e-Second Opinions: 100 Search Engines and Tools for Medical Self-Diagnosis

26 april 2009--Although seeing a doctor is best, it's not always easy to get to a doctor right away. Fortunately, there are loads of tools online designed to help you diagnose and treat symptoms right at home. Here we've listed 100 of the best.

Search Engines

Simply type your symptoms or ailment into these search engines, and you'll find helpful information.

1. eCureMe: To self diagnose with this search engine, you'll just have to search for your most troublesome symptom.
2. MedlinePlus: MedlinePlus is designed to make finding information on drugs, diseases, and more easy.
3. Google Health Co-op: Find hand-picked sites for your condition with this search tool from Google.
4. Amniota: Find all of the information you need with this health search engine.
5. iSeekHealth: With this handpicked directory, you'll find loads of information.
6. Healia: This search engine offers high quality information and personalization.
7. InteliHealth: Powered by Aetna, this site will help you learn about symptoms, conditions, drugs, and more.
8. NOAH: On this site, you can research health topics by body area or disease.
9. e-Lynks Health: You'll find lots of information with this portal to health websites.
10. CureResearch Symptom Center: In this symptom checker, you can search for diseases that match up with what you're feeling.
11. Healthline Symptom Search: Find possible cures based on your symptoms with this search engine. You can even get a search plug-in for Firefox.
12. gopubmed: Search for medical publications with this tool.
13. Yahoo! Health: Use Yahoo! Health to find information about drugs, diseases, and more.
14. AnswerMed: Simply type in a query to learn about a medical condition or surgery.
15. OrganizedWisdom: Use this human-powered health search to find the diagnosis information you're looking for.
16. Afraid to Ask: Use this search tool to find answers to the questions you're afraid to ask your real doctor.
17. Mayo Clinic: Look up a disease, symptom, and more with the Mayo Clinic's search tools.

Databases

Check out these databases to get answers to some of the most common medical questions.

18. Conditions and Concerns: This reference provides easy access to information about common ailments and symptoms.
19. Go Ask Alice!: Check out Go Ask Alice! to find answers to medical questions.
20. Medical-Articles: Find published medical news with this resource.
21. Healthwise Self-Care Checklist: On AOL Body, you'll find this checklist that walks you through diagnosis, education, and treatment.
22. Dr. Koop's Symptoms Reference Index: Go through this extensive list of symptoms to find out what's wrong.
23. Healthcyclopedia: This site offers an alphabetic index of health conditions.
24. WrongDiagnosis Symptom Center: Here you can research popular symptoms for more than 10,000 diseases.
25. Medifocus: Get researched information with Medifocus' guides.
26. Netwellness: This resource has more than 55,000 pages of information from the faculty of three leading universities.
27. Home Healthcare Guide: This service from Surgery Door offers lots of information on conditions, emergencies, operations, and more.
28. Health Library: Check out this library for information that's hand-picked from government agencies, nonprofits, and universities.
29. Ohio State University Medical Center Patient Education: Find information on conditions, tests, and much more with this resource.
30. Medinfo: Here you'll find lots of patient-centric information on specific conditions.
31. eMedTV Health Information: This library of medical information offers data on diseases, procedures, drugs, and more.
32. Netdoctor Library of Diseases: Find an extensive library of expertly reviewed medical articles here.
33. All Health: Here you'll find a great medical reference library and symptom finder.
34. Stop Getting Sick: Use this database to find general information news, and research on diseases and conditions.
35. SHARing Point Server: This health information system shares data across the world.
36. Family Doctor: This database has more than 600 articles and guides on medical topics, all reviewed and edited by medical experts.
37. Diseases Database: Here you can look for information on diseases, symptoms, drugs, and more.

Online Professionals

These sites feature professionals that offer their services online.

38. Just Answer: With this service, you'll be able to talk to doctors and nurses that are online and ready to answer questions.
39. eDocAmerica: Whether you're looking for a physician, psychologist, or advice from a nurse, check out this site for help.
40. BumperBrain: Use this site to locate and get health experts in just about any field.
41. Netwellness Ask an Expert: Get information from more than 500 world-class experts in this resource.
42. aarogya: On this wellness site, you can talk to doctors in specific specialties, like cardiology, homeopathy, and oncology.
43. InteliHealth Ask the Doc: In this resource, you can search for questions and answers related to your ailment, or ask a question of your own.
44. The ICU Answer Page: Learn all about the ICU in this guide from a critical care nurse.
45. WrongDiagnosis Ask a Doctor: Choose from 5 fully reviewed doctors for medical advice on this site.
46. HealthySelf: Ask this expert to do medical research for you.
47. Allexperts Medical Q&A: Here you'll find past answers to medical questions, plus be able to ask your own.
48. Kasamba Health & Medicine Experts: Choose from over a hundred health experts online with this site.
49. Afraid to Ask: Talk to Afraid to Ask's doctors to get answers to the questions you don't want to ask your regular doctor.
50. Ask the Doctor Online: Contact these doctors for a standard or urgent consultation.
51. Dr. Sinatra: Check out Dr. Sinatra for information on solutions to health problems.
52. Consult Doctors: With this service, you can choose to get a standard or stat consultation, and even a full report on a medical question within just a few days.

Tools

Simply plug your medical issues into these tools, and you'll get all sorts of information.

53. The Analyst: Answer 900 optional multiple-choice questions to get a look at your entire health spectrum with this tool.
54. Health A to Z: Get a look at what's ailing you with this symptom checker.
55. PreOp Patient Education: Use this tool to research surgery procedures.
56. Symptom Checker: Select symptoms, find factors, and get results with this tool.
57. Descipher: With this tool, you can self-interpret lab test results from your doctor.
58. MSN Health & Fitness Symptom Checker: Use this visual symptom checker to cure what ails you.
59. HealthCentral: Use HealthCentral's illustrated guide to find out where it hurts.
60. EasyDiagnosis: Designed by a team of doctors, EasyDiagnosis takes a look at your main symptoms to determine your illness.
61. MedicineNet: Use this illustrated guide to pinpoint where it hurts.

Communities

Get support and advocacy from these medical communities.

62. ThirdAid: Find out how others with your condition are doing, and get independent knowledge from this community.
63. MSN Health & Fitness Support Groups: Find others with your condition with these support groups.
64. iMedix: Join this healthcare community to get information on symptoms, diseases, treatments, and more.
65. WrongDiagnosis Conditions Forum: Check out these forums for information on specific conditions from other sufferers.
66. Afraid to Ask Forums: Discuss sexuality, body functions, and much more in this community.
67. Healthcyclopedia Support Groups: Here you'll find support groups for all sorts of conditions and diseases.
68. MDJunction: Find a support group and learn more about your condition on this site.
69. Netdoctor Forums: Get information on general health and beyond in these forums.
70. MedHelp: On MedHelp's Ask a Doctor forums, you can find answers and ask questions of certified doctors.
71. Case Health: Hear about the medical success stories of others on this site.
72. MSN Health & Fitness Message Boards: Learn about and discuss conditions like pregnancy, depression, and more on these message boards.
73. PatientsLikeMe: Share your experience and learn from others on this support site.
74. DailyStrength: Here you'll find more than 500 support groups for just about every health issue out there.
75. HelpShare: Here you can ask a medical question and set the value of a good answer.
76. WrongDiagnosis Symptoms Forum: Learn and share information about symptoms for fertility, allergies, and more here.
77. HealthWorldWeb: On this site, you'll find loads of communities in which to learn more about your symptoms and conditions.

Assessment

Stay on top of your health and possible risks using these resources.

78. Heart Attack Risk Calculator: Learn how susceptible you are to a heart attack with this quiz.
79. Postpartum Depression Assessment: Find out if your intense feelings after pregnancy are normal or discover the sign of a condition that needs to be treated.
80. Alcohol: Are You Addicted?: Follow this questionnaire to find out if you have a problem with drinking.
81. How to Review Your Blood Test Results: This guide offers advice on normal ranges for test results.
82. New Hope Health Clinic: Get this holistic clinic's home testing kit, and you'll learn about your body and what you can do to take care of it.
83. Online Checkups: Get quick assessments for a variety of conditions with HealthFinder's online checkups.
84. Stress Trigger Assessment: Assess and identify the stressors in your life with this tool.
85. Nicotine: Are You Addicted?: Use this questionnaire to assess your addiction to cigarettes.
86. Fitness Assessment: Find out just how fit you are using this quiz.
87. Do I Have an Eating Disorder: Answer these questions to find out if you have a problem with food.
88. Breast Cancer Risk Assessment: Find out if you're at risk for this commonly diagnosed cancer.
89. Risk Factor Center: Find out your risk factors for diseases and more based on your lifestyle, exposure, and other factors.
90. The Menopause Assessment Scale: Assess your menopause symptons here.
91. Type 2 Diabetes Risk Assessment: This quiz will help you determine your risk for Type 2 diabetes.
92. Lab Tests Online: Get information on lab tests, conditions, and more from this resource.
93. Urinary Incontinence Test: Follow this questionnaire to determine whether or not you suffer from urinary incontinence.
94. Interactive Weight Tool: Determine your risk level for weight-related diseases using this tool.
95. Coronary Artery Disease Assessment: Use this quiz to find out how high your risk is for this common heart disease.
96. KnowYourRisk Assessment: Revolution health's tool will tell you your risk for diabetes, stroke, and heart disease, and offers information on how you can better prevent these conditions.
97. WrongDiagnosis Home Diagnostic Testing Center: Get tested right at home for ailments like diabetes, fertility, and more.
98. Depression Risk Assessment: Follow this questionnaire to see how likely you are to have depression.
99. Cold or Flu?: Find out if you're sick with the cold, or worse, the flu.
100. Pitfalls of Online Diagnosis: This article warns against some of the problems that can arise from online diagnosis.

Deadly new flu strain erupts in Mexico, U.S.

MEXICO CITY ,25 april 2009-- A strain of flu never seen before has killed up to 60 people in Mexico and also appeared in the United States, where eight people were infected but recovered, health officials said on Friday.

Mexico's government said at least 20 people have died of the flu and it may also be responsible for 40 other deaths.

It shut down schools and canceled major public events in Mexico City to try to prevent more deaths in the sprawling, overcrowded capital. Authorities said they had enough antiviral medicine to treat about 1,000 suspected cases reported so far.

The World Health Organization said tests showed the virus from 12 of the Mexican patients was the same genetically as a new strain of swine flu, designated H1N1, seen in eight people in California and Texas.

"Our concern has grown as of yesterday," Dr. Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention told reporters in a telephone briefing.

Global health officials were not ready to declare a pandemic -- a global epidemic of a new and deadly disease such as flu. "So far there has not been any change in the pandemic threat level," Besser said.

But the human-to-human spread of the new virus raised fears of a major outbreak. Mexico's government suspended classes for millions of children in Mexico City, where scared residents rushed out to buy face masks and kept their kids at home.

"We're frightened because they say it's not exactly flu, it's another kind of virus and we're not vaccinated," said Angeles Rivera, 34, a government worker who fetched her son from a public kindergarten that was closing.

Close analysis showed the disease is a mixture of swine, human and avian viruses, according to the CDC.

Humans can occasionally catch swine flu from pigs but rarely have they been known to pass it on to other people.

Mexico reported 1,004 suspected cases of the new virus, including four possible cases in Mexicali on the border with California.

Most of the dead were aged between 25 and 45, a health official said. It was a worrying sign as seasonal flu can be more deadly among the very young and the very old but a hallmark of pandemics is that they affect healthy young adults.

Health Minister Jose Angel Cordova said Mexico has enough antiviral drugs to combat the outbreak for the moment. "In the last 20 hours, fewer serious cases of this disease and fewer deaths have been reported," he told reporters.

The WHO said the virus appears to be susceptible to Roche AG's flu drug Tamiflu, also known as oseltamivir, but not to older flu drugs such as amantadine.

NO CONTAINMENT

Canada has not reported any cases of the flu and is not issuing a travel warning for Mexico, but the country's chief public health officer David Butler-Jones said the outbreak was "very concerning" and Canada was paying close attention.

The CDC's Besser said it was probably too late to contain the outbreak. "There are things that we see that suggest that containment is not very likely," he said. Once it has spread beyond a limited geographical area it would be difficult to control.

But there is no reason to avoid Mexico, CDC and the WHO said. "CDC is not recommending any additional recommendations for travelers to California, Texas and Mexico," Besser said.

Worldwide, seasonal flu kills between 250,000 and 500,000 people in an average year, but the flu season for North America should have been winding down.

The U.S. government said it was closely following the new cases. "The White House is taking the situation seriously and monitoring for any new developments. The president has been fully briefed," an administration official said.

In California, where six people have been infected with the flu, Governor Arnold Schwarzenegger said authorities were monitoring patients with flu-like symptoms and communicating with Mexican health officials.

Mexico's government cautioned people not to shake hands or kiss when greeting or to share food, glasses or cutlery. Flu virus can be spread on the hands, and handwashing is one of the most important ways to prevent its spread.

The outbreak jolted residents of the Mexican capital, one of the world's biggest cities with around 20 million residents. One pharmacy ran out of surgical face masks after selling 300 in a day.

The virus is an influenza A virus, carrying the designation H1N1. It contains DNA from avian, swine and human viruses, including elements from European and Asian swine viruses, said the CDC, which is already working on a vaccine.

Scientists were trying to understand why there are so many deaths in Mexico when the infections in the United States seem mild, Besser said.

The CDC said it will issue daily updates here

Surveillance for and scrutiny of influenza has been stepped up since 2003, when H5N1 bird flu reappeared in Asia. Experts fear that or another strain could cause a pandemic that could kill millions.

The last flu pandemic was in 1968 when "Hong Kong" flu killed about a million people globally.

Cryptosporidiosis under-recognized in the elderly

25 april 2009- Cryptosporidiosis -- an illness characterized by diarrhea, fever, and chills -- appears to be under-reported in the U.S. elderly population, Massachusetts-based researchers report.

Cryptosporidiosis, caused by the waterborne parasite Cryptosporidium, is associated with dehydration and poor health outcomes, including death. As Dr. Siobhan M. Mor told Reuters Health, "The elderly may have co-existing conditions, such as heart or renal failure, which can be aggravated by the fluid and electrolyte imbalances caused by cryptosporidiosis diarrhea."

She added, "The current healthcare and surveillance systems pick up a minority of cases of cryptosporidiosis, and they do not provide sufficient information about vulnerable populations, such as the elderly."

In order to gain more information, Mor, of Tufts Cummings School of Veterinary Medicine, North Grafton, and colleagues identified 1304 people elderly people who had a cryptosporidiosis-related illness between 1991 and 2004.

Hospitalizations rose yearly at a rate of 0.15 to 0.39 cases per 100,000 elderly subjects. However, the researchers attribute this mainly to increased awareness and testing.

There were considerable state-by-state variations in hospitalizations. Furthermore, of 178 hospitalizations in 1993, 65 percent involved Wisconsin residents and more than 80 percent of these were Milwaukee residents hospitalized during the large-scale cryptosporidiosis outbreak in that city.

People aged 85 and older were more than twice as likely to be hospitalized as patients aged 65 to 74 years. They were also more likely to die.

The researchers call for strengthened surveillance systems and increased screening and testing for cryptosporidiosis in the elderly. "Testing and reporting practices such as those used in Wisconsin," they conclude, "may serve as an example to health practitioners and authorities in all US states."

SOURCE: Clinical Infectious Diseases, March 15, 2009.

Think memory worsens with age? Then yours probably will

25 april 2009--Thinking your memory will get worse as you get older may actually be a self-fulfilling prophecy. Researchers at North Carolina State University have found that senior citizens who think older people should perform poorly on tests of memory actually score much worse than seniors who do not buy in to negative stereotypes about aging and memory loss.

In a study published earlier this month, psychology professor Dr. Tom Hess and a team of researchers from NC State show that older adults' ability to remember suffers when negative stereotypes are "activated" in a given situation. "For example, older adults will perform more poorly on a memory test if they are told that older folks do poorly on that particular type of memory test," Hess says. Memory also suffers if senior citizens believe they are being "stigmatized," meaning that others are looking down on them because of their age.

"Such situations may be a part of older adults' everyday experience," Hess says, "such as being concerned about what others think of them at work having a negative effect on their performance – and thus potentially reinforcing the negative stereotypes." However, Hess adds, "The positive flip side of this is that those who do not feel stigmatized, or those in situations where more positive views of aging are activated, exhibit significantly higher levels of memory performance." In other words, if you are confident that aging will not ravage your memory, you are more likely to perform well on memory-related tasks.

The study also found a couple of factors that influenced the extent to which negative stereotypes influence older adults. For example, the researchers found that adults between the ages of 60 and 70 suffered more when these negative stereotypes were activated than seniors who were between the ages of 71 and 82. However, the 71-82 age group performed worse when they felt stigmatized.

Finally, the study found that negative effects were strongest for those older adults with the highest levels of education. "We interpret this as being consistent with the idea that those who value their ability to remember things most are the most likely to be sensitive to the negative implications of stereotypes, and thus are most likely to exhibit the problems associated with the stereotype."

"The take-home message," Hess says, "is that social factors may have a negative effect on older adults' memory performance."

Hess is the lead author on the study, "Moderators of and Mechanisms Underlying Stereotype Threat Effects on Older Adults' Memory Performance." Co-authors on the study are former NC State students Joey T. Hinson and Elizabeth A. Hodges. The study was published online April 1 by Experimental Aging Research.

Oral Bisphosphonates Link to Esophageal Cancer Analyzed

Studies reported in NEJM correspondence find no cancer risk with osteoporosis drug

25 april 2009-- Oral bisphosphonate does not appear to increase risk for esophageal cancer, according to analyses of Danish and U.S. data reported by separate researchers in the April 23 issue of the New England Journal of Medicine.

In one study, Bo Abrahamsen, M.D., of Copenhagen University Hospital Gentofte in Hellerup, Denmark, and colleagues compared national registry data for 13,678 osteoporosis patients on oral bisphosphonates with 27,356 patients not on bisphosphonates. The researchers followed the patients for a median of 2.2 years and identified 37 cases of esophageal cancer and 48 cases of gastric cancer. Hazard ratios for the bisphosphonate patients compared to the non-bisphosphonate patients were 0.78 for the combined cancers, 0.35 for esophageal cancer only, and 1.23 for gastric cancer only.

In the other study, Daniel H. Solomon, M.D., of Brigham and Women's Hospital in Boston, and colleagues compared esophageal cancer rates among osteoporosis patients on oral bisphosphonates and those on other osteoporosis medications with incidence estimates from Surveillance, Epidemiology, and End Results (SEER) data. The esophageal cancer incident rates per 100,000 patients were 26.7 for patients on bisphosphonates, 48.4 for patients on other medications, and 23.7 for SEER registrants.

"In standardized analyses, we found no increase in the incidence rate of esophageal cancer among persons who received oral bisphosphonates as compared with persons who received other osteoporosis medications and as compared with SEER estimates," Solomon and colleagues write.

Authors of the first study disclosed financial relationships with various pharmaceutical companies; authors of the second disclosed grant support from Amgen.

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Ranolazine Shows Angina Benefits in Broader Group

Drug linked to lower rate of recurrent ischemia in those with chronic angina, but not CV death

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25 april 2009-- Ranolazine may be effective in treating chronic angina, but does not appear to serve as a disease-modifying secondary preventive therapy, according to research published in the April 28 Journal of the American College of Cardiology.

Sean R. Wilson, M.D., of the Brigham and Women's Hospital in Boston, and colleagues analyzed data from 3,565 subjects with prior chronic angina who were enrolled in the Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndromes 36 (MERLIN-TIMI 36) trial, which compared ranolazine versus placebo in patients with acute coronary syndrome. Treated patients received intravenous ranolazine, then twice-daily oral doses until the end of the study. Follow-up lasted a median of 350 days.

Patients on ranolazine had a lower rate of recurrent ischemia (hazard ratio, 0.78). However, the treatment had no significant effect on risk of cardiovascular death or myocardial infarction. Ranolazine was also associated with reduction of worsening angina

"In this largest study of ranolazine in patients with established coronary artery disease, ranolazine was effective in reducing angina and recurrent ischemia in a substantially broader group of patients with angina than previously studied with a favorable overall profile of safety in a high-risk group of patients. Ranolazine is an option to be considered in the optimal medical therapy of patients with chronic angina," the authors conclude.

CV Therapeutics supported the MERLIN-TIMI 36 trial, and several authors disclosed financial relationships with the company; one author also disclosed arrangements with Sanofi-Aventis.

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Heavy NSAID Use Linked to Dementia in Elderly

Study differs from previous studies; possibly due to delayed onset

24 april 2009- Contrary to earlier studies suggesting that users of nonsteroidal anti-inflammatory drugs (NSAIDs) have a reduced risk of developing dementia, heavy NSAID use in the elderly is associated with a higher risk of developing dementia, according to a study published online April 22 in Neurology.

John C. S. Breitner, M.D., from the Department of Veterans Affairs Medical Center in Seattle, and colleagues examined the association between the use of NSAIDs and dementia in 2,736 elderly (65 years and older) dementia-free individuals.

Based on computerized pharmacy records, the researchers found that 351 individuals (12.8 percent) were heavy NSAID users (more than 500 standard daily doses) at baseline, while an additional 107 became heavy users during the follow-up period. After up to 12 years of follow up, 476 individuals developed dementia, of which 356 was Alzheimer dementia. Heavy NSAID use was associated with a higher risk of developing dementia (adjusted hazard ratios of 1.66 for dementia and 1.57 for Alzheimer dementia).

"These findings differ from those of other studies with younger cohorts," Breitner and colleagues conclude. "The results observed elsewhere may reflect delayed onset of Alzheimer dementia in NSAID users."

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Commonly used ulcer drugs may offer treatment potential in Alzheimer's disease

Amsterdam, 24 april 2009– In a new study, published in the May issue of Elsevier's Experimental Neurology (www.elsevier.com/locate/yexnr), scientists at the University of British Columbia have discovered that drugs commonly used to treat ulcers have significant neuroprotective properties, which appear to be enhanced when used in combination with ibuprofen, a widely used anti-inflammatory drug.

"Our results show that proton pump inhibitors are also antiinflammatory agents. They open up an entirely new application for these drugs" said Dr. Sadayuki Hashioka, first author on the paper.

Proton pump inhibitors include lansoprazole and omeprazole. They are remarkably safe drugs which have so far been used only to treat ulcers and other conditions where there is excess gastric acidity. These include Helicobacter pylori infections and side effects from treatment with NSAIDs such as ibuprofen. The finding that they also have anti-inflammatory potential opens up the possibility of using these drugs in a variety of inflammatory conditions where NSAIDs are now used. There would be the double effect of protection from gastrointestinal side effects plus enhanced antiinflammatory activity.

The researchers found that when human microglia, or human monocytic THP-1 cells, were exposed in vitro to the proton pump inhibitors, their secretions became less toxic towards human neuroblastoma cells. In addition, they found that these drugs acted synergistically with ibuprofen, a very widely used antiinflammatory agent. To confirm that the proton pump inhibitors were acting to inhibit inflammation, they found that lansoprazole and omeprazole reduced the secretion from THP-1 cells of the inflammatory cytokine tumor necrosis factor alpha.

Dr. Patrick McGeer, senior investigator on the UBC team, commented "Many epidemiological studies have revealed that individuals on long term treatment with ibuprofen are relatively spared from Alzheimer disease. Our investigation indicates that individuals taking lansoprezole or omeprazole in addition to ibuprofen might be getting even greater protection. It also suggests that a clinical trial of a combination of ibuprofen and a proton pump inhibitor might be effective for those already suffering from Alzheimer disease".

Epidemiological studies might show a sparing effect of Alzheimer disease through the use of proton pump inhibitors alone".

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The UBC study was supported by the Pacific Alzheimer Research Foundation.

Palliative care skills training needed for health-care staff in sub-Saharan Africa

24 april 2009--A new study, led by Lucy Selman and colleagues from King's College London, has found that patients with incurable, progressive diseases and their family carers in sub-Saharan Africa often do not receive enough information about the patient's disease and its management, which impacts negatively on their ability to cope with illness. The results of the study have been published online by the BMJ today.

The study was conducted in collaboration with five palliative care services in South Africa and Uganda and the palliative care associations of South Africa (HPCA) and Africa (APCA).

A major finding from interviews with 90 patients and 38 family carers was that healthcare staff did not provide enough information to help patients and carers understand the disease, its causes and symptoms, as well as its treatment and management. Patients and carers also felt insufficiently informed about the financial and social support available to them. These information gaps can cause anxiety for the patient and affect the family's ability to provide good patient care.

Patients and carers drew on a wide range of sources for information, including friends and family, peers with a similar condition and the media. Although patients and carers appreciated efforts made by their palliative care team to provide information, many still had unanswered questions.

For example, a patient with HIV reported that hospital staff never properly explained his diagnosis, likely symptoms and future care. Other patients talked about not receiving the results of blood tests, and described the trauma of being broken bad news in an insensitive manner. Carers reported not being told the patient's diagnosis directly, but learning it from his or her medical notes or from simply being sent on an HIV education course.

'The poor knowledge and lack of information provided impacted negatively on patients' and carers' ability to cope with their situation. For both groups, not having the information they needed was related to anxiety regarding the disease and the future', said Lucy Selman, Research Associate in the Department of Palliative Care, Policy & Rehabilitation at King's.

'The study highlights that it is crucial for all clinical staff to receive generalist training in palliative care skills, including communication and basic counselling. Communication with patients and carers should be open and honest, and records be kept of the discussions between healthcare staff and patients regarding their condition. It is also essential that services work closely with families and volunteer carers in the community, empowering them to provide the care the patient needs, including sensitive and accurate communication.'

This study is the first to explore the information needs of patients and carers attending palliative care services in Africa, identify information needs and understand past experiences of communicating with healthcare staff. Patients' diagnoses included cancer (28 cases), HIV infection (61) and motor neurone disease (1).

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The full paper can be obtained on the BMJ website: http://www.bmj.com/cgi/content/full/338/apr22_1/b1326. A podcast interview with Lucy Selman regarding the results of the study will be available from Friday 24 April on http://podcasts.bmj.com/bmj/.

Poor treatment for common vertebral compression fractures

The advice and treatment given to patients with vertebral compression fractures is not satisfactory. A thesis presented at the Sahlgrenska Academy, University of Gothenburg, Sweden, shows that the majority of patients still have severe pain one year after the fracture.

24 april 2009--Vertebral compression fracture describes the pressing together of a vertebra in the spine such that its height is decreased. Approximately 15,000 patients suffer from vertebral compression fractures in Sweden each year, most of these caused by osteoporosis. The fracture that arises is treated with analgesics, and the patients are advised about exercise.

"The patients are told that the prognosis is good and that most people get better after a few months, but no-one has actually investigated the prognosis and course of such acute compression fractures", says Professor Tommy Hansson who was supervisor for the thesis.

The author of the thesis, research student Nobuyi Suzuki, returned to Japan immediately after the disputation.

The thesis shows that reality is quite different for patients with vertebral compression. The study followed 107 men and women in Gothenburg for one year after they had been admitted to hospital with a vertebral compression fracture. Once the initial period of acute pain had passed, the patients' condition improved somewhat, but many subsequently deteriorated. Over two thirds had intense pain or very intense pain one year after the injury. This degree of pain is fully comparable with that experienced by patients with lumbar disc herniation immediately before undergoing surgery.

"The thesis shows clearly that the treatment and advice that is given to patients with an acute vertebral compression fracture is far from satisfactory. We must develop new methods for l investigating and treating these patients", says Tommy Hansson.

OSTEOPOROSIS IN BRIEF

Osteoporosis causes a reduction in the strength of the skeleton making it much easier for a person with osteoporosis to suffer from fractures. The most common fractures occur in the vertebrae, hip and wrist. Osteoporosis is more than twice as common in women than it is in men, and a middle-aged woman has a 50% risk of suffering a fracture caused by osteoporosis in her remaining years.

Hypertension, diabetes and increased carotid artery wall thickness means increased risk of stroke

24 april 2009--Increased carotid artery wall thickness (CAWT), which can cause heart attack and stroke in many patients, is significantly related to diabetes and hypertension, according to a study performed at A.O.U. in Cagliari Sardegna, Italy (Chairman, Professor Giorgio Mallarini).

During the study, 186 patients were evaluated using multidetector row CT to see if CAWT is associated with cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia and a history of smoking. Results showed that there is a statistically significant relationship between diabetes and hypertension. "There was no significant statistical correlation between the increase of carotid wall thickness, smoking and dyslipidemia," said Luca Saba, MD, lead author of the study.

"Our group demonstrated that the presence of CAWT greater than 1mm in patients with diabetes or hypertension is strongly correlated with a risk to suffer a stroke. Patients at higher risk should be monitored every 12 months," said Dr. Saba.

"The detection and evaluation of CAWT together with the study of other cardiovascular factors allows for improvement in patient follow up and risk stratification. Imaging as part of the diagnostic process and management of patients with high cardiovascular risks is important," he said.

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This study will be presented at the 2009 ARRS Annual Meeting in Boston, MA, April 26-30. For a copy of the full study, please contact Heather Curry via email at hcurry@arrs.org.

Study Finds Risk of Dementia Increases After Hypoglycemia

By RONI CARYN RABIN

23 april 2009--People with Type 2 diabetes may be at increased risk for developing dementia as they age, several studies have suggested. Now researchers say the higher odds may be linked to life-threatening drops in blood sugar, or hypoglycemia, usually caused by excess insulin.

A long-term study of thousands of older patients with Type 2 diabetes in Northern California found that those who had experienced even one episode of hypoglycemia serious enough to send them to a hospital were at higher risk for developing dementia than diabetic patients who had not experienced such an episode. With each additional episode, the risk of developing dementia increased, the study found.

The findings, to be published on Wednesday in the Journal of the American Medical Association, are significant given the high rates of Type 2 diabetes around the world, and the expectation that dementia rates will increase as the population ages.

“We’ve known for some time that patients with Type 2 diabetes are at greater risk of dementia and cognitive problems,” said Rachel A. Whitmer of the Division of Research at Kaiser Permanente in Oakland, Calif., one of the authors. “This adds to the evidence that balance of glycemic control is important, and that trying to aim for a very low glycemic target might not be beneficial and might even be harmful.”

The study found that the risk of dementia among patients who had experienced a single episode of hypoglycemia that required hospitalization was 26 percent higher than the risk for patients who had never had an episode.

Patients who had experienced two episodes faced an increased risk of 80 percent, while those who had experienced three episodes or more had a 94 percent increase in risk, or almost double the odds of developing dementia.

“To see an effect after just one episode is remarkable,” said Dr. Alan M. Jacobson, a researcher at the Joslin Diabetes Center in Boston. An earlier study of Type 1 diabetes and dementia found no connection, Dr. Jacobson noted.

Researchers gathered their data from 16,667 Kaiser Permanente patients with Type 2 diabetes. They used hospital data to determine how many had experienced severe hypoglycemic episodes from 1980 to 2002 and how many had first received a diagnosis of dementia from 2003 to 2007, when their mean age was 74 to 78.

BRAIN BLEEDING CAUSED BY ASPIRIN

23 april 2009--"The ‘wonder drug’ aspirin may cause bleeding in the brain", the Daily Express

has reported. The story comes from research looking at brain scans from more than a thousand people, finding that those taking aspirin had a 70% higher chance of having microscopic bleeding in their brains. This research looked at a range of antithrombosis drugs, including aspirin, which prevent blood from clotting within blood vessels.

There are limitations to this research that should be taken into account when interpreting its findings. For example, the study cannot easily prove that these drugs actually caused bleeding. Also, as these drugs are prescribed to those with an increased risk of cardiovascular disease (including heart disease and strokes) it is possible that the problems being treated are actually behind the increased bleeding risk. In addition, scans were only taken after people had used the drugs in question, so it is possible that bleeding had already occurred before the drugs were actually taken.

Anti-clotting drugs are known to increase the risk of bleeding and when prescribing them, clinicians should carefully consider both the risks and benefits of treatment on an individual basis.

Where did the story come from?

This research was conducted by Dr Vernooij and colleagues of Erasmus MC University Medical Centre, Rotterdam, the Netherlands. The Rotterdam Study is supported by a number of organisations including Erasmus University Rotterdam, the Netherlands Organization for Scientific Research,the Dutch Ministry of Health, Welfare and Sports, and the European Commission (DG XII).

The study was published in the peer-reviewed medical journal, Archives of Neurology.

What kind of scientific study was this?

This was a cross-sectional study of an elderly population, investigating the relationship between the use of antithrombotic drugs such as aspirin and the presence of ‘microbleeds’ from small blood vessels in the brain lobes. Small vessel bleeds are believed to result from either hardening of the blood vessels (arteriosclerosis) or the formation of amyloid protein deposits in the blood vessel wall.

Participants were sourced from the previous Rotterdam Study, a large study that looked at a number of different risk factors for a range of health problems among the elderly. In this new study, the researchers selected 1062 members of the Rotterdam Study who had undergone MRI brain scans between 2005 and 2006.

To detect microbleeds the researchers examined participants’ MRI scans, looking for haemosiderin (iron deposits), which are a sign of bleeding. Presence, number and location of microbleeds in the brain were recorded by an experienced neuroradiologist, with location defined as:

• lobar (grey and lobar white matter of the cerebral cortex),
• deep (deep grey matter [basal ganglia and thalamus])
• white matter of the internal or external capsule and corpus callosum (which connects the left and right hemisphere), and
• infratentorial (brainstem and cerebellum).

Each participant’s antithrombotic drug use over the preceding 14 to 15 years was determined by pharmacy-filled prescriptions that included details of the drug, dose and date of prescription. Antithrombotic drugs were defined as those that prevent platelet aggregation (clumping of platelets within blood vessels), such as aspirin or anticoagulant drugs, including warfarin or heparin.

Antithrombotics are usually prescribed for people at risk or with a history of coronary heart disease or strokes and these conditions are also related to the risk of cerebral microbleeds. The researchers also assessed cardiovascular risk factors (through history, examination and lab results) and took them into account in their analyses. They also noted the presence of infarcts (markers of ischemic cerebrovascular disease, i.e. stroke) on MRI scans.

The researchers looked at the relationship between antithrombotic use and microbleeds, including further subanalysis according to antithrombotic drug used and site of microbleed within the brain.

What were the results of the study?

The average age of people in the study was 69.6 years, with equal numbers of men and women in the sample.

There were 363 people (34.2%) who had used some kind of antithrombotic drug in the years before their MRI. Within this group, 67% (245) had exclusively used the platelet aggregation inhibitors aspirin or carbasalate calcium, with the latter being used by the majority of people. Of the 363 people, 17% had used only anticoagulant drugs.

Cerebral microbleeds were more prevalent among users of antiplatelet drugs, with a 71% increased risk compared to those who did not use any antithrombotic therapy (odds ratio 1.71, 95% confidence interval 1.21 to 2.41). There was no statistically significant relationship between anticoagulant use and risk of microbleeds.

Of those taking antiplatelet drugs, microbleeds in the cerebral lobes of the brain were more common among those taking aspirin, with a more than double increased risk compared to non-users (OR 2.70, 95% CI 1.45 to 5.04). For carbasalate calcium, there was a non-significant risk increase in lobar bleeds compared to non-users.

What interpretations did the researchers draw from these results?

The researchers conclude that their analysis has shown that use of platelet aggregation inhibitors is associated with cerebral microbleeds. The two platelet aggregation inhibitors analysed, aspirin and carbasalate calcium, may differently affect risk of microbleeds in strictly lobar regions of the cerebral cortex.

This large cross-sectional analysis had demonstrated the increased prevalence of microbleeds in the brains of middle-aged to elderly people who had been using antiplatelet drugs, aspirin in particular.

It should be noted that antiplatelet and anticoagulant drugs are taken because the person is considered to be at increased risk of cerebrovascular disease, e.g. clots in the blood vessels of the heart or brain, and both types of drug are known to increase the risk of bleeds in the brain. The physiological process that leads to a change in the structure of small blood vessels of the brain (and increase their tendency to bleed) may be related both to the processes of the cardiovascular disease being treated and to the antithrombotic drugs used. Therefore, it is difficult to attribute the increased risk of bleeding solely to antiplatelet use, although researchers did attempt to take this into account by adjusting for age, sex and subjects’ score on a scale of heart risk.

Some further points to note about this study:

• Causation could be better assessed through a prospective study, that is, people examined by MRI prior to commencing antithrombotic treatment and then re-assessed at a later date to see whether microbleeds had developed. As the authors acknowledge, with their method of assessment, it is not possible to say when the bleed actually occurred, as iron deposits can remain in the brain for an undefined period. This means a bleed may have occurred before antithrombotics were used.
• Aspirin was associated with increased risk of microbleed in lobar regions of the brain. However, the number of people exclusively using aspirin in this sample was relatively small (67), reducing the accuracy of any calculated risk estimate. A larger number used carbasalate calcium, which is not a prescribed antiplatelet drug in the UK.
• Although anticoagulant drugs were not significantly associated with bleeds, fewer people exclusively used anticoagulants (61) compared to exclusive use of antiplatelets (245). This may not be a sufficiently large sample to find a difference if one exists.
• Drug use in the preceding 15 years was determined by filled pharmacy prescriptions. However, from this it is not possible to assess whether the drugs were actually taken as prescribed.

When prescribing any antiplatelet or anticoagulant drug, clinicians should always carefully consider both the risks and benefits of treatment on an individual basis.

Links to the science

Vernooij MW, Haag MDM, van der Lugt A et al. Use of Antithrombotic Drugs and the Presence of Cerebral Microbleeds: The Rotterdam Scan Study. Arch Neurol, Apr 2009

Further reading

There are several reviews in the Cochrane Library that consider the effects of aspirin, including:
Saxena R, Koudstaal PJ. Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database of Systematic Reviews 2004, Issue 4.

Drug offers hope on Alzheimer's

A new drug which shows promise as a treatment for Alzheimer's disease has been developed by UK scientists.

23 april 2009--The Proceedings of the National Academy of Sciences reports the drug, CPHPC, removes a protein thought to play a key role in Alzheimer's from the blood.

Tests at the University College London found the protein also disappeared from the brains of five Alzheimer's patients given the drug for three months.

Longer and larger scale clinical studies are now being planned.

“ New treatments for Alzheimer's disease are desperately needed ”
Rebecca Wood Alzheimer's Research Trust

The protein - serum amyloid P component (SAP) is always present in both the sticky clumps (plaques) and the tangles of nerve fibres that are found in the brains of people with Alzheimer's disease, and are thought to damage healthy cells.

It appears to prevent both structures from breaking up, and has also been shown - in lab experiments at least - to promote formation of the amyloid protein which forms the damaging plaques.

There is also some evidence that SAP itself can damage brain cells directly.

Two of the big potential advantages CPHPC are that it is not broken down once inside the body, and it has a very specific action, not interacting with cells at all, thus reducing the risk of side effects.

Molecular process

The researchers expected a depletion of SAP in the five patients' blood - but were taken aback at the drug's apparent effect on the brain.

By using laboratory tests they were also able to reveal both the molecular process underpinning the effect of the drug, and the way in which SAP accumulates in the brain in Alzheimer's disease.

The study also confirmed that use of the drug - and the removal of SAP from the brain - had no side effects on the patients.

CPHPC has already been given to patients with other diseases without any any adverse effects.

Although the three-month treatment period was too short to show any clinical benefit there was no obvious deterioration.

Longer and larger scale clinical studies are being planned to confirm safety and seek evidence of benefit to the patients.

Lead researcher Professor Mark Pepys said: "The complete disappearance of SAP from the brain during treatment with CPHPC could not have been confidently predicted, and the drug, also to our surprise, entered the brain.

"Coupled with the absence of any side effects, these new findings strongly support further clinical studies to see whether longer term treatment with CPHPC protects against the inexorable mental decline in patients with Alzheimer's disease."

Dr Susanne Sorensen, head of research at the Alzheimer's Society, said: "A key characteristic of Alzheimer's disease is the clumping together of proteins in the brain.

"It's very exciting that this drug could potentially interfere with this process, but it's too early to say how much it will benefit people with the disease."

Rebecca Wood, of the Alzheimer's Research Trust, said the study was small, but the results were cause for "cautious optimism".

"New treatments for Alzheimer's disease are desperately needed, and it's possible that this small molecule could be a future candidate."

Test 'sheds light on back pain'

A simple technique could help doctors differentiate between patients with different causes of back pain and thus improve treatment, a study suggests.

23 april 2009--Researchers writing in PLoS Medicine have devised "bedside" tests which distinguish between neuropathic - nerve damage - and other causes of pain.

Neuropathic pain is commonly described as "burning" or "stabbing" but it is often difficult to formally diagnose.

Back pain is the most commonly cited reason for being absent from work.

A team from Massachusetts General Hospital in the US and Addenbrooke's in the UK recruited more than 300 patients with chronic back pain.

Some had a known history of nerve damage caused by diabetes or shingles, while others had low back pain with or without evidence of spinal nerve root damage.

Question time

By carrying out detailed comparisons of the patients, researchers were able to formulate a set of six questions and 10 physical tests which distinguished between the two groups.

“ Although back pain is very common, in many cases we still have a poor understanding of where the pain is coming from ”
Dries Hettinga BackCare

The results, they said, were superior to existing screening tests for neuropathic pain and even to MRI scanning of the spine, which can be misleading as many people have damage to their spinal discs without any pain.

In most types of neuropathic pain, all signs of any injury have usually disappeared but certain nerves continue to send pain messages to the brain.

Traditional pain killers often do not help - other options include antidepressants, and physical as well as psychological treatment.

"Currently clinicians measure pain only by asking how bad it is, using scales from mild to moderate to severe or asking patients to rate their pain from one to 10," said lead author Joachim Scholz, an assistant professor of anaesthesia.

"This approach misses key characteristics that reflect the mechanisms causing the pain.

"The treatment of neuropathic and nonneuropathic pain is quite different, and if a diagnosis is wrong, patients may receive treatment, including surgery, that does not improve their pain."

Dries Hettinga, head of research & policy at the charity BackCare, said: "Although back pain is very common, in many cases we still have a poor understanding of where the pain is coming from and how to tailor treatments to individual cases.

"This is why the diagnostic tool that the researchers developed could make a big difference to many people with back pain.

"People with neuropathic back pain need a different treatment approach than those with non-neuropathic pain and an accurate and easy to use tool to distinguish the two types of pain would not only benefit people with back pain, but also help to tailor treatments for people with back pain and thus decrease costs."

Osteoporosis drug promotes healing of fractures, study finds

Teriparatide, or Forteo, helped 93% of patients after only eight to 12 weeks on the drug. The treatment could reduce pain suffered and time spent in nursing homes.

By Thomas H. Maugh II
23 april 2009--A drug used to treat severe osteoporosis promotes healing of hard-to-mend fractures in the elderly and others, reducing pain and time spent in nursing homes, researchers said Tuesday.

In preliminary studies, 93% of 145 patients who had unhealed bone fractures -- some for as long as six months -- had significant healing after only eight to 12 weeks on the drug, called teriparatide, or Forteo.

An estimated 5% of the 6 million fractures suffered by Americans each year are slow to heal or do not heal at all, and as many as a quarter of the elderly with pelvic and hip fractures die within a year as a result of their injuries.

Others with such injuries are forced to go into nursing homes, so the drug has great promise for reducing medical costs and improving quality of life, said Dr. Susan V. Bukata of the University of Rochester Medical Center, lead author of the study.

"This is a drug with a good clinical track record that has proved to be remarkably safe, and it could have great utility," said Dr. Richard S. Bockman, chief of the endocrine service at the Hospital for Special Surgery in New York, who was not involved in the study.

Bukata and her colleagues reported their findings at a February meeting of the Orthopaedic Research Society and are now submitting a report to a major journal.

Teriparatide is a fragment of parathyroid hormone, containing 34 amino acids compared with the 84 in the intact hormone. Studies as early as the 1930s showed that parathyroid hormone injections increase bone density and healing in animals. But because the hormone could not be patented, pharmaceutical companies were loath to expend money on clinical trials.

In 2003, however, Eli Lilly & Co. received approval to market teriparatide under the brand name Forteo for treatment of severe osteoporosis. An estimated half-million people have been treated with the drug.

Many physicians have reported observing accelerated healing of fractures in the elderly given Forteo for osteoporosis, and some doctors are now using the drug off-label for such purposes, Bockman said.

Bukata and her colleagues studied 145 mostly elderly patients with fractures at a variety of sites. All the fractures had proved resistant to healing, some for more than six months. The researchers found that 135 of the patients given teriparatide had complete healing of their fractures after eight to 12 weeks. Six had only partial healing, "but they were much more comfortable and happy with the results," she said. Only four patients received no benefit.

No adverse effects were noted, Bukata said. Three of the patients stopped using it because they did not like giving themselves injections, but two had already healed when they stopped.

The Rochester team is beginning a placebo-controlled trial, sponsored by the National Institutes of Health, on people with pelvic fractures. Such fractures "are very painful, and people can't walk for two to three to four months," Bukata said. "We want to get them up and moving as quickly as we can."

The team has begun another study, also sponsored by NIH, in spinal fractures. So far, "we have seen a fairly rapid response there, in eight weeks or so," she said.

The chief drawback of the treatment is the cost, about $800 per month. But if the patient's stay in a nursing home could be reduced by a week, "that would pay for the drugs," Bukata said.

And perhaps, "with more uses for the drug, maybe it will encourage others to make the product and lower costs," Bockman said.

Bukata and her colleagues give paid speeches for Lilly. The company provided the drugs for the research but had no control over the study.

Is There a Longevity Personality?

By JOHN CLOUD

22 april 2009--Why do some people live to be older than others? You know the standard explanations: keeping an abstemious diet; engaging in regular exercise; and, if you're an unusual Frenchwoman, smoking cigarettes until you are 117 years old.

But what effect does your personality have on your longevity? Do some kinds of temperaments lead to longer lives? A new study in the Journal of the American Geriatrics Society looked at this question by examining the personality traits of 246 children of people who had lived to be at least 100. (The study chose the offspring of centenarians because they are easier to follow over time than the very aged since they don't die as often before follow-up interviews can be conducted. Also, children of those who live to 100 are themselves likelier to live longer.) (See pictures of the world's most celebrated senior citizens.)

The study shows that those who live the longest are more outgoing, more active and less neurotic than other people. Long-living women are also more likely to be empathetic and cooperative than women with a normal life span. These findings comport with what you would expect from evolutionary theory: those who are extroverted enough to make friends and help others are those who are going to be able to gather enough resources to make it through tough times. (See 20 ways to get and stay happy.)

Interestingly, however, other traits that you might consider advantageous had no impact in this study on whether participants were likely to live longer. Those who were more self-disciplined, for instance, were no more likely to live to be very old (which might explain the long life of the smoking French lady). Also, being open to new ideas had no relationship to long life, which might explain all those cantankerous old people who are fixed in their ways.

Whether you can successfully change your personality as an adult is the subject of a longstanding psychological debate . But the new paper suggests that if you want long life, you should strive to be as outgoing as possible.

Unfortunately, another recent study shows that your mother's personality - which, of course, you can't change - may also help determine your longevity. That study looked at nearly 28,000 Norwegian mothers and found that those moms who were more anxious, depressed and angry were more likely to feed their kids unhealthy diets full of chocolate, soda and pancakes. Patterns of childhood eating can be very hard to break when we're adults adults, which may mean that kids of depressed moms end up dying younger.

Personality isn't destiny, of course, and everyone knows that individuals can learn to change. But both of the new studies show that long life isn't just a matter of your physical health but of your mental health also.

Antipsychotic drug for dementia have adverse effects

NEW YORK, 22 april 2009 - Elderly patients with Alzheimer's disease who are treated with second-generation antipsychotics should be monitored closely for weight gain and lipid abnormalities, according to an analysis of data from the Clinical Antipsychotic Trials of Intervention Effectiveness--Alzheimer's disease (CATIE-AD).

The 36-week trial included 421 outpatients with Alzheimer's disease who were treated for delusions and aggression. The average patient age was 78 years and 56 percent were female. The findings are reported in the online edition of the American Journal of Psychiatry.

Seventy-two patients had no exposure to the study drugs, while the remaining subjects were assigned to treatment with olanzapine (Zyprexa) , quetiapine (Seroquel), and risperidone (Risperdal); they could switch antipsychotic medication during the trial.

Female subjects gained an average of 0.14 pounds per week and body mass index increased by 0.03 per week, Dr. Lon S. Schneider at the University of Southern California, Los Angeles, and associates report. Changes in weight and BMI among males were not statistically significant.

The duration of antipsychotic use by women was significantly associated with weight gain. "The prevalence of significant weight gain was 10 percent, 17 percent, and 20 percent among patients with less than 12 weeks, 12 to 24 weeks, and greater than 24 weeks of use compared to 7 percent with no use," Schneider's team reports.

The effect on weight was significant for olanzapine and quetiapine, but less so for risperidone. Olanzapine was also significantly associated with increased waist circumference and decreased HDL cholesterol - the "good" cholesterol.

The metabolic changes that correlated with treatment with a second-generation antipsychotic drug were of similar magnitude to those observed in younger people with schizophrenia, the team notes.

The results from a previous analysis of the CATIE-AD data indicated that the drugs did not improve patients' function and quality of life and did not decrease their need for care.

The worsening cardiac and metabolic risks among these Alzheimer's patients are "particularly concerning," they add, and likely explain the increased risk of mortality seen with these drugs.

SOURCE: American Journal of Psychiatry, April 17, 2009.

Psoriasis linked to diabetes, hypertension: study

CHICAGO, 22 april 2009 - Women with psoriasis run a higher risk of diabetes and high blood pressure, perhaps because of the underlying inflammation that causes the skin condition, researchers said on Monday.

Psoriasis should be considered "a systemic disorder, rather than simply a skin disease," Dr. Abrar Qureshi of Brigham and Women's Hospital and Harvard Medical School in Boston wrote in a study in the April issue of Archives of Dermatology.

They looked at data from thousands of female U.S. nurses who enrolled in a study in 1991 and have been checked periodically for numerous health-related issues.

They said 1,813 women were diagnosed with psoriasis over a 14-year period. These women were 63 percent more likely to develop diabetes and 17 percent more likely to develop hypertension than those who were psoriasis-free.

The team said inflammation can lead to high blood pressure and may also be a factor in insulin resistance, a pre-diabetic condition.

"Inflammation could be a biologically plausible mechanism" underlying the association with diabetes, the researchers said. "Psoriasis is a chronic inflammatory disease, and inflammation is a risk factor for hypertension."

The link was found regardless of their weight, age and whether they smoked. While other studies have linked psoriasis to diabetes and hypertension, factors like obesity and smoking have variously been blamed, the researchers said.

Psoriasis, a chronic inflammatory skin disease that causes itchy red plaques on the skin's surface, affects about 7.5 million people in the United States alone. In severe cases large areas of the body can be affected, and it can bring arthritis, depression and other problems.

Because the study was restricted to white women, the findings cannot be generalized to men or to other races, the researchers added.

While systemic steroid therapy for psoriasis could foster diabetes or hypertension, such treatment is not the standard for care in the United States, the researchers said. And patients often abandon steroid creams after short periods of use.

Human stem cells promote healing of diabetic ulcers

Circulation Research paper

22 april 2009--Treatment of chronic wounds is a continuing clinical problem and socio-economic burden with diabetic foot ulcers alone costing the NHS £300 million a year. Scientists in Bristol have found that human foetal stem cells can effectively be used to treat back leg ischaemic ulcers in a model of type 1 diabetes.

The researchers also found the culture in which the stem cells had been grown mimicked the wound-healing ability of the cells, suggesting that they could be used as a "factory" of wound-healing substances. Alternatively, the active ingredients in the culture, once identified, could be used instead; this would avoid the ethical concerns of using human foetal stem cells.

In humans, diabetic patients with ischaemic foot ulcers have the worst outcome of all chronic skin wounds, with higher amputation and mortality rates than patients carrying non-ischaemic ulcers. Topical gels containing single growth factors have recently been used with some success in non-ischaemic ulcers, but have been unsuccessful in ischaemic ulcers, which are also resistant to other conventional treatment. Ischaemia results when the blood supply to a tissue is greatly reduced or stopped - this can occur in diabetes since it can also cause impaired blood flow in patients.

The healing activity of stem cells is recognised for their ability to separate into the various component cells of injured tissues, as well as to discharge growth factors that may encourage the formation of new blood vessels in the patient.

Paolo Madeddu, Professor of Experimental Cardiovascluar Medicine and colleagues at the Bristol Heart Institute, previously used stem cells in models of back leg ischaemia, showing that foetal stem cells could be more therapeutically effective than adult stem cells.

Foetal stem cells possess a better ability to multiply and to graft onto host tissue, and to separate into other cell types to replace those in the damaged tissue. The group led by Bristol University's Professor Madeddu have found that foetal stem cells accelerate the closure of ischaemic diabetic ulcers, while stem cells from blood of adult donors are ineffective.

Professor Madeddu, commenting on the research, said: "This is the first study to demonstrate the healing capacity of local therapy with CD133+ stem cells in a model of diabetic ischaemic foot ulcer. The foetus-derived cells would be difficult to obtain for therapeutic applications. However, the finding that conditioned culture is also effective in stimulating wound healing may have important implications for the cure of the ischaemic complications of diabetes.

"Foetal CD133+ cells might be used in the future as a "factory" of therapeutic substances. Alternatively, synthetic replica of the conditioned medium could be produced to obviate ethical concerns surrounding the direct use of foetal stem cells."

Karen Addington, Chief Executive of Juvenile Diabetes Research Foundation (JDRF), added: "Chronic wounds and diabetic foot ulcers are serious long-term complications of type 1 diabetes. Because of the difficulties involved in managing type 1 diabetes, people living with the condition are at an increased risk of requiring a non-traumatic limb amputation. Although more work needs to be done before we can begin to think about potential new treatments, this research represents a useful way to help identify new strategies for dealing with type 1 diabetes."

The researchers discovered that a particular type of stem cell – CD133+ cells (derived from human foetal aorta) promoted blood vessel formation in order to salvage the diabetic limb. Three days following the graft consisting of collagen plus CD133+ cells, hardly any CD133+ cells were detected in the ischaemic diabetic ulcer – indicating that transplanted cells had done their task in the very first days after transplantation possibly by boosting the generation of new vessels through an indirect mechanism.

They found that the CD133+ cells released large amount of growth factors and cytokines endowed of pro-angiogenic and pro-survival potential. To confirm the importance of these released factors, Professor Madeddu and colleagues have grown the CD133+ cells in vitro, and then used the "conditioned" culture to reproduce the effects on wound healing and angiogenesis. These additional experiments confirmed that wound healing and angiogenesis are equally benefited either by giving stem cells or the stem cells' released product.

In the attempt to explain which component of the healing cocktail were really important, they withdrew likely candidates one by one by blocking antibodies. Interestingly, they found that the vascular endothelial growth factor A (VEFG-A) and some interleukins were the crucial factors accounting for the healing effect of transplanted stem cells.

Importantly, VEGF-A was recognized to be the responsible for reactivation of foetal genes, belonging to the Wingless gene family, in the wounded tissue. Withdrawal of wingless gene products also prohibited the beneficial action of conditioned medium on the wound closure and reparative angiogenesis.

This discovery provides a new perspective in the use of foetal stem cells. It is known that wounds heal so well in foetuses that no scar can be visible at birth. It is therefore possible that, when foetal stem cells are transplanted onto diabetic ulcers, they reactivate a foetal program in the recipient to allow those adult ulcers to repair as efficiently as foetal wounds do.