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<urn:uuid:63c36d04-9ba2-4ae4-b204-12149ab4205c> | wiki | A lack of exercise is often cited as a primary factor in the development of obesity, but a recent study by the University of Massachusetts Lowell, MassCOSH, and the Boston Workers Alliance has shed new light on the role of working conditions in exacerbating this issue among lower-income workers.
The study, which examined the health risks associated with obesity among low-wage workers, found that factors such as physically demanding work, psychological stress, and decreased ability to engage in physical activity due to injury or illness significantly impact body weight. These findings are supported by in-depth interviews with participants, national data, and a review of existing scientific literature, providing a comprehensive understanding of the multifaceted relationship between working conditions and obesity among lower-income workers.
Research participants identified several key factors that influence their diets, including physically demanding work, which often results in illnesses and/or injuries, limiting their ability to participate in physical activity outside of the job. Additionally, psychological stressors, such as high demands in the workplace, can lead to increased consumption of high-calorie foods, while time pressure and limited access to healthy food options at work further exacerbate the issue.
The study's findings highlight the need for employers to prioritize the health and well-being of their low-wage workers, particularly in terms of providing adequate breaks and meals, supporting daily communication of rest and meal break times, and creating clean, adequately equipped eating facilities. Furthermore, the researchers emphasized the importance of adopting policies that address work organization, work scheduling, physical demands, and psychosocial stressors, as well as offering strong health and safety protections.
To address obesity among lower-wage workers, the researchers recommended that employers establish worker-management committees that incorporate health, safety, and wellness, and provide supportive supervisory and management styles. They also suggested that employers select group health coverage and third-party service contractors that address working conditions and are sensitive to the needs of low-wage workers. By prioritizing the health and well-being of their employees, employers can play a critical role in reducing the prevalence of obesity among lower-income workers. |
<urn:uuid:fa5d8f6f-2b37-42cd-9f3d-2939d62342c1> | wiki | A 45-year-old healthy male, with a family history of premature coronary artery disease, is found to have hypertriglyceridemia during routine screening. Despite a healthy lifestyle, including regular exercise and a reasonable diet, his triglyceride levels are elevated at 400 mg/dL, while his LDL cholesterol is within the normal range. His waist circumference is 96 cm, indicating a moderate level of central obesity. The patient's fasting blood glucose level is 90 mg/dL, and his thyroid and renal function are normal.
Hypertriglyceridemia is a common form of dyslipidemia that is frequently associated with premature coronary artery disease, a condition characterized by the occurrence of a myocardial infarction or the need for a coronary-artery procedure before the age of 55 in men and 65 in women. The relationship between hypertriglyceridemia and coronary artery disease is complex, and it is unclear whether hypertriglyceridemia causes coronary artery disease or is a marker for other lipoprotein abnormalities that contribute to the condition.
Several genetic disorders of hypertriglyceridemia, including familial combined hyperlipidemia and familial hypoalphalipoproteinemia, are associated with premature coronary artery disease. These disorders share features of the metabolic syndrome and are relatively common, affecting approximately 1% of the general population. In contrast, monogenic familial hypertriglyceridemia, a rare inherited form of the condition, is not associated with premature coronary artery disease.
Obesity, particularly central obesity, is a significant risk factor for hypertriglyceridemia and decreased HDL cholesterol levels. Central obesity paired with insulin resistance is a major contributor to the dyslipidemia associated with type 2 diabetes, familial combined hyperlipidemia, and familial hypoalphalipoproteinemia. The metabolic syndrome is associated with an increased risk of coronary artery disease, even in the absence of diabetes.
Other causes of secondary hypertriglyceridemia include untreated or uncontrolled diabetes, certain medications, and excessive alcohol consumption. Patients with triglyceride levels above 2000 mg/dL are almost always found to have both a secondary and a genetic form of hypertriglyceridemia.
The evaluation of patients with hypertriglyceridemia should initially focus on identifying a family history of the condition or premature coronary artery disease, as well as potential secondary causes such as medications or untreated diabetes. Waist circumference and body-mass index should also be calculated to assess the risk of insulin resistance and coronary disease. A fasting lipid profile is usually sufficient to evaluate lipids in patients with elevated triglyceride levels and premature coronary artery disease.
In patients with familial combined hyperlipidemia or familial hypoalphalipoproteinemia, apolipoprotein B levels and LDL cholesterol levels can be used to distinguish between the two conditions. However, the measurement of apolipoprotein B is not currently recommended in routine care due to the lack of standard values and the limited predictive value of the measurement. The size or density of LDL particles is also not recommended for routine use, but may be useful in assessing the relative risk of atherosclerosis in patients with hypertriglyceridemia and other lipid or nonlipid cardiovascular risk factors.
Treatment of hypertriglyceridemia should focus on reducing triglyceride levels and modifying associated abnormalities of intermediate-density lipoprotein, LDL, and HDL cholesterol. Fibrates are effective in lowering triglyceride levels, but the results of randomized trials have been equivocal in terms of major outcomes. Statins are generally considered the first drug of choice to lower LDL cholesterol, and nicotinic acid therapy may be an alternative first choice in patients at risk for premature coronary artery disease.
In patients with type 2 diabetes, the combination of statins and fibrates has been used to treat hypertriglyceridemia, but the use of fenofibrate did not result in a significant reduction in the primary outcome of nonfatal myocardial infarction or fatal coronary heart disease. Nicotinic acid therapy may be used in patients with well-controlled diabetes, but its use should be cautious due to potential effects on glucose control.
The optimal pharmacologic approach in patients with premature coronary artery disease remains uncertain, and the role of fibrates also remains unclear. The National Cholesterol Education Program recommends specific targets for LDL cholesterol levels, but not for triglyceride levels. Treatment with fibrates is recommended for patients with triglyceride levels above 1000 mg/dL to decrease the risk of triglyceride-induced pancreatitis.
In conclusion, the patient described in the vignette has an elevated triglyceride level and a low HDL cholesterol level, but his LDL cholesterol is within the normal range. A family history of premature coronary artery disease suggests familial combined hyperlipidemia or familial hypoalphalipoproteinemia, and pharmacologic therapy should be considered in addition to lifestyle modification. A combined treatment with nicotinic acid and a statin may be the most effective approach, but further studies are needed to determine the optimal therapy. |
<urn:uuid:10b6939b-18ce-4476-9f18-1000afbcfe72> | wiki | The notion that brain and behavior are inextricably linked has led to a profound exploration of the relationship between personality and neurobiology. Personality, in turn, is a multifaceted construct that encompasses various attitudes, dispositions, and preferences that influence an individual's behavior in specific contexts. The nervous system, as the primary control mechanism, is believed to be responsible for governing these personality traits, thereby rendering them susceptible to neurobiological influences.
The hierarchical structure of extraversion, a personality trait that has garnered significant attention in the realm of neurobiology, is characterized by sociability, activity, assertiveness, and impulsivity. Research has posited that these traits are underpinned by neuronal processes, with the ascending reticulocortical activating system playing a pivotal role in regulating arousal levels. However, studies have yielded mixed results, with EEG readings failing to demonstrate a strong correlation between brain arousal and extraversion.
Recent research, spearheaded by Richard Depue, has sought to elucidate the neurobiological basis of extraversion. According to Depue, extraversion is not merely a manifestation of overall arousal levels, but rather a motivated behavior driven by an increased sensitivity to reward signals. This perspective posits that extraverts are characterized by an enhanced propensity for social dominance and achievement, which is reflected in their behavior in social situations. Depue's model necessitates the identification of three critical criteria: the definition of neural structures associated with the trait, the explanation of individual differences within the functioning of that network, and the identification of sources of individual differences.
Utilizing an animal model, Depue has demonstrated that the ventral tegmental area dopamine projection system facilitates incentive-motivated behavior in rats. Dopamine agonists and antagonists in this region have been shown to modulate exploratory, aggressive, social, and sexual behavior, with similar phenomena observed in humans. The dopamine model of personality has been further supported by the discovery of a direct relationship between dopamine response and extraversion levels, as well as the inverse relationship between dopamine and extraversion, mediated by the enzyme monoamine oxidase.
The dopamine model of personality has been likened to a behavioral on-and-off switch, with the behavioral activation or facilitation system regulating exploratory and goal-directed behavior through the release of dopamine, and the behavioral inhibition system controlled by serotonin levels. Low serotonin levels have been linked to impulsiveness and oversensitivity, while high levels can lead to anxiety. The dopamine model has also been implicated in the development of personality disorders, with extreme levels of either dopamine or serotonin playing a role.
While the dopamine model provides valuable insights into the neurobiological basis of personality, it is essential to acknowledge that personality is a complex construct that cannot be attributed solely to a single neurotransmitter or neural structure. Rather, it is likely an intricate interaction between multiple chemicals and neurons in the brain. The amine neurotransmitters, including dopamine, serotonin, and norepinephrine, have been shown to be active in brain structures associated with emotion, motivation, and cognition, all of which are critical components of personality formation.
The observed correlations between neurotransmitters and personality have raised fundamental questions regarding self-determination, free will, and choice. Do we possess inherent predispositions towards certain personalities and behaviors, and do we have control over these predispositions? Furthermore, what is this sense of "I" that emerges from the complex interplay of chemical reactions in the brain? These questions have led to a reevaluation of one's own responsibility for actions controlled by chemicals, casting doubt on the notion of accountability.
Neurobiology, employing a reductionist approach, seeks to investigate these questions through the examination of chemical release at synapses and the correlation of such activity with behavior. However, Steven Rose has argued that reductionism faces significant challenges in establishing a causal relationship between observed chemical phenomena and behavior. Rose advocates for a more holistic perspective, emphasizing the importance of autopoiesis, a process whereby the organism develops itself, interacting with and affecting its environment.
Personality research has a rich history in the field of psychology, with the recent emergence of neurobiological explanations marking a significant shift in the field. While it is unlikely that neurobiology will be able to confirm or refute Freud's theories on personality development in the near future, the chemical basis of personality offers valuable insights into the mechanisms underlying behavior and the potential for intervention. By elucidating the neurobiological mechanisms that underpin personality, researchers may uncover novel avenues for treatment and intervention, from mild anxiety to severe personality disorders. |
<urn:uuid:fbafec04-9dfc-468d-b69b-160abf661ab5> | wiki | The notion that family caregivers should be granted honorary medical or nursing licenses is a tongue-in-cheek commentary on the multifaceted and demanding nature of their role, encompassing the tasks of information gathering, advocacy, informed decision-making, direct care provision, status monitoring, and bureaucratic navigation. This sentiment is underscored by a parent's observation that family caregivers are effectively managing a new small business, amidst their existing caregiving responsibilities.
The increasing recognition of the family's role in caregiving has led to the provision of various resources by hospitals, family support organizations, and other sources, primarily targeting adult caregivers, particularly the elderly. However, pediatric hospice programs and state and other initiatives for children with special needs also acknowledge the needs of parents or other caregivers. Research and experience suggest that many family caregivers lack explicit training for the physically and emotionally demanding responsibilities of caregiving, with studies highlighting the scarcity of such training.
In addition to providing information, internet sites can facilitate parental engagement by suggesting questions to ask about specific medical conditions, symptom management, and assistance sources. These prompts can empower parents to participate more effectively in developing, understanding, and implementing their child's care plan. Furthermore, internet sites can offer forums for people to seek and share information on caregiving strategies.
Comprehensive guidance for family caregivers should encompass physical and emotional problems, responses, and concerns for child patients, parents, and siblings, including isolation, depression, anxiety, and bereavement. It should also address spiritual resources, practical concerns such as advance care directives, health insurance management, and community agency assistance. The next chapter will delve into the spiritual, emotional, and practical dimensions of care for the child and family. |
<urn:uuid:6772d1c2-1584-4155-a7b3-e408843adaf5> | wiki | Disease monitoring is the ongoing systematic collection, analysis, and dissemination of health-related information pertaining to animal populations. This process involves the surveillance of specific diseases within a defined monitoring framework, with the aim of initiating an intervention strategy at a predetermined threshold level. For diseases such as equine infectious anemia or foreign animal diseases, a single case detection triggers an intervention, whereas for other diseases, mitigation activities are only initiated upon the observation of multiple cases or the occurrence of a disease event in an environment conducive to spread.
The primary objective of veterinary monitoring and surveillance is to provide a basis for informed decision-making regarding the control and prevention of infectious and communicable diseases affecting animal populations. For equids, the primary goals are to minimize the impact of disease on the health and welfare of the equine population and to prevent disruptions in commerce or trade. Furthermore, disease surveillance also has implications for public health, as equine infections such as West Nile virus or Eastern equine encephalomyelitis virus indicate that humans are also at risk within a given locale.
Monitoring and surveillance systems are tailored to specific objectives, which typically include the estimation of disease frequency, certification of disease-free status for animals, farms, states, or countries, and the detection of foreign animal or emerging diseases. These systems should be periodically evaluated and assessed through a formal review process. The Centers for Disease Control and Prevention has published guidelines for evaluating surveillance systems applicable to both human and veterinary diseases.
Equine disease surveillance data are primarily collected from diseased animal cases, with diagnostic testing required by breed associations, compulsory industry-initiated testing programs, or interstate or international travel requirements also providing valuable data. Reports from veterinary diagnostic laboratories, academic institutions, or equine clinics constitute the majority of veterinary surveillance data, while reporting by veterinary practitioners to animal health regulatory officials of infectious diseases is an invaluable component of a comprehensive surveillance system.
Surveillance is a process that involves the evaluation of animals for evidence of past or present exposure to a particular infectious agent based on a formal sampling protocol. This process is most useful in estimating disease prevalence. The United States Department of Agriculture, Animal Plant Health Inspection Service, Veterinary Services, in collaboration with the United States Animal Health Association, is conducting a targeted sampling of domestic horses to establish a national prevalence estimate for equine piroplasmosis caused by Babesia caballi and Theileria equi.
The decision to monitor a specific equine disease is typically made at the state level. However, some diseases can result in excessive losses in equine populations, but if they are widely distributed, such as Rhodococcus equi infections or leptospirosis, they are not readily amenable to interventions.
The USDA's National Surveillance Unit has established a web-based platform where the public can access up-to-date surveillance information, including maps that display the number and distribution of cases of EIA, vesicular stomatitis, and West Nile virus encephalitis. While the scope and quantity of available data may be limited, this platform provides a uniform method of reporting and has the potential to serve as a central repository for national equine surveillance data.
Recommendations for evaluating public health surveillance systems have been published by the Centers for Disease Control and Prevention. The guidelines provide a framework for assessing the effectiveness of surveillance systems and identifying areas for improvement. |
<urn:uuid:daa27db0-ce38-49e7-ab33-2c5471fe5421> | wiki | Http request failed |
<urn:uuid:e214570b-1920-4721-ad6e-fe55c34e039f> | wiki | The staging of cancer, particularly for those prone to widespread dissemination, is crucial in determining the extent of the disease and guiding treatment decisions. This process, known as staging, enables healthcare professionals to assess a patient's prognosis upon initial diagnosis and tailor treatment accordingly. Breast cancer is categorized into stages ranging from 0 to IV, with stage 0 representing ductal carcinoma in situ (DCIS) and stages I through IV denoting varying degrees of tumor progression.
Staging is typically based on a combination of factors, including patient symptoms, physical examination findings, tumor size, and the presence of nearby lymph nodes, as well as the results of common blood tests. If cancer is suspected to have metastasized, imaging tests are employed to identify the location and extent of the disease. For breast cancer, these imaging modalities include computed tomography (CT or CAT) scans, positron emission tomography (PET) scans, and bone scans. However, the American Society of Clinical Oncology (ASCO) recommends that these tests not be used for staging DCIS or stage I or II breast cancers, as they are often falsely positive, expose patients to unnecessary radiation, and do not significantly impact patient outcomes.
In contrast, imaging tests can be beneficial in situations where symptoms, physical examination findings, tumor size, or blood test results suggest later-stage breast cancer (stages III and IV). These tests can reveal abnormal areas in the body that may not be palpable or visible through other means. Nonetheless, it is essential to note that not all abnormal findings are indicative of cancer, and further testing is required to determine the presence and extent of the disease.
Patients with early-stage breast cancer that is unlikely to have spread may benefit from imaging tests, but these procedures can add unnecessary complexity, radiation exposure, and financial burden without significantly improving patient outcomes. Therefore, it is essential for patients to engage in open discussions with their healthcare providers regarding the benefits and drawbacks of imaging tests and to carefully weigh the potential risks and benefits.
When consulting with a healthcare provider, patients should inquire about the following:
1. What stage of breast cancer have I been diagnosed with?
2. How is the stage determined?
3. What tests are required to determine the stage?
4. Are imaging tests of other body parts necessary, and why or why not?
5. What additional information would these tests provide that could aid in determining treatment options?
6. What is the cost of each test?
By engaging in informed discussions with their healthcare providers and carefully considering the potential benefits and drawbacks of imaging tests, patients can make more informed decisions about their care and treatment. |
<urn:uuid:7bcb0f21-01e2-43b6-9dfb-78cb8fccf5c5> | wiki | The association between morbid obesity before pregnancy and adverse obstetric and neonatal outcomes has been a subject of considerable concern. Despite the Institute of Medicine's 2009 recommendations for gestational weight gain, the optimal weight gain for obese women remains unclear. A study conducted in Sweden examined the effects of variable gestational weight gain on obstetric outcomes in morbidly obese women and found that low weight gain or weight loss was associated with improved maternal and fetal outcomes.
The study, which analyzed data from the Swedish Medical Birth Registry, included 46,595 women with a body mass index (BMI) of 30 or higher. The researchers found that obese women who lost weight during pregnancy had a decreased risk of cesarean delivery and large-for-gestational-age births compared to those who gained the recommended amount. However, the risk of small-for-gestational-age births was twofold increased in obesity class III women who lost weight.
The study also found that excessive gestational weight gain was associated with an increased risk of pre-eclampsia, cesarean delivery, instrumental delivery, bleeding, large for gestational age, and fetal distress. The risk of these adverse outcomes was higher in obesity class II and III women with excessive weight gain.
The researchers noted that the risk of unwanted obstetric and neonatal outcomes is high among morbidly obese women, even with weight loss or low gestational weight gain. Excessive gestational weight gain during pregnancy also substantially increases the risk of postpartum weight retention, which can contribute to a worse obstetric outcome in subsequent pregnancies.
The study's findings have implications for the management of obesity in pregnancy. While the risk of adverse outcomes is high among morbidly obese women, the benefits of weight loss or low gestational weight gain may outweigh the risks. However, further research is needed to determine the optimal weight gain for obese women and to develop personalized recommendations for gestational weight gain.
The study's strengths include its large sample size and the use of prospective data from the Swedish Medical Birth Registry. However, the study's limitations include the potential for recall bias and the lack of data on potential confounding factors such as maternal age and parity. |
<urn:uuid:9a256a3b-759a-430b-9027-a618abf09141> | wiki | A considerable proportion of patients with unilateral cleft lip and palate presenting in their teenage years or later in developing countries exhibit noticeable deformities, with over 80% of the global population residing in these regions, rendering the standard repair protocols ineffective. Despite the prevalence of this issue, there is a notable absence of literature addressing this problem. The author focuses on correcting the nasal deformity, a critical aspect of treatment, given the patients' primary concern with aesthetic outcomes. Traditional procedures for primary nasal correction in infants are often unsuccessful in restoring nasal shape and symmetry in patients presenting at a later age. Building upon the author's experience with radical correction of secondary nasal deformities in unilateral cleft lip patients presenting late, they propose a novel approach of definitive primary correction of the nasal deformity in cleft patients presenting late. This study encompasses 22 patients with unilateral cleft lip deformity, aged between 13 and 22 years, who underwent a comprehensive surgical intervention between August 1997 and December 2000. Of these patients, 11 had a cleft of the lip alone, eight also had a cleft of the alveolus, and three had a cleft of the palate continuous with the cleft lip, with all patients exhibiting maxillary hypoplasia. The surgical procedures included external rhinoplasty with lip repair, columellar lengthening, augmentation of the nasal floor, pyriform margin, and alveolus using bone grafts, submucous resection of the nasal septum, repositioning of lower lateral cartilages, and augmentation of the nasal dorsum by bone graft. Clinical follow-up ranged from 4 to 24 months, with a median follow-up period of 13 months. The results have been highly satisfactory, surpassing those achieved with other primary rhinoplasty techniques. When treating unilateral cleft lip in adolescents, the author advocates for a comprehensive approach, addressing the entire deformity in a single stage, providing complete vector reorientation, and augmenting the hypoplastic elements using autologous tissue. In the author's opinion, merely correcting the lip deformity without attempting definitive rhinoplasty would be insufficient surgical intervention. |
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<urn:uuid:06316cd6-53e7-4f8f-90fd-551d6faaf8f1> | wiki | T-cell lymphomas comprise approximately 15 percent of all non-Hodgkin lymphoma cases in the United States, with a similar lymphocyte, the natural killer cell, exhibiting comparable characteristics. The latter's cancerous form, known as NK or NK/T-cell lymphoma, is generally categorized alongside other T-cell lymphomas. A diverse array of T-cell lymphomas exists, including those that are extremely rare, with varying growth rates, ranging from aggressive and fast-growing to indolent and slow-growing.
Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) accounts for approximately one-quarter of all PTCL cases and is the most common subtype of T-cell lymphoma, encompassing a group of diseases that do not fit into any other category. This subtype is characterized by its aggressive nature and requires combination chemotherapy upon diagnosis. The majority of patients diagnosed with PTCL-NOS present with their disease confined to the lymph nodes, although extranodal sites, such as the liver, bone marrow, gastrointestinal tract, and skin, may also be involved.
Anaplastic large cell lymphoma (ALCL) comprises approximately 12 to 15 percent of all T-cell lymphomas in adults and 10 to 30 percent of all lymphomas in children. This lymphoma can be divided into three types: two systemic subtypes, which are either ALK positive or ALK negative, and one non-systemic type, known as primary cutaneous ALCL, which appears exclusively on the skin. The systemic subtypes are typically fast-growing, whereas the skin-only type is usually more slow-growing.
Angioimmunoblastic lymphoma is a fast-growing T-cell lymphoma, accounting for 15 to 18 percent of all T-cell lymphomas in the United States. Initial symptoms often include swollen lymph nodes and systemic symptoms such as fever and rash. This lymphoma is generally treated like other fast-growing T-cell lymphomas, although milder therapies may be employed in certain circumstances.
Cutaneous T-cell lymphoma accounts for 2 to 3 percent of all non-Hodgkin lymphoma cases and predominantly affects adults. This group of typically slow-growing cancers appears on and is most often confined to the skin, with mycosis fungoides being the most common type. Less common forms include Sézary syndrome, primary cutaneous anaplastic large cell lymphoma, and lymphomatoid papulosis.
Adult T-cell leukemia/lymphoma (ATLL) is a rare form of T-cell lymphoma linked to infection by the human T-cell lymphotropic virus type 1 (HTLV-1) virus. This virus is commonly found in individuals from the Caribbean, parts of southern Japan, and central Africa, as well as sporadic cases from around the world. While most people who carry the virus remain asymptomatic carriers, only about 2 percent will develop lymphoma, which can be either indolent or aggressive.
Blastic NK-cell lymphoma is a very rare cancer, affecting only a few individuals each year, predominantly adults. This lymphoma was previously thought to arise from a T- or NK-cell, but newer studies suggest it may originate from another type of white blood cell, such as a plasma or dendritic cell. This lymphoma is characterized by its fast-growing nature and can be challenging to treat, often arising in various parts of the body.
Enteropathy-type T-cell lymphoma is an extremely rare subtype of T-cell lymphoma that appears in the intestines and is strongly associated with celiac disease. Hematosplenic gamma-delta T-cell lymphoma is another rare and aggressive disease that begins in the liver or spleen, often occurring in individuals with inflammatory bowel disease who are immunosuppressed.
Lymphoblastic lymphoma can manifest in both B-cells and T-cells, but is predominantly found in T-cells, comprising approximately 80 percent of all lymphoblastic lymphomas. This lymphoma is often diagnosed in children and can be effectively treated with intensive chemotherapy, resulting in a high complete remission rate.
Nasal NK/T-cell lymphomas are relatively rare in the United States but common in Asia and parts of Latin America. This fast-growing lymphoma typically originates in the lining of the nose or upper airway and is treated with radiation and various combinations of chemotherapy.
Treatment-related T-cell lymphomas can occur after solid organ or bone marrow transplantation, resulting from the immune system suppression required for transplantation. These lymphomas may require specialized therapies that differ from standard treatments for these conditions.
Patients diagnosed with rare forms of lymphoma should consult their medical team to explore promising therapies or clinical trials. Due to the diverse array of T-cell lymphomas, treatment options vary widely, and standard therapies, including chemotherapy, radiation, stem cell transplantation, and surgery, may be effective. Patients should also be aware of potential long-term effects or late effects of treatment, which can be influenced by factors such as duration and frequency of treatments, age, gender, and overall health.
Lymphoma survivors are encouraged to maintain regular follow-up care with a physician familiar with their medical history and treatment regimen. Survivors and their caregivers are also advised to keep detailed records of their medical history, treatment information, and test results, as this documentation will be essential for tracking any effects resulting from treatment or potential disease recurrences.
The Lymphoma Research Foundation (LRF) offers a range of resources, including treatment options, research advances, and information on coping with all aspects of lymphoma. LRF provides educational activities, such as in-person meetings, teleconferences, and webcasts, as well as a wide range of publications and a transportation assistance fund for patients undergoing treatment. |
<urn:uuid:196dd8c3-473c-4421-8125-e69886f9cc84> | wiki | Morning sickness, also known as nausea and vomiting of pregnancy or NVP, is a condition characterized by nausea and vomiting that occurs in the first few months of pregnancy. Despite its name, morning sickness can persist throughout the day and occur at any time, affecting approximately 7 in 10 women during the first trimester, which spans the first three months or approximately 12 weeks of gestation. Typically, symptoms begin around six weeks of pregnancy and reach their peak severity around nine weeks, although some women may continue to experience morning sickness throughout their pregnancy.
Mild morning sickness poses no risks to the mother or the developing fetus, but severe cases, known as hyperemesis gravidarum, can lead to significant weight loss and dehydration, potentially compromising the health of both the mother and the baby. In such cases, hospitalization may be necessary to provide treatment, including intravenous fluids to replenish lost fluids and electrolytes.
The exact cause of morning sickness remains unknown, although it is thought to be linked to an increase in pregnancy hormones, such as human chorionic gonadotropin (HCG), or low blood sugar levels early in pregnancy. Additionally, factors such as stress, fatigue, certain foods, and travel can exacerbate symptoms. To alleviate morning sickness, women can try various methods, including dietary changes, stress management, and over-the-counter medications, which may be prescribed by a healthcare provider.
In some cases, morning sickness can be severe, characterized by persistent vomiting that prevents the mother from consuming any food or fluids. This condition, known as hyperemesis gravidarum, can be life-threatening if left untreated and may require hospitalization and intravenous fluids to prevent dehydration and weight loss.
Women who experience severe morning sickness may be more likely to develop this condition if they have a history of motion sickness, are underweight, or have a family history of hyperemesis gravidarum. Healthcare providers may prescribe medication to alleviate symptoms, and in severe cases, hospitalization may be necessary to provide treatment and monitor the mother's and baby's health.
Pregnancy signs can be an important indicator of a woman's reproductive health, and recognizing these signs can help her determine whether she is pregnant. Some common signs of pregnancy include increased urination, breast tenderness, and fatigue, although these symptoms can also be caused by other conditions. Women who suspect they may be pregnant should consult their healthcare provider to confirm the diagnosis and begin prenatal care.
As pregnancy progresses, women may start to feel their baby's movements, known as quickening, which can be a reassuring sign that the baby is healthy and growing. This milestone typically occurs between 18 and 25 weeks of gestation, although first-time mothers may experience it earlier, while second- or third-time mothers may experience it sooner. Women may initially confuse gas with their baby's movements, but as they become more attuned to their baby's activity, they will begin to recognize patterns and develop a sense of anticipation and excitement. |
<urn:uuid:03d0fdb7-3dd2-483c-9ef1-1623151a8b66> | wiki | Most health economic evaluations of childhood vaccination only capture the health and short-term economic benefits. Measuring broader, long-term effects of vaccination on productivity and externalities could provide a more complete picture of the value of vaccines. MEDLINE, EconLit and NHS-EED databases were searched for articles published between January 1990 and July 2011, which captured broader economic benefits of vaccines in low and middle-income countries. Studies were included if they captured at least one of the following categories on broader economic impact: outcome-related productivity gains, behavior-related productivity gains, ecological externalities, equity gains, financial sustainability gains or macroeconomic benefits.
Twenty-six relevant studies were found, including observational studies, economic models and contingent valuation studies. Of the identified broader impacts, outcome-related productivity gains and ecological externalities were most commonly accounted for. No studies captured behavior-related productivity gains or macroeconomic effects. There was some evidence to show that vaccinated children aged 8-14 years benefited from increased cognitive ability. Productivity loss due to morbidity and mortality was generally measured using the human capital approach. When included, herd immunity effects were functions of coverage rates or based on reduction in disease outcomes. External effects of vaccines were observed in terms of equitable health outcomes and contribution towards synergistic and financially sustainable healthcare programs.
Despite substantial variation in the methods of measurement and outcomes used, the inclusion of broader economic impact was found to improve the attractiveness of vaccination. Further research is needed on how different tools and techniques can be used in combination to capture the broader impact of vaccination in a way that is consistent with other health economic evaluations. In addition, more country-level evidence is needed from low and middle-income countries to justify future investments in vaccines and immunization programs. Finally, the proposed broader economic impact framework may contribute towards better communication of the economic arguments surrounding vaccine uptake, leading to investments in immunization by stakeholders outside of the traditional health care sector such as ministries of finance and national treasuries.
In the last two decades, several vaccines have been developed that target a range of infectious diseases of global public health importance. However, the list price of these vaccines in high-income countries is substantially greater than for traditional vaccines. Hence, governments and external funders with limited resources often have to trade off purchasing vaccines against investing in other preventative and therapeutic interventions. In many high-income countries, assessment of the relative cost-effectiveness of competing strategies is a key element to the adoption of new health technologies, alongside other considerations such as effectiveness, disease burden and equity impact.
However, it has been suggested that these cost-effectiveness analyses may present too narrow a perspective of the benefits of vaccination and other child health programs. This is particularly relevant to many low and middle-income countries, where decisions about health care spending are often made in the context of wider development goals, and not on issues restricted to the health care sector alone. Furthermore, many such countries do not have locally established decision rules to facilitate the optimal allocation of resources within a fixed health care budget, so wider considerations such as the impact of immunization on economic growth or national budgets are often highly relevant.
Aside from their effectiveness in reducing disease and mortality, the economic benefits of vaccination have usually been measured in terms of the averted costs of medical care. Sometimes consideration is also made of the immediate productivity loss to patients and their carers. However, in the longer term, it has been suggested that vaccines can increase lifetime productivity due to better physical health, decreased chance of cognitive impairment caused by some vaccine-preventable diseases, and better educational outcomes through increased school attendance.
It has also been suggested that reduced childhood mortality may encourage mothers to decrease the number of planned births, hence increasing household investment per child and enabling greater labor force participation. In the long run, decreasing fertility may improve the dependency ratio and increase investment in physical and human capital. On a community level, vaccination is associated with positive externalities due to its effect on the pathogen-host ecology. For instance, vaccination can decrease the infection risk of unvaccinated people since they will no longer be at risk of becoming infected by vaccinated people (herd immunity). The use of vaccines may also reduce the need for antimicrobial use against affected organisms, hence reducing antimicrobial resistance.
Vaccination programs may also improve the financial sustainability and affordability of healthcare programs in low and middle-income countries. Their use as part of a treatment cluster, or in combination with other infrastructure projects, such as water management systems, to maximize community health outcomes, offers opportunities for cost-sharing between programs. Additionally, introduction of vaccination to disease-endemic areas may boost private demand for vaccines within communities, which could enable partial cost recovery by health departments.
Traditional health economic evaluations only consider the sector-specific impact of interventions on the health care sector. However, large outbreaks of diseases such as cholera or pandemic influenza can affect other sectors of the economy such as manufacturing, tourism, and transport. In countries with a high disease burden, vaccination may modulate such outbreaks, and have a substantial impact on demand, supply, trade, and investment in the wider economy.
Recently, several frameworks have been proposed by which these wider benefits of vaccination can be categorized. However, the extent to which these broader benefits are considered in current economic evaluations of vaccines is unclear. This systematic review aims to identify the extent to which broader economic benefits are already incorporated within existing economic evaluations of vaccines in low and middle-income countries, and to examine the validity of the underlying methodologies and associated outcomes employed in estimating their effect.
A systematic review was conducted to identify economic evaluations capturing the benefits of vaccination apart from health effects, health treatment costs saved, and short-term productivity losses due to being ill or caring for someone ill. For the purpose of this review, "narrow benefits" are defined as health effects, healthcare costs, and short-term productivity losses to patients and caregivers. These benefits are typically incorporated into traditional economic evaluations. They are generally short-term and are restricted to the vaccinated individual and closely related individuals, such as caregivers.
"Broader" benefits are defined as potential benefits of vaccination aside from these; they typically involve longer-term effects and/or wider externalities other than individuals vaccinated and their caregivers. The framework proposed in Bärnighausen et al. also differentiates between narrow and broad benefits on these grounds. However, following our review, we expanded Bärnighausen's framework to encompass other externalities and macroeconomic-level benefits proposed in recent literature.
In our classification, benefit categories were grouped under three broad headings depending on whether they related to health gains, productivity gains, or community externalities. Productivity gains related to outcomes were divided into narrow short-term outcomes (immediate disease or death) and long-term outcomes (effects of better health leading to improved physical, educational, and cognitive outcomes).
We reviewed MEDLINE, EconLit, and the National Health Service Economic Evaluation Database (NHS-EED) for English language articles published between January 1990 and July 2011. Search filters for identifying papers specific to vaccination, economic outcomes, and low and middle-income countries were then applied in combination. In addition, specific keywords associated with the various benefit categories were also included in the search in combination with these filters.
A separate search was conducted for the broader benefits identified by Bärnighausen et al. (category B3-4 and C1-4 in Table 1), using category-specific keywords. Full search terms can be found in the additional file. Grey literature reports and working papers published online were also identified through discussions with subject experts involved in a World Health Organization consultation on the broader economic impact of vaccination (Toronto, 2011). To ensure reproducibility of search results, grey literature reports not publicly available on the internet were excluded. Reference lists in identified articles were scanned to identify additional studies missed during the search (snowball method).
Each study identified through the database search was initially categorized on the basis of its title and abstract to determine its possible relevance to the review. Studies could be economic evaluations, reviews, epidemiological studies (observational or experimental), contingent valuation studies, or descriptions of measurement tools. Articles were then read to ensure that they met the following criteria: (i) in humans, (ii) not studies of travel vaccines, (iii) discussed or measured at least one of the benefits of vaccination listed in categories B3-4 or C1-4 of Table 1, (iv) conducted in low and middle-income countries, (v) discussed both cost and benefits of vaccines, (vi) discussed economic consequences of vaccine use (and not purely epidemiological studies looking at the impact of vaccination on infection or disease).
Full texts of 92 articles were obtained. Of these, 26 were found to meet the selection criteria, and were included in the qualitative synthesis. Three of these 26 studies were grey literature reports or working papers and were not retrieved from a database. A PRISMA flow diagram of search results can be found as an additional file. A detailed description of all included studies can be found as an additional file.
Half the studies incorporated both narrow and broad economic benefits of vaccination, while the other half solely incorporated broader benefits. Perhaps reflective of growing interest in the measurement of broader benefits, only three included studies were published in 2005 or earlier. Five studies also estimated economic gains from vaccine use in multiple low and middle-income countries.
Table 22 shows the number of articles mentioning different categories of benefit, and the associated vaccine antigens and targeted age groups discussed. While there were no clear patterns, on the whole, outcome-related productivity gains and equity were discussed most often in articles dealing with vaccines targeted at children under five years old. Financial sustainability was discussed most often in articles dealing with vaccines targeted at both children and adults. Ecological externalities were discussed equally often in both types of articles.
Productivity gains related to long-term outcomes were included in eight studies. Three were primary studies (one cluster randomized trial and two observational longitudinal studies) examining the long-term productivity effects of vaccination against childhood diseases. Barham and Calimeris used a quasi-randomized cluster design to find that early childhood vaccination combined with a family planning program in Bangladesh significantly improved cognitive |
<urn:uuid:f089e635-ebee-4e78-997f-a576efe59a4a> | wiki | Despite the implementation of prenatal vaccination and testing protocols, as mandated by the Centers for Disease Control and Prevention (CDC) in 1991 and reaffirmed by the U.S. Preventive Services Task Force in 2009, maternal hepatitis B surface antigen (HBsAg) screening remains a contentious issue, with only 27 states having enacted laws governing the practice. Notably, these laws often lack the necessary enforcement mechanisms to ensure compliance, as highlighted by a study conducted by Euler et al. in 2003, which found that state screening laws do not necessarily translate into increased testing rates.
A study conducted by Ferrante et al. in 2008, which surveyed family physicians in New Jersey, revealed that despite the presence of a maternal screening law, a significant proportion of respondents (22%) did not recommend testing pregnant women for HBV infection. This finding underscores the challenges associated with implementing effective screening programs, particularly in the absence of robust enforcement mechanisms.
Furthermore, a study presented by Chao et al. at the 2009 International Symposium on Viral Hepatitis and Liver Disease shed light on the knowledge gaps among healthcare providers regarding hepatitis B and its management. The study, which surveyed 100 obstetrician/gynecologists (OB/GYNs) and 31 peripartum nurses in Santa Clara County, CA, found that while most OB/GYNs reported testing pregnant women for HBsAg and advising HBsAg-positive women to vaccinate their newborns, overall knowledge about hepatitis B was limited. Specifically, only 26% of OB/GYNs and 10% of peripartum nurses recognized that the prevalence of chronic hepatitis B is higher in Asian populations than in other ethnic groups, while only 33% of OB/GYNs and 17% of peripartum nurses acknowledged the high risk of HBV infection becoming chronic in exposed newborns.
The study also found that only 22% of OB/GYNs referred their HBsAg-positive pregnant patients for chronic-hepatitis management, highlighting the need for improved education and training among healthcare providers. Notably, the study's findings were similar to those reported by Ferrante et al. in 2008, which found that healthcare providers' knowledge about hepatitis C was similarly insufficient.
In a related study, Ferrante et al. (2008) surveyed family physicians in New Jersey and found that while 95% would recommend testing individuals who inject drugs (IDUs) for HCV infection, only 81% would recommend testing individuals who received blood transfusions before 1992, and only 65% would recommend testing incarcerated persons—all populations that are at high risk for HCV infection and that fall within national testing guidelines. These findings underscore the need for improved education and training among healthcare providers regarding hepatitis C, as well as the importance of addressing the social determinants of health that contribute to HCV transmission.
In contrast, HCV testing of pregnant women is not supported by any evidence-based guidelines, highlighting the need for further research on this topic. |
<urn:uuid:04489f29-1280-45b5-abe2-e11cf7d99b77> | wiki | Obesity among children poses a multitude of severe health issues, both in the present and in the future, with type 2 diabetes and heart disease being among the most significant concerns. The excessive weight in young bodies can lead to a plethora of chronic conditions that significantly impact their quality of life. Chronic diseases in the United States, largely associated with obesity, account for 70 percent of deaths and 75 percent of healthcare costs, with the current epidemic of childhood obesity positioning children to surpass the chronic ailments experienced by older generations.
Research published in the journal Health Affairs reveals that medical spending associated with obesity in individuals over the age of 18 has risen to nearly 10 percent of total medical spending per year, amounting to $147 billion annually. Furthermore, findings published in Health Affairs online indicate that costs associated with obesity-related hospitalizations in children have increased from $125.9 million in 2001 to $237.6 million in 2005, adjusted for inflation.
Obese children are more susceptible to orthopedic conditions, asthma, and diabetes-related problems, such as infections, due to compromised bones, airways, and metabolic processes. Marc Jacobson, a pediatrician specializing in nutrition, lipids, and weight problems, notes that being obese can have a profound impact on a child's mental health, including depression, anxiety, and emotional distress. Sandra Hassink, director of the Weight Management Program at Nemours/Alfred I. duPont Hospital for Children, emphasizes that school becomes an adverse environment for obese children, leading to decreased performance and academic struggles.
Obstructive sleep apnea, a common sleep disorder associated with obesity, can cause a person to stop breathing, snore loudly, and experience excessive daytime fatigue, often leading to confusion with attention deficit disorder. Hassink also highlights the prevalence of asthma among obese children, which exacerbates wheezing and shortness of breath. In addition, the liver can suffer from inflammation and scarring due to fatty deposits, known as nonalcoholic steatohepatitis, affecting approximately 15 to 20 percent of obese children.
Obese children are also more prone to orthopedic issues, such as Blount's disease and hip joint fractures, due to the excessive weight burden on developing bones and joints. Furthermore, girls who are obese may experience early-onset menstruation, polycystic ovarian syndrome, and irregular or stopped periods, leading to potential complications in adulthood.
Despite the challenges, Hassink emphasizes that parents and obese children can work together to manage the problem. A supportive household, real hard look at nutritional and activity habits, and concerted effort are essential. Parents should not rely on sugary foods and beverages to entice picky eaters, as they require a balanced diet of fruits, vegetables, lean meats, and low-fat dairy. Hassink also stresses the importance of promoting physical activity, such as play with other kids, to encourage exercise and outdoor play. |
<urn:uuid:dfed1062-16b2-482e-b6ea-3b6732a66d6c> | wiki | Alcoholism is a condition characterized by a dependency on alcohol, which can have a detrimental impact on bone health due to excessive alcohol consumption. Amenorrhea, the abnormal absence of menstrual periods, can also lead to brittle bones and an increased risk of fractures, particularly in early stages caused by overtraining. Anorexia nervosa, an eating disorder marked by an irrational fear of weight gain, can result in nutritional and hormonal problems that negatively affect bone health.
Arthritis, a general term for conditions causing inflammation and swelling of joints and surrounding tissues, may coexist with osteoporosis and Paget's disease. Individuals with asthma are at a heightened risk of osteoporosis, especially in the spine, due to chronic lung disease. Maintaining balance, flexibility, and strength can significantly reduce the risk of falling.
Bisphosphonates are medications used to treat osteoporosis and other bone diseases. Bone is a living, growing tissue composed mainly of collagen, while a bone biopsy involves analyzing a small sample of tissue for analysis. Bone mineral density testing measures bone strength and fracture risk, whereas bone remodeling involves the process of bone renewal through resorption and formation.
Bone scans are nuclear scanning tests used to diagnose various bone-related conditions, including Paget's disease. Breast cancer survivors may be at increased risk of osteoporosis due to reduced estrogen levels, chemotherapy, or early menopause. Calcitonin, a hormone involved in calcium regulation, is used to treat osteoporosis and Paget's disease.
Calcium is an essential mineral for bone health, also necessary for the heart, muscles, and nerves to function properly and for blood to clot. Celiac disease, an inherited intestinal disorder, can lead to bone loss if left untreated. Collagen, a family of fibrous proteins, is crucial for osteogenesis imperfecta, a genetic disorder affecting collagen production.
Constipation, a decrease in bowel movements with hardening of the stool, can be associated with osteogenesis imperfecta. Diabetes, a disease characterized by insulin production or utilization issues, may increase the risk of osteoporosis. Dual-energy x-ray absorptiometry (DXA) is a common test for measuring bone mineral density, a painless procedure similar to an x-ray but with less radiation exposure.
Endocrinologists treat the endocrine system, which regulates metabolic activity, including osteoporosis, diabetes, and thyroid and pituitary gland diseases. Estrogen therapy, using the female hormone estrogen, can treat osteoporosis. Family doctors provide long-term care for individuals or families, emphasizing internal medicine, gynecology, and pediatrics.
Flexibility, balance, and strength are essential for maintaining stability while moving or standing still, significantly reducing the risk of falling. Bisphosphonates are used to treat osteoporosis and other bone diseases. Bone is a living, growing tissue composed mainly of collagen, while a bone biopsy involves analyzing a small sample of tissue for analysis.
Bone mineral density testing measures bone strength and fracture risk, whereas bone remodeling involves the process of bone renewal through resorption and formation. Bone scans are nuclear scanning tests used to diagnose various bone-related conditions, including Paget's disease. Breast cancer survivors may be at increased risk of osteoporosis due to reduced estrogen levels, chemotherapy, or early menopause.
Calcitonin, a hormone involved in calcium regulation, is used to treat osteoporosis and Paget's disease. Calcium is an essential mineral for bone health, also necessary for the heart, muscles, and nerves to function properly and for blood to clot. Celiac disease, an inherited intestinal disorder, can lead to bone loss if left untreated.
Collagen, a family of fibrous proteins, is crucial for osteogenesis imperfecta, a genetic disorder affecting collagen production. Constipation, a decrease in bowel movements with hardening of the stool, can be associated with osteogenesis imperfecta. Diabetes, a disease characterized by insulin production or utilization issues, may increase the risk of osteoporosis.
Dual-energy x-ray absorptiometry (DXA) is a common test for measuring bone mineral density, a painless procedure similar to an x-ray but with less radiation exposure. Endocrinologists treat the endocrine system, which regulates metabolic activity, including osteoporosis, diabetes, and thyroid and pituitary gland diseases.
Estrogen therapy, using the female hormone estrogen, can treat osteoporosis. Family doctors provide long-term care for individuals or families, emphasizing internal medicine, gynecology, and pediatrics. Flexibility, balance, and strength are essential for maintaining stability while moving or standing still, significantly reducing the risk of falling.
Glucocorticoids, steroid medications used to reduce inflammation, can cause bone loss. Gynecologists diagnose and treat conditions of the female reproductive system and associated disorders. Hypercalciuria, a disorder characterized by excessive calcium loss, can lead to bone loss.
Hypertension, high blood pressure, can increase the risk of osteoporosis. Hypogonadism, abnormally low levels of sex hormone, can be a secondary cause of osteoporosis in men. Idiopathic osteoporosis may be characterized as having no identifiable cause, particularly in children and men.
Internists diagnose and treat many diseases, including osteoporosis. Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, can increase the risk of osteoporosis due to chronic inflammation. Joint laxity, a common symptom in people with osteogenesis imperfecta, can lead to increased risk of fractures.
Juvenile osteoporosis affects children and adolescents, while lactose intolerance, an inability to digest lactose, can increase the risk of osteoporosis if dairy products are avoided. Lupus, a chronic inflammatory disease, can affect many body systems, including joints, skin, kidneys, blood cells, heart, and lungs, increasing the risk of osteoporosis.
Menopause, the cessation of menstruation in women, can lead to bone health deterioration due to reduced estrogen levels. MRI scans produce clear pictures of soft tissues, including ligaments, tendons, and blood vessels, unlike x-rays, which show only bony structures.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen, and naproxen, can ease pain and inflammation but may cause bone loss. Orthopaedic surgeons specialize in musculoskeletal conditions, including congenital skeletal malformations, bone fractures, and infections.
Orthopaedists diagnose and treat bone and joint disorders. Osteogenesis imperfecta, a genetic disorder characterized by bones that break easily, can be caused by a genetic defect affecting collagen production. Osteopenia, low bone mass, can increase the risk of fractures.
Osteoporosis, literally meaning "porous bone," is characterized by too little bone formation, excessive bone loss, or a combination of both, leading to bone fragility and increased risk of fractures. Parathyroid hormone, a form of human parathyroid hormone, is used to treat osteoporosis. Paget's disease of bone, a bone disease causing bones to grow larger and weaker than normal, can increase the risk of fractures.
Peak bone mass, the amount of bone tissue in the skeleton, can be reached around age 30, after which bones have reached their maximum strength and density. Periodontitis, a chronic infection affecting the gums and bones that support the teeth, can lead to tooth loss, fall, or removal.
Physiatrists specialize in physical medicine and rehabilitation, evaluating and treating patients with impairments, disabilities, or pain arising from various medical problems, including bone fractures. Prostate cancer, a disease characterized by abnormal tumor cells in the prostate gland, can increase the risk of osteoporosis and broken bones.
RANK ligand (RANKL) inhibitors, a type of drug, are approved for the treatment of osteoporosis. Rheumatoid arthritis, an inflammatory disease causing pain, swelling, stiffness, and loss of function in the joints, can increase the risk of bone loss and fractures.
Rheumatologists diagnose and treat diseases of the bones, joints, muscles, and tendons, including arthritis and collagen diseases. Risk factors, including genetics, lifestyle, and medical conditions, can increase the chances of having osteoporosis. Scoliosis, a sideways curvature of the spine, can increase the risk of fractures.
Secondary osteoporosis, caused by an underlying medical disorder or medications, can be treated with various therapies. Selective estrogen receptor modulator (SERM) is a type of drug used to prevent or treat postmenopausal osteoporosis. T-score measures the extent to which an individual's bone density differs from that of a typical individual of the same age, gender, and weight.
TENS, transcutaneous electrical nerve stimulation, can be used to manage pain and inflammation. Vitamin A, a family of fat-soluble compounds, plays a crucial role in vision, bone growth, reproduction, cell division, and cell differentiation, but excessive levels can lead to bone loss and increased risk of hip fracture.
Vitamin D, a nutrient essential for calcium absorption, is necessary for maintaining bone health. Weight-bearing exercise, such as walking, hiking, jogging, climbing stairs, and lifting weights, is best for strengthening bones. Z-score measures the extent to which an individual's bone density differs from that of a typical individual of the same age, gender, and weight. |
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<urn:uuid:a239cf9f-52dd-41bb-a8a2-4d43d966fa85> | wiki | A recent investigation has revealed that the genetic makeup of individual tumor cells in breast cancer patients is uniquely distinct, mirroring the inherent variability found in human genetic profiles. This study, spearheaded by Nicholas Navin, Ph.D., a genetics expert at M.D. Anderson Cancer Center in Houston, has uncovered the remarkable heterogeneity of tumor cells, with each exhibiting distinct growth rates. The findings of this research hold significant implications for the diagnosis and treatment of breast cancer, as well as the development of strategies to combat chemotherapy resistance.
The results of Navin's study, published in the journal Nature, have significantly advanced the understanding of "genomic diversity" within tumors. Large-scale sequencing studies of breast tumors have identified numerous prevalent mutations, yet have provided limited insight into the diversity of tumor cells. Navin's team developed a novel sequencing approach, dubbed Nuc-Seq, which has revealed that different subtypes of breast cancer display varying levels of tumor diversity.
According to Navin, the study uncovered two distinct "molecular clocks" operating at different stages of tumor growth. Specifically, tumor cells from triple-negative breast cancer exhibited an increased mutation rate, whereas those from estrogen receptor-positive (ER+) breast cancer did not. Approximately 75% of breast cancers are ER+, and these tumors typically respond to hormone therapy, whereas triple-negative breast cancers account for 15 to 25% of all breast cancers and generally do not respond well to hormone therapy or standard chemotherapy.
Navin's team developed Nuc-Seq as a single-cell genome sequencing method, which was applied to study the occurrence of cell mutations in both ER+ and triple-negative breast cancers. By combining single-cell molecule sequencing with targeted single-molecule deep sequencing, the researchers were able to profile thousands of cells, thereby addressing a significant challenge in the field of single-cell genomics, namely the inability to validate mutations detected in individual cells.
The study's findings have shed light on a pressing question in the field of chemotherapy, namely whether resistance mutations pre-exist in rare cells within the tumor or emerge spontaneously in response to therapy. Navin noted that this question has been extensively studied in bacteria, yet remains poorly understood in most human cancers. The data obtained from this study suggests that a large number of diverse mutations are likely to be pre-existing in the tumor prior to chemotherapy, thereby implying that measuring genomic diversity may have prognostic value in identifying patients who are likely to develop resistance to chemotherapy.
Furthermore, the study's results indicate that genomic diversity may have valuable clinical applications for predicting tumor invasion, metastasis, and poor survival in patients. |
<urn:uuid:94870934-a778-4156-b99d-267a519de8e4> | wiki | A total of nine studies were incorporated into this review, all of which employed a before-and-after design that incorporated education for healthcare professionals. However, each study exhibited problems with various aspects of study quality, with none of the studies assessing the impact of breast-feeding counselors on the outcomes.
Six studies focused on educational interventions aimed at enhancing the knowledge and support of healthcare professionals in relation to breast-feeding. These studies demonstrated a statistically significant increase in the proportion of women who reported exclusive breast-feeding at discharge, full breast-feeding at three months, and any breast-feeding at six months following the implementation of the 18-hour United Nations Children's Fund (UNICEF) training, which was designed to prepare healthcare workers for the Baby Friendly Hospital Initiative (BFI). For instance, a study involving 571 healthcare workers and 2,669 mother-baby pairs reported a statistically significant increase in exclusive breast-feeding at discharge, with no actual values provided. In contrast, a study conducted at a teaching hospital, which involved 73 midwives and paediatricians, and 50 mother-baby pairs before and after, demonstrated no effect on breast-feeding duration, although it showed a reduction in babies separated from their mothers overnight and the use of formula feed in hospital. Four other studies yielded mixed results.
One study focused on the teaching of the "hands-off" technique to hospital midwives and healthcare assistants, involving 1,400 mothers. At two weeks after discharge, this study reported a statistically significant increase in any breast-feeding and exclusive breast-feeding, with p-values of 0.005 and no actual values provided. However, at six weeks, there was no significant difference.
A single study examined the impact of changing the maternity unit philosophy, involving 325 mother-baby pairs before and after. At six days after discharge, this study reported an increase in exclusive breast-feeding, from 48% to 90%, as well as a decrease in mixed feeding, from 37% to 7%, and bottle feeding, from 15% to 3%.
A final study investigated the introduction of evidence-based guidelines supported by other strategies, involving 702 mothers before and 866 after. Although this study reported no significant difference in breast-feeding initiation or duration or the number of babies readmitted to hospital, it did report an increase in readmission due to jaundice, without providing any actual values or statistical significance. |
<urn:uuid:059a64d0-65b5-487d-b184-601abfd1cf8c> | wiki | Hypotension, a condition characterized by abnormally low blood pressure, can manifest in various forms, with some individuals experiencing persistent low readings, while others experience episodic drops in blood pressure due to specific events or underlying medical conditions. Hypotension is a medical concern only if it results in noticeable symptoms, such as dizziness, fainting, or, in extreme cases, shock.
The body's sensitivity to changes in blood pressure is remarkable, with specialized cells in the arteries, known as baroreceptors, capable of detecting even slight fluctuations in blood pressure. When these baroreceptors detect a rise or drop in blood pressure, they trigger a range of responses throughout the body in an attempt to restore normal blood pressure.
For instance, if an individual stands up quickly, the baroreceptors will sense a drop in blood pressure, prompting the heart to beat faster and harder, and the small arteries and veins to constrict. Most forms of hypotension arise when the body is unable to effectively counteract these fluctuations or respond quickly enough.
In a healthy individual, hypotension without symptoms is generally not a cause for concern and may not require treatment. However, if hypotension results in noticeable symptoms, medical attention is necessary to identify and address any underlying conditions. In extreme cases, severe hypotension can lead to shock, a life-threatening condition that requires immediate medical attention.
There are several types of hypotension, including chronic asymptomatic hypotension, orthostatic hypotension, neurally mediated hypotension, and severe hypotension associated with shock. Orthostatic hypotension, for example, occurs when an individual stands up from a sitting or lying down position, leading to a temporary drop in blood pressure and symptoms such as dizziness and fainting.
Dehydration, certain medications, and underlying medical conditions are common causes of hypotension. Neurally mediated hypotension, on the other hand, occurs when the brain and heart fail to communicate effectively, leading to a drop in blood pressure. Severe hypotension associated with shock is a life-threatening condition that requires prompt medical attention.
Hypotension can affect individuals of all ages, with certain age groups being more susceptible to specific forms of the condition. The symptoms of hypotension vary depending on the type and severity of the condition, but may include dizziness, fainting, lightheadedness, and confusion.
Diagnosis of hypotension typically involves a medical history and physical examination, with specialists such as cardiologists and nephrologists playing a crucial role in diagnosis and treatment. Diagnostic tests and procedures may include blood pressure monitoring, electrocardiograms, and imaging studies.
Treatment of hypotension depends on the underlying cause and severity of the condition. In general, treatment aims to relieve symptoms, manage underlying conditions, and restore normal blood pressure. For orthostatic hypotension, treatment may involve lifestyle modifications, medication, and, in some cases, surgery. Neurally mediated hypotension may be treated with medications and lifestyle changes, while severe hypotension associated with shock requires immediate medical attention and treatment in a hospital or by emergency medical personnel.
With proper treatment and management, many individuals with hypotension can lead normal, healthy lives. It is essential for individuals with hypotension to take steps to prevent or minimize symptoms, such as dizziness and fainting, and to seek medical attention if symptoms persist or worsen. |
<urn:uuid:7a7d185c-1e2d-4f7d-ba42-15d3a757c52e> | wiki | Polycomb-group proteins are a family of proteins initially identified in fruit flies that can remodel chromatin, thereby facilitating the epigenetic silencing of genes. These proteins are renowned for their role in silencing Hox genes during embryonic development in fruit flies (Drosophila melanogaster).
In Drosophila, the Polycomb-group (PcG) and Trithorax-group (trxG) proteins operate antagonistically and interact with chromosomal elements known as Cellular Memory Modules (CMMs). The trxG proteins maintain the active state of gene expression, while the PcG proteins counteract this activation with a repressive function that is stable over multiple cell generations and can only be overcome by germline differentiation processes. Polycomb Gene complexes or PcG silencing consist of at least three kinds of multiprotein complexes, including PRC1 (Polycomb Repressive Complex 1), PRC2, and PhoRC. These complexes collaborate to carry out their repressive effect.
In mammals, Polycomb Group gene expression plays a pivotal role in various aspects of development. The Bmi1 polycomb ring finger protein promotes neural stem cell self-renewal. Mutations in PRC2 genes in mice result in embryonic lethality, whereas most PRC1 mutants are live-born homeotic mutants that die perinatally. Conversely, overexpression of PcG proteins is associated with the severity and invasiveness of several cancer types. The mammalian PRC1 core complexes are remarkably similar to those in Drosophila. Polycomb Bmi1 is known to regulate the ink4 locus (p16Ink4a, p19Arf).
In Physcomitrella patens, the PcG protein FIE is specifically expressed in stem cells, such as the unfertilized egg cell. Following fertilization, the FIE gene is inactivated in the young embryo. The Polycomb gene FIE is expressed in unfertilized egg cells of the moss Physcomitrella patens and its expression ceases after fertilization in the developing diploid sporophyte.
Notably, unlike in mammals, PcG proteins are essential for maintaining cells in a differentiated state. Loss of PcG proteins leads to de-differentiation and promotes embryonic development. Polycomb-group proteins also intervene in the control of flowering by silencing the Flowering Locus C gene. This gene is a central component of the pathway that inhibits flowering in plants, and its silencing during winter is suspected to be one of the main factors intervening in plant vernalization.
The Polycomb-group proteins also include various other proteins, such as Heterochromatin protein 1 (Cbx), PCGF2 (Polycomb group RING finger protein 2), SUV39H1 (histone-lysine N-methyltransferase), EZH2 (Enhancer of Zester Homolog 2), SUZ12 (Suppressor of Zeste 12), Jarid2 (jumonji, AT-rich interactive domain 2), and RE1-silencing transcription factor (REST). These proteins interact with chromatin to regulate gene expression and maintain genomic stability. The Polycomb-group proteins also contribute to the formation of bivalent chromatin, a specialized chromatin structure that is essential for maintaining gene expression.
Polycomb-group proteins have been extensively studied in various organisms, including fruit flies, mammals, and plants. Research has revealed that these proteins play a crucial role in regulating gene expression, maintaining genomic stability, and controlling cellular differentiation. The Polycomb-group proteins have also been implicated in the development of various diseases, including cancer. Understanding the mechanisms of Polycomb-group proteins is essential for developing novel therapeutic strategies for these diseases. |
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<urn:uuid:8cd5b156-a4ab-4668-ab36-4250f5328d67> | wiki | Researchers have discovered that glucose, a naturally occurring sugar, has a tempering effect on brain activity in regions that regulate appetite and reward, whereas fructose, a commonly consumed sweetener, does not exhibit a similar effect. A brain imaging study conducted by Robert Sherwin, MD, of Yale University, and colleagues found that participants who consumed a glucose-sweetened drink experienced significant reductions in cerebral blood flow in the hypothalamus, a region that plays a crucial role in appetite regulation. In contrast, those who consumed a fructose-sweetened drink showed a slight increase in activity in the hypothalamus.
Glucose also reduced activation in the insula and striatum, other brain regions that regulate appetite, motivation, and reward processing, whereas fructose did not. The researchers noted that the hypothalamus and other brain regions are interconnected, and the ingestion of glucose initiates a coordinated response between the homeostatic-striatal network that regulates feeding behavior. This response was not observed when fructose was consumed.
The study, which involved 20 normal-weight, healthy adults, found that glucose significantly reduced blood flow in the thalamus, insula, anterior cingulate, and striatum, compared to baseline. In contrast, fructose reduced blood flow in the hippocampus, posterior cingulate cortex, fusiform, and visual cortex, but also in the thalamus.
The researchers also found that glucose upped the links between the hypothalamus and the thalamus and striatum, whereas fructose only increased connectivity between the hypothalamus and thalamus, but not the striatum. This suggests that the ingestion of glucose, but not fructose, initiates a coordinated response between the homeostatic-striatal network that regulates feeding behavior.
In terms of circulating hormone levels, glucose elevated levels of insulin and glucagon-like peptide-1 (GLP-1), which are hormones that can increase satiety, whereas fructose did not. The researchers noted that the differences in brain effects between glucose and fructose also appeared to coordinate with ratings of hunger, as there was a significant difference from baseline in terms of fullness and satiety when participants drank glucose, but not fructose.
The study's findings have implications for our understanding of the effects of fructose on appetite regulation and the potential consequences of its widespread consumption in the American diet. Fructose is a common sweetener found in both sucrose and high-fructose corn syrup, and its effects on metabolism and appetite regulation are distinct from those of glucose. The researchers cautioned that the study was limited, as functional MRI does not provide a direct measure of neuronal activity, and thus any clinical implications cannot yet be determined.
Editorialists Jonathan Purnell, MD, and Damien Fair, PhD, noted that while some researchers and clinicians warn that the total amount of calories is more important than the type of food when it comes to losing weight, the "reality is that hunger and fullness are major determinants of how much humans eat, just as thirst determines how much humans drink." They emphasized that reducing the food element, if possible, is a key component of the remedy for weight loss. |
<urn:uuid:e7d63ae9-8a4e-47df-862a-d8093be316b0> | wiki | Researchers at the University of Texas at San Antonio (UTSA) have made significant strides in the development of therapies to combat tularemia, a deadly bacterial infection, according to a study published in the Proceedings of the National Academy of Sciences Early Edition on February 2, 2009. The research, conducted in collaboration with the Burnham Institute for Medical Research, the University of Texas Southwestern Medical Center at Dallas, and Thomas Jefferson University, has led to the discovery of a unique metabolic pathway utilized by Francisella tularensis, the bacterium responsible for the disease, to produce nicotinamide adenine dinucleotide (NAD).
Francisella tularensis, a highly infectious organism, causes morbidity and mortality in humans, with very little known about its molecular mechanisms of pathogenesis. The lack of a vaccine for tularemia, the disease it causes, has raised concerns about its potential use as a bioweapon. However, the researchers' findings offer promise, as the unique pathway used by F. tularensis to produce NAD can be targeted to destroy the organism without harming the human host.
The conventional method of producing NAD, a crucial metabolic molecule, is distinct from the pathway employed by F. tularensis, which utilizes the enzyme nicotinamide mononucleotide synthetase (NMS). This discovery provides a potential target for the development of therapeutics against tularemia, a disease that affects approximately 200 individuals in the United States each year, primarily through exposure to infected insects, animals, or contaminated food and water.
The bacterium, typically found in rural areas and associated with rodents and rabbits, can cause bioweapons concern due to the small number of bacteria required to induce disease. If released into the air, F. tularensis can cause respiratory infections, including pneumonia, and symptoms such as fever, headaches, and muscle aches. Individuals may not exhibit symptoms for up to two weeks after exposure, but antibiotics can be effective in treating the disease once symptoms appear. |
<urn:uuid:3bf7f9b1-0941-4e9d-8cce-8dfc0849be66> | wiki | The human immune system is a multifaceted and dynamic network that defends the body against foreign invaders, recognizing and responding to substances known as antigens, whether they are infectious agents or part of the body itself. This intricate system relies on a complex interplay of various immune cells, including lymphocytes, which are predominantly white blood cells, and are categorized into two major classes: T cells and B cells.
T cells, a crucial component of the immune system, play a pivotal role in destroying infected cells and coordinating the overall immune response. Equipped with a molecule on their surface known as the T-cell receptor, T cells interact with molecules called MHC (major histocompatibility complex), which are present on the surfaces of most other cells in the body and facilitate the recognition of antigen fragments. B cells, on the other hand, are renowned for their ability to produce antibodies, which bind to antigens and mark them for destruction by other immune system cells.
In addition to T and B cells, other types of white blood cells, including macrophages and neutrophils, circulate in the blood and survey the body for foreign substances. Upon detecting foreign antigens, these cells engulf and destroy them through the production of toxic molecules such as reactive oxygen intermediate molecules. However, when these toxic molecules are overproduced, they can also contribute to the destruction of surrounding tissues, as seen in autoimmune diseases like Wegener's granulomatosis and rheumatoid arthritis.
MHC molecules, which are ubiquitous on all cell surfaces, play a pivotal role in the immune system's defense mechanism. When a virus infects a cell, a MHC molecule binds to a piece of the virus and displays the antigen on the cell's surface, allowing T cells to recognize and respond to the foreign substance. The interaction between MHC molecules and T-cell receptors is accompanied by the presence of co-stimulatory molecules, which facilitate the activation of T cells and enable them to respond to foreign antigens.
Upon activation, T cells can take various paths, including T cell activation, tolerance, or T cell death. The subsequent steps are influenced by the interactions between co-stimulatory molecules and the recognition of antigens by MHC molecules. Researchers are intensively studying these interactions to develop new therapies that can control or stop the immune system's attack on self-tissues and organs.
Cytokines and chemokines are proteins and small molecules, respectively, that play a crucial role in the immune system's response to foreign antigens. Cytokines can activate, grow, or induce the death of surrounding immune system cells, while chemokines can attract immune cells to the site of infection. Overproduction of chemokines can lead to the invasion and inflammation of target organs, as seen in autoimmune diseases like rheumatoid arthritis.
B cells, another critical component of the immune system, participate in the removal of foreign antigens from the body by binding to antigens or producing specific antibodies that can target and destroy specific foreign substances. However, B cells can only produce antibodies when signaled by a T cell, which can occur through the secretion of cytokines that act as messenger molecules.
In some autoimmune diseases, B cells can mistakenly produce antibodies against tissues of the body, leading to tissue damage and dysfunction. For instance, in myasthenia gravis, autoantibodies target a part of the nerve that stimulates muscle movement, resulting in muscle weakness. Similarly, in pemphigus vulgaris, autoantibodies are misdirected against cells in the skin, leading to skin blisters.
Immune complexes, formed when many antibodies bind to antigens in the bloodstream, can accumulate and initiate inflammation within small blood vessels that nourish tissues. This can lead to the destruction of organs such as the kidney, as seen in systemic lupus erythematosus. The complement system, a group of specialized molecules, helps to remove immune complexes by making them more soluble and preventing their accumulation in the wrong places.
Genetic factors can significantly impact an individual's immune system and its responses to foreign antigens. Genes determine the variety of MHC molecules present on cells and influence the potential array of T-cell receptors present on T cells. Furthermore, some MHC genes are associated with autoimmune diseases, highlighting the complex interplay between genetic and environmental factors in determining susceptibility to autoimmune diseases. |
<urn:uuid:8a975129-db4a-4fb2-9b1c-3c6d7c267ae5> | wiki | Cells within the human body are perpetually subjected to stress stemming from environmental toxins or disruptions in routine cellular processes, which can either precipitate damage or serve as a catalyst for mitigating such harm. A recent study conducted by a team of researchers at the University of Rochester has elucidated a pivotal mechanism by which cells can discern when they are under stress and activate the DNA repair machinery to counter the threat of damage. The findings, slated for publication in the journal Science, are expected to shed new light on the intricate interplay between cellular stress and DNA repair.
Led by biologists Vera Gorbunova and Andrei Seluanov, the research team focused their attention on the most pernicious form of DNA damage, namely double-strand breaks, which, if left unrepaired, can precipitate premature aging and cancer. The scientists investigated the impact of oxidative stress on the efficiency of DNA repair, a process by which the body neutralizes highly reactive molecules that are typically generated during routine cellular activities. The research revealed that human cells experiencing oxidative stress exhibited an increase in the synthesis of a protein called SIRT6, thereby augmenting their capacity to repair double-strand breaks.
Further analysis demonstrated that the elevated levels of SIRT6 were instrumental in stimulating the DNA repair machinery, a finding that was corroborated by the administration of a drug that inactivated SIRT6, thereby halting DNA repair. Gorbunova posited that the SIRT6 protein shares structural affinities with another protein, SIR2, which has been shown to extend lifespan in multiple model organisms. Notably, SIRT6's role in DNA repair extends beyond oxidative stress, as it also modulates the repair process in the absence of such stress, albeit with a diminished effect.
The SIRT6 protein appears to function as a master regulator, coordinating stress and DNA repair activities by priming the repair enzymes only when damage necessitates repair. This multifaceted role underscores the significance of SIRT6 in maintaining cellular homeostasis and mitigating the deleterious effects of oxidative stress. |
<urn:uuid:b2cad2ff-e00e-4c2c-af79-967390566d55> | wiki | Research conducted by the University of Illinois has demonstrated that chronic inflammation of skeletal muscle can lead to significant physical impairment, with up to half of a person's body mass consisting of muscle tissue being affected. According to Kimberly Huey, a professor of kinesiology and community health at the University of Illinois, past studies have shown that Vitamin E possesses antioxidant properties, which may be associated with reduced expression of pro-inflammatory cytokines in various cell types.
To investigate the potential effects of Vitamin E on skeletal and cardiac muscle, Huey and a team of researchers, including Rodney Johnson, a professor of animal sciences, conducted a study in mice. This study represents the first time researchers have examined the in vivo effects of Vitamin E administration on local inflammatory responses in skeletal and cardiac muscle.
In the study, mice were administered Vitamin E for three days prior to receiving a low dose of E. coli lipopolysaccharide (LPS) to induce acute systemic inflammation. The effects of Vitamin E and a placebo treatment were compared, and the researchers examined the impact on the mRNA and protein levels of three cytokines: interleukin (IL-6), tumor necrosis factor-alpha (TNF-alpha), and IL-1beta.
The study found that Vitamin E administration resulted in a significant reduction in the amount of oxidized proteins in the muscle, which could potentially correlate to increased muscle strength. Additionally, the researchers observed a significant decrease in two cytokines, IL-6 and IL-1beta, with Vitamin E compared to the placebo.
However, the interpretation of these findings is complex, as IL-6 can have both pro- and anti-inflammatory actions. While the study suggests that Vitamin E may be beneficial in individuals with chronic inflammation, such as the elderly or patients with type II diabetes or chronic heart failure, further research is needed to determine whether these findings will translate to humans.
The study's findings provide a foundation for future investigations and may suggest an additional benefit of taking Vitamin E beyond what is already known. Nevertheless, Huey cautioned that it is still too early to speculate on results in humans, emphasizing that the study is an animal model and that further research is necessary to confirm the findings. |
<urn:uuid:e51bd009-a039-49d6-aa37-41c861166cd0> | wiki | Enterococcus faecalis and Enterococcus faecium are gram-positive cocci that can occur in singles, pairs, and short chains, sometimes exhibiting coccobacillary morphology when cultured on agar plates. Historically classified as group D streptococci, this group also comprises Streptococcus bovis and Streptococcus equinus. Enterococci are facultative anaerobes capable of thriving in extreme conditions, including 6.5% NaCl, high pH, 40% bile salts, and a temperature range of 10°C to 45°C. The most reliable method for presumptively identifying a catalase-negative gram-positive coccus as an Enterococcus species is to demonstrate positivity for PYR (L-pyrrolidonyl-β-naphthylamide) and LAP (leucine-β-naphthylamide) and to observe growth in 6.5% NaCl and at 45°C. Although this identification method does not provide definitive proof, most Enterococcus species do not exhibit hemolysis on blood agar, with rare alpha- or beta-hemolytic strains being exceptions.
Enterococci are non-fastidious organisms that can be found in a wide range of environments, including soil, food, water, plants, animals, birds, and insects. In humans, they are primarily found in the gastrointestinal tract, where they comprise a significant portion of the normal aerobic gut flora. Small numbers of Enterococci can also be isolated from oropharyngeal secretions, vaginal secretions, and perineal skin. Traditionally, Enterococcal infections were considered to be acquired from the patient's own normal flora. However, recent studies have highlighted the emergence of Enterococci as nosocomial pathogens, leading to increased interest in their epidemiology. In most cases, nosocomial strains of Enterococci are also found in the gut of infected patients.
The most common clinical infections caused by Enterococci are urinary tract infections, bacteremia, endocarditis, intra-abdominal, and pelvic infections. Less commonly, E. faecalis and E. faecium can cause wound and soft tissue infections, meningitis, particularly following neurosurgical procedures, and respiratory infections. Enterococci are generally less virulent than Staphylococcus aureus and Streptococcus pyogenes, as they do not secrete exotoxins or produce superantigens. However, their resistance to multiple antibiotics allows them to survive and proliferate in patients receiving multiple antimicrobials, leading to superinfections. Enterococci exhibit intrinsic resistance to many antibiotics and possess the ability to acquire new mechanisms of resistance. The most clinically significant of this resistance is the development of vancomycin-resistant enterococci (VRE), first described in the late 1980s. Multiple antimicrobial agents have been developed to treat VRE, including quinupristin/dalfopristin, linezolid, and daptomycin. Notably, quinupristin/dalfopristin is effective only for infections caused by E. faecium, as E. faecalis is intrinsically resistant to this combination.
Historically, E. faecalis accounted for 80-90% of clinical Enterococcus isolates, with E. faecium accounting for only 5-10% and various minor species making up the remainder. Recent studies, however, suggest that the prevalence of E. faecium is increasing, particularly the vancomycin-resistant strain. The resistance to vancomycin, as well as ampicillin, is more commonly associated with E. faecium (52% of all isolates were VRE) than with E. faecalis (1.9% of isolates were VRE). A study comparing E. faecalis and E. faecium bacteremia identified risk factors favoring E. faecium, including hematologic malignancies, neutropenia, and previous use of aminoglycosides, carbapenems, cephalosporins, or clindamycin. Urinary catheterization was found to be a risk factor for E. faecalis bacteremia. Notably, there was no difference in mortality between E. faecalis and E. faecium bacteremia (27% and 29% respectively at 30 days). Other studies have suggested that patients with E. faecium infections tend to be sicker and die at a higher rate, although this may not be directly attributable to the Enterococcal infection.
References:
1. Mandell, Bennett, & Dolin. Principles and Practice of Infectious Disease, 6th edition. 2005.
2. Murray, P et al. Manual of Clinical Microbiology. 7th edition. 1999.
3. Suppola, JP. et al. “Comparison of risk factors and outcome in patients with Enterococcus faecalis vs. Enterococcus faecium bacteraemia.” Scandinavian Journal of Infectious Disease. 1998; 30(2):153-157. |
<urn:uuid:5e267789-2a0f-44e0-8123-aeeac6e3485a> | wiki | A secondary analysis of a large, multicenter clinical trial has revealed that a diet rich in fruits, vegetables, and fiber, and lower in fat, significantly reduces the risk of breast cancer recurrence in early-stage survivors, particularly those without hot flashes, by approximately 31%. This subgroup, which comprises women with higher recurrence and lower survival rates than their counterparts with hot flashes, has been found to benefit from a diet that is high in fruits, vegetables, and fiber, with a 47% lower risk of recurrence observed in postmenopausal women.
The study, led by researchers at the Moores Cancer Center at the University of California, San Diego, in collaboration with six other sites, including the University of California, Davis, reported its findings online on December 15, 2008, in the Journal of Clinical Oncology. The results build upon previous research conducted by the Women's Healthy Eating and Living Trial (WHEL), which compared the effects of two diets on cancer recurrence in over 3,000 early-stage breast cancer survivors. Although the original study found no overall difference in recurrence rates between the two diet groups, the current analysis has identified a significant association between the high-vegetable, fruit diet and reduced breast cancer recurrence in women without hot flashes.
According to Ellen B. Gold, Ph.D., professor and chair of the UC Davis Department of Public Health Sciences and first author of the study, women with early-stage breast cancer who experience hot flashes tend to have better survival and lower recurrence rates than those who do not. The researchers' findings suggest that a major dietary change may help bridge the gap in prognosis between these two groups, with a diet high in fruits, vegetables, and fiber potentially playing a key role in reducing estrogen levels and thereby mitigating the risk of breast cancer recurrence.
The interest in examining this subgroup arose from the observation that hot flashes are associated with lower circulating estrogen levels, while the absence of hot flashes is linked to higher estrogen levels. Reducing estrogen levels is a major treatment strategy in breast cancer, and the researchers hypothesize that a dietary pattern high in fruits, vegetables, and fiber, which has been shown to reduce circulating estrogen levels, may only be beneficial among women with estrogen levels above a certain threshold.
Approximately 30% of the original group of 3,088 breast cancer survivors did not report hot flashes at study entry, and were randomly assigned to one of two diets between 1995 and 2000. The "no hot flashes" group was further divided into two subgroups: one receiving the special, high-vegetable, fruit diet, and the other receiving the generally recommended diet of five servings of fruits and vegetables per day. The results showed that the high-vegetable, fruit diet group had a significantly lower rate of breast cancer recurrence (16.1%) compared to the five-a-day diet group (23.6%).
Interestingly, the dietary effect was even more pronounced (47% lower risk) in postmenopausal women. Researchers have proposed several possible mechanisms to explain why this diet may have had a more significant impact on women without hot flashes. One hypothesis suggests that women with estrogen receptor-positive cancers may be more susceptible to the effects of a gene-drug interaction that prevents them from receiving an effective dose of hormone therapy, such as tamoxifen or aromatase inhibitors. According to John P. Pierce, Ph.D., principal investigator of the WHEL study, if the endocrine therapy is working, no further reduction in estrogen levels would be needed, and following a rigorous dietary pattern may reduce estrogen levels enough to mitigate the risk of breast cancer recurrence.
The study's findings have been replicated by a diverse group of co-authors, including researchers from the University of California, San Diego, the University of California, Davis, Stanford University, Kaiser Permanente, and the M.D. Anderson Cancer Center. |