Monthly Archives: June 2016

Homing In on the Genetics of Migraine

SUNDAY, June 26, 2016 (HealthDay News) -- An international team of scientists has identified dozens of new genetic variants associated with migraine headaches.

The researchers say their findings could lead to new treatments.

Most of the variants are in or close to genes involved in circulatory system regulation. This supports the theory that abnormal blood vessel function in the brain is an important factor in migraines, the investigators said.

"These genetic findings are the first concrete step towards developing personalized, evidence-based treatments for this very complex disease. We doctors have known for a long time that migraine patients differ from each other and the drugs that work for some patients are completely inefficient for others," said John-Anker Zwart, of Oslo University Hospital in Norway, who participated in the research.

"In the future, we hope that this information can be utilized in dividing the patients into different genetic susceptibility groups for clinical drug trials, thus increasing the chances of identifying the best possible treatment for each subgroup," he added in a news release from the University of Helsinki in Finland.

Migraine affects about 1 in 7 people worldwide.

The findings stem from analysis of DNA samples taken from 375,000 Europeans, Americans and Australians. Nearly 60,000 were migraine sufferers.

The team pinpointed nearly 30 new genetic variants linked with migraine. The variants are in 38 genomic regions, only 10 of which have previously been associated with migraine risk.

"Our consortium is devoted to uncovering the genetic causes of migraine and during the past few years we have been able to identify many risk variants," said Dr. Aarno Palotie, leader of the International Headache Genetics Consortium, which coordinated the study.

"Yet, in this latest, large-scale study, tens of new genetic risk factors were discovered," added Palotie, from the Psychiatric and Neurodevelopmental Genetics Unit Center for Human Genetic Research
at Massachusetts General Hospital in Boston.

"Because all of these variants modify the disease risk only slightly, the effect could only be seen when this large amount of samples became available," he noted.

The study was published online June 20 in the journal Nature Genetics.

More information

The U.S. National Institute on Neurological Disorders and Stroke has more on migraine.

Experimental Genital Herpes Drug Shows Promise

MONDAY, June 20, 2016 (HealthDay News) -- An experimental immune-boosting treatment for genital herpes shows promise, researchers report.

The drug, called GEN-003, may reduce both virus activity and the number of days with recurrent herpes in patients. The treatment is given in a series of three injections and appears to last for up to one year, the investigators said.

The researchers tested the vaccine on 310 people with a history of chronic, recurrent genital herpes. The findings were to be presented Monday at an American Society for Microbiology meeting in Boston. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

The study was funded by Genocea Biosciences, the Cambridge, Mass.-based company that makes the drug.

"GEN-003 is believed to work through a different pathway from most vaccines by recruiting T-cells, which are critical to controlling chronic infections such as herpes," study author Dr. Kenneth Fife said in a society news release. Fife is a professor of medicine at Indiana University in Bloomington.

The vaccine also stimulates antibodies against the virus, he explained.

"The importance of these clinical findings is that it represents a new approach to treatment, and may provide a new option for patients suffering from chronic, recurrent genital herpes," Fife said.

Genital herpes is common in the United States, affecting about one out of every six people aged 14 to 49 years. Current treatments for the sexually transmitted disease consist of antiviral medications. There is no cure for herpes, according to the U.S. National Institutes of Health.

"GEN-003 is expected to be tested in combination with antiviral medications to potentially provide a level of relief not currently achievable," Fife said.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more on genital herpes.

How to Prevent Painful Swimmer's Ear

SATURDAY, June 18, 2016 (HealthDay News) -- Swimmer's ear -- a common summertime problem among children -- is easy to prevent, an expert says.

"Swimmer's ear is a bacterial or fungal infection caused by water caught in the ear canal. The tell-tale signs are swelling of the ear canal and some drainage or discharge," said Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children's Hospital of the University of California, Los Angeles.

Other types of ear infections cause pain inside the ear, but swimmer's ear causes pain when the outside of the ear is touched, Shapiro said in a university news release.

Swimmer's ear can be prevented by using the corner of a washcloth or towel to dry ears after swimming. If a hair dryer is available, use the low setting and place the dryer about one foot away from the ear to dry it, Shapiro said.

Never use a cotton swab to clean or dry the ear canal because it can damage the ear drum, she warned.

You can get over-the-counter ear drops to prevent swimmer's ear, but these should not be used on children who have ear tubes, ruptured eardrums or have had ear surgery, Shapiro said.

If a child does develop swimmer's ear, doctors may prescribe anesthetic, antibiotic or antifungal ear drops, she said.

More information

The American Academy of Pediatrics has more about swimmer's ear.

How to Prevent Painful Swimmer's Ear

SATURDAY, June 18, 2016 (HealthDay News) -- Swimmer's ear -- a common summertime problem among children -- is easy to prevent, an expert says.

"Swimmer's ear is a bacterial or fungal infection caused by water caught in the ear canal. The tell-tale signs are swelling of the ear canal and some drainage or discharge," said Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children's Hospital of the University of California, Los Angeles.

Other types of ear infections cause pain inside the ear, but swimmer's ear causes pain when the outside of the ear is touched, Shapiro said in a university news release.

Swimmer's ear can be prevented by using the corner of a washcloth or towel to dry ears after swimming. If a hair dryer is available, use the low setting and place the dryer about one foot away from the ear to dry it, Shapiro said.

Never use a cotton swab to clean or dry the ear canal because it can damage the ear drum, she warned.

You can get over-the-counter ear drops to prevent swimmer's ear, but these should not be used on children who have ear tubes, ruptured eardrums or have had ear surgery, Shapiro said.

If a child does develop swimmer's ear, doctors may prescribe anesthetic, antibiotic or antifungal ear drops, she said.

More information

The American Academy of Pediatrics has more about swimmer's ear.

Spikes in Blood Pressure Don't Always Need ER Care

MONDAY, June 13, 2016 (HealthDay News) -- If your blood pressure reading at a routine doctor's office visit is alarmingly high, in most cases that doesn't mean a trip to the emergency room, a new study suggests.

In the Cleveland Clinic study of office visits by almost 60,000 patients with "hypertensive urgency" (very high blood pressure), less than 1 percent needed a referral to a hospital ER.

The rest were treated and then sent home with no added risk in terms of patient outcomes, the researchers said.

"Hypertensive urgency is common in the outpatient setting," noted the team led by the clinic's Dr. Krishna Patel. However, the researchers believe that "most patients probably can be safely treated in the outpatient setting, because cardiovascular complications are rare in the short term."

Dr. Suzanne Steinbaum, who directs Women's Heart Health at Lenox Hill Hospital in New York City, called the finding "reassuring."

"For those patients with hypertension, an episode of elevated blood pressure can be alarming," she said.

However, the Cleveland study suggests that "hypertensive urgency -- defined as a blood pressure of at least 180/110 [millimeters of mercury, or mm Hg] -- without symptoms or evidence of end organ damage can be managed safely as an outpatient," Steinbaum said.

The findings are published online June 13 in JAMA Internal Medicine.

As the researchers explained, high blood pressure can result in organ damage over time. So, doctors may be concerned about the threat of organ damage in people with severely elevated blood pressure -- even for a brief period.

But it's been unclear whether the best course of action is to send such patients to the ER.

The new study found it was only necessary in a small minority (0.7 percent) of patients. And overall, patients referred to the ER and those sent home had similar rates of major heart problems within the next week, month and year, the research team said.

Patients who were sent home had lower odds of needing admission to a hospital over the next week, compared to those who'd been sent to the ER, the study found.

And while patients who were sent home were more likely to have uncontrolled blood pressure one month later, this difference faded away by the six-month mark, Patel's team said.

Treating people outside of the ER could be cost-effective, too.

Sending people to the hospital "was associated with increased use of health care resources but not better outcomes," the Cleveland Clinic researchers reported.

All of this doesn't mean that most patients' hypertension disappeared, however: Most still had uncontrolled high blood pressure months later, the study found.

That was a concern for Steinbaum.

"The real issue becomes addressing the reality that two-thirds of [study] patients who were either hospitalized or outpatient had uncontrolled blood pressures at six months," she said.

Dr. Howard Selinger is chair of family medicine at the Frank H. Netter M.D. School of Medicine at Quinnipiac University, in North Haven, Conn. He believes doctors must still treat hypertensive patients on a case-by-case basis.

Frailty is a key factor, Selinger said.

"If this patient is a frail elderly who perhaps sustained an earlier stroke, that changes the potential for an adverse outcome," he explained.

Other factors -- including the speed at which treatment is available in an outpatient setting, or transport or communication issues -- should also factor into the decisions physicians make, Selinger said.

And, of course, a spike in blood pressure becomes more urgent when other symptoms of heart trouble are present, he added.

"Not to be confused as a hypertensive urgency is a hypertensive crisis -- in which symptoms are already present, such as severe headache, visual changes, chest pains," Selinger stressed. In those cases, ER care may be warranted, he said.

More information

The American Academy of Family Physicians has more about high blood pressure.

Tight Blood Sugar Control Helps Fight Diabetic Eye Disease

SATURDAY, June 11, 2016 (HealthDay News) -- Intensive blood sugar control appears to reduce the risk of eye disease progression in people with type 2 diabetes, a new study says.

People with type 2 diabetes are at risk for the eye disease called diabetic retinopathy. This condition damages tiny blood vessels in the retina, the light-sensitive tissue in the back of the eye.

Researchers compared type 2 diabetes patients who received either intensive therapy or standard therapy to control blood sugar. To measure how well the therapy worked, people in the study had hemoglobin A1C tests. The A1C test estimates several months of blood sugar levels.

People are diagnosed with diabetes when their A1C is 6.5 percent or higher, the U.S. National Institute of Diabetes and Digestive and Kidney Disease says. In general, the goal for people with type 2 diabetes is to have an A1C of less than 7 percent, according to the American Diabetes Association. But this goal can be changed, depending on someone's individual health.

In the new study, participants on intensive therapy had average hemoglobin A1C levels of 6.4 percent when the research ended. The standard therapy group had A1C levels that averaged 7.7 percent, the researchers said.

The researchers checked the study volunteers' eye health four years after treatment ended. At that point, A1C levels were almost the same -- 7.8 for the intensive group and 7.9 for the standard group. The researchers found the risk of diabetic retinopathy progression for patients in the intensive therapy group was 6 percent. In the standard therapy group, that rate was 13 percent.

"This study sends a powerful message to people with type 2 diabetes who worry about losing vision," said lead author Dr. Emily Chew. She is deputy director of the division of epidemiology and clinical applications at the U.S. National Eye Institute.

"Well-controlled [blood sugar] has a positive, measurable and lasting effect on eye health," she said in an institute news release.

Previous studies have reported similar findings, the researchers said.

Almost 8 million people have diabetic eye disease in the United States. The eye condition is the leading cause of vision loss among working-age Americans, the researchers said.

The study was scheduled to be presented Saturday at the American Diabetes Association's annual meeting, in New Orleans. Findings presented at meetings are generally viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Eye Institute has more about diabetic retinopathy.

3 Popular Diet Plans May Help Ease Type 2 Diabetes, Too

FRIDAY, June 10, 2016 (HealthDay News) -- People with type 2 diabetes may get some help with blood sugar control from a few commercial weight-loss programs, but conclusive evidence on most plans is lacking, a new review finds.

Researchers reviewed 18 published studies. The studies looked at 10 popular, commercial weight-loss programs that involved a total of 764 people with type 2 diabetes.

Three programs -- Jenny Craig, Nutrisystem and Optifast -- seemed to reduce blood sugar levels more than when people received weight-loss counseling alone, the review found.

"A few of these programs may be a viable option for improving blood sugar control in patients with type 2 diabetes and those at risk for the disease, but we need more gold-standard studies to make that claim," said review leader Dr. Zoobia Chaudhry.

Chaudhry is an assistant professor of medicine at Johns Hopkins University School of Medicine.

The researchers said it's possible that other commercial weight-loss programs may help lower blood sugar levels, but there's currently not enough evidence to say so.

Chaudhry noted that there is a link between being overweight or obese and developing type 2 diabetes. She said that previous research has shown that losing even a small amount of body weight -- 5 to 10 percent -- can help lead to long-term blood sugar reductions in people with type 2 diabetes.

However, that research was mostly based on intensive lifestyle change programs that include carefully controlled diets and guided exercise. Such programs aren't readily available to most of the estimated 29 million people in the United States with type 2 diabetes, Chaudhry said in a university news release.

The review also looked at information from more than 2,400 people who didn't have type 2 diabetes. None of the commercial weight-loss programs in the review led to lower blood sugar in people without diabetes, the study authors said.

The findings were published in the June issue of Obesity Reviews Journal.

More information

The American Diabetes Association has more on type 2 diabetes.

California Enacts Right-to-Die Law

By Dennis Thompson
HealthDay Reporter

THURSDAY, June 9, 2016 (HealthDay News) --
California on Thursday becomes the fifth and largest state in the country to allow terminally ill patients to end their own lives.

With the state's right-to-die law in effect, the percentage of terminally ill U.S. adults who can ask for medical aid in dying will leap from 4 percent to 16 percent, according to advocacy group Compassion & Choices.

As many as 34,000 terminally ill Californians per year are expected to ask their doctors for information about the law, according to the group, and up to 1,500 prescriptions will be written each year. That's based on experiences in states that have already enacted similar legislation.

"We know in Oregon that for every one prescription that is written, it's noted that 25 people inquire about the process," said Sean Crowley, national spokesman for Compassion & Choices.

Stanford University family physician Dr. Catherine Sonquist Forest believes the law will comfort patients dealing with a fatal illness.

"Studies have demonstrated that simply having the option of medical aid in dying and the ability to shorten an unbearable dying process provides great peace of mind to terminally ill people and their families," said Sonquist Forest, medical director of the Stanford Health Center at Los Altos and a clinical assistant professor at Stanford Medicine.

"I'm relieved to know that starting [Thursday], mentally capable terminally ill California adults with a medical prognosis of six months or less to live will have the option to request physician-prescribed aid in dying," she added.

Three states have already passed right-to-die laws -- Oregon, Washington and Vermont. A court has ruled that medical aid in dying is legal in Montana.

Elizabeth Wallner, a 52-year-old single mother from Sacramento, Calif., told reporters that she's "grateful" to have the option provided by the new law.

Wallner has been battling advanced colon cancer since March 2011, undergoing 18 weeks of chemotherapy, six surgeries to remove parts of her liver, lung, diaphragm, gall bladder and colon, and additional radiation therapy. Her cancer has since spread to her liver and lungs.

Once the act takes effect, "I will then be able to ask my doctors for a prescription for medication that I can decide to ingest if my suffering becomes intolerable in my final days," Wallner said at Wednesday news briefing held by Compassion & Choices. "That will allow me to have a measure of control and allow me to die peacefully at home in my sleep and surrounded by my loved ones, as opposed to scared, in pain or even worse in the hospital."

The new law has met with resistance from some religious organizations, however. The California Catholic Conference issued a statement this week saying that California will cross an "unwelcomed threshold" when the law takes effect.

"By allowing doctors to prescribe a lethal dose of drugs to their patients, California is embarking on a dangerous course," the statement reads. "This new law will place the disabled, the elderly and other vulnerable people at risk for abuse and mistreatment and will undermine the healing professions' venerable commitment to 'First, do no harm.'"

But Compassion & Choices' Crowley said that, under the new law, people are not required to take their life-ending prescription within any sort of timeframe.

"Every year in Oregon, two-thirds of folks end up using the medication, and one-third do not," he said.

People with a terminal illness must also complete a series of legal hurdles before they can receive a lethal prescription to be filled and used at their own discretion, according to an analysis by the California Medical Association's legal counsel:

  • The person must be able to prove they are a resident of California, and have a physician who has diagnosed them with an incurable disease that is expected to end their lives within six months.

  • They must submit two oral requests to their doctor at least 15 days apart, as well as one written request. The written request must be signed and dated in the presence of two witnesses. All three requests must be received by their doctor, not a designee or surrogate.

  • Both the person's doctor and a second consulting physician must agree that the patient is capable of making medical decisions for himself or herself, is not being coerced, and has made an informed decision regarding the right to die.

The patient's doctor is required to counsel him or her to have another person present when they take the fatal dose, to not take the drug in a public place, to keep the drug in a safe and secure place prior to use, and to consider participating in a hospice program.

The patient is not required to undergo a mental health assessment as part of the process, but their doctor can ask for one if the patient seems to have a mental disorder. The mental health assessment then becomes part of the supporting paperwork.

A mentally ill person can still qualify to receive an aid-in-dying drug, but a mental health specialist must determine that the person is not suffering from impaired judgment and is capable of deciding for themselves, the California Medical Association says.

The law specifically states that a terminally ill patient's use of a properly acquired aid-in-dying drug is not considered suicide.

The California Catholic Conference said it's concerned that the law does not require a psychological assessment for all people requesting assisted suicide. It also is concerned there may not be enough safeguards built into the law.

California passed the law following the widely publicized ordeal of Brittany Maynard, a 29-year-old resident of northern California who moved to Oregon in 2014 after being diagnosed with terminal brain cancer.

Maynard became a strong advocate in the right-to-die movement before ending her life on Nov. 1, 2014. Prior to her death, she recorded testimony on behalf of right-to-die legislation being considered in California.

"I am immensely proud of this conversation that my wife Brittany started, and the impact that her voice made on this basic human right," Maynard's husband, Dan Diaz, said Wednesday at the news briefing.

More information

For more on helping a loved one cope with a terminal illness, visit the Mayo Clinic.

Coming Soon: A Wearable Artificial Kidney?

TUESDAY, June 7, 2016 (HealthDay News) - Someday, dialysis patients might free themselves of clunky machines, moving about with a "wearable artificial kidney" instead.

That's the promise of a new clinical trial that suggests this type of technology is finally within reach.

"This would be a game changer," said one kidney specialist, Dr. Maria DeVita. "The fact that clinical trials are beginning gives us all hope that we will have a significant improvement in the care of those patients requiring ongoing hemodialysis."

DeVita is associate director of nephrology at Lenox Hill Hospital in New York City.

People with advanced kidney disease must often resort to spending hours a day at dialysis centers, with special machines cleansing their blood as their kidneys once did.

The dream has long been a small portable device that could perform dialysis as patients went about their usual day.

That dream may be getting nearer: A prototype of such a device was recently tested on seven patients at the University of Washington Medical Center in Seattle. The study was led by the device's inventor, Dr. Victor Gura of Cedars-Sinai Medical Center in Los Angeles and chief medical officer of Blood Purifications Technologies in California.

The trial was designed to see how well the wearable kidney might work to safely take over some of the functions of failed kidneys. Patients used the device for up to 24 hours.

It did seem to work: The device successfully cleared the blood of urea, creatinine and and phosphorus -- all waste products, the resarchers said. It also helped rid the blood of excess water and salt.

Patients seemed to tolerate the therapy well, with no effect on circulation and no serious adverse effects, Gura's team found.

And there was another bonus. During standard dialysis, patients have to adhere to a strict diet to keep blood electrolytes stable. But the participants in the trial had no such problems, even when they ate what they wanted, the researchers said.

Overall, the research team believes that a wearable artificial kidney is feasible. However, the researchers said some redesigns are needed to correct device-related technical problems that occurred during testing.

For example, there was excessive formation of carbon dioxide gas bubbles in the dialysis solution, and intermittent variations in solution and blood flow, Gura's team explained.

The device redesigns will also focus on ease of use and reliability during use, because the objective is to enable patients to undergo dialysis at home.

Another expert was cautiously optimistic about the technology.

"The wearable artificial kidney is a concept that has been discussed for years," said Dr. Robert Courgi, an endocrinologist at Northwell Health's Southside Hospital in Bay Shore, N.Y.

"It is exciting to see this technological breakthrough come to reality in clinical trials," he said.

"Unfortunately there were some shortcomings, in the form of technical problems, and traditional hemodialysis remains the standard of care for the moment," Courgi said. However, "the wearable artificial kidney may become a reality in the very near future," he added.

Drs. Jonathan Himmelfarb and Larry Kesslerwas, of the University of Washington, were senior authors on the study, which was published this month in the journal JCI Insights.

More information

The National Kidney Foundation has more about dialysis.

Two-Pronged Chemo Helps Some With Advanced Ovarian Cancer

By Dennis Thompson
HealthDay Reporter

SATURDAY, June 4, 2016 (HealthDay News) -- Some women with advanced ovarian cancer may fare better if chemotherapy is dripped directly into their abdomens as well as introduced into their bloodstream through traditional IV, a new study finds.

Clinical trial results show the combination of abdominal and IV chemotherapy can slow the progression of ovarian cancer better than IV chemo by itself in women who already have had surgery to remove all or nearly all of their cancer.

Close to 77 percent of women who got combination treatment had at least a nine-month delay in the progression of their cancer, compared with slightly less than 58 percent of women who received IV therapy alone.

Average overall survival also was longer, 59 months versus 38 months, respectively. However, the researchers said the difference was not statistically significant.

Progression-free survival was similar between the two groups, amounting to slightly more than 11 months with IV chemotherapy compared with 12.5 months from IV/abdominal chemotherapy, the findings showed.

Nevertheless, these statistics support using IV/abdominal chemotherapy in certain patients, said Dr. Don Dizon, director of medical oncology for the women's oncology program at Women & Infants Hospital of Rhode Island. He was not involved in the study.

Women taking this path first receive traditional chemotherapy to reduce the size of their tumor, and then undergo surgery to have as much of their cancer removed as possible, Dizon explained.

A port is then installed into their bellies to allow chemotherapy to drip directly into their abdominal cavities, he said. They also receive chemotherapy via IV.

"I think this represents a very valid option for this population, who are receiving primary chemotherapy before surgery and then have successful surgery," Dizon said. "I think you need to mention this option and these data when discussing treatment with those patients."

The researchers will continue to track the patients in this study in hopes of figuring out the best potential recipients of this combination therapy, said presenting researcher Dr. Helen Mackay. She is divisional head of medical oncology and hematology at the Sunnybrook Odette Cancer Center in Toronto.

"If we can identify the long-term survivors, we hope this will help us better predict who truly benefits from this approach," Mackay said.

About 22,280 women are expected to receive a diagnosis of ovarian cancer in 2016, and about 14,240 women will die from the disease, according to the American Cancer Society. Ovarian cancer is the fifth most common cause of cancer death among women.

The new clinical trial involved 200 women who first underwent chemo to shrink their tumor, followed by surgery to remove the cancer. Afterward, they were randomly assigned to receive either IV chemotherapy or IV/abdominal chemotherapy.

Researchers were scheduled to present the findings Sunday at the American Society of Clinical Oncology's annual meeting, in Chicago.

This therapeutic option delivers chemotherapy directly to cancer cells, without having to wend its way through the bloodstream, noted Dr. Linus Chuang. He is a professor of obstetrics, gynecology and reproductive science with the Icahn School of Medicine at Mount Sinai, in New York City.

Chuang pointed out that for nine out of 10 ovarian cancer patients, their cancer is confined to their abdomen when they are first diagnosed.

Delivering chemo directly into the abdomen "may improve efficacy by increasing concentration of the cytotoxic agent directly against the tumor in the abdominal cavity," Chuang said.

The researchers also noted this technique allows delivery of higher doses of chemotherapy to the tumor, while sparing other parts of the body from side effects.

The rate of severe side effects was slightly lower among women who received the combo therapy, about 16 percent compared to 23 percent. However, the difference was not statistically significant.

More information

For more on ovarian cancer, visit the American Cancer Society.