Monday, March 31, 2008

New Blood Pressure Medication Has Fewer Side Effects, Global Study Suggests

ScienceDaily (Apr. 1, 2008) — A major Canadian-led global study has found that a new blood pressure medication is effective in reducing cardiovascular death, with fewer side effects than the current standard of care.

The study found a new drug telmisartan is as effective as the popular drug ramipril in reducing cardiovascular death in high risk patients and it has fewer side effects.
Dr. Salim Yusuf, director of the Population Health Research Institute at McMaster University and Hamilton Health Sciences and principal investigator of the study, presented the results of ONTARGET March 31 at the American College of Cardiology conference. The paper has also been published on-line by the New England Journal of Medicine.

Previous studies such as the Heart Outcomes Prevention Evaluation Trial (HOPE) demonstrated that angiotensin converting enzyme (ACE) inhibitors such as ramipril reduce cardiovascular death, myocardial infarction, strokes and heart failure in high risk individuals, however, a significant proportion (about 20 percent) of patients are unable to tolerate an ACE-inhibitor due side effects such as coughing, hypotension or swelling.

An alternate therapy, telmisartan, which is an angiotensin II receptor blocker, proved to be at least as effective and better tolerated, offering clinicians and patients an important alternative.
"This study is of clinical importance because it demonstrates that telmisartan is an effective and safe alternative to ramipril. This means both patients and physicians have choices and can use telmisartan where appropriate with a high degree of confidence," said Yusuf, a professor of the Michael G. DeGroote School of Medicine at McMaster. Dr. Yusuf is also vice-president of research and chief scientific officer at Hamilton Health Sciences.

Investigators from 733 centers in 40 countries collaborated in conducting the ONTARGET study, which enrolled 25,620 patients with coronary heart disease or diabetes plus additional risk factors and were over the age of 55 years of age, but did not have evidence of heart failure. Patients were randomized to receive ramipril 10-mg a day, telmisartan 18-mg a day or the combination of the two. The mean duration of follow-up of the study was 55 months.

Telmisartan and ramipril were found to be equally effective but telmisartan was better tolerated than ramipril with the chief differences being lower rates of coughing and lower rates of angioneurotic edema (a life-threatening swelling of the throat and airways).

There was a small excess of minor symptoms related to hypotension such as dizziness with telmisartan.

"All people who have cardiovascular disease or diabetes with organ target damage and physicians managing these diseases should be interested in the results of this important trial," said Dr. Gilles Dagenais, cardiologist at the Laval University Heart and Lung Institute, Quebec City, and one of the Canadian national co-ordinators of the ONTARGET trial. "If it's possible to have access to a medication that can prevent serious cardiovascular events but with fewer side effects and better compliance than what's currently available, it will also have a great impact on their quality of life."

Dr. Koon Teo, professor of medicine at McMaster University and head of clinical trials in the Population Health Research Institute at Hamilton Health Sciences, said: "The ONTARGET trial is very important because it addresses the question of how we can best prevent heart attack, stroke, heart failure, cardiovascular death and other outcomes such as diabetes. These conditions affect millions of people around the world and if we can find a better treatment that improves these outcomes we're doing a lot of good."

Surprisingly, combination therapy did not offer any additional benefit but was associated with a higher rate of hypotension related side effects including fainting. There was also an increase in discontinuations for hyperkalemia (high potassium levels).
Adapted from materials provided by McMaster University, via EurekAlert!, a service of AAAS.

Source: McMaster University. "New Blood Pressure Medication Has Fewer Side Effects, Global Study Suggests." ScienceDaily 1 April 2008. 31 March 2008

Sunday, February 3, 2008

What is pseudo sciatica?

Sciatica is often confused as a disease. However, sciatica is actually a symptom of a disease commonly understood as compression of the sciatic nerve. This is mainly caused by a slipped or a herniated disc. Sciatica pain transmits from low back, via one of the buttocks, along the path of the sciatic nerve at the back of a leg down to the toes. The pain can be excruciating and can aggravate on exertion. In severe cases the lower back can also get ‘locked’ in a sideways bending position.

However, conditions other than a compressed sciatic nerve can also create symptoms of pain that mimic the typical sciatica pain. Sciatica-like pain may be triggered if the nerve gets trapped along its path. And for some reason sciatica has become a general term that is used for any pain that is associated with the buttocks and the legs.

Pseudo sciatica is the compression of the peripheral sections of the sciatic nerve. The tension in the soft tissue of the piriformis, gluteal and other related muscles is usually the cause behind it. Such tension may be caused by unhealthy postures, sports activity and lack of exercise.

* Sitting or standing in a particular position for long periods.
* Protruding the head for peering at the computer screen.
* Regularly lifting the baby out of the back car seat.
* Sitting with wallet in the back pocket.
* Sitting on chairs with a high seat that puts constant pressure on hamstrings.

Gluteal muscles are large skeletal muscles that form the buttocks and help in thigh movement. They run from the pelvis to the hip and are responsible for stabilizing the thigh during walking. Walking too fast or for too long, especially on hard and rough surfaces, can activate hip pain. Holding the foot on the car accelerator may also result in immobilization of the gluteal muscles.

Psoases are two muscles of the abdomen and pelvis that flex the trunk and rotate the thigh. These muscles are continually shortened by sitting for long periods in a reclined position in sloping chairs or sleeping in a fetal position. Tension in these muscles can activate trigger points causing sciatica like pain.

Such conditions cause, what is known as, pseudo sciatica.

The standard treatment for pseudo sciatica is similar to sciatic nerve treatment with more emphasis on stretching exercises, anti inflammatory drugs and massages. Sciatica alternative remedies like herbal massages, yogic exercises, chiropractic manipulations and homeopathic treatment can play a pivotal role in treating pseudo sciatica. All treatment is followed by correcting faults in the gait of the patient and occupational positions.


Monday, January 28, 2008

Baby's IQ Raised by Breastmilk and Genes

Gene found to account for higher IQ in breastfed infants

Durham, NC -- The known association between breast feeding and slightly higher IQ in children has been shown to relate to a particular gene in the babies, according to a report this week in the Proceedings of the National Academy of Sciences.

In two studies of breast-fed infants involving more than 3,000 children in Britain and New Zealand, breastfeeding was found to raise intelligence an average of nearly 7 IQ points if the children had a particular version of a gene called FADS2.

"There has been some criticism of earlier studies about breastfeeding and IQ that they didn't control for socioeconomic status, or the mother's IQ or other factors, but our findings take an end-run around those arguments by showing the physiological mechanism that accounts for the difference," said Terrie Moffitt, a professor of psychological and brain sciences in Duke University's Institute for Genome Sciences and Policy.

Moffitt, who performed the research with her husband and co-author Avshalom Caspi at King's College in London, found that the baby's intellectual development is influenced by both genes and environment or, more specifically, by the interaction of its genes with its environment.
"The argument about intelligence has been about nature versus nurture for at least a century," Moffitt said. "We're finding that nature and nurture work together."

Ninety percent of the children in the two study groups had at least one copy of the "C" version of FADS2, which yielded higher IQ if they were breast-fed. The other 10 percent, with only the "G" versions of the gene, showed no IQ advantage or disadvantage from breastfeeding.
The gene was singled out for the researchers' attention because it produces an enzyme that helps convert dietary fatty acids into the polyunsaturated fatty acids DHA (docosahexaenoic acid) and AA (arachidonic acid) that have been shown to accumulate in the human brain during the first months after birth.

Since the first findings about breastfeeding and IQ appeared a decade ago, many formula makers have added DHA and AA fatty acids to their products. The children in these studies however were born in 1972-73 in New Zealand and 1994-95 in England, before fatty acid supplementation in formula began.

Though the jury is still out on whether such supplementation has made a difference in humans, laboratory studies in which rodents and primates were fed supplemental fatty acids have shown increased brain DHA concentrations and enhanced abilities in tests of learning, memory and problem-solving.

"Our findings support the idea that the nutritional content of breast milk accounts for the differences seen in human IQ," Moffitt said. "But it's not a simple all-or-none connection: it depends to some extent on the genetic makeup of each infant."

Moffitt and Caspi joined the Duke faculty in August, but are finishing up their research in London before moving to Durham in December.

Moffitt noted that the researchers aren't particularly interested in IQ or breastfeeding, per se. Rather, this study fits into a body of work they have done on gene-environment interactions and the brain.

"We're more interested in proving to the psychiatric community that genes usually have a physiological effect," Moffitt said. "When looking at depression or intelligence, the key bit that's often left out here is the environmental effects."

The research was supported by the National Institute of Mental Health (US), the Medical Research Council (UK), and the Health Research Council (New Zealand).
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