Association Between Gastroesophageal Reflux Disease and Laryngeal Disorders

October 22, 2008 · Filed under Uncategorized · Tagged , , , , , , ,

The association between gastroesophageal reflux disease (GERD) and laryngeal disorders has been recognized since the late 1960s. Chronic laryngeal signs and symptoms associated GERD are often referred to as reflux laryngitis or laryngopharyngeal reflux (LPR). However, the cause-and-effect relationship between GERD and LPR still remains elusive..

A research article published in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Yung-Chih Lai at Cathay General Hospital conducted the study to assess the prevalence rate of LPR in patients with reflux esophagitis and to disclose the factors contributing to the development of LPR.

A total of 167 patients proved to have reflux esophagitis by endoscopy were enrolled. They would receive laryngoscopy to grade the reflux findings for the diagnosis of LPR. A validated questionnaire was used to identify the presence of laryngopharyngeal symptoms. A stringent criteria of inclusion was adopted to increase the specificity of laryngoscopic findings. The data of patients were then analyzed statistically to find out factors related to LPR.

In their research, LPR was present and associated with reflux esophagitis. Age, hoarseness, and hiatus hernia were factors significantly associated with LPR. However, the development of LPR might be different from that of reflux esophagitis based on the findings of the study. The importance of hiatus hernia in LPR was revealed and deserves further study to elucidate in the future.

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Article adapted by Medical News Today from original press release.

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Study Finds People with Fragile X Carriers Likely to Have Additional Conditions

September 30, 2008 · Filed under Uncategorized · Tagged , , , , , , , , , , , ,

Study Finds People With Fragile X, Carriers Likely To Have Additional Conditions

People with fragile X syndrome, as well as those who carry the gene, are likely to have additional conditions that include attention problems and anxiety, according to a study by researchers at RTI International.

The study, published in the Aug. 15 issue of American Journal of Medical Genetics, surveyed more than 1,000 parents of children who either had fragile X syndrome, the most common inherited cause of intellectual disability, or were a carrier of the disease.

In this first large-scale assessment of conditions associated with fragile X syndrome, researchers found that most boys and many girls with the syndrome experience attention problems, anxiety and hyperactivity, in addition to developmental delay, 85 percent of males and 44 percent of females experienced two or more additional conditions.

Additionally, the study showed that carriers, those who have the altered gene but generally do not show signs of the disease, also had an increased prevalence of co-occurring conditions. Boys who carried the gene were more likely than typical children to have been diagnosed or treated for developmental delay, attention problems, aggression, seizures, autism, and anxiety.

Girls who carried the gene were more likely than typical children to have been diagnosed or treated for attention problems, anxiety, depression, and developmental delay.

“This study provides new insights into what it means to be a carrier of fragile X syndrome,” said Don Bailey, Ph.D., a Distinguished Fellow at RTI and director of the project that produced this research. “Obviously carriers who are parents experience many challenges in raising a child with fragile X. This study suggests the possibility that carriers of fragile X may also have a higher biological susceptibility to things like anxiety or attention problems.”

The number of co-occurring conditions children experienced was strongly associated with parent reports of the child’s ability to learn, adaptability and quality of life. The findings suggest that clinicians should be sure to assess both carriers and individuals affected by fragile X to determine whether they have any of these co-occurring conditions so that they can be treated.

Fragile X syndrome is caused by the disruption of a single gene that leads to a protein needed for normal brain development. Changes in the gene are passed down from one generation to the next, usually silently in individuals who are not aware that they carry the disrupted gene. In each generation, the risk for having an affected child increases.

The study was funded by a grant from the Centers for Disease Control & Prevention.

About RTI International

RTI International is one of the world’s leading research institutes, dedicated to improving the human condition by turning knowledge into practice. Our more than 3,800 professionals provide research and technical services to governments and businesses in more than 40 countries in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy, and the environment. For more information, visit http://www.rti.org.

American Journal of Medical Genetics

www.jenniferzaranis.com

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Make the call today!

September 22, 2008 · Filed under Uncategorized · Tagged , , , , , ,

Dial the Shaklee Success Line!

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Allopurinol Lowers Blood Pressure in Mild Hypertension

September 18, 2008 · Filed under Uncategorized · Tagged , , , , , , , , , , , , , ,

Allopurinol Lowers Blood Pressure in Mild Hypertension

Lowering elevated serum uric acid levels might treat hypertension in adolescents.

 

Serum uric acid (UA) is known to be elevated in adolescents with hypertension, but only recently have results from animal studies suggested a causal relation. Investigators performed a randomized, double-blind, placebo-controlled crossover study to determine whether lowering serum UA levels with allopurinol (200 mg twice daily for 4 weeks) reduces blood pressure (BP) in children with stage 1 hypertension (BP >95th percentile and <99th percentile + 5 mm Hg) and serum UA levels ≥6.0 mg/dL.

Of 30 children (age range, 11–17 years), 73% were overweight or obese. Allopurinol treatment resulted in significant reductions in serum UA concentrations, in casual systolic BP (mean reduction, 6.9 mm Hg) and diastolic BP (mean reduction, 5.1 mm Hg), and in ambulatory systolic BP (mean reduction, 6.3 mm Hg) and diastolic BP (mean reduction, 4.6 mm Hg). Placebo treatment was not associated with significant BP changes. Twenty-nine patients remained hypertensive during placebo treatment, whereas only 10 remained hypertensive during allopurinol treatment. Plasma renin levels and peripheral vascular resistance decreased significantly during treatment with allopurinol but not with placebo. No adverse effects were reported.

Comment: Serum UA levels are an important component of the evaluation of hypertension in children. UA levels often are elevated in patients with hypertension, and elevated levels have long been thought to be a marker for vascular injury resulting from prolonged hypertension. These data suggest that serum UA should be monitored in children with hypertension, and, if levels are significantly elevated, treating the UA elevation might treat the hypertension. Because obesity itself raises serum UA levels, UA elevation might be one mechanism for obesity-related hypertension.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine September 3, 2008

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Sweet and Salty: Hemoglobin A1c and Cardiovascular Events in Heart Failure

September 11, 2008 · Filed under Uncategorized

Sweet and Salty: Hemoglobin A1c and Cardiovascular Events in Heart Failure

In a CHARM substudy, increased HbA1c levels were strongly associated with adverse outcomes in heart failure patients, whether or not they had diabetes.

 

A progressive association exists between increasing levels of hemoglobin A1c (HbA1c) and cardiovascular events in individuals with or without diabetes. The toxic effects of hyperglycemia may be especially harmful to an already struggling left ventricle, placing patients with heart failure at heightened risk for adverse events.

In a prespecified analysis of 2412 participants in the manufacturer-sponsored Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity (CHARM) study, elevated HbA1c level was significantly associated with — and was an independent risk factor for — cardiovascular events or death. This association persisted even after adjustment for known diabetes, medication use, smoking, renal function, and other variables. In patients without diabetes, a 27% increase in risk for cardiovascular events or death (adjusted for age and sex) was found with each 1% increase in HbA1c level.

Comment: Although the link between hemoglobin A1c levels and cardiovascular events in heart failure is not fully understood, these findings expand its implications for patients, regardless of their diabetes status. Whether lowering glucose levels should be a goal of heart failure therapy is a clinically important question that remains to be answered.

— William T. Abraham, MD

Published in Journal Watch Cardiology September 10, 2008

Jennifer Zaranis

Independent Shaklee Distributor

www.shaklee.net/zaranis

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Which Short-Chain Carbs are the Villains in IBS?

September 1, 2008 · Filed under Uncategorized · Tagged , , , , , , , , , , ,

Which Short-Chain Carbs Are the Villains in IBS?

Researchers challenged IBS patients with dietary fructose, fructans, and glucose.

 

Malabsorption of fructose and other short-chain carbohydrates is thought to produce symptoms of irritable bowel syndrome (IBS). Common dietary sources of fructose include fruits, honey, and high-fructose corn syrup. Some carbohydrates, such as fructo-oligosaccharides (fructans) and galactosaccharides (e.g., raffinose), cannot be absorbed by humans.

Now, in a double-blind, randomized, crossover trial, researchers have assessed the effects of fructose and fructans (alone or in combination) as dietary triggers of IBS symptoms. Twenty-five patients with known fructose malabsorption were challenged by graded-dose introduction of fructose, fructans, the combination, or a glucose control administered as drinks with meals for a 2-week test period, followed by a 10-day washout period.

In a dose-dependent manner, fructose reproduced IBS symptoms in 70% of patients, fructans reproduced symptoms in 77%, and the combination induced symptoms in 79%. Only 14% of those challenged with glucose showed IBS symptoms (P≤0.002).

Comment: Up to 40% of patients with IBS have been shown to absorb fructose incompletely (JW Gastroenterol Sep 28 2007). In this study, IBS symptoms were induced by either fructose or fructans, indicating that symptoms are reproduced by the bowel’s response to delivery of undigested carbohydrates to the colon and distal small bowel. These data supply more evidence to suggest that carbohydrate malabsorption plays a role in the pathogenesis of IBS symptoms.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology August 28, 2008

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August 29, 2008 · Filed under Uncategorized · Tagged , , , , ,

Translating Hemoglobin A1c into Average Glucose Values

In stable diabetic patients, each percentage point of HbA1c corresponded to about a 29 mg/dL increment in estimated average glucose.

 

The interpretation of glycosylated hemoglobin (HbA1c) levels is not intuitively obvious to many diabetic patients, who are accustomed to thinking in terms of blood glucose levels. In this international study, researchers explored the relation between HbA1c and average blood glucose levels in 507 people; 86% had stable diabetes, and 14% were not diabetic. Each subject underwent 2 days of continuous glucose monitoring every 4 weeks for 12 weeks (generating 288 glucose readings on each monitored day) and finger-stick capillary glucose monitoring seven times daily on 3 days each week for 12 weeks. HbA1c was measured at 12 weeks.

A significant linear relation between average glucose and HbA1c levels was confirmed and is reported in Table 1.

link to table go to: http://general-medicine.jwatch.org/cgi/content/full/2008/828/1/T1

  Thus, each percentage point of HbA1c corresponded to about a 29 mg/dL increment in estimated average glucose.Comment: The authors propose that laboratories should report the corresponding estimated average glucose when they report HbA1c results; this move presumably would facilitate communication with diabetic patients. Note, however, that the association between average glucose and HbA1c levels exhibits some variability: For example, inspection of a scatter plot in this paper shows that, for HbA1c of 7%, average glucose values for individual patients range from about 120 mg/dL to 180 mg/dL.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 28, 2008

Citation(s):

Nathan DM et al. Translating the A1C assay into estimated average glucose values. Diabetes Care 2008 Aug; 31:1473.

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Preventing Stroke Recurrence: How Best to Control Hypertension?

August 28, 2008 · Filed under Uncategorized · Tagged , , , , , , , , , , , ,

Preventing Stroke Recurrence: How Best to Control Hypertension?

In a randomized trial, use of an ARB to lower blood pressure in patients with recent stroke did not improve outcomes.

 

In the Perindopril Protection against Recurrent Stroke Study (PROGRESS, JW Cardiol Dec 14 2001), lowering blood pressure with an ACE inhibitor plus a diuretic after a stroke reduced the rate of recurrent stroke. The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) was an industry-sponsored, international study of strategies to reduce the risk for recurrent stroke. In the antihypertensive arm of the trial, 20,332 patients were randomized to receive telmisartan (an angiotensin-receptor blocker) or placebo within 120 days after experiencing an ischemic stroke; additional blood-pressure control agents were allowed at investigators’ discretion. Mean patient age was 66, and about one third were women. At baseline, mean systolic blood pressure was 144 mm Hg, and about three quarters of the patients had histories of hypertension.

As expected, the average systolic blood pressure was lower in the telmisartan group than in the placebo group, by 5.4 mm Hg at 1 month and 4.0 mm Hg at 1 year. At a mean follow-up of 30 months, a first recurrent stroke (the primary outcome) occurred in 8.7% of the telmisartan group and 9.2% of the placebo group (hazard ratio, 0.95; P=0.23). Cardiovascular events occurred in 13.5% of the telmisartan group and 14.4% of the placebo group. Mortality was similar in the two groups. Over the course of the study, more patients in the telmisartan group than in the placebo group discontinued study medications, primarily because of hypotensive symptoms. No interaction was found with the results of the antiplatelet arm of the same trial (JW Cardiol Aug 27 2008).

Comment: These results show yet again that improvement in a risk factor may not translate into patient benefit, and they substantiate the importance of testing specific strategies. In patients with stroke and modest elevations of systolic blood pressure, treatment with telmisartan failed to confer a clinical benefit over 30 months, even though the intervention lowered blood pressure. We also cannot determine from this study whether such outcomes are specific to telmisartan or might be found with all ARBs.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology August 27, 2008

To learn about healthy products and savings that can help contribute to the prevention of cardiac problems to go www.shaklee.net/zaranis

Jennifer Zaranis

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Low Serum Vitamin D to Increased Hip Fracture Risk in Postmenopausal Women

August 19, 2008 · Filed under Uncategorized · Tagged , , , , , , , , ,

Low Serum Vitamin D Linked to Increased Hip Fracture Risk in Postmenopausal Women

Low serum vitamin D is associated with increased hip fracture risk, according to a nested case-control study in Annals of Internal Medicine. 

 

 

After adjustment for confounders including age, BMI, and calcium intake, hip fracture risk was significantly higher among women in the lowest quartile of vitamin D relative to those in the highest quartile (odds ratio, 1.7). The vitamin D–hip fracture link persisted even when frailty, physical function, and number of falls were taken into account.

 

The authors list several study limitations — for example, they were unable to test whether bone mineral density mediated the association between low vitamin D and hip fracture.

 

Annals of Internal Medicine

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August 19, 2008 · Filed under Uncategorized · Tagged , , , , , , , ,

Prehypertension and Hypertension in Adolescents

An estimated 7% of prehypertensive adolescents develop hypertension annually.

 

Hypertension often goes undiagnosed in children (JW Pediatr Adolesc Med Aug 29 2007). An important question is the extent to which sporadically elevated blood pressure (BP) persists in adolescents. In this study, investigators examined the persistence of hypertension (systolic or diastolic BP ≥95th percentile) or prehypertension (systolic or diastolic BP ≥90th percentile or ≥120/80 mm Hg but lower than the threshold for hypertension) in 8533 adolescents whose BP was measured at age 13, 14, or 15 and repeated 2 and 4 years later.

Initially, 67% of boys and 77% of girls were normotensive; most remained normotensive at 2 years, but 31% and 12% were prehypertensive at 2 years, and 5% and 4% had developed hypertension. Among boys and girls initially classified as prehypertensive (21% and 13%, respectively), 50% and 24% remained prehypertensive at 2 years, and 14% and 12% had developed hypertension. Among those who were initially hypertensive (11% of boys and 10% of girls), 31% and 26% remained hypertensive at 2 years and 47% and 26% were prehypertensive. Among both boys and girls, changes at 4 years were similar to those at 2 years and systolic BP was associated significantly with weight gain.

Comment: Although these data were based on single BP measurements and probably overestimate the prevalence of elevated BP in adolescents, analysis of follow-up measurements suggests that about 7% of prehypertensive adolescents become hypertensive annually. The message is that BP should be measured in adolescents at every healthcare visit.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 13, 2008

Citation(s):

Falkner B et al. Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics 2008 Aug; 122:238.

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