Archive for September, 2008

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

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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Allopurinol Lowers Blood Pressure in Mild Hypertension

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

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

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Which Short-Chain Carbs are the Villains in IBS?

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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