Dr. Bray Links

Saturday, July 7, 2018

Alpha-Gal Allergy: Symptoms, Treatment, Causes, and More

Galactose-alpha-1,3-galactose (alpha-gal) is a carbohydrate found in the cells of many mammals that humans eat, such as cows, sheep, and pigs. Poultry that has been injected with natural flavoring containing beef or other mammal cells may also have alpha-gal. As a result of autoimmune responses, some people become allergic to alpha-gal.

People with this allergy may experience mild discomfort after eating meat, or they may have a dangerous reaction that leaves them unable to breathe. The spectrum of reactions to alpha-gal varies. Most instances of this allergy are triggered by tick bites.

https://www.healthline.com/health/allergies/alpha-gal

Tuesday, June 26, 2018

Why petroleum jelly may not be the best thing to heal cuts - BBC News

Prof Ariens said: "We did laboratory and animal studies which showed this film could be a barrier against microbial infection for at least 12 hours, and this gives the immune system time to get white blood cells to the wound to counteract any infection."

Adding petroleum jelly perforated the protective film.

Prof Ariens said: "If you get a scrape or a cut it is best to let it clot for half an hour to let the film form. Do clean it of course if it needs it, but the clot will make its own perfect plaster. After that, it might not be so bad to add petroleum jelly, but before then, from our findings, it appears to damage this film."

Independent wound care advisor Jacqui Fletcher, who is also the clinical editor of the journal Wound UK, said: "You do see it used in sports. Boxing is a good example. If the fighter gets a cut they can use it to stop the blood running down the their face so that they can continue the fight. 

https://www.bbc.com/news/health-44600618

Monday, June 25, 2018

The effects of micronutrient deficiencies on bacterial species from the human gut microbiota

Vitamin and mineral (micronutrient) deficiencies afflict 2 billion people. Although the impact of these imbalances on host biology has been studied extensively, much less is known about their effects on the gut microbiota of developing or adult humans. Therefore, we established a community of cultured, sequenced human gut-derived bacterial species in gnotobiotic mice and fed the animals a defined micronutrient-sufficient diet, followed by a derivative diet devoid of vitamin A, folate, iron, or zinc, followed by return to the sufficient diet. Acute vitamin A deficiency had the largest effect on bacterial community structure and metatranscriptome, with Bacteroides vulgatus, a prominent responder, increasing its abundance in the absence of vitamin A. Applying retinol selection to a library of 30,300 B. vulgatus transposon mutants revealed that disruption of acrR abrogated retinol sensitivity. Genetic complementation studies, microbial RNA sequencing, and transcription factor-binding assays disclosed that AcrR is a repressor of an adjacent AcrAB-TolC efflux system. Retinol efflux measurements in wild-type and acrR-mutant strains plus treatment with a pharmacologic inhibitor of the efflux system revealed that AcrAB-TolC is a determinant of retinol and bile acid sensitivity in B. vulgatus Acute vitamin A deficiency was associated with altered bile acid metabolism in vivo, raising the possibility that retinol, bile acid metabolites, and AcrAB-TolC interact to influence the fitness of B. vulgatus and perhaps other microbiota members. This type of preclinical model can help to develop mechanistic insights about the effects of, and more effective treatment strategies for micronutrient deficiencies.

Combo antibiotic found inferior for MDR bloodstream infections | CIDRAP

The results of a large, international randomized trial indicate that the use of a combination therapy being investigated as a potential alternative to carbapenem antibiotics should be avoided in patients with certain multidrug-resistant bloodstream infections (BSIs), because of increased risk of mortality.

The findings of the MERINO Trial, presented this week at the 28th annual European Congress of Clinical Microbiology and Infectious Disease (ECCMID), showed that the combination antibiotic piperacillin/tazobactam is inferior to meropenem for treating BSIs caused by third-generation cephalosporin-resistant Escherichia coli or Klebsiella pneumoniae. The number of patients on piperacillin/tazobactam who died at the 30-day mark was more than three times the number who died in the meropenem arm.

http://www.cidrap.umn.edu/news-perspective/2018/04/combo-antibiotic-found-inferior-mdr-bloodstream-infections

Saturday, May 26, 2018

Atopic Dermatitis severity reduced by topical microbiome treatment

Roseomonas mucosa bacteria obtained from healthy volunteers without atopic dermatitis reduced the severity of the disorder in a small, early-phase study of 10 adults and 5 children with atopic dermatitis. Also today, a new device could detect osteoarthritis with sound and motion, seven days of antibiotics is enough for gram-negative bacteremias, and canagliflozen is linked to lower HbA1c levels in younger patients. 


https://www.mdedge.com/oncologypractice/article/166415/mixed-topics/mdedge-daily-news-atopic-dermatitis-severity-reduced

Thursday, May 10, 2018

Very Low-Carbohydrate Diet Beneficial in Type 1 Diabetes

The study included 316 individuals, of whom 54% were adult patients and 42% were parents of children with type 1 diabetes. All were part of an international Facebook group for people with type 1 diabetes who follow Bernstein's recommended VLCD diet.

The approach includes a weight-based carbohydrate prescription of no more than 30 grams/day, derived from fibrous vegetables and nuts with a low glycemic index. High-protein foods are substituted for carbohydrates, and insulin doses adjusted empirically by postprandial and fasting glucose levels.  

Most of the participants were from the United States, Canada, Europe, or Australia, the majority (88%) were white, and 84% were college graduates. Mean age at diabetes diagnosis was 16 years, diabetes duration was 11 years, and time following the VLCD diet was 2.2 years.

Confirmatory data were obtained from diabetes care providers and medical records, including a multi-tiered investigation to ensure all participants had type 1 diabetes — not type 2 diabetes or a genetic variant. However, not all data points were available for all respondents.  

Participants reported consuming an average of 36 grams/day of carbohydrate. The mean reported HbA1c was 5.67%, a drop of 1.45 percentage points following adoption of the VLCD (P < .001). Average blood glucose level was 104 mg/dL in the 137 patients who had continuous glucose monitoring data.

In a regression analysis, carbohydrate intake goal was the only significant predictor of variation in HbA1c (P = .001), with an increase in HbA1c of 0.1% per 10 g of carbohydrate consumed. The mean daily insulin dose was 0.40 U/kg/day.

https://www.medscape.com/viewarticle/896288

Tuesday, May 1, 2018

Tick and Mosquito Infections Spreading Rapidly, C.D.C. Finds - The New York Times

The real case numbers were undoubtedly far larger, Dr. Petersen said. For example, the C.D.C. estimates that about 300,000 Americans get Lyme disease each year, but only about 35,000 diagnoses are reported.

The study did not delve into the reasons for the increase, but Dr. Petersen said it was probably caused by many factors, including two related to weather: ticks thriving in regions previously too cold for them, and hot spells triggering outbreaks of mosquito-borne diseases.

Other factors, he said, include expanded human travel, suburban reforestation and a dearth of new vaccines to stop outbreaks.

More jet travel from the tropics means that previously obscure viruses like dengue and Zika are moving long distances rapidly in human blood. (By contrast, malaria and yellow fever are thought to have reached the Americas on slave ships three centuries ago.)

A good example, Dr. Petersen said, was chikungunya, which causes joint pain so severe that it is called "bending-up disease."

In late 2013, a Southeast Asian strain arrived on the Dutch Caribbean island of St. Maarten, its first appearance in this hemisphere. Within one year, local transmission had occurred everywhere in the Americas except Canada, Chile, Peru and Bolivia.

Tickborne diseases, the report found, are rising steadily in the Northeast, the Upper Midwest and California. Ticks spread Lyme disease, anaplasmosis, babesiosis, Rocky Mountain spotted fever, rabbit fever, Powassan virus and other ills, some of them only recently discovered.

Ticks need deer or rodents as their main blood hosts, and those have increased as forests in suburbs have gotten thicker, deer hunting has waned, and rodent predators like foxes have disappeared.

https://mobile.nytimes.com/2018/05/01/health/ticks-mosquitoes-diseases.html

Saturday, April 7, 2018

Intestinal microbiota as a tetrahydrobiopterin exogenous source

We further confirmed that at least two PTPS-2-producing species, Aldercreutzia equolifaciens and Microbacterium schleiferi, generate BH4 and are present in hph-1 fecal material. In conclusion, intestinal Actinobacteria generate BH4. This finding has important translational significance, since manipulation of the intestinal flora in individuals with congenital biopterin deficiency may allow for an increase in total body BH4 content.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5227711/#!po=1.16279

Friday, March 30, 2018

Federal Agency Courted Alcohol Industry to Fund Study on Benefits of Moderate Drinking

It was going to be a study that could change the American diet, a huge clinical trial that might well deliver all the medical evidence needed to recommend a daily alcoholic drink as part of a healthy lifestyle.

That was how two prominent scientists and a senior federal health official pitched the project during a presentation at the luxurious Breakers Hotel in Palm Beach, Fla., in 2014. And the audience members who were being asked to help pay for the $100 million study seemed receptive: They were all liquor company executives.

The 10-year government trial is now underway, and Anheuser Busch InBev, Heineken and other alcohol companies are picking up most of the tab, through donations to a private foundation that raises money for the National Institutes of Health.

The N.I.H., a federal agency, is considered one of the world’s foremost medical research centers, investing over $30 billion of taxpayer money in biomedical research each year. The vast majority of the funding goes to scientists outside the N.I.H., which manages the grants and provides oversight.

The alcohol study is overseen by the National Institute on Alcohol Abuse and Alcoholism, one of 27 centers under the N.I.H. The lead investigator and N.I.H. officials have said repeatedly that they never discussed the planning of the study with the industry. But a different picture emerges from emails and travel vouchers obtained by The New York Times under the Freedom of Information Act, as well as from interviews with former federal officials.
...

https://www.nytimes.com/2018/03/17/health/nih-alcohol-study-liquor-industry.html

Sunday, March 25, 2018

Sodium bisulfite

Sodium bisulfite is also added to leafy green vegetables in salad bars and elsewhere, to preserve apparent freshness, under names like LeafGreen. The concentration is sometimes high enough to cause severe allergic reactions.[12]


https://en.m.wikipedia.org/wiki/Sodium_bisulfite

Saturday, March 17, 2018

Physical Fitness Tied to a Nearly 90% Reduction in Dementia Risk

A high level of cardiovascular physical fitness in middle-aged women is associated with close to a 90% reduction in dementia risk in later life, results of a longitudinal study show.

https://www.medscape.com/viewarticle/894032

Thursday, March 15, 2018

'Reinventing Healthcare' Without the People Who Care for Patients

Unfortunately, too many of those who seek to disrupt healthcare have dollar signs in their eyes, making it impossible for them to see and acknowledge their ignorance—their lack of any real insight in the daily practice of healthcare. Those with the practical experience to help shape a better system that integrates the potential efficiencies of telemedicine, machine learning, and big data with current practice patterns in order to provide efficient and high-quality care are too often relegated to the sidelines; changes are imposed upon them from above by people with no understanding of the potential unintended consequences of their unilateral decisions.

I believe the US healthcare system is poised for significant change in the coming years. This may be rudderless navigation directed overwhelmingly by profiteering individuals from a business and technology background, merely seeking a short-term exit strategy to maximize their wealth rather than a true transformation of healthcare in a meaningful, beneficial way. But there are new entrants in the healthcare arena who may have the more noble goal of creating a US healthcare system that truly works, rather than being dragged down by colossal inefficiencies and the deliberate foot-dragging of the incumbent stakeholders who benefit from this. The recently announced collaboration among Amazon, Berkshire Hathaway, and JP Morgan to create and demonstrate a path to efficient medical care in America[1] may have the needed power and, possibly, the long-term vision to execute on this promise.

To do so, it will be critical to welcome the participation not only of the medical dilettantes who consider themselves experts because they technically still see a few stray patients as a small fraction of their workweek, but the vast majority of working doctors who unfortunately remain an afterthought of far too many who expect to redefine how healthcare is delivered. At the same time, physicians who fit that bill and care for patients day to day should strive to play a more active role in these initiatives. We only have the right to not be shepherded around by those outside healthcare if we, as practicing physicians, are not complacent enough to act like sheep.

https://www.medscape.com/viewarticle/893790

Arsenic, Lead Found in Popular Protein Supplements - Consumer Reports

Whether for weight loss, muscle building, or simply as a convenient quick meal on the go, many Americans turn to protein powders and drinks.

But a new study shows that many of the top-selling powders and drinks may contain concerning levels of heavy metals such as arsenic, cadmium, mercury, and lead, and toxins like bisphenol A (BPA), a chemical found in some plastic containers and food can liners.

These substances have been linked to cancer, brain damage, and reproductive issues.

https://www.consumerreports.org/dietary-supplements/heavy-metals-in-protein-supplements/

Thursday, March 8, 2018

America's Love/Hate Relationship With Doctors

The truth of the matter is that a large degree of America's love/hate relationship with doctors is fueled primarily by our idealized notion of what a doctor should be. When asked to describe their vision of an ideal doctor, patients often use such words as "empathetic," "wise," "confident," "attentive," "brilliant," "dedicated," and "altruistic." But they want trust, friendliness, respect, honesty, timeliness, and sincerity, too.

That's an awfully high pedestal. And these expectations extend to physicians' lives and behavior outside the office as well.

How did we get here? Once upon a time, long ago (before third parties inserted themselves into medicine), we had the doctor and the patient. Alone. In one room. Many times, in a bedroom during a house call. The relationship between doctor and patient was undisturbed by layers of bureaucracy, faxes, and phone trees, uncorrupted by superbills and CPT codes.

This fairy-tale physician—our savior in a white coat—who will come to our aid any time of day or night lives in our collective consciousness. Doctors yearn to be heroes, and suffering patients seek a savior. We fulfill each other's core needs. After all, without patients, doctors couldn't exist.

https://www.medscape.com/viewarticle/888837

Wednesday, March 7, 2018

Male urinary biomarkers of antimicrobial exposure and bi-directional associations with semen quality parameters

Abstract

Antimicrobials including parabens, triclosan, and triclocarban have endocrine disrupting properties. Among 501 male partners of couples planning to become pregnant, preconception urinary biomarkers of parabens, triclosan and triclocarban exposure were quantified in spot urine samples. Men also provided two fresh semen samples collected approximately one month to undergo 24-h semen quality analysis. Linear mixed-effects models, adjusted for creatinine, race, age and body mass index, were utilized to assess the relationship between log transformed chemical concentrations rescaled by their standard deviations and semen parameters. Methyl, ethyl and butyl parabens, were associated with diminished sperm count and several sperm motility parameters. Hydroxylated paraben metabolites and triclosan were significantly positively associated with select semen quality parameters. Overall, our findings suggest that specific urinary parabens found in consumer goods (methyl, ethyl and butyl parabens) may adversely impact sperm quality parameters among reproductive-age male partners of couples trying for pregnancy.

https://www.ncbi.nlm.nih.gov/pubmed/29474822

Tuesday, March 6, 2018

HbA1c Below 8% in Diabetes for 'Most' Says ACP, But Others Disagree

"ACP's analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7% or less, compared with targets of about 8%, did not reduce deaths or macrovascular complications, such as heart attack or stroke, but did result in substantial harms," said Jack Ende, MD, ACP president, in a statement.

"For most people with type 2 diabetes, achieving an HbA1c between 7% and 8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs," he added.

https://www.medscape.com/viewarticle/893421

For all their risks, opioids had no pain-relieving advantage in a yearlong clinical trial

By some measures, the people using non-opioid drugs such as Tylenol, ibuprofen and lidocaine experienced more pain relief than people using medications like morphine, Vicodin and oxycodone — though the differences weren't large enough to be considered statistically significant. Patients in both groups saw similar improvements in their quality of life.


http://www.latimes.com/science/sciencenow/la-sci-sn-opioid-painkillers-no-better-20180306-story.html

Sunday, March 4, 2018

Diabetes is actually five separate diseases, research suggests - BBC News

The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.

    Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
    Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
    Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
    Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
    Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder

http://www.bbc.com/news/health-43246261

Saturday, March 3, 2018

Calcium Supplements Up Risk for Precancerous Serrated Polyps



Calcium supplementation alone more than doubled the risk for serrated sessile adenomas or polyps (SSA/Ps), and when combined with vitamin D, it almost quadrupled the risk, according to the results of a large randomized chemoprevention trial published online today in Gut.

https://www.medscape.com/viewarticle/893319

Wednesday, February 28, 2018

Urinary Phthalate Metabolites Are Associated With Decreased Serum Testosterone in Men, Women, and Children

Results:

Multiple phthalates were associated with significantly reduced T in both sexes and in differing age groups. In females, the strongest and most consistent inverse relationships were found among women ages 40–60 years. In boys 6–12 years old, an interquartile range increase in metabolites of di-2-ethylhexyl phthalate was associated with a 29% (95% confidence interval, 6, 47) reduction in T. In adult men, the only significant or suggestive inverse associations between phthalates (metabolites of di-2-ethylhexyl phthalate and dibutyl phthalate) and T were observed among men ages 40–60 years.

https://academic.oup.com/jcem/article/99/11/4346/2836774