All Posts tagged therapy

Ten major advances in heart disease in 2010

The American Heart Association has compiled its annual list of the top 10 major advances in heart disease. “We have come far in the past decade, reducing heart disease deaths by more than 27 per cent,” said Ralph Sacco of the University of Miami. “But we know there is still much to be done in improving the lives of heart disease and stroke patients – and more importantly, in preventing these devastating diseases in the first place. Scientific research will help us lead the way,” said Sacco.

The highlights of the top ten advances in cardiovascular research in 2010:

1. Tailoring treatment for people with diabetes to reduce their risk of cardiovascular disease
New research from the ACCORD Study Group offered insight into specific treatments that can reduce their risk of cardiovascular disease (CVD). The first study found that aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD. In a second study, a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD.

2. New advances for patients who aren't candidates for conventional valve surgery
Two new studies have supported evidence that Transcatheter aortic valve implantation (TAVI) can improve symptoms and outcomes – including quality of life – even over the course of several years. While there are some risks associated with TAVI, including strokes and other major cardiovascular events, the catheter-based procedure offers significant progress in this area.

3. Improving the way we reverse sudden cardiac arrest
Significant studies reported that chest compression only, or ''Hands Only CPR'' for adults by bystander lay rescuers improves survival outcome. Public awareness campaigns resulted in increased use of hands only CPR, as well as improved survival rates. While the new procedure appeared successful in adults, it is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest.

4. More options for reducing stroke risk in atrial fibrillation
For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). Warfarin (Coumadin) has long been the standard anti-clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin – and are simpler for patients to take – offering an important advance in this field.

5. Adjusting pacing therapies can improve outcomes for heart failure patients
New studies showed that adding additional resynchronization pacing to ICD therapy could lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices.

6. Hopeful new procedure for infants with congenital heart disease
The Pediatric Heart Network's randomized trial of Norwood shunt types in infants with single-ventricle lesions showed that the type of shunt used makes a difference in outcomes. Better transplantation-free survival at 12 months is a possibility with this new understanding of the better shunt choice for these patients. This was the first large-scale randomized trial in congenital heart surgery, offering an approach that should provide answers to other questions in the future.

7. Finding the right anti-clotting (anti-platelet) therapy
New research from the PLATO investigators has found that ticagrelor may improve outcomes and reduce adverse events better than the current standard, clopidogrel. The CURRENT-OASIS 7 Trial is exploring the optimal dosing of clopidogrel and aspirin in patient undergoing invasive surgery. These studies will help providers better understand the situations where new choices and dosages may improve results for the patient.

8. Basic science findings offer insight into future progress
Several studies this year brought the future of medicine closer to the present with new insight into emerging technologies. Findings from stem cell therapy have shown improved quality of life and survival in several early studies of patients with chronic heart failure and support the development of future cell-based therapeutics. A large animal study defined the basic mechanisms for heart muscle regeneration initiated by specific types of stem cells. The results demonstrated that these stem cells repair scarred myocardium through promotion of the generation of new heart muscle and blood vessel).

9. Using science to support healthy lifestyle behaviours
New science examining lifestyle behaviours in adults and children, with particular emphasis on physical activity and consumption pattern, show that such conditions as obesity and hypertension are positively influenced by a change in diet with decreasing sodium levels. Results from the school setting suggest that the earlier one starts to adopt healthy behaviours the better the effect on health outcomes.

10. Get With The Guidelines participation eliminates disparity gaps in care
Racial and ethnic disparities have been found in the quality of care delivered to patients with cardiovascular disease and achieving equity and addressing disparities has implications for quality, cost, risk management, and community benefit. These findings are the first to show that participating in a quality improvement program, such as Get With The Guidelines-Coronary Artery Disease, can eliminate racial and ethnic disparities of care while increasing the overall use of evidence-based care for heart attack patients.

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Allergy study highlights risks for children

A lack of testing for food allergies is putting children's health at risk and could lead to life threatening reactions, a study has found. The study, Adverse reactions to food in New Zealand children age 0-5 years, was published in the New Zealand Medical Journal. It looked at a cross-section of 110 children who had attended Plunket clinics. It found 44 had experienced an adverse reaction to food, but only four had been clinically evaluated. Those children were found to have adverse reactions to food allergens, including a life threatening peanut allergy. Two others had been hospitalised with systemic symptoms, but neither had undergone testing for food allergy. “If these children have food allergies, they remain at risk for continued and possibly severe reactions,” the study said.

Parents modifying children's diets or breastfeeding mothers cutting out food without advice from a physician or dietician could also have adverse affects, it said. “Failure to thrive is commonly seen in children experiencing FA (food allergy) as a result of multiple foods being removed from their diet.” The data indicated adverse reactions to food were a public health concern and may be under investigated — even when symptoms were severe, the study said.

“There is an urgent need to investigate the epidemiology, diagnosis, and prevention of FA (food allergy) in New Zealand to reduce morbidity, improve child health, and reduce the burden to health costs.” Thirty-three of the children were reported to have eczema. Ten had worsening symptoms two hours after eating, the study said. Symptoms improved in six of them with dietary changes. Doctors had prescribed topical therapy for 18 of those children with eczema, but symptoms had persisted.

“One possible explanation for this observation is undiagnosed FA (food allergy). Without testing, allergic triggers for eczema could not be identified in these participants.” Further investigation of food allergy as the cause of eczema was warranted, the study said.

Adverse reactions to food worldwide in children was an increasing concern and food allergy was as common in New Zealand as in other countries, the study said. The study was conducted by the Auckland District Health Board and led by Associate Professor Rohan Ameratunga and lead researcher Dr Christine Crooks. Allergy New Zealand chief executive Penny Jorgensen said the study was “really disturbing” because it highlighted that many children were not being assessed for food allergy. The risk was the potential for life-threatening reactions, she said.

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New approach for diabetes therapy

Nutrition experts at Oregon State University have essentially “cured” laboratory mice of mild, diet-induced diabetes by stimulating the production of a particular enzyme. The findings could offer a new approach to diabetes therapy, experts say, especially if a drug could be identified that would do the same thing, which in this case was accomplished with genetic manipulation.

Increased levels of this enzyme, called fatty acid elongase-5, restored normal function to diseased livers in mice, restored normal levels of blood glucose and insulin, and effectively corrected the risk factors incurred with diet-induced diabetes. “This effect was fairly remarkable and not anticipated,” said Donald Jump, a professor of nutrition and exercise sciences at Oregon State, where he is an expert on lipid metabolism and principal investigator with OSU’s Linus Pauling Institute. “It doesn’t provide a therapy yet, but could be fairly important if we can find a drug to raise levels of this enzyme,” Jump said. “There are already some drugs on the market that do this to a point, and further research in the field would be merited.”

The studies were done on a family of enzymes called “fatty acid elongases,” which have been known of for decades. Humans get essential fatty acids that they cannot naturally make from certain foods in their diet. These essential fatty acids are converted to longer and more unsaturated fatty acids. The fatty acid end products of these reactions are important for managing metabolism, inflammation, cognitive function, cardiovascular health, reproduction, vision and other metabolic roles.

The enzymes that do this are called fatty acid elongases, and much has been learned in recent years about them. In research on diet-induced obesity and diabetes, OSU studied enzyme conversion pathways, and found that elongase-5 was often impaired in mice with elevated insulin levels and diet-induced obesity.

The scientists used an established system, based on a recombinant adenovirus, to import the gene responsible for production of elongase-5 into the livers of obese, diabetic mice. When this “delivery system” began to function and the mice produced higher levels of the enzyme, their diet-induced liver defects and elevated blood sugar disappeared.

“The use of a genetic delivery system such as this was functional, but it may not be a permanent solution,” Jump said. “For human therapy, it would be better to find a drug that could accomplish the same thing, and that may be possible. There are already drugs on the market, such as some fibrate drugs, that induce higher levels of elongase-5 to some extent.”

There are also drugs used with diabetic patients that can lower blood sugar levels, Jump said, but some have side effects and undesired complications. The potential for raising levels of elongase-5 would be a new, specific and targeted approach to diabetes therapy, he said. While lowering blood sugar, the elevated levels of elongase-5 also reduced triglycerides in the liver, another desirable goal. Elevated triglycerides are associated with “fatty liver,” also known as non-alcoholic fatty liver disease. This can progress to more severe liver diseases such as fibrosis, cirrhosis and cancer.

Further research is needed to define the exact biological mechanisms at work in this process, and determine what the fatty acids do that affects carbohydrate and triglyceride metabolism, he said. It appears that high fat diets suppress elongase-5 activity.

“These studies establish a link between fatty acid elongation and hepatic glucose and triglyceride metabolism,” the researchers wrote in their report, “and suggest a role for regulators of elongase-5 activity in the treatment of diet-induced hyperglycemia and fatty liver.”

The study was published in the Journal of Lipid Research. The research was supported by the National Institutes of Health and the National Institute for Food and Agriculture of the U.S. Department of Agriculture.

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Diet Advice can help control diabetes

Individuals with either type 1 or type 2 diabetes know that maintaining a nutritious diet is one of the most important things they can do to control their disease. The findings of a new study suggest that the services of a registered dietitian may help individuals accomplish this goal.

A team of investigators from the American Dietetic Association reviewed evidence from previous research and summarized their findings in a report published in the Journal of the American Dietetic Association.

In their write-up, researchers laid out a set of exhaustive dietary guidelines for individuals affected by diabetes. Researchers said that the services of registered dietitians may be key in helping individuals follow the guidelines, which could help them significantly improve their condition.

“The evidence is strong that medical nutrition therapy provided by registered dietitians is an effective and essential therapy in the management of diabetes. Registered Dietitians are uniquely skilled in this process,” said Marion Franz, who led the investigation.

The guidelines developed by the research team lay out 29 nutritional points that can help diabetics improve their blood sugar control.

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Meditation reduces the emotional impact of pain

The study, to be published in the journal Pain, found that particular areas of the brain were less active as meditators anticipated pain, as induced by a laser device. Those with longer meditation experience (up to 35 years) showed the least anticipation of the laser pain.

Dr Brown, who is based in the University's School of Translational Medicine, found that people who meditate also showed unusual activity during anticipation of pain in part of the prefrontal cortex, a brain region known to be involved in controlling attention and thought processes when potential threats are perceived.

He said: “The results of the study confirm how we suspected meditation might affect the brain. Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse.”

Dr Brown said the findings should encourage further research into how the brain is changed by meditation practice. He said: “Although we found that meditators anticipate pain less and find pain less unpleasant, it's not clear precisely how meditation changes brain function over time to produce these effects.

“However, the importance of developing new treatments for chronic pain is clear: 40% of people who suffer from chronic pain report inadequate management of their pain problem.”

In the UK, more than 10 million adults consult their GP each year with arthritis and related conditions. The estimated annual direct cost of these conditions to health and social services is £5.7 billion.

Study co-author Professor Anthony Jones said: “One might argue that if a therapy works, then why should we care how it works? But it may be surprising to learn that the mechanisms of action of many current therapies are largely unknown, a fact that hinders the development of new treatments. Understanding how meditation works would help improve this method of treatment and help in the development of new therapies.

“There may also be some types of patient with chronic pain who benefit more from meditation-based therapies than others. If we can find out the mechanism of action of meditation for reducing pain, we may be able to screen patients in the future for deficiencies in that mechanism, allowing us to target the treatment to those people.

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Behaviour therapy can calm irritable bowels

Lead researcher Dr. Jeffrey M. Lackner from the State University of New York, Buffalo said cognitive behavioral therapy was known to be a very promising treatment for IBS, with the current findings helping to identify which patients would likely maintain a positive response.

Lackner and his colleagues are conducting a larger, longer-term study, as the current study being a small one, it remains unclear how long the benefits of cognitive behavioral therapy may last i. e. do they carry over to 9 months, a year or more.

IBS symptoms include bouts of abdominal cramps, bloating and changes in bowel habits i. e. diarrhoea or constipation, or alternating episodes of both. While, no one knows the exact cause of the disorder, there are certain symptom triggers like particular foods, large meals and emotional stress.

Cognitive behavioral therapy helps IBS patients to recognize their symptom triggers and manage them. Other treatment options include general diet changes, like reducing gas-producing foods; fibre supplements, if constipation is a primary symptom; and anti-diarrhoeal medications, when diarrhoea is a primary symptom.

There are two prescription medications for specific IBS cases: Lotronex, for women with diarrhoea dominant IBS not responding to other treatments; and Amitiza, for constipation dominant IBS.

Around 20% of people have IBS symptoms, with women affected at about twice the rate of men

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Alcohol Use Accelerates HIV Progression

HIV disease tends to progress at a faster rate in infected individuals who consume two or more alcoholic drinks a day, according to a new study in AIDS Research and Human Retroviruses, a peer-reviewed journal published by Mary Ann Liebert, Inc.

The article, entitled “Alcohol Use Accelerates HIV Disease Progression,” clearly demonstrates that frequent alcohol use, defined as two or more drinks daily, is associated with declining CD4+ cell counts (which indicate a weakened immune system) in individuals with HIV disease who either are or are not receiving antiretroviral therapy (ART). Based on the results of a 30-month prospective study, the authors, Marianna Baum, Carlin Rafie, Sabrina Sales, and Adriana Campa, from Florida International University (Miami), Shenghan Lai, from Johns Hopkins University, and John Bryan Page, from University of Miami, Florida, conclude that alcohol has a direct effect on CD4 cells and that the accelerated decline in CD4+ cell counts in frequent alcohol users is not simply due to poorer adherence to ART in this population.

Another article by Natascha Ching, Karin Nielsen-Saines, Jaime Deville, Lian Wei, Eileen Garratty, and Yvonne Bryson, from the David Geffen School of Medicine at UCLA, Los Angeles, CA, demonstrated that children who were infected with HIV while in utero via maternal-fetal transmission, were subsequently given antiretroviral therapy, and had no detectable HIV in their blood, still produced neutralizing antibodies against HIV, suggesting that low levels of viral replication might still be occurring despite drug therapy. In the article, the authors present data to support their conclusion that the children's CD4 T-cells may contain latent HIV reservoirs that formed early in life before antiretroviral therapy was initiated.

“It is important that HIV infected individuals make informed decisions relating to alcohol consumption. This article will help to achieve that goal,” says Thomas Hope, PhD, Editor-in-Chief of AIDS Research and Human Retroviruses and Professor of Cell and Molecular Biology at the Feinberg School of Medicine, Northwestern University, Chicago, IL.

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How your Medical Practice can benefit

Nastaran’s individually-designed client plans:

  • Provide early diagnosis of nutrition-related health problems
  • Facilitate better management of chronic conditions through diet and lifestyle change
  • Lead to fewer nutrition-related secondary complications such as neuropathies from diabetes
  • Dispel myths regarding fad diets
  • Teach patients how to take personal responsibility for their own health status
  • Raise awareness regarding nutrition-related problems like high cholesterol, diabetes and hypertension

Placement in Practitioner’s Office

Some practitioners would prefer their patients receive all medical services in their own offices. Nastaran is available for scheduled placement in your office to meet with patients you believe would benefit from professional nutrition services. From once a month, to once a week, Nastaran can accommodate your office and patient needs.

Lunch & Learn

Recognizing how quickly nutritional information changes, Nastaran offers free lunchtime programs in your office, specifically tailored to your patient base and staffing needs.

Topics include:

  • Eating for thyroid disorder
  • Celiac disease
  • Chronic fatigue
  • Supplement protocols
  • Diabetes care and prevention
  • General Nutrition
  • Pediatric Nutrition

Please contact Nastaran directly with any questions regarding any of our services.

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