Dr. Bray Links

Saturday, January 20, 2018

What's the Best 'Breathing Retraining' for Uncontrolled Asthma?

A recent trial[1] compared two methods of breathing retraining: self-taught, using a video; or three face-to-face sessions with a respiratory therapist. The training focused on diaphragmatic breathing, nasal breathing, and slow breathing, as well as controlled breath holds and simple relaxation exercises.

Compared with usual care, both methods of breathing retraining improved asthma-related quality of life. Although the interventions didn't change measures of airway inflammation or obstruction, patients reported increased control over breathing and reduced need for medication. They also felt more relaxed.

So, for your patients struggling with their asthma, consider adding breathing retraining to their treatment. Even patients who don't have easy access to respiratory therapists can benefit from the self-taught video training. It's a simple, low-cost option.

https://www.medscape.com/viewarticle/891195

The Doctor Of The Future: Prescribing Lifestyle As Medicine | Mark Rowe | TEDxUCD

Thursday, January 18, 2018

Five-foot long tapeworm came 'wiggling out' of man's body after he ate sushi

The emergency room physician was initially skeptical when the man insisted to residents at Community Regional Medical Center, "I really want to get treated for worms" until he saw for himself the disgusting proof.

After being unraveled, the tapeworm ended up being 5.5 feet long. The patient said he felt the worm "wiggling out" and then, began to remove the worm, which started moving.

http://www.foxnews.com/health/2018/01/18/five-foot-long-tapeworm-came-wiggling-out-mans-body-after-ate-sushi.html

This new blood test can detect early signs of 8 kinds of cancer

Scientists have developed a noninvasive blood test that can detect signs of eight types of cancer long before any symptoms of the disease arise.

The test, which can also help doctors determine where in a person's body the cancer is located, is called CancerSEEK. Its genesis is described in a paper published Thursday in the journal Science.

The authors said the new work represents the first noninvasive blood test that can screen for a range of cancers all at once: cancer of the ovary, liver, stomach, pancreas, esophagus, colon, lung and breast.

Together, these eight forms of cancer are responsible for more than 60% of cancer deaths in the United States, the authors said.

http://www.latimes.com/science/sciencenow/la-sci-sn-blood-test-cancer-20180118-story.html

Tuesday, January 16, 2018

Are Meta-Analyses a Form of Medical Fake News? | Circulation

How many dreadful manuscripts describing the results of a meta-analysis are submitted to and rejected from journals each year? We cannot know, but many published meta-analyses do not use appropriate methods or contribute meaningfully to medical thought or patient care. Some journals avoid all meta-analyses, whereas others pride themselves on publishing only the best; still others are delighted to have anything to print in an era where the number of opportunities to publish greatly exceeds the number of valid observations.

Many have critically examined the methodology of meta-analysis, and others have set standards for their execution. Despite such guidance, meta-analyses continue to proliferate, but we should ask: do they really contribute? Esteemed organizations regard the conclusions of a well-executed meta-analysis as a higher level of evidence than a single well-done clinical trial. This commentary explains why this cannot possibly be true.

http://circ.ahajournals.org/content/136/22/2097.long

Nora Gedgaudas The Silent Autoimmunity Explosion

Monday, January 15, 2018

Engineered commensal microbes for diet-mediated colorectal-cancer chemoprevention | Nature Biomedical Engineering

Chemoprevention—the use of medication to prevent cancer—can be augmented by the consumption of produce enriched with natural metabolites. However, chemopreventive metabolites are typically inactive and have low bioavailability and poor host absorption. Here, we show that engineered commensal microbes can prevent carcinogenesis and promote the regression of colorectal cancer through a cruciferous vegetable diet. The engineered commensal Escherichia coli bound specifically to the heparan sulphate proteoglycan on colorectal cancer cells and secreted the enzyme myrosinase to transform host-ingested glucosinolates—natural components of cruciferous vegetables—to sulphoraphane, an organic small molecule with known anticancer activity. The engineered microbes coupled with glucosinolates resulted in >95% proliferation inhibition of murine, human and colorectal adenocarcinoma cell lines in vitro. We also show that murine models of colorectal carcinoma fed with the engineered microbes and the cruciferous vegetable diet displayed significant tumour regression and reduced tumour occurrence.

https://www.nature.com/articles/s41551-017-0181-y

L-carnitine for hyperthyroidism?

Old studies in animals and unblinded studies in a few hyperthyroid patients suggested that L -carnitine is a periferal antagonist of thyroid hormone action at least in some tissues. This conclusion was substantiated by our recent observation that carnitine inhibits thyroid hormone entry into the nucleus of hepatocytes, neurons, and fibroblasts. In the randomized, double-blind, placebo-controlled 6-month trial reported here, we assessed whether 2 or 4 g/d oral L-carnitine were able to both reverse and prevent/minimize nine hyperthyroidism- related symptoms. We also evaluated changes on nine thyroid hormone-sensitive biochemical parameters and on vertebral and hip mineral density (bone mineral density). Fifty women under a fixed TSH-suppressive dose of L -T(4) for all 6 months were randomly allocated to five groups of 10 subjects each. Group 0 associated placebo for 6 months; groups A2 and A4 started associating placebo (first bimester), substituted placebo with 2 or 4 g/d carnitine (second bimester), and then returned to the association with placebo. Groups B2 and B4 started associating 2 and 4 g/d carnitine for the first two bimesters, and then substituted carnitine with placebo (third bimester). Symptoms and biochemical parameters worsened in group 0. In group A, symptoms and biochemical parameters worsened during the first bimester, returned to baseline or increased minimally during the second bimester (except osteocalcin and urinary OH-proline), and worsened again in the third bimester. In group B, symptoms and biochemical parameters (except osteocalcin and urinary OH-proline) did not worsen or even improved over the first 4 months; they tended to worsen in the third bimester. In both the A and B groups, the two doses of carnitine were similarly effective. At the end of the trial, bone mineral density tended to increase in groups B and A (B > A). In conclusion, L-carnitine is effective in both reversing and preventing symptoms of hyperthyroidism and has a beneficial effect on bone mineralization. Because hyperthyroidism depletes the body deposits of carnitine and since carnitine has no toxicity, teratogenicity, contraindications and interactions with drugs, carnitine can be of clinical use.

https://www.ncbi.nlm.nih.gov/pubmed/11502782


The present pilot study has shown that L-Carn + Se significantly reduced symptoms associated with SHyper, improving QoL of patients, without significant modifications of their endocrine profile. In addition, it is noteworthy that the extension of treatment seems necessary to prevent symptoms reappearance. Prospective randomized controlled trials are needed to address clinicians to define the appropriate treatment-settings for this disorder.'

https://www.ncbi.nlm.nih.gov/pubmed/28537653

Saturday, January 13, 2018

Over-the-counter mouthwash use and risk of pre-diabetes/diabetes - ScienceDirect

Over-the-counter mouthwash comprises part of routine oral care for many; however, potential adverse effects of the long-term daily use have not been evaluated. Most mouthwash contain antibacterial ingredients, which could impact oral microbes critical for nitric oxide formation, and in turn predispose to metabolic disorders including diabetes. Our aim was to evaluate longitudinally the association between baseline over-the-counter mouthwash use and development of pre-diabetes/diabetes over a 3-year follow-up.

http://www.sciencedirect.com/science/article/pii/S1089860317301532

Thursday, January 11, 2018

Perverse Incentives: Do You See What I See? - PulmCCM

Recently, a 91-year-old relative had a serious intracerebral hemorrhage, but recovered miraculously. It is really hard for him to get around, but he always goes for an annual checkup. His stroke wasn't going to stop him from his routine.

During the visit, his physician told him that the office x-ray equipment wasn't working, and that he needed to return in 2 weeks for his routine annual chest x-ray (which was normal during his recent stroke). When I heard the story, I told him that the x-ray wasn't needed. He didn't need to make special arrangements to return to the office.

So he asked: "Why would a physician ask me to return for a test that I didn't need?"

Good question. Why do physicians check the serum cholesterol in women who have advanced ovarian cancer?

Too many physicians order tests and recommend procedures primarily because they can be paid to do them.

Many healthcare practices -- and entire health systems -- focus on generating revenues in every possible way. The goal is to eke out every dollar from every patient interaction. In many instances, it means encouraging patients to undergo tests and procedures that are not needed but will be reimbursed.

This obsession with revenues is destroying medicine.

https://pulmccm.org/policy-ethics-education-review/warning-physicians-perverse-incentives-may-impair-vision/

Pfizer to Halt Alzheimer’s and Parkinson’s Drug Research | The Scientist Magazine(R)

 US pharmaceutical corporation Pfizer announced plans this week to abandon research of new drugs to treat Alzheimer's and Parkinson's diseases. The decision will result in about 300 layoffs in the company's neuroscience discovery and early development programs, which are located in Massachusetts and Connecticut, according to a statement emailed to journalists.

"We have made the decision to end our neuroscience discovery and early development efforts and reallocate funding to those areas where we have strong scientific leadership and that will allow us to provide the greatest impact for patients," the company says in the statement (via Reuters).

https://mobile.the-scientist.com/article/51264/pfizer-to-halt-alzheimer-s-and-parkinson-s-drug-research

Monday, January 8, 2018

US child mortality ranks worst among 20 wealthy countries, study finds - CNN

The United States has the worst overall child mortality rate compared with those of 19 other wealthy nations in the Organisation for Economic Co-operation and Development.
That's according to a study published in the journal Health Affairs on Monday.
The study examined child mortality rates between 1961 and 2010 in the US and comparable nations in the OECD, a group of 35 countries, founded to improve economic development and social well-being around the world. It found that mortality rates were not evenly distributed.

"This study should alarm everyone. The US is the most dangerous of wealthy, democratic countries in the world for children," said Dr. Ashish Thakrar, lead author of the study and an internal medicine resident at Johns Hopkins Hospital and Health System in Baltimore.

http://www.cnn.com/2018/01/08/health/child-mortality-rates-by-country-study-intl/index.html

Hospital Medicine: Better, or Less Personal, Care?

"As the number of physicians caring for a patient increases, the depth of the relationship between patient and physician tends to diminish — a phenomenon of particular concern to those who regard the patient–physician relationship as the core of good medical care."

More physicians involved in a patient's care may result in miscommunication and discoordination of care, especially at admission and discharge.

"From the patient's point of view, it can be highly disconcerting to discover that the physician who knows you best will not even see you at your moment of greatest need — when you are in the hospital, facing serious illness or injury," Dr Gunderman explains. "The patient–physician relationship is built largely on trust, and levels of trust are usually lower among strangers."

Community physicians are also at risk for less professional and personal fulfilment when they do not oversee their patients' hospitalizations. Potential disadvantages for the medical profession include increased fragmentation of patient care, faster burnout, and less knowledge sharing and camaraderie.

Hospitalists may suffer from lack of outpatient experience, becoming less accountable to nonhospitalized patients and their communities, and therefore less effective advocates for comprehensive medical care. Their employment by hospitals may shift their loyalty away from patients and their profession.

https://www.medscape.com/viewarticle/867409

Mortality Lower When Inpatients See Their Own PCP in Hospital

Unadjusted 30-day mortality was lowest among patients cared for by PCPs, followed by the rates in those cared for by hospitalists and other generalists (8.6%, 10.8%, and 11.0%, respectively; test of difference, P < .001).

"These findings persisted in adjusted analyses for PCPs (AOR, 0.94; 95% CI, 0.91 - 0.97; P < .001) and other generalists (AOR, 1.09; 95% CI, 1.07 - 1.12; P < .001), with hospitalists as the reference group," the authors write.

This pattern also remained significant in a sensitivity analysis that accounted for the complexity of the admission and patient disease burden. "For example, patients cared for by PCPs had the lowest 30-day mortality across all 3 physician groups at all quantiles of DRG complexity and patient comorbidities," the authors write.

https://www.medscape.com/viewarticle/888520

Many Adults With Arthritis Not Receiving Exercise Counseling

"[T]he prevalence of counseling remains low for a self-managed behavior (exercise) with proven benefits and few risks, especially among those who are inactive. Various strategies such as health care provider education and training in exercise counseling and electronic medical record prompts might increase health care provider counseling for exercise among adults with arthritis," Jennifer Hootman, PhD, from the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues write.

Approximately 54 million Americans have arthritis. Many of these people also have common comorbidities, such as diabetes, heart disease, and obesity, for which exercise is recommended to improve disease control.  However, arthritis pain can be a barrier to exercise for people with these conditions.

At the same time, exercise can decrease the pain of arthritis. The American College of Rheumatology recommends exercise as first-line nonmedication therapy for managing osteoarthritis symptoms. One of the goals of the Healthy People 2020 initiative is to increase counseling about the benefits of exercise for people with arthritis.

https://www.medscape.com/viewarticle/891015

Ibuprofen linked to male infertility, study says - CNN

Ibuprofen has a negative impact on the testicles of young men, a study published Monday in the journal Proceedings of the National Academy of Sciences found. When taking ibuprofen in doses commonly used by athletes, a small sample of young men developed a hormonal condition that typically begins, if at all, during middle age. This condition is linked to reduced fertility.
Advil and Motrin are two brand names for ibuprofen, an over-the-counter pain reliever. CNN has contacted Pfizer and Johnson & Johnson, the makers of both brands, for comment. 

http://www.cnn.com/2018/01/08/health/ibuprofen-male-fertility-study/index.html

Sunday, January 7, 2018

Targeting the Warburg effect for Cancer Treatment: Ketogenic Diets for Management of Glioma

A promising approach to cancer control is to develop interventions to slow or halt progression of early stages of carcinogenesis to invasive disease as indicated by biomarkers of disease progression as well as related symptom burden. Our goal is to utilize a broad-spectrum approach targeting multiple signaling pathways that result in modulation of apoptosis, proliferation, inflammation and related pathologies, relevant to progression in early stage disease to advanced cancers. The metabolic pathways which support rapid growth of tumors represent a promising therapeutic target for cancer. Ketogenic therapies in the form of a KD and/or pharmacological modulators using exogenous KAs represent one potential tool to exploit the metabolic vulnerabilities of tumors. A number of distinct yet interrelated effects of ketosis may be implicated in the potential anti-tumor effects of ketosis (Fig. 2). Ketogenic therapy for CNS tumors, including glioma, extends far beyond the originally proposed mechanism of reducing glucose availability, and may work through multiple and yet distinct mechanisms such as reducing inflammation, altering in oxidative stress, enhancing anti-tumor immunity, altering gene expression, sensitizing tumors to standard of care and adjuvant therapies, among others (Fig. 5). Some of these mechanisms may depend directly on ketone signaling, supporting the notion that an elevation in blood ketones is a significant component of ketogenic therapy for CNS tumors. To date, case reports and pilot projects have reported moderate success evaluating KD in patients with advanced stage disease (HGG). However, it is important to acknowledge that advanced stage disease, including GBM, display significant increases in genomic complexity and a variety of cell-signaling redundancies. Thus, clinicians face multiple patient-related (due to illness, compliance and other co-morbidities) and metastatic disease- related challenges. It is possible that the KD would be more effective in earlier stage disease (LGG) and provide an opportunity to potentially increase the likelihood of pinpointing targets for transformational therapies. However, to date, there continues to be a paucity of research that exploits these mechanisms and systematically examines interventions such as the ketogenic diet, relevant to tumor progression in glioma. If successful, these novel treatments could provide a non-toxic, cost-effective adjuvant therapy to standard of care in a disease currently with a grim prognosis.

http://www.sciencedirect.com/science/article/pii/S1044579X17301244

Saturday, January 6, 2018

DNA Damage May Underlie Alcohol Link to Cancer Risk



In the Cancer Research UK Science Blog, Dr Patel stated that in mice that lacked the enzyme that breaks down acetaldehyde, he and his colleagues "saw huge amounts of DNA damage" after just one dose of ethanol. Acetaldehyde is the main metabolic product of alcohol.

"Bits of DNA were deleted, bits were broken, and we even saw parts of chromosomes being moved about and rearranged," he added.

https://www.medscape.com/viewarticle/890929

Friday, January 5, 2018

Depo birth control shot linked to risk of HIV infection | Endocrine Society

In addition to these clinical studies, the review's authors examined animal, cell and biochemical research on the form of progestin used in DMPA—medroxprogesterone acetate, or MPA. The analysis revealed MPA acts differently than other forms of progestin used in contraceptives. MPA behaves like the stress hormone cortisol in the cells of the genital tract that can come in contact with HIV.

"The increased rate of HIV infection among women using DMPA contraceptive shots is likely due to multiple reasons, including decreases in immune function and the protective barrier function of the female genital tract," Hapgood said. "Studying the biology of MPA helps us understand what may be driving the increased rate of HIV infection seen in human research. These findings suggest other forms of birth control should rapidly replace DMPA shots."  

https://www.endocrine.org/news-room/current-press-releases/common-birth-control-shot-linked-to-risk-of-hiv-infection