
of abnormal blood vessels in the retina. Nonproliferative retinopathy is much more common and may not require treatment. In proliferative retinopathy, abnormal blood vessels start to grow when the existing blood vessels close off. The proliferative type of retinopathy can lead to impaired vision.

Risk factors-

1) Duration of diabetes

2) Sex=> female sex: male sex= 4:3

3) Poor metabolic control

4) Heredity: autosomal recessive

5) Pregnancy: accelerates the changes

6) Hypertension:  associated hypertension accelerates changes

7) Smoking

8) obesity

9) hyperlipidaemia (increased blood cholesterol)

Symptoms:

Blurring of vision mostly during the daytime is seen in some patients. But in a majority it progresses without any symptoms.

Black spots floating in the visual field. (floaters)

Finally there is complete loss of vision

Blurry vision



On fundoscopic examination, a doctor will see cotton wool spots, flame hemorrhages and dot-blot hemorrhages.

Incidence by age-

Nearly 50% patients develop disease by the end of 10 years. 70% by the end of 20 years and nearly 90 % patients develop the disease by the end of 30 years.

Pathogenesis- 

Diabetic retinopathy is the result of microvascular changes in the retinal blood vessels. Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls. These damages change the formation of the blood-retinal barrier and also make the retinal blood vessels become more permeable.
The pericyte death is caused when "hyperglycemia persistently activates protein kinase C-δ (PKC-δ, encoded by Prkcd) and p38 mitogen-activated protein kinase (MAPK) to increase the expression of a previously unknown target of PKC-δ signaling, Src homology-2 domain–containing phosphatase-1 (SHP-1), a protein tyrosine phosphatase. This signaling cascade leads to PDGF receptor- dephosphorylation and a reduction in downstream signaling from this receptor, resulting in pericyte apoptosis."
Small blood vessels – such as those in the eye – are especially vulnerable to poor blood sugar (blood glucose) control. An overaccumulation of glucose and/or fructose damages the tiny blood vessels in the retina. During the initial stage, called nonproliferative diabetic retinopathy (NPDR), most people do not notice any change in their vision.
Some people develop a condition called macular edema. It occurs when the damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.
Elevation of blood-glucose levels can also cause edema (swelling) of the crystalline lens (hyperphacosorbitomyopicosis) as a result of sorbitol (sugar alcohol) accumulating in the lens. This edema often causes temporary myopia (nearsightedness). A common sign of hyperphacosorbitomyopicosis is blurring of distance vision while near vision remains adequate.
As the disease progresses, severe nonproliferative diabetic retinopathy enters an advanced, or proliferative, stage when blood vessels proliferate (ie grow). The lack of oxygen in the retina causes fragile, new, blood vessels to grow along the retina and in the clear, gel-like vitreous humour that fills the inside of the eye. Without timely treatment, these new blood vessels can bleed, cloud vision, and destroy the retina. Fibrovascular proliferation can also cause tractional retinal detachment. The new blood vessels can also grow into the angle of the anterior chamber of the eye and cause neovascular glaucoma.
Nonproliferative diabetic retinopathy shows up as cotton wool spots, or microvascular abnormalities or as superficial retinal hemorrhages. Even so, the advanced proliferative diabetic retinopathy (PDR) can remain asymptomatic for a very long time, and so should be monitored closely with regular checkups.

Treatment options include laser photo coagulation, panretinal photocoagulation, intra vitreal triamcinolone, and finally vitrectomy.

Protect from Diabetic Retinopathy (diabetic blindness)

Diabetic retinopathy refers to the retinal changes in patients with diabetes mellitus. It is a common complication of diabetes mellitus, which can eventually lead to blindness. It is an ocular manifestation (involves the eye) of systemic disease which affects up to 80% of all patients who have had diabetes for 10 years or more. With the increase in life expectancy of people with diabetes, the incidence of retinopathy is on the rise. It is the leading cause of blindness in the developed nations. Research indicates that at least 90% of these new cases of diabetic retinonathy could be reduced if there was proper and vigilant treatment and monitoring of the eyes.

To know about symptoms, treatment etc. click here...

Methods to prevent progression of Diabetic retinopathy
1) Regular eye check ups. Consult your diabetologist for further advice.
Recommendations vary depend on the degree of progression.
2) Recent studies suggest that even a peripheral doctor or a trained paramedic is helpful in recognizing these changes.

This study was lead by Dr. Hugh Taylor at the University of Melbourne in Australia. The objective was to investigate whether remote clinics could help reach people who would otherwise not visit an eye specialist, Taylor and his team reviewed data from 20 studies that compared the accuracy of eye exams using these clinics to what a specialist would do. They found that, overall, remote screening picked up 83 percent of people with retinopathy, which Taylor called "very good," and it didn't matter whether or not the photographer had medical training or not. However, the screens falsely labeled 12 percent as having retinopathy even though they didn't, and photographers with less training were more prone to such mistakes.

Another study done in this aspect towards the prevention of diabetes is to know the factors that may aid in delaying the progress of the disease. the following are the results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study, supported by the National Institutes of health.  The ACCORD Eye Study clearly indicates that -
3)intensive glycemic control and 
4) fibrate treatment added to statin therapy separately reduce the progression of diabetic retinopathy. "The main ACCORD findings showed that fibrate treatment added to statin therapy is safe for patients like those involved in the study. However, intensive blood sugar control to near normal glucose levels increased the risk of death and severe low blood sugar, so patients and their doctors must take these potential risks into account when implementing a diabetes treatment plan."In high-risk adults with type 2 diabetes, researchers have found that two therapies may slow the progression of diabetic retinopathy. 

Intensive treatments included control of blood sugar to near normal levels, control of blood pressure to normal levels, and combination treatment of multiple blood lipids with fenofibrate and simvastatin compared to standard treatment with simvastatin alone. Fenofibrate treatment lowers triglycerides and raises the "good" high density lipoprotein (HDL) cholesterol levels, while simvastatin lowers the "bad" low density lipoprotein (LDL) cholesterol levels.

Intensive blood sugar control reduced the progression of diabetic retinopathy compared with standard blood sugar control, and combination lipid therapy with a fibrate and statin also reduced disease progression compared with statin therapy alone. However, intensive blood pressure control provided no additional benefit to patients compared with standard blood pressure control.

Compared with standard blood sugar control, intensive control decreased the progression of diabetic retinopathy by about one-third, from 10.4 percent to 7.3 percent, over four years. Participants in the intensive control group had a median blood sugar level of 6.4 percent hemoglobin A1c-a level close to values in people without diabetes. The standard blood sugar control group maintained a median level of 7.5 percent.

In addition, compared with simvastatin treatment alone, combination lipid therapy with fenofibrate plus simvastatin also reduced disease progression by about one-third, from 10.2 percent to 6.5 percent, over four years. No prior clinical trial has shown that the combination of fenofibrate and simvastatin reduces diabetic eye disease progression.

Treatment options include laser photo coagulation, panretinal photocoagulation, intra vitreal triamcinolone, and finally vitrectomy.

Stem cells in treatment of diabetes

Stem cells are cells that are characterized by the ability to renew themselves through mitotic cell division and also to differentiate into a diverse range of specialized cell types. In other words these are juvenile cells that can grow into any adult type. It is a long known fact that these stem cells can convert to any adult cell types based on the culture media and growth conditions.


Type 1 Diabetes is a condition seen mainly in children and young adults mostly, but can also occur in middle aged. In this condition the body mounts an auto immune response i.e. attacks its own cells in pancreas. As these cells are responsible for the secretion of insulin, a decrease in these cells leads to insulin deficiency and diabetes.

Thus these patients need to take insulin throughout their lives.another treatment option that is available is the Edmonton protocol (transfer of pancreatic cells from cadavers). This is a costly procedure and has its own limitations of rejection and scarcity of cells available for transplant.

An answer to this problem is the transplantation of pancreatic cells that are grown from the stem cells. A team at Georgetown University in Washington worked with spermatogonial stem cells (the master cells that give rise to sperms in men).

Ian Gallicano and colleagues at the Georgetown university used germ cell-derived pluripotent stem cells, which are made from the spermatogonial stem cells. They grew these cells in appropriate culture media with compounds designed to make these cells start acting like pancreatic beta cells, which produce insulin.

When transplanted into diabetic mice, these cells produced insulin, acting like the normal pancreatic beta cells.
Gallicano speaking at a meeting of American Society for cell biology said men's own cells could be used as a source of their transplants, and he said perhaps the approach may work in women too. "While these cells come from the human testis, the work here is not necessarily male-centric," they wrote. "These fundamental aspects could easily be applied to the female counterpart, oocytes." 

Something to cheer up for the little kids who need to have injections everyday.

monomethyl auristatin E (MMAE)- new drug for Hodgkins lymphoma

An investigational drug composed of a monoclonal antibody linked to a potent chemotherapy agent led to complete or substantial tumor shrinkage in nearly 40 percent of patients with Hodgkin lymphoma in a phase I clinical trial, researchers reported November 4, 2010, in the New England Journal of Medicine.

In the trial, 42 patients with Hodgkin lymphoma and three patients with anaplastic large-cell lymphoma (ALCL) who had relapsed after earlier treatments (including stem cell transplantation) or were resistant to standard treatments received the drug brentuximab vedotin (SGN-35). The antibody component of the drug targets a protein called CD30 that sits on the surface of lymphoma cells. Attached to the antibody is a powerful investigational chemotherapy agent called monomethyl auristatin E (MMAE).

Developed by Seattle Genetics, MMAE is 100 to 1,000 times more potent than other chemotherapy drugs, according to the company. The antibody directs the drug to cancer cells, where it is absorbed and degraded by enzymes in the cells’ nuclei, releasing the MMAE and leading to cell death.

Among the 17 patients who had measurable responses, 11 had no evidence of existing cancer (complete response) after treatment, and the remainder had at least 50 percent tumor shrinkage (partial response). Because it was a phase I trial, patients received different doses. Among the 12 patients who received the most effective dose for which side effects were the least severe (the maximum tolerated dose), six had a measurable response. Overall, 86 percent of patients in the trial had at least some tumor shrinkage and side effects were limited.

Over the last 3 decades, there has been little progress in developing new treatments for Hodgkin lymphoma. So, these results offer significant promise for patients, said the study’s lead investigator, Anas Younes, M.D., of the University of Texas M. D. Anderson Cancer Center. “I think it is remarkable that the majority of patients had tumor reductions when they were treated on the phase I study,” he wrote in an e-mail.

Initial results from a phase II trial of the drug in the same patient population appear to be even stronger than the phase I results, according to Seattle Genetics. In late September 2010, the company announced that 75 percent of the 102 patients in the phase II trial, all of whom had relapsed/refractory Hodgkin lymphoma, had an objective response. And, in early October, the company reported that patients with ALCL in another phase II trial of brentuximab had an 86 percent measurable response rate. More complete results and details from both trials will be presented at the American Society of Hematology annual meeting in December 2010.

source- www.cancer.gov

choosing heart healthy foods

Womenshealth.gov offers these guidelines for a heart-healthy diet:

• Eating plenty of vegetables and fruits.
• Making at least half of your daily grain consumption whole grains. These may include whole-grain barley, brown rice, whole-grain corn and oatmeal.
• Eating low-fat dairy foods, such as yogurt, cheese and milk.
• Getting lots of nuts and dry beans, lean meat, fish and poultry without the skin.
• Favoring polyunsaturated and monounsaturated fats via vegetable oils, fish and nuts.
• Avoiding: saturated and trans fats, sodium (salt), cholesterol and added sugars.

Radiation, Tamoxifen for breast cancer

Radiation or Tamoxifen after surgery reduces risk of recurrence of breast cancer.

 A recent study shows that Women with localized breast cancer are less likely to develop invasive cancer if they receive radiation after surgery.

Tamoxifen is an antagonist for estrogen(female sex hormone) receptors in the breast tissue.The researchers also found that treatment with the drug tamoxifen greatly reduced the risk of the recurrence of localized cancer. Tamoxifen acts by negating the tumor enhancing effect of estrogen.

The three-nation study included patients with ductal carcinoma in situ (DCIS), the most common type of noninvasive breast cancer, who were followed for a median of 12.7 years.

The researchers found that radiation after surgery reduced the risk of invasive cancer in the same breast by nearly 70 percent and decreased recurrent DCIS in the same breast by more than 60 percent. Radiation therapy had no effect on the other breast.

"This study is very important in confirming the benefits of radiotherapy in the treatment of ductal carcinoma in situ and, most importantly, decreasing the incidence of invasive carcinoma developing in the same breast," said Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City. "If we could only identify which particular patients were most at risk, we could target our radiotherapy to those patients who truly benefit from it and avoid over-treating others."

The study also found that treatment with tamoxifen lowered the risk of cancer recurrence in the same breast by about 30 percent, and it decreased the risk of new cancer in the other breast by more than 65 percent.

The findings confirm "the long-term beneficial effect of radiotherapy and reports a benefit for tamoxifen in reducing local and contralateral new breast events for women with DCIS treated by complete excision," study author Jack Cuzick, of Cancer Research U.K. and Queen Mary's School of Medicine and Dentistry in London, and colleagues wrote in a news release from the journal.

"This trial emphasizes the importance of radiotherapy in high-grade [more quickly growing and more likely to spread] DCIS and also suggests a role for tamoxifen, primarily for new contralateral disease," they concluded.

SOURCES: The Lancet Oncology, news release, Dec. 7, 2010; Lauren Cassell, M.D., chief, breast surgery, Lenox Hill Hospital, New York City

Imatinib for ALL (blood cancer)

Imatinib is a drug used to treat certain types of cancer mainly indicated in chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GISTs).

Imatinib acts by specifically inhibiting a certain enzyme that is characteristic of a particular cancer cell, rather than non-specifically inhibiting and killing all rapidly dividing cells, and served as a model for other targeted therapy modalities through tyrosine kinase inhibition. 

A study done in the University College London shows  promising results for a regimen of Imatinib (Gleevec) in patients with Philadelphia chromosome-positive (Ph+) ALL, a form of acute lymphoblastic leukemia that progresses rapidly and has a poor prognosis.

The team, led by Adele K. Fielding from University College London, tracked treatment outcomes of about 440 patients. The first group of Ph+ patients was treated solely with chemotherapy and stem cell transplants before imatinib became available in 2003. Post-2003, a second group was given 600 milligrams daily of imatinib following two rounds of chemotherapy. And in 2005, a third group received an earlier round of imatinib in conjunction with a second round of chemotherapy. The imatinib patients continued their drug regimen for two years.

After three years of follow-up, Fielding and colleagues found that each successive approach yielded better results. In the pre-imatinib group, the survival rate was 25 percent. By contrast, survival increased to 34 percent among the imatinib post-chemotherapy group and to 48 percent among the with-chemotherapy group.

The authors concluded that early treatment with imatinib can optimize long-term survival.

Zoledronic acid for blood cancer

Zoledronic acid, a type of bisphosphonate, is given to myeloma patients to increase bone strength and reduce the risk for fracture and bone pain that are a common feature of the disease. It is also used in patients as well as for treating osteoporosis.

Results from a study published in the Dec. 4 online edition of The Lancet suggest that treating multiple myeloma patients with zoledronic acid can improve survival.

Although prior research has suggested that zoledronic acid (brand names include Zometa and Reclast) may have a broader anti-cancer effect, the current study finds that a well-tolerated regimen of the drug can reduce the risk of death among myeloma patients.

"These data add to growing clinical evidence supporting anti-cancer benefits with zoledronic acid in patients with newly diagnosed cancers," the study team, led by Gareth J. Morgan from the Institute of Cancer Research in London, said in a journal news release.

The authors base their conclusions on work with 1,960 multiple myeloma patients, about half of whom were treated with zoledronic acid in combination with either intensive or non-intensive chemotherapy. The other half received clodronic acid (another type of bisphosphonate) and equivalent chemotherapy regimens.

Treatments continued for an average of one year, while further follow-up was conducted for nearly four years.

The zoledronic acid patients experienced 16 percent fewer fatalities (and saw their life expectancy extended by 5.5 months) compared with those on the alternative treatment program, the authors found.

The team also noted that progression-free survival rates came in 12 percent better among those given zoledronic acid. Chemotherapy intensity did not appear to affect fatality and survival outcomes.

Side effects can include fatigue, anemia, muscle aches, fever, and/or swelling in the feet or legs and Flu-like symptoms.

Contraindications are Poor renal function, Hypocalcemia, Pregnancy and Paralysis.

new treat ment for DVT (blood clots in legs)

DVT or Deep Vein Thrombosis is a life threatening condition.

A new anti-clotting pill, rivaroxaban (Xarelto), may be an effective, convenient and safer treatment for patients coping with deep-vein thrombosis (DVT), a pair of new studies indicate.

According to the research, published online Dec. 4 in the New England Journal of Medicine, the drug could offer a new option for these potentially life-threatening clots, which most typically form in the lower leg or thigh.

The findings are also slated for presentation Saturday at the annual meeting of the American Society of Hematology (ASH), in Orlando, Fla.

"These study outcomes may possibly change the way that patients with DVT are treated," study author Dr. Harry R. Buller, a professor of medicine at the Academic Medical Center at the University of Amsterdam, said in an ASH news release. "This new treatment regimen of oral rivaroxaban can potentially make blood clot therapy easier than the current standard treatment for both the patient and the physician, with a single-drug and simple fixed-dose approach."

Another heart expert agreed.

"Rivaroxiban is at least as effective as the older drug [warfarin] and seems safer. It is also far easier to use since it does not require blood testing to adjust the dose," said cardiologist Dr. Alan Kadish, currently president of Touro College in New York City.

The study was funded in part by Bayer Schering Pharma, which markets rivaroxaban outside the United States. Funding also came from Ortho-McNeil, which will market the drug in the United States should it gain U.S. Food and Drug Administration approval. In March 2009, an FDA advisory panel recommended the drug be approved, but agency review is ongoing pending further study.

The authors note that upwards of 2 million Americans experience a DVT each year. These leg clots -- sometimes called "economy flight syndrome" since they've been associated with the immobilization of long flights -- can migrate to the lungs to form potentially deadly pulmonary embolisms.

The current standard of care typically involves treatment with relatively well-known anti-coagulant medications, such as the oral medication warfarin (Coumadin) and/or the injected medication heparin.

While effective, in some patients these drugs can prompt unstable responses, as well as problematic interactions with other medications. For warfarin in particular, the potential also exists for the development of severe and life-threatening bleeding. Use of these drugs, therefore, requires intense and continuous monitoring.

The search for a safer and easier to administer treatment option led Buller's team to analyze two sets of data: One that pitted rivaroxaban against the standard anti-clotting drug enoxaparin (a heparin-type medication), and the second which compared rivaroxaban with a placebo.

In the first instance, about 1,700 DVT patients were given rivaroxaban, while a similar number received enoxaparin, for a period of up to a year. In the second investigation, about 600 DVT patients who had completed at least six months of the first trial (on either medication) were randomly chosen to take rivaroxaban, while a similar number of patients were given a placebo.

The authors observed that fewer cases of clotting took place among the rivaroxaban group compared with those taking enoxaparin (2.1 percent vs. 3 percent, respectively). Major bleeding was also slightly less common among the former than the latter.

The new medication also significantly outperformed the placebo, with just over 1 percent of rivaroxaban patients experiencing clotting problems compared with more than 7 percent in the placebo group.

Although bleeding issues were more prevalent among rivaroxaban patients than among those taking a placebo, the research team determined that the new treatment option is both safe and effective for the treatment of DVT.

Dr. Murray A. Mittleman, director of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center at Harvard Medical School in Boston, said finding alternate treatments for DVT could be an "important advancement," even though rivaroxaban is likely to be a more expensive option.

"The problem with current treatments is not cost," he noted, "in the sense that warfarin, for example, has been around for a very long time and is very cheap. It's more a question of the considerable complications that come with current treatments, which means they require sometimes cumbersome and frequent monitoring, as well as dosage adjustments."

Kadish agreed. "While the cost of rivaroxiban is significant, the absence of monitoring costs, reduced time away from work [since blood test are not required] and the lower bleeding rate all serve to mitigate the cost differential relative to warfarin," he said.

"Also, DVT affects a broad age range of patients," Mittleman noted. "And that means that the risk for bleeding with current treatments can impact the lifestyles of young active people who are often advised to avoid activities that might prompt complications. So, it's a quality-of-life issue as well. So absolutely, a new, good treatment that would be safer and at least as effective would be very useful."

SOURCES: American Society of Hematology, news release, Dec. 4, 2010; New England Journal of Medicine, Dec. 4, 2010; Alan Kadish, M.D., cardiologist and president, Touro College, New York City; Murray A. Mittleman, M.D., director, cardiovascular epidemiology research unit, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston

Gifting to stay healthy

Computers, mobile phones and other gadgets often become out-dated before you even figure out how to use them. This holiday season, why not try giving gifts that will last a lifetime? Help your friends and loved ones stay healthy, and they’ll remember how much you care about them for years to come.

A variety of kitchen gadgets can help you prepare nutritious low-fat foods. Durable nonstick cookware helps cooks cut down on added fats and oils. Slow cookers, rice cookers and vegetable steamers can all aid in the preparation of healthy meals. You can also encourage loved ones to prepare tasty, healthy dishes by giving a healthy cookbook. NIH has several no- and low-cost options with nutritious recipes reviewed by NIH experts (see Wise Choices).

Some people get a surprising amount of their empty calories by going out to lunch or getting take-out food throughout the work week. Encourage them to bring healthy food from home with an insulated soup container, a lunchbox that doesn’t look like it’s left over from grade school or a reusable storage container with several small compartments for food.

For that friend or family member who’s been talking about getting into shape, make up a coupon for a run, bike ride or workout together. A pass to a local, state or national park system can encourage walking, biking, hiking or even kayaking. Give a gift card for a visit with a fitness trainer or classes at a local health club, pool or community center. Or try to revive interest in a neglected sport with a tune-up at a local bike shop, protective eyewear for an indoor racket sport or a nice yoga or Pilates mat.

Exercise clothing can make a great holiday gift. So can accessories, like a pedometer or a watch with a heart rate monitor. A watch with a GPS (global positioning system) helps runners track distance and pace. Hikers might also appreciate a GPS device or other accessories, like a walking stick.

For kids, sports equipment can be a great gift. Even something as simple as a flying disc, boomerang, football or soccer ball can provide hours of healthy and fun family activity

source of empty calories

Nearly 1 in 3 children in the US are overweight or obese. These children are at an increased risk of developing diabetes, heart disease, high blood pressure, cancer, asthma and a variety of other health problems. Both greater energy consumption (calories intake) and less physical activity are factors that contribute to the weight problems
it is often seen that mothers complain that their children don't eat much but are gaining weight. 

Scientists at the National Institute of Health tried to find out where the children were getting their extra calories. They examined extensive data on children’s diets to learn more about where the extra calories are coming from. Overall, the top 5 sources of energy were grain desserts (cakes, cookies, donuts, pies, crisps and granola bars), pizza, soda, yeast breads and chicken dishes.
Nearly 40% of the energy consumed by kids and teens comes in the form of “empty” calories. Half of those empty calories come from the solid fats and added sugars in just 6 sources: soda, fruit drinks, dairy desserts, grain desserts, pizza and whole milk.

Experts recommend that kids limit their intake of empty calories to between 8% and 20% of their total calories. But the researchers found that nearly 40% of the children’s total energy came from empty calories. Sugar-sweetened beverages, a major source of empty calories, contributed a whopping 10% of total energy.

“The epidemic of obesity among children and adolescents is now regarded as one of the most important public health problems in the United States,” says study co-author Dr. Jill Reedy of NIH’s National Cancer Institute. The findings suggest that sugar-sweetened drinks should be a major target of efforts to improve our children’s health.

Making Your Resolutions Stick

How to Create Healthy Habits

New Year’s resolutions—they’re easy to make but easier to break. Why is it so hard to make the healthy changes that we know can help us feel better and live longer? And why is it so hard to make them last? NIH-funded scientists are learning more about how we can make healthy changes and, even more important, how we can sustain them.

“Change is always possible,” says Dr. Linda Nebeling, an expert in behavioral change and nutrition at NIH. You’re never too out-of-shape, too overweight or too old to make healthy changes.

Some of the most common New Year’s resolutions are losing weight, getting more physical activity, eating more nutritious foods, quitting cigarettes, cutting back on alcohol, reducing stress and sleeping better. But no matter which healthy resolution you choose, research suggests that some common strategies can boost your chance of making the change a habit, a part of your daily lifestyle.

“One challenge with New Year’s resolutions is that people often set unrealistic goals. They can quickly become frustrated and give up,” says Nebeling. “Any resolution to change needs to include small
goals that are definable and accompanied by a solid plan on how you’ll get to that goal.”

For instance, a resolution to lose 30 pounds may seem overwhelming. Instead, try setting smaller goals of losing 5 pounds a month for 6 months. Think baby steps rather than giant leaps.

Next, develop an action plan. You might decide to walk a half hour each day to burn calories. You might stop buying vending machine snacks. Or you might limit and keep track of your daily calories. “These are specific behaviors that could help you meet your larger goal of losing 30 pounds,” says Dr. Deborah Tate, an obesity and behavioral researcher at the University of North Carolina.

To make a long-lasting change in your life, prepare yourself for the challenges you might face. “Think about why you want to make the change. Is it important to you, or is it mostly influenced by others—like your doctor, your spouse or a friend?” says Tate. “Research suggests that if it’s something you really want for yourself, if it’s meaningful to you, you’re more likely to stick to it.” 

Think of exactly how the change will enhance your life. For instance, when you stop smoking, your risk plummets for cancer, heart disease, stroke and early death. Reducing stress might cut your risk for heart disease and help you fight off germs. Even small improvements in your physical activity, weight or nutrition may help reduce your risk for disease and lengthen your life. In one study, overweight or obese people who lost just 7% of their body weight slashed their risk for diabetes by nearly 60%. Keeping facts like this in mind can help you maintain your focus over the long haul.

Setting up a supportive environment is another step toward success. “Think about the physical support you’ll need, like the right equipment for exercise, appropriate clothing and the right kinds of foods to have at home,” says Dr. Christine Hunter, a behavioral researcher and clinical psychologist at NIH. Remove items that might trip up your efforts. If you’re quitting smoking, throw away your ashtrays and lighters. To improve your nutrition, put unhealthy but tempting foods on a hard-to-reach shelf, or get rid of them.

Social support is also key. Research shows that people’s health behaviors—like smoking or weight gain—tend to mirror those of their friends, family and spouses. “You can enlist friends and family to help you eat better, to go on walks with you, to remind you to stay on track,” says Tate. “Find things that are fun to do together, and you’ll be more likely to stick with it.”

“It helps when you’re connected to a group, where lifestyle change like weight loss is a joint goal,” says NIH’s Dr. Sanford Garfield, who heads a large study called the Diabetes Prevention Program. Participants who lost weight through dietary changes and physical activity reduced their chances of developing diabetes. Group counseling that emphasized effective diet, exercise and behavior modification were credited, in part, with participants’ success. “There’s a long history of group support leading to good results,” Garfield says.  “People learn from each other and reinforce each other in working toward their goals.”

While making a change is one thing, sticking to it is something else. “Maintaining a change requires continued commitment until the change becomes a part of your life, like brushing your teeth or washing your hair,” says Nebeling. “People who can maintain or engage in efforts to change their behavior, and do it for 6 to 8 weeks, are more likely to be able to support that effort longer term.”

Some researchers are studying people who’ve made lasting healthy changes. The ongoing National Weight Control Registry compiles information on more than 5,000 adults who’ve dropped at least 30 pounds and kept it off for a year or more. Although the way these people lost their weight varied, those who’ve maintained their weight loss tend to use similar strategies. Notably, many participants track their progress closely, often in a daily journal or diary. If the numbers rise, they have an early warning to adjust their behaviors.

“Self-monitoring or tracking seems to be critical for almost every sort of behavior change,” says Hunter. That includes jotting down the foods you eat, keeping an exercise diary or making a record of your sleeping patterns.

Monitoring yourself might feel like a burden, but it’s one of the best predictors of successful change. “Think about how you can make tracking more convenient, so it fits naturally into your life,” Hunter says. For some people, that might be a pad of paper in a purse or pocket; for others, a mobile app or a computer program.

Make sure to have a plan to get back on track if you start to slip. “If you feel that your motivation is waning, think back and remind yourself why the change was important to you in the first place,” says Tate. “Maybe you wanted to have more stamina, feel better, to be able to play with grandchildren. Recalling these personal reasons can encourage you to get back on track.”

Of course, you don’t need a new year to make healthy changes; you can make them any time of the year. But New Year’s is an opportunity to think about the improvements you’d like to make and then take concrete steps to achieve them. Set realistic goals, develop an action plan and set it in motion. Make your new year a healthy one.

source- http://newsinhealth.nih.gov

dopamine receptor variant plays major role in sexual behavior

Genetics might help explain why some people are more prone to infidelity and promiscuity, says a new study.

Researchers analyzed the DNA of 181 young adults who provided a complete history of their sexual activity and intimate partnerships. They concluded that the dopamine receptor D4 (DRD4) gene plays a major role in sexual behavior.

Previous research has linked the DRD4 gene, which influences brain chemistry, to sensation-seeking activities such as gambling and alcohol use.

"What we found was that individuals with a certain variant of the DRD4 gene were more likely to have a history of uncommitted sex, including one-night stands and acts of infidelity," study leader Justin Garcia, of the laboratory of evolutionary anthropology and health at Binghamton University, State University of New York, said in a university news release.

"The motivation seems to stem from a system of pleasure and reward, which is where the release of dopamine comes in. In cases of uncommitted sex, the risks are high, the rewards substantial and the motivation variable -- all elements that ensure a dopamine 'rush,'" Garcia explained.

The findings, published in the current issue of the online journal PLoS One, shouldn't be viewed as an excuse for cheating or promiscuity, Garcia stressed.

"These [gene-behavior] relationships are associative, which means that not everyone with the genotype will have one-night stands or commit infidelity. Indeed, many people without this genotype still have one-night stands and commit infidelity," Garcia said. "The study merely suggests that a much higher proportion of those with this genetic type are likely to engage in these behaviors."

SOURCE: Binghamton University, news release, Nov. 30, 2010

Obesity and Breast cancer

Scientists at the National Cancer Institute, USA have identified a molecular link between BRCA1 protein levels and obesity

NCI researchers have defined a possible molecular link between breast cancer risk and obesity. New study results show that a protein called C-terminal binding protein (CtBP) acts to control a gene linked to breast cancer risk in rapidly growing cells by monitoring and responding to how the cells use and store energy (metabolic state). The cancer susceptibility gene, BRCA1, performs many functions in the cell, including the regulation of cellular growth and division as well as the repair of DNA or genetic damage. In breast tissue, BRCA1 expression rapidly increases in response to the growth effects caused by estrogen. This study, led by Kevin Gardner, M.D., Ph.D., Laboratory of Receptor Biology and Gene Expression,found that under conditions where there is a metabolic imbalance—available cellular energy is greater than the energy required to carry out cellular functions—the activity of CtBP increases and suppresses the expression of BRCA1.The paper is published in the Nov. 21, 2010 issue of Nature Structural and Molecular Biologywith post-doctoral fellow, Li-Jun Di, Ph.D., as first author.

The scientists demonstrated metabolic imbalance either by manipulating the metabolic state of the human breast cancer cells with drugs, or by deleting expression of the CtBP gene. When they created a cellular energy imbalance, a condition when the cell’s energy stores are very high compared with normal energy usage—much in the way energy imbalance occurs in obesity in humans—the cells produced less BRCA1 type 1 breast cancer susceptibility protein. When they decreased the levels of CtBP or reversed the energy imbalance, they could recover or rescue BRCA1 expression. Past studies have determined that high-fat diets increase the risk and severity of mammary cancer in mice and that calorie restriction has beneficial effects that can reverse this trend. The goal of Gardner and his team is to examine these experimentally induced mammary cancers in combination with available breast-tissue samples from patients in clinical studies to see if increased CtBP activity and lowered BRCA1 expression are important molecular events in breast cancer.

HIV testing in 60 seconds!

Unbelievable! But true.
FDA has recently approved a new rapid test for diagnosis of HIV infection.  INSTI™ HIV-1 Antibody Test is a  single use rapid test for the detection of HIV antibodies developed by BioLytical Laboratories of Canada. The newly approved test provides results in as little as 60 seconds. This test works by the detection of antibodies to Human Immunodeficiency Virus Type 1 (HIV-1) in human venipuncture whole blood, fingerstick blood, or plasma specimens.

Rapid HIV tests allow people to learn their HIV status in a single visit, instead of returning days later for results.

Rapid testing also helps increase access to HIV testing because testing can be performed outside of the traditional laboratory setting. Individuals who undergo testing can be counseled immediately concerning their HIV status and, if they are positive, given the opportunity to enter medical care.

It is highly sensitive [The overall sensitivity for the different sample types: 99.8% (95% CI = 99.3% - 99.9%) in fingerstick whole blood, 99.9% (95% CI = 99.5% - 100%) in venipuncture whole blood, 99.9% (95% CI = 99.5% - 100%) in plasma] and specific [The overall specificity for the different samples types: 99.5% (95% CI = 99.0% - 99.8) in fingerstick whole blood, 100% (95% CI = 99.7% - 100%) in venipuncture whole blood, 100% (95% CI = 99.7% - 100%) in plasma] for the detection of antibodies to HIV-1.

But heres a word of CAUTION- The assay is not intended to be used for screening of blood donors.

THE MAGIC PILL- live longer

A Harvard Medical School professor believes that the day is not far when just popping a pill could make you live longer and healthier.

Associate Professor of Pathology David Sinclair said his work to activate the sirtuin genes, which control ageing "could expand lifespan by five to 10 healthy years."

It wouldn't stop you getting old, he said, but instead would push back the point at which you become impaired before "hopefully, [you] immediately drop dead," reports The Sydney Morning Herald.

He suggested that activating the sirtuins increases memory and endurance but also slow ageing and alleviate the impact of a high-fat diet.

"If the animal studies are borne out in humans, you would have a pill for arthritis that would prevent Alzheimer's, cardiac arrest, would slow down heart disease and even protect you against cataracts," Sinclair said.

"Within scientific circles this is as cutting edge as stem cell research," he added.

Sinclair also pioneeered the use of resveratrol - and now synthetic compounds up to 10,000 times more potent - which have been shown to slow the ageing process and prevent the onset of many diseases in animals.

However, he admitted that there was a risk because the effects of long-term doses in humans were not known, but no side effects in either animals or humans had been found

Lifestyle changes curb overnight bathroom trips

If you're frequently bothered by waking in the middle of the night to empty your bladder, there may be some simple and drug-free lifestyle adjustments that can help, a small study suggests.

So-called "nocturia" is the complaint of getting up at least once a night to urinate -- either due to a heightened production of urine or the inability of the bladder to hold it, sometimes as a result of an underlying medical problem. The condition can contribute to fatigue and depression, and raise the risk of heart disease and gastrointestinal disorders.

However, as experts note, nocturia is also very normal, especially as people age. And not everyone affected is bothered by it.

The standard treatments for frequent nighttime urination include "medical therapy as well as lifestyle modifications such as fluid restrictions," senior researcher Dr. Koji Yoshimura of Kyoto University Graduate School of Medicine in Kyoto, Japan, told Reuters Health in an email. "However, the efficacy of the lifestyle therapy has not been established so far."

Yoshimura and his colleagues studied 56 people complaining of nocturia who were about 75 years old, on average. They tested the effects of four easy lifestyle changes: fluid restriction, limiting any excess hours in bed, moderate daily exercise and keeping warm while sleeping.

Each patient was advised of the benefits of each modification, including a recommendation to limit their fluid intake to about 2 percent of their body weight during the day -- avoiding too much in the evening. This translates to about one and a half quarts of water for a 165-pound person.

After four weeks, the participants' average number of nighttime bathroom trips dropped. More than half of the patients experienced an improvement of more than one episode a night, Yoshimura and colleagues report in The Journal of Urology. Total urine volume also decreased (from 923 to 768 milliliters).

Dr. Serge Marinkovic of St. Francis Hospital, in Indianapolis, who was not involved in the study, noted that the effectiveness of the lifestyle changes was comparable to that of drug interventions.

Current medication options for nocturia include a synthetic version of a hormone that keeps the body from making urine at night, a drug that blocks the ability of the bladder muscles to contract, and antidepressants that make it harder to urinate by increasing tension at the bladder neck, he told Reuters Health.

"None of these medications are a great cure, and all have side effects, including dry mouth, constipation and heartburn," Marinkovic said. "They're significant enough for up to 70 percent of patients to stop using the drug within 6 months."

A limitation of the current study, Marinkovic noted, is the fact that patients were not monitored to determine how well they actually adhered to each of the behavior modifications. Another limitation is the lack of an untreated control group, which means a placebo effect can't be ruled out.

In his practice, Marinkovic typically starts off with his nocturia patients by going over a medical history to rule out underlying conditions such as diabetes or renal problems. Then he has them keep a diary of fluid intake and nighttime symptoms, which helps him prescribe behavioral changes such as fluid restriction. On top of this, he often adds medications, he said.

But again, not everyone is bothered by frequent trips to the bathroom during the night, Marinkovic emphasized.

"I saw a guy two weeks ago who gets up four times a night, and it's not a problem for him," he said. "He told me he does some of his best thinking when he's walking to the bathroom."

SOURCE: http://link.reuters.com/nuc57n The Journal of Urology, September 2010. (Reuters Health)

Quitting smoking helps after serious heart attack damage

It's never too late for smokers to do their hearts good by kicking the habit -- even after a heart attack has left them with significant damage to the organ's main pumping chamber, a new study suggests.

Past studies have found that smokers who kick the habit after suffering a heart attack have a lower rate of repeat heart attacks and live longer than their counterparts who continue to smoke.

But little has been known about the benefits of quitting among heart attack patients left with a complication called left ventricular (LV) dysfunction -- where damage to the heart's main pumping chamber significantly reduces its blood-pumping efficiency.

So it has been unclear whether that dysfunction might "drown out" the heart benefits of smoking cessation, said Dr. Amil M. Shah, the lead researcher on the new study and a staff cardiologist at Brigham and Women's Hospital in Boston.

But in their study, Shah and his colleagues found that heart attack survivors with LV dysfunction may stand to benefit as much from smoking cessation as other heart attack patients do.

The researchers found that among 2,231 patients with LV dysfunction, those who quit smoking within six months of their heart attack were less likely to die within five years or suffer a repeat attack than smokers who continued the habit.

Of all patients, 463 were smokers at the time of the heart attack but had quit six months later; 268 were still smoking at the six-month mark. Among quitters, 15 percent died or suffered another heart attack by the end of the study, which followed the patients for up to five years.

That compared with a rate of 23 percent among patients who were still smoking six months after their initial heart attack.

When Shah's team accounted for a number of other factors -- including age, medical history and body weight -- smoking cessation itself was linked to a 40 percent reduction in the risk of death compared with persistent smoking.

Quitters were about 30 percent less likely to die, suffer a repeat heart attack or be hospitalized for heart failure during the study period.

"The findings aren't completely surprising," Shah told Reuters Health. But, he said, they offer reassurance to patients with LV dysfunction that they can benefit from smoking cessation -- and the magnitude of that benefit is similar to what has been seen among heart attack survivors without LV dysfunction.

"I've had patients who say, 'What's the point of quitting now?'" Shah noted. "But it's never too late to benefit from smoking cessation."

Some studies have found that smoking-cessation counseling begun in the hospital, and continued after discharge, may be particularly effective for heart attack patients.

Patients at hospitals that do not offer such counseling should speak with their cardiologist or primary care doctor about smoking cessation, Shah advised. Behavioral counseling will generally be the first step, he noted -- though for patients who ultimately need more, nicotine-replacement products or medications such as Zyban or Chantix may be options.

A number of studies have suggested that these products are generally safe for people with heart disease -- though, Shah pointed out, most of the data come from patients with stable heart disease, and not those who have just recently suffered a heart attack or other complication.

SOURCE: http://link.reuters.com/dew47n American Journal of Cardiology, published online August 13, 2010. (Reuters Health)

allergies and heart disease

Common allergies that bring on wheezing, sneezing and watery eyes could be next to join the list of factors linked to heart disease, suggests a large new study.

However, the researchers stress that the findings do not prove that allergies actually cause heart disease, the leading cause of death in the U.S.

To look for ties between common allergic symptoms and heart disease, Dr. Jongoh Kim of Albert Einstein Medical Center in Philadelphia, Pennsylvania and colleagues analyzed data on more than 8,600 adults aged 20 or older who participated in the National Health and Nutrition Examination Survey conducted between 1988 and 1994.

They found that common allergies and heart disease frequently paired up.

Eighteen percent of the adults reported wheezing and 46 percent suffered bouts of a stuffy nose or itchy and watery eyes -- a combination of allergic symptoms known as rhinoconjunctivitis.

Heart disease was present in 6 percent of the adults overall. It was found in 13 percent of wheezing cases, 5 percent of rhinoconjunctivitis cases and 4 percent of people without any allergic symptoms.

After adjusting for other related factors, such as age and asthma, there was a 2.6-fold increased risk of heart disease with wheezing and a 40 percent increased risk with rhinoconjunctivitis, compared to no allergies. The association was mainly seen in women younger than age of 50.

Kim suggests that the intermittent inflammation that comes with allergies may lead to the thickening of artery walls, and eventually heart disease. It could also be that some people simply carry genes that are linked to the development of both allergies and heart disease, Kim added.

But given the nature of the study, the researchers are not yet able to say if allergies truly have a role to play in the development of heart disease.

Much more study is needed to "clearly see" whether there is a cause and effect relationship, Kim said. "And even if there is a cause and effect, it is not clear whether treating allergic disease can reduce the risk," Kim noted.

Dr. Carlos Iribarren, a research scientist at Kaiser Permanente in Oakland, California, who was not involved in the study, said: "Because common allergic symptoms are highly prevalent in asthma, these findings are consistent with prior research conducted at Kaiser Permanente showing a significant association between self-report of asthma and future risk of coronary disease, particularly among women."

But he cautioned, in an email to Reuters Health, against jumping to any "premature conclusion, consumer-level advice or public health recommendation based on these findings."

Iribarren also noted that study subjects with allergy (particularly wheezing) had a greater burden of heart disease risk factors (for example, smoking, obesity, high blood pressure), compared with allergy-free subjects. Therefore, "allergists, internists and cardiologists should be made aware of this link and intensify cardiovascular risk profile assessment and modification among patients presenting with allergy."

Dr. Viola Vaccarino, of the Rollins School of Public Health at Emory University School of Medicine in Atlanta, told Reuters Health that the current findings also fit with studies she and her colleagues have done, "finding of an association of chronic inflammatory conditions such as asthma and other allergic conditions with coronary disease in women but not in men."

"Young women may have a stronger inflammatory response due to allergic conditions than men, perhaps due to estrogens," explained Vaccarino, who was also not involved in the current study.

It's also possible, she said, that "people with history of coronary heart disease are sicker with respiratory symptoms just because they have coronary heart disease and not vice-versa."

"I really wouldn't draw any strong message from this study," said Vaccarino. "I would not alarm the public with the news that common allergic symptoms (other than asthma) increase the risk of coronary heart disease in women, based on this study."

SOURCE: http://link.reuters.com/qut47n The American Journal of Cardiology, online August 13, 2010. (Reuters Health)