It started with a blister on his big toe. Unbeknownst to Reynaldo Reyna, it was the sign of something bigger. But Reyna is a roof inspector. He spends his days walking buildings and warehouses in North Texas and across the country.
To him it was just a blister that wouldn’t go away, he said.
“I’ve had a lot of problems with my legs for a long time,” he said, “I just worked until I got tired, then I would get right up again. I thought I could just work around it.”
After about a month of discomfort, he went to the doctor, who referred him to a specialist in Fort Worth. After undergoing an angiogram, an X-ray of blood flow, the doctor said they would have to amputate his leg. At that point, Reynes was poorly controlling his diabetes and his chronic myopathy. This neglect resulted in total artery blockage in his right leg arteries, from his knee down to his right foot.
An amputation meant the end of Reyna’s career, his livelihood, his quality of life.
At this point, Reyna’s blister had escalated into an open wound. He was referred to the Wound Care Center at Texas Health Plano, where he was referred to Dr. Vijay Ramanath for Second Opinion.
As an intraventricular cardiologist, Ramanath’s specialty is clearing clogged arteries. In his career, he’s seen patients just like Reyna with 100 percent blockages in their arteries, and his solution wasn’t amputation.
“He was willing to take the risk,” Reyna said.
To fix a blocked artery, doctors must carefully drill through the plaque built up to create a pathway for blood to flow.
“We basically had to recreate the whole artery for him, which, fortunately, we were able to do and restore blood flow to his heel,” he said.
To Ramanath, it was simply a challenge he’d faced before and conquered. Thanks to Reyna’s young age – anything below 75 in the medical world is young – Ramanath said his arteries were in solid shape for surgery.
“Fortunately for Reyna, since he’s south of 60, he hasn’t had as much time for all this blockage to form,” he said. “So because of that, it didn’t put up as much of a fight.”
It took two procedures, but Ramanath was able to clear the blockages. The blockage did cost Reyna his big toe, but he’s still able to walk his roofs and do his work.
As the leader of the hospital’s Limb Salvage Program, Ramanath said he and doctors like him work to help cases like Reyna, “to get back people’s lives, especially those who have young families, that have full-time jobs. We want them to get back to their way of life.”
Since the surgery, Reyna said he’s completely turn around his lifestyle. He eats better and exercises regularly and he’s keeping his diabetes under control.
“The biggest lesson here was that diabetes is serious,” he said. “You need to take care of yourself. The bottom line: If you do what the doctor says, you exercise and eat right, live right, then you’ll be alright.”
https://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.png00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 08:59:512020-07-10 08:59:51Second Opinion Saves Man From Double Amputation!!
As a young girl growing up in Buffalo, New York, Devan Brady’s bedtime story selection was more a survey of American literature than preschool perennials. She remembers her father reading Moby-Dick to her when she was just 3 years old.
“My dad went for the big guns,” Devan says. “The bigger the book, the better.” These adventures unleashed Devan’s imagination. As she grew older, she saw some of her favorite books, such as the Harry Potter series, leap from the page to the big screen. Devan knew there was only one path forward for her: creating magical worlds for kids who love to escape through books and film, just like she did.
But after graduating from college in 2016 with a degree in media production, a medical scare threatened to steal this dream from Devan.
An avid traveler, Devan was on a flight to Japan in January when her legs kept falling asleep, which she knew was common, but the frequency and severity were still puzzling. Several months later in August, Devan was working three part-time jobs: production assistant on a local film crew, wedding photographer and restaurant server. While on her feet for a restaurant shift, Devan felt her legs go numb again. She didn’t regain full sensation for several hours.
Worried, Devan called her local primary care provider, who ran some blood and imaging tests. The results were normal, but her doctor referred Devan to a neurologist for further evaluation.
In the weeks between appointments, Devan didn’t experience any additional episodes and started thinking she was in the clear. After completing a more rigorous set of tests with the neurologist, Devan expected to hear that she had something relatively simple like a pinched nerve. She didn’t expect to leave his office with a diagnosis of the autoimmune disease neuromyelitis optica, more commonly known as NMO.
NMO occurs when the body’s immune system produces a molecule called an antibody that mistakenly targets healthy tissue. Antibodies normally attack targets such as cancer or infection so that the immune system can clear those damaged cells out of the body. But with NMO, these antibodies attach to healthy tissue in the central nervous system, mainly in the optic nerves and spinal cord, but sometimes in the brain, too. As a result, people can experience blindness, weakness or paralysis in the legs or arms, and painful spasms.
An Uncertain Future
“For the whole month of October, I was on edge, nervous,” says Devan. “NMO is a serious disease, and to tell a 22-year-old girl that you could lose your eyesight or use of your legs, that’s scary. What is my life going to be like? I’m going to live in constant fear of losing the ability to do what I love.”
While the neurologist couldn’t confirm the diagnosis through an MRI, Devan tested positive for the NMO antibody in two blood tests, so he prescribed an immune system-suppressing drug to inactivate the circulating antibodies and stop their production, which in turn could prevent further attacks.
A lifetime of taking powerful drugs was just as startling to Devan as the diagnosis. Because her local neurologist had only seen a handful of patients with NMO in the last decade, Devan and her father, a nurse with the Veterans Health Administration, began researching options for a Second Opinion. Through friends and her father’s colleagues, Devan learned about Mayo Clinic’s Department of Neurology and its expertise in NMO.
For at least the last 75 years, what is now known as a spectrum of NMO disorders — sometimes called Devic’s disease — was commonly misdiagnosed as multiple sclerosis (MS). Because MS is treated with medication that boosts immune system action, these therapies could be ineffective and even harmful in the case of NMO. In 2005, physician-scientists and basic researchers at Mayo Clinic discovered a unique antibody specific to NMO. This breakthrough allowed for the development of a diagnostic test, ensuring that NMO patients get the right treatment right away.
“Especially since the test for NMO was created at Mayo Clinic, we thought if anyone would know about this, they would,” Devan says.
Scene Two
Devan and her father made the trip to Rochester, Minnesota, in November and met with neurologists B. Mark Keegan, M.D., and Natalie Parks, M.D., a former Mayo Clinic fellow now at Dalhousie University in Canada. As a provider in Mayo’s Division of Multiple Sclerosis and Autoimmune Neurology, Dr. Keegan regularly sees patients seeking second opinions for diagnoses ranging from multiple sclerosis to NMO and a variety of rare inflammatory diseases affecting the central nervous system.
The team explained that Dr. Parks would do an in-depth examination with Devan and discuss the results with Dr. Keegan. Then, Dr. Keegan would do a second examination.
After comparing their notes on Devan’s medical history and physical tests, Dr. Keegan shared the team’s conclusion.
“He said, ‘If you would have come here after that first day that you had issues and told me your symptoms, I never would have even thought to test for NMO. But because your doctor did, and the result was positive, now we have to deal with it,'” Devan recalls.
The first step was to repeat Devan’s bloodwork, but this time using a much more sophisticated version of the NMO test, which Mayo Clinic has continuously refined over the past decade. If the test came back positive, Dr. Keegan would perform an MRI to look for lesions on her spine. If it came back negative, he would be reasonably confident that Devan did not have NMO. Because getting the blood test results would take a few days, Devan and her father returned to Buffalo to await the news.
A week later, Devan was back at work on a film set when she got a call from Mayo Clinic. It was Dr. Parks with her test results: Devan did not have NMO.
Listening to Dr. Parks explain that the local test results were false positives, Devan started crying tears of relief. She immediately called her father, who interpreted the emotion in Devan’s voice as a bad sign.
“He was like, ‘It’s OK, it’s OK. We’ll book a flight to Rochester.’ And I was saying, ‘No, Dad, the test was negative.’ And I just heard him go, ‘Woo-hoo!’ Like, screaming on the phone.”
Dr. Keegan called a few days later to reassure Devan of the results. In his opinion, Devan’s local neurologist likely relied too heavily on the less sophisticated blood test to make a diagnosis and didn’t factor in the complete picture — Devan’s normal medical history, evaluations and MRI test, plus the fact that Devan’s symptoms were nonspecific to NMO.
Devan has been in good health since then, which she credits to staying active and sticking to her workout routine. She now says her only fear for the future is the same as any post-college graduate’s: finding a job.
But armed with the same boundless imagination that fueled her childhood dreams, she knows the possibilities are limitless.
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 08:54:372020-07-10 08:54:37Second Opinion Shifts Film School Graduate’s Outlook !!
An unusual silence fills the waiting area of my fellow pediatrician’s office in suburban Maryland. On a typical day, one would expect to see the animated bustle of children. Nowadays, only two out of 10 scheduled visits might take place. Unused vaccine vials rapidly accumulate as families shelter at home.
With lockdowns and fears of the pandemic, this scene has been playing out in pediatricians’ offices around the country.
Data from the Centers for Disease Control and Prevention’s Vaccine Safety Datalink show an almost 50 percent drop in children being vaccinated for measles during the first quarter of 2020, compared with the same period in 2019.
This situation also unfolded across the world as countries ordered lockdowns of varying severity. At least 25 countries suspended mass measles immunization campaigns in the face of the pandemic as of late last month, according to UNICEF. As the coronavirus continues its relentless spread, leaving death and economic devastation, other ancient diseases may gain a foothold as vaccination rates drop precipitously.
Measles can cause pneumonia, swelling of the brain and death. Very young children and susceptible adults are more likely to suffer from these complications. Like the coronavirus, it is spread person-to-person through droplets in the air. But the measles virus is about 10 times more transmissible than the coronavirus, and often deadlier. Vaccination coverage of up to 95 percent is needed to prevent measles transmission in communities.
Before the pandemic, global measles cases were already surging, reaching an estimated 10 million in 2018 with 140,000 measles-related deaths — a 58 percent increase from the previous two years. Although measles was all but eliminated in the United States in 2000, misinformation and a loss of public trust in vaccines resulted in 1,200 cases of measles in 2019 — the highest number in almost three decades.
In recent years, many measles cases entered the United States from foreign travel destinations. Now, with diminished vaccinations of children causing a wider gap in community immunity, there is clear and present danger that hard-won gains could be reversed. As schools start reopening their doors, vaccination rates among children could improve. However, school vaccination requirements are not ironclad; medical and nonmedical exemptions will leave some children unprotected. Public understanding of this risk and improved confidence in vaccines is crucial.
And yet, the anti-vaccine movement has seized on the Covid-19 pandemic as a rallying point, inexplicably arguing against any vaccine that may be developed. The assertions are baseless and endanger public health.
At the same time, other deadly scourges lurk in the shadows. Poliomyelitis, one of the most feared diseases of the early 1900s, was headed toward global eradication, with only a few remaining pockets of transmission in the world. Now these clusters are expanding. The Global Polio Eradication Initiative’s interactive map indicates that polio cases have increased this year. Diphtheria, another deadly disease of the early 20th century, has resurged recently in places like Venezuela, Bangladesh and Yemen, where state failure, conflict or the displacement of populations have severely weakened public health systems.
The danger is that the continuing pandemic will disrupt immunizations and monitoring of infectious diseases, which could lead to the further spread of these ancient diseases into new populations instead of being consigned to history.
No example from the recent past could be more poignant than the West African Ebola virus disease outbreak in 2014, whose devastating impact extended far beyond just Ebola cases and deaths. Ebola overwhelmed local health care systems, while societal stigma and anxiety led to reduced vaccination. An estimated 200,000 cases of measles may have resulted because of these disruptions.
And then, in 2019, twice as many children died from a fast-moving outbreak of measles in the Democratic Republic of Congo than from an Ebola outbreak there that received far more public attention.
As the pandemic advances and universal immunization keeps slipping worldwide, preventable diseases in children will keep surging in the background. Many outpatient dispensaries and vaccination clinics were shuttered as health care systems shifted to support the response to the coronavirus, public transport became unavailable, and fear of Covid-19 became rife. The World Health Organization says routine immunization services should be prioritized, yet estimations indicate that over 100 million children around the world are unlikely to receive their basic vaccines.
The Greek historian Thucydides vividly described the plague of Athens of 430 B.C. He attributed the strikingly deadly toll not just to disease but also to the failed societal response. History can be instructive, but only if we take its lessons seriously.
Avoiding vaccine-preventable deaths is critical for nations to preserve their gains in child survival. To do so, governments should establish vaccination as an essential service and reinstate services to stop diseases from re-emerging, particularly among vulnerable populations. Next, while Covid-19 control measures are being instituted, countries must catch up on missed immunizations. Third, governments should improve how they communicate with the public, to allay concerns about vaccinations and re-establish community demand for them.
Finally, health agencies should expand collaborations with nutrition, education and other government operations — and especially with regional and national governments. Disease surveillance within and across nations is essential to these public health efforts. Neither the coronavirus nor the measles virus respects geographic boundaries.
In the face of the current pandemic, it can be easy to lower our guard against the potential for future public health disasters. We cannot let that happen. Governments at all levels must work together to protect children from the deadly preventable scourges we have done so much to eradicate.
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 08:39:382020-07-10 08:39:38Will The Pandemic Lead To Outbreaks Of Other Maladies?
Apart from the many benefits of doing exercise, new research has now found that exercise can slow down or prevent the development of macular degeneration and may benefit other common causes of vision loss, such as glaucoma and diabetic retinopathy.
The new study from the University of Virginia School of Medicine found that exercise reduced the harmful overgrowth of blood vessels in the eyes of lab mice by up to 45 per cent. This tangle of blood vessels is a key contributor to macular degeneration and several other eye diseases.
The study represents the first experimental evidence showing that exercise can reduce the severity of macular degeneration, a leading cause of vision loss, the scientists report. Ten million Americans are estimated to have the condition.
“There has long been a question about whether maintaining a healthy lifestyle can delay or prevent the development of macular degeneration. The way that question has historically been answered has been by taking surveys of people, asking them what they are eating and how much exercise they are performing,” said researcher Bradley Gelfand, PhD, of UVA’s Center for Advanced Vision Science.
“That is basically the most sophisticated study that has been done. The problem with that is that people are notoriously bad self-reporters … and that can lead to conclusions that may or not be true. This [study] offers hard evidence from the lab for the very first time,” Gelfand added.
Enticingly, the research found that the bar for receiving the benefits from exercise was relatively low – more exercise didn’t mean more benefit.
“Mice are kind of like people in that they will do a spectrum of exercise. As long as they had a wheel and ran on it, there was a benefit. The benefit that they obtained is saturated at low levels of exercise,” Gelfand said.
An initial test comparing mice that voluntarily exercised versus those that did not found that exercise reduced the blood vessel overgrowth by 45%. A second test, to confirm the findings, found a reduction of 32 per cent.
The scientists aren’t certain exactly how exercise is preventing the blood vessel overgrowth. There could be a variety of factors at play, they say, including increased blood flow to the eyes.
Gelfand, of UVA’s Department of Ophthalmology and Department of Biomedical Engineering, noted that the onset of vision loss is often associated with a decrease in exercise.
“It is fairly well known that as people’s eyes and vision deteriorate, their tendency to engage in physical activity also goes down. It can be a challenging thing to study with older people. … How much of that is one causing the other?” he said.
The researchers already have submitted grant proposals in hopes of obtaining funding to pursue their findings further.
“The next step is to look at how and why this happens, and to see if we can develop a pill or method that will give you the benefits of exercise without having to exercise,” Gelfand said.
He explained, “We’re talking about a fairly elderly population [of people with macular degeneration], many of whom may not be capable of conducting the type of exercise regimen that may be required to see some kind of benefit.” (He urged people to consult their doctors before beginning any aggressive exercise program.)
Gelfand, a self-described couch potato, disclosed a secret motivation for the research: “One reason I wanted to do this study was sort of selfish. I was hoping to find some reason not to exercise,” he joked. “It turned out exercise really is good for you.”
A new study reveals that the toxic particles can enlarge lymph nodes.
Getting a permanent tattoo can cause toxic nanoparticles to travel inside the body, leading to chronic enlargement of the lymph nodes – an important part of our immune system, a study has warned.
Toxic impurities that make up the ink in tattoos can travel inside the body in the form of nanoparticles and affect the lymph nodes, researchers said.
Little is known about the potential impurities in the colour mixture applied to the skin. Most tattoo inks contain organic pigments, but also include preservatives and contaminants like nickel, chromium, manganese or cobalt.
Besides carbon black, the second most common ingredient used in tattoo inks is titanium dioxide (TiO2), a white pigment usually applied to create certain shades when mixed with colorant, researchers said.
TiO2 is also commonly used in food additives, sunscreens and paints. Delayed healing, along with skin elevation and itching, are often associated with white tattoos, and by consequence with the use of TiO2.
The hazards that potentially derive from tattoos were previously known only by chemical analysis of the inks and their degradation products in vitro.
Researchers at European Synchrotron Radiation Facility (ESRF) in Germany used X-ray fluorescence measurements which allowed them to locate titanium dioxide at the micro and nano range in the skin and the lymphatic environment.
They found a broad range of particles up to several micrometres in size in human skin, but only smaller (nano) particles were transported to the lymph nodes.
This may lead to the chronic enlargement of the lymph node and lifelong exposure, researchers said.
Scientists also used the technique of Fourier transform infrared spectroscopy to assess biomolecular changes in the tissues in the proximity of the tattoo particles.
“We already knew that pigments from tattoos would travel to the lymph nodes because of visual evidence. The lymph nodes become tinted with the colour of the tattoo. It is the response of the body to clean the site of entrance of the tattoo,” researchers said.
“What we didn’t know is that they do it in a nano form, which implies that they may not have the same behaviour as the particles at a micro level. And that is the problem we don’t know how nanoparticles react,” said Bernhard Hesse, from ESRF The study was published in the journal Scientific Reports.
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 06:01:452020-07-10 06:01:45Think Before You Get A Tattoo; Toxic Nanoparticles May Harm Your Immune System
Parental denial is keeping children with special needs from getting help. For the sake of your child don’t listen to people who tell you ‘he’ll catch up’ or ‘just give it time’. At what point do you admit that something is seriously amiss. It’s not an easy call to make, but developmental experts are saying that parental denial is hampering diagnosis, and treatment, of children with special needs.
Ninam was diagnosed with autism at 18 months; he is now nearly 3. His mother Sarita Lama is vehement that parents need to open up to the special needs of their child. “Unless you change, society won’t,” she says.
Early signs that a child may need special care include babies not making eye contact, not responding to people by smiling or gesticulating, delayed speech, focusing intently on something to the exclusion of others for long periods, or making repetitive movements, such as rocking and twirling.
“Four As — awareness, acceptance, action and acknowledgement — are the pillars crucial to supporting differently abled kids. It is very important to empower parents, especially mothers, as they are usually the ones taking care of the child all day,” says Dr Deepak Gupta, consultant child and adolescent psychiatrist at Sir Ganga Ram Hospital.
Identifying the right therapy centre takes time as it is, so the quicker one acts the better.
“Getting the right help at an early stage can change the trajectory of the child’s development and future success in learning and socialisation,” says Jackie Harland, clinical director at the London Learning Centre (LLC) in New Delhi. “It is hard to see children whom you know would make significant progress with the right help, not receiving that support. With the right programme, all children can make progress.”
Three young Delhi mothers share their journeys, from symptoms through diagnoses and finding the right therapy for their babies.
‘Sharing the news has helped’
When Ninam was still not responding to his name at 18 months, Sarita consulted a paediatrician, who suspected autism spectrum disorder and referred her son to a psychiatrist.
“I had no clue what autism was, so I went home and Googled to read up,” says mother Sarita Lama. “The next day, we went to a therapy centre to get a psychiatric diagnosis for our son.”
While many prefer to keep such information to themselves, Sarita looped in her friends and family on the day of diagnosis.
“I mailed them reading material so they would be sensitive to Ninam’s needs. Since I was proactive, my friends have also started forwarding interesting information they come across,” says Sarita, who now actively uses Facebook and WhatsApp to spread awareness about autism.
“I also regularly share updates on my son’s progress. I know he will never outgrow it; some issues will always be there. I just want him to be as independent and self-sufficient as possible.”
The biggest parenting challenge for her is that Ninam has trouble sleeping, which also affects her sleep. “I thought it would pass but it’s been two years and eight months since I slept well, which makes me physically and emotionally exhausted. There are days when you feel very down but then you push yourself, especially when you hear about children who’ve overcome challenges,” says Sarita, who gave up her job as a teacher in Delhi’s Nirmal Bharti School to spend time with her son.
With therapy, Ninam can now communicate his basic needs. “He comes to the kitchen and says ‘I want food’, which is a huge achievement,” she says.
‘If you start late, everything will take longer’ Kalpana Jacob discovered that her son Zach was not able to form words when he was 18 months old. “Zach was doing fine till the age of one, and then there was a big lag. He even stopped saying words he had said earlier. He turned hyperactive, running around as an excuse for not talking,” Jacob says.
She adds that it helped that she had friends and family who didn’t sympathise but rather supported. “They are sensitive to his needs but are also firm when required.”
Not being able to talk made him under-confident, which made him socially withdrawn. “But since he is also a sensory seeker with sensory needs, certain things calm him down, like play dough. We let him play in the mud without worrying about his immunity. That helps,” says Kalpana, who runs an organization that offers life skills and leadership training to teenagers though music and storytelling.
Her experience has taught her that early intervention is key to helping children meet their development goals and integrate socially.
“As parents, you must watch for signs, however small, and track milestones,” she says. “You shouldn’t listen when people say your child will catch up. If you start late, everything will take longer — the child will learn to socialise late and may become withdrawn.”
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 05:56:162020-07-10 05:56:16Don’t ignore early signs. Think your baby’s missed a milestone? See a doctor
What if a single injection could lower blood levels of cholesterol and triglycerides — for a lifetime?
In the first gene-editing experiment of its kind, scientists have disabled two genes in monkeys that raise the risk for heart disease. Humans carry the genes as well, and the experiment has raised hopes that a leading killer may one day be tamed.
“This could be the cure for heart disease,” said Dr. Michael Davidson, director of the Lipid Clinic at the University of Chicago Pritzker School of Medicine, who was not involved in the research.
But it will be years before human trials can begin, and gene-editing technology so far has a mixed tracked record. It is much too early to know whether the strategy will be safe and effective in humans; even the monkeys must be monitored for side effects or other treatment failures for some time to come.
The results were presented on Saturday at the annual meeting of the International Society for Stem Cell Research, this year held virtually with about 3,700 attendees around the world. The scientists are writing up their findings, which have not yet been peer-reviewed or published.
The researchers set out to block two genes: PCSK9, which helps regulate levels of LDL cholesterol; and ANGPTL3, part of the system regulating triglyceride, a type of blood fat. Both genes are active in the liver, which is where cholesterol and triglycerides are produced. People who inherit mutations that destroyed the genes’ function do not get heart disease.
People with increased blood levels of triglycerides and LDL cholesterol have dramatically greater risks of heart disease, heart attacks and strokes, the leading causes of death in most of the developed world. Drug companies already have developed and are marketing two so-called PCSK9 inhibitors that markedly lower LDL cholesterol, but they are expensive and must be injected every few weeks.
Researchers at Verve Therapeutics, led by Dr. Sekar Kathiresan, the chief executive, decided to edit the genes instead. The medicine they developed consists of two pieces of RNA — a gene editor and a tiny guide that directs the editor to a single sequence of 23 letters of human DNA among the genome’s 32.5 billion letters.
The RNA is shrouded in tiny lipid spheres to protect the medicine from being instantly degraded in the blood. The lipid spheres travel directly to the liver where they are ingested by liver cells. The contents of the spheres are released, and once the editor lands on its target, it changes a single letter of the sequence to another — like a pencil erasing one letter and writing in another.
Not only did the system work in 13 monkeys, the researchers reported, but it appeared that every liver cell was edited. After gene editing, the monkeys’ LDL levels dropped by 59 percent within two weeks. The ANGPTL3 gene editing led to a 64 percent decline in triglyceride levels.
One danger of gene editing is the process may result in modification of DNA that scientists are not expecting. “You will never be able to have no off-target effects,” warned Dr. Deepak Srivastava, president of the Gladstone Institutes in San Francisco.
In treating a condition as common as heart disease, he added, even an uncommon side effect can mean many patients are affected. So far, however, the researchers say that they have not seen any inadvertent editing of other genes.
Another question is how long the effect on cholesterol and triglyceride levels will last, Dr. Davidson said. “We hope it will be one-and-done, but we have to validate that with clinical trials,” he said.
Jennifer Doudna, a biochemist of the University of California, Berkeley, and a discoverer of Crispr, the revolutionary gene editing system, said: “In principle, Verve’s approach could be better because it’s a one-time treatment.”
But it is much too soon to say if it will be safe and long-lasting, she added.
If the strategy does work in humans, its greatest impact may be in poorer countries that cannot afford expensive injections for people at high risk of heart disease, said Dr. Daniel Rader, chairman of the department of genetics at the University of Pennsylvania and a member of Verve’s scientific advisory board.
Dr. Kathiresan, of Verve, noted that half of all first heart attacks end in sudden death, making it imperative to protect those at high risk.
Dr. Kathiresan began the research at the Massachusetts General Hospital and the Broad Institute, where he and his colleagues found a collection of genes that increase risk of heart attack at a relatively young age, as well as eight genes that, when mutated, decrease risk.
Those protective genes, he reasoned, could be targets for gene editing if there were a way to alter them in people. Gene editing is only now succeeding, and so far its successes have been in rare diseases.
Other investigators and companies have tried editing genes in mice to prevent heart disease, with some success, but primates are a much more difficult challenge.
Dr. Kathiresan said that to his knowledge, his study is the first to use the pencil-and-eraser type gene editing in primates for a very common disease. Verve licensed the technology, called base editing, from Beam Therapeutics.
If all goes well, Dr. Kathiresan hopes in a few years to begin treating people who have had heart attacks and still have perilously high cholesterol. For them, the risk of another heart attack is so high that the possible benefit may far outweigh the risks of the treatment.
Heart disease generally occurs only after decades of high cholesterol levels, Dr. Davidson noted. By age 50, people most likely to have a heart attack already have a significant accumulation of plaque in their arteries.
But if the PCSK9 gene could be knocked out in 20-year-olds, he said, “there would be no heart disease in their future.”
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 05:47:072020-07-10 05:47:07A ‘Cure for Heart Disease’? A Single Shot Succeeds in Monkeys!!
The damage in teenagers occurs at blood pressure levels that are below the clinical definition of hypertension in the age group. Teenagers are at risk of heart and vessel damage as well.
Is your teenage son or daughter suffering from high blood pressure? Beware, if left uncontrolled the condition can lead to organ damage as in adults, according to a research. The findings showed that organ damage — damage to the heart and blood vessels — from high blood pressure does not only occur in adults, but also in teenagers.
Importantly, the damage in teenagers occurs at blood pressure levels that are below the clinical definition of hypertension in the age group, the researchers said. “Some adolescents may have organ damage related to blood pressure and are not targeted for therapy,” said Elaine M. Urbina, Director at the Cincinnati Children’s Hospital in Ohio. “Imaging of the heart may be useful in youth in the high-normal range of blood pressure to determine how aggressive therapy should be.” High blood pressure in teenagers is defined on the basis of percentiles, rather than blood pressure level as in adults.
In the study, presented at the 2017 American Heart Association (AHA) Council on Hypertension in San Francisco, the team looked at whether organ damage in teens develops below the 95th percentile — the clinical definition of high blood pressure in teenagers. The researchers examined blood pressure and measured organ damage in 180 teenagers (14-17 years old, 64 per cent white, 57 per cent males). The results showed evidence of organ damage even among the youth categorised as “normal” with blood pressure less than in the 80th percentile. It also revealed heart and vessel damage in the mid-risk group, which had blood pressures in the 80th to 90th percentiles and the high-risk group, with blood pressures above the 90th percentile.
https://imedworks.com/wp-content/uploads/2020/03/MedWorks-Logo-v1.png400400seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 05:31:552020-07-10 05:31:55High BP can cause organ damage in teenagers too
The move follows a health ministry review of diagnostic facilities in four states– Gujarat, Tamil Nadu, Madhya Pradesh and Jharkhand. The Union health ministry has decided to upgrade and modernise at least one diagnostic laboratory in each district across India to fast-track diagnosis, especially during an epidemic.
These “model labs” can then be replicated across health centres and hospitals across states, which will help reduce overcrowding of tertiary care hospitals due to referrals.
“The lab of one district hospital will be upgraded with a focus on strengthening microbiology, pathology and biochemistry. States can select and choose the one they want to upgrade first and can later replicate the model in other district hospitals,” said Dr Jagdish Prasad, director general of health services (DGHS).
The move follows a health ministry review of diagnostic facilities in four states– Gujarat, Tamil Nadu, Madhya Pradesh and Jharkhand.
“The assessment report found some labs didn’t have equipment while the others did not have adequately trained staff to handle those sophisticated machines. Maintenance is also a big problem, as a result many expensive equipment lie unused and people are referred to far-off places for tests,” said Prasad.
On October 25, the DGHS reviewed technical advisory group meeting for integrated laboratories at the district level, and asked for response from the states.
The project is expected to take about six months to complete, and will be spearheaded by director National Centre for Disease Control (NCDC) and his team.
“Health is a state subject, so the project can’t materialise without taking the states on board. We have asked the states to choose districts as per their requirement. We will show them it is possible to create facilities with a limited budget and produce high-class test reports,” he says.
As part of the greater plan, the health ministry will also mentor a medical college in each state and train doctors, nurses, paramedical and technical staff, who can further train their peers in other hospitals.
“We want to standardise medical colleges and hospitals attached to them. This will be a good way to ensure all of them follow a standard protocol. All these hospitals and labs will gradually be integrated to benefit patients in the long run,” said Prasad
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 01:14:422020-07-10 01:14:42Health Ministry to set up ‘model lab’ in each district to fast-track diagnosis
According to a study seasonal-dependent behaviours such as reduced physical activity and dietary changes could also play a role in the increased occurrence of heart attack during colder weather.
The body responds to cold by constricting superficial blood vessels, which decreases thermal conduction in the skin and subsequently increases arterial blood pressure. Other responses are shivering and increased heart rate, which raise the metabolic rate and in turn increase body temperature.
The risk of suffering a heart attack is more likely to peak in the winter season and decline in summers because air temperature acts as an external trigger for the life threatening disease, an analysis has shown. The findings revealed that the average number of heart attacks per day was significantly higher during colder temperatures as compared to warmer. When the daily temperature dropped to less than zero degree Celsius, the average rate of heart attacks a day peaked to four, as compared to when it was above 10 degrees. Furthermore, the occurrence of heart attacks increased with higher wind velocities, limited sunshine duration and higher air humidity.
“There is seasonal variation in the occurrence of heart attack, with incidence declining in summer and peaking in winter,” said lead author Moman A. Mohammad, from the Lund University in Sweden. “Our results consistently showed a higher occurrence of heart attacks in sub-zero temperatures. The findings were the same across a large range of patient subgroups, and at national as well as regional levels, suggesting that air temperature is a trigger for heart attacks,” Mohammad added. The body responds to cold by constricting superficial blood vessels, which decreases thermal conduction in the skin and subsequently increases arterial blood pressure. Other responses are shivering and increased heart rate, which raise the metabolic rate and in turn increase body temperature, the researchers explained.
“In the majority of healthy people these mechanisms are well tolerated. But in people with atherosclerotic plaques in their coronary arteries they may trigger a heart attack,” Mohammad noted. Respiratory tract infections and influenza are also known risk factors for heart attack that have a clear seasonal variation. “In addition, seasonal-dependent behaviours such as reduced physical activity and dietary changes could also play a role in the increased occurrence of heart attack during colder weather,” Mohammad said.
The results were presented at the European Society of Cardiology Congress in Barcelona. For the study, the team investigated the association between heart attack incidence and weather conditions such as air temperature, sunshine duration, precipitation, and air pressure in more than 2,80,000 patients.
00seshunarayanahttps://imedworks.com/wp-content/uploads/2020/09/MedWorks-Logo-02-300x300.pngseshunarayana2020-07-10 00:48:202020-07-10 00:48:20Why heart attacks are more prevalent in winters
