Monthly Archives: May 2013

Sleep And Depression

Scientists sleep like the rest of us—though Thomas Edison was reported to only do it two hours a day—but how it works is still not well-understood. New discoveries, however, are helping bring us to a more complete understanding of what sleep is. For example, researchers at the RIKEN Brain Science Institute in Japan recently found that a brain region called the lateral habenula plays an important role in the lightest stage of sleep, the rapid eye movement or REM phase, when the best-recalled dreams happen.

When you’re awake, the lateral habenula is one of the parts of the brain that deals with stress and pain, and reacts to unpleasant events. It is heavily involved in processing the neurotransmitter serotonin, which has a number of roles in the brain. Serotonin is associated with happiness and is one of the brain’s “reward chemicals,” part of a feedback system that makes things that are good for the body feel good. For example, eating healthy food—food with a nutrient ratio historically well-suited to the body’s needs—releases serotonin. Serotonin also helps start the sleep cycle and shortens REM sleep periods.

The researchers found that the lateral habenula, by metabolizing serotonin, lowers the levels of the neurotransmitter in the blood; they hypothesized that this may explain part of the connection between depression and insomnia. In many cases, clinical depression is associated with low levels of serotonin. That means the same neurochemical deficit that contributes to depression also makes it harder to fall asleep, and makes the sleep patients do get shallower and less restful.

This connection is stronger since insomnia itself can exacerbate depression; it causes anxiety, also associated with low serotonin, and like depression reduces pleasure in otherwise enjoyable activities. Drugs that increase serotonin levels, such as selective serotonin reuptake inhibitors, which slow the process by which serotonin released in the brain is expended, are used for depression, anxiety, and insomnia. Similarly, a carb-heavy diet increases the body’s production of serotonin, as does exercise, and these things are known to help both sleep and depression.

Scratching The Itch

Itching is a common annoyance that almost every human being experiences at some time or another. Particularly in the summer, insects, sunburn, and other sources of itch make the discomfort a big part of the season. Now a team of scientists at the National Institute of Dental and Craniofacial Research in Bethesda, Maryland think they know what itching is. Their research has found that the ability to feel itching is associated with a protein called neuropeptide natriuretic polypeptide B.

From the body’s perspective, itching is not pain. The neural signaling pathways for itching and pain are different; someone who is hurting and someone who is itching will use different nerves and parts of the brain to process the sensation. The medical community’s recognition of this distinction began with the 1997 discovery of pruriceptors. Itching is the activation of those pruriceptors; regardless of the ultimate cause of the itching, it is through the pruriceptors that itching is recognized. NPPB, the Maryland team found, is how it is activated. It is through the medium of NPPB that itching is recognized, though a different neurotransmitter is involved in scratching as a response to itch.

Normally NPPB is produced in the heart muscle—a high level is a sign of heart failure, and normal levels are a relatively sure sign that the patient’s heart has not failed. Kidney disease can also lead to excessive NPPB. Its function is to keep the heart going and to protect it from unnecessary changes in operation. It also plays an important role in keeping blood vessels clear and controlling the level of sodium in the blood. Now it appears to be involved in itching as well. In experimental animals bred not to experience itching, NPPB, which is normally found in a variety of mammals in addition to humans, cannot be detected. That indicates that the protein plays a central role in itching.

It would be impractical, of course, to remove the protein from humans, leaving nothing to perform its useful functions. However, researchers are looking at ways to moderate the purireceptor response to NPPB so as to alleviate itching.

Chemotherapy Without Hair Loss

Cancer patients who are tearing their hair out over a common side effect of radiation treatment may have some good news. Researchers say they have found a way to significantly reduce—in some cases even eliminate—hair loss as a result of radiotherapy. Taking advantage of the latest discoveries about the science of hair growth, doctors will be able to help keep the temporary hair loss characteristic of chemotherapy and radiation therapy to a minimum.

These treatment techniques work by destroying cancer cells in the body, with chemicals or radiation, as the case may be. However, in some patients, this can entail doing some damage to healthy cells, particularly fast-growing ones—such as hair follicles. This isn’t necessarily a characteristic of the specific chemotherapy drugs administered. The same drug can cause different degrees and patterns of hair loss in different patients; some may lose head hair, some eyebrows and eyelashes, some body hair, various combinations, and some patients lose no hair at all.

It has historically been difficult to predict the effects in a particular patient, but it is usually temporary—though when it does grow back, usually between shortly before the end of the treatment period and a few weeks afterward, it may come back different from what it was like before. What the researchers have found is that when treatments are administered has an effect on how much hair is lost. Hair growth appears to be tied to the circadian rhythm, or body clock, which keeps various autonomous functions keyed to an approximately 24-hour cycle. In laboratory animals, hair growth is fastest early in the day, while evening hours are generally given over to repairing DNA errors that cropped up.

When radiation is administered during this repair period, it seems to have a smaller effect on hair than when it’s administered during the morning growth period. That suggests that the best time to treat humans is likewise when hair growth is slowest, the next task being to determine when that is. This may prove to be the first effective way to prevent hair loss from cancer treatment. Other attempts have not met with success; even the pattern baldness treatment minoxidil appears to have no effect for cancer patients.

Hereditary Angioedema

Approximately 300 Americans suffer painful random swelling in their arms, legs, face, lungs, and other parts of the body due to a rare disease called hereditary angioedema. This condition can be life-threatening—swelling in the airway can made breathing impossible—but it can be difficult to diagnose. That’s because the symptoms mimic those of other, more common illnesses, and doctors often don’t even consider hereditary angioedema as a possibility. In addition to the airway, other internal organs can be affected, such as the intestines. In addition to damaging the intestines directly, this can lead to malnutrition.

The condition, as the name suggests, is usually inherited. In particular, mutations in genes responsible for proteins called C1 inhibitors cause the proteins to be missing or abnormal. This points to an autoimmune aspect to hereditary angioedema. When C1 inhibitor doesn’t properly perform its function, substances called peptides build up and lead to swelling. The symptoms of the condition can vary significantly from patient to patient, or even over the course of a lifetime for a single patient. In addition, because it is such a rare condition, doctors often don’t consider it as a possibility even when the symptoms all seem consistent with that diagnosis. Often sufferers are told their discomfort is psychosomatic, with no physical cause.

In 2010, a drug called icatibant was found to be effective in treating hereditary angioedema. The discovery was made by a team at Massachusetts General Hospital led by Aleena Banerji. Icatibant works by blocking the bradykinin receptor, a site in the body involved in pain and inflammation, so that the built-up peptides have no place to go and don’t lead to swelling.

“We have not had many options for treating painful, debilitating and potentially life-threatening attacks of hereditary angioedema, and these studies showed that icatibant improves symptoms and is not associated with any concerning side effects, Dr. Banerji said in a statement. Other treatments include replacing the insufficient C1 inhibitor directly and administering drugs to jump-start the production of the protein.

Stay Safe At The Pool This Summer

For many people, Memorial Day marks the start of summer swimming season. That means today is a good time for child pool safety tips from your friends at Medex Supply:

  • No one should go into the pool who doesn’t know how to swim or isn’t staying close to someone who knows how to swim.
  • Keep a close eye on your child. If you’re in a group of adults, know who is responsible for the children at all times; no one should say “I thought you were watching them.”
  • Don’t leave the pool area without your child. They’ll grumble, but they’ll be safe.
  • Keep glass bottles and other dangerous, breakable items away from the pool area. Electrical devices such as music players should also be a safe distance from the water.
  • Flotation devices can make pool time more fun, but they’re no substitute for adult supervision. Armbands, rings, vests, and other floating things can give parents and children alike a false sense of security. Floaties are no substitute for knowing how to swim.
  • Toys in the pool are a temptation for the young and impulsive, so take them out when swimming time is over.
  • It’s never too soon to teach safety. Even young children can learn to tread water, get to the pool wall, and other water survival skills that will keep them safe.
  • At a pool in someone’s home, make sure there’s a first-aid kit and emergency equipment handy, and ideally someone trained in first aid should be nearby.
  • A home pool needs protection: a fence, a lock, a cover, maybe even an alarm. If you can keep curious kids from getting to the pool without your knowledge, you don’t have to worry about them being in it unsupervised.
  • Safety rules are there for a reason and apply to everyone. Hold your child to them; don’t give them dispensation to ignore them. Make sure they know to listen to the lifeguard.
  • Never roughhouse or, if you have the authority, let anyone else roughhouse near the water

Swimming-pool safety is important for keeping Memorial Day, and the rest of summer, fun for everyone—parents as well as children.

Living With Celiac

For an estimated 3 million Americans, pizza-and-movie nights have to skip the pizza and there are no pretzels at the ball game. That’s how many people have celiac sprue, a condition in which an immune reaction to wheat gluten causes inflammation in the small intestine. This does more than cause pain and discomfort; over time, this inflammation can cause damage to the intestine that interferes with the ability to properly absorb nutrients.

The cause of celiac is not well understood, though research suggests that some people have a genetic predisposition to the disease, and it is correlated with certain genetic mutations. Often people first exhibit signs of the illness after surgery, pregnancy and childbirth, or a viral infection, or in times; it can also be triggered by emotional stress. People with colitis, type 1 diabetes, or other autoimmune diseases are at heightened risk for celiac, and scientists believe there is a link.

Celiac not only leads to diarrhea, nausea, cramping and weight loss, but the condition can also affect the skeletal, nervous, and even reproductive systems. People with celiac may experience anemia, fatigue, pain in the bones and joints, depression or anxiety, problems with fertility, a type of rash called dermatitis herpetiformis, and discolored teeth as well as digestive problems. It’s not only food that sufferers have to be wary of. Many products, including medications and cosmetics, can contain wheat, barley, rye, or other sources of gluten.

There is currently no cure. People with celiac must maintain a strict lifelong gluten-free diet, avoiding barley, bulgur, durum, farina, Graham flour, malt, rye, semolina, spelt, triticale, and wheat at all times. Every time a person with celiac consumes foods made with these ingredients, it does some damage to the small intestine. However, research is being conducted on an enzyme supplement that might allow sufferers to digest gluten, the way lactase is available for people with lactose intolerance. Patients who are having issues with nutrient absorption may need supplements to help make up the deficit, most commonly calcium, iron, and B vitamins as well as other nutrients. Corticosteroids such as prednisone, or other anti-inflammatory drugs, may be given to control inflammation.

Bunions

When you stand on your own two feet, you get bunions. According to anthropologists, the reason bunions develop has to do with human bipedalism—the human tendency to walk upright on two feet instead of down on four like most mammals. In addition, while the tendency may have to do with how we walk, actual bunions are a hereditary condition, studies now show.

Doctors have found that one in four adults—and more than one in three seniors—have the painful bumps that form on the base of the big toe. For a long time, experts blamed high heels for the prevalence of the condition. However, researchers in Massachusetts discovered that far more than what shoes people wear, their parents’ feet can be linked to who will develop bunions and who will not.

Bunions occur when a bone in the toe called the first metatarsal moves inward, pushing the big toe into the others. The big to rotates slightly in place, causing a bunion to form. Left untreated, unfortunately, the condition will get progressively worse and the bump will get gradually bigger. If it goes on long enough, the deformity will spread and the second toe will become dislocated as the big toe slips under it.

Despite the hereditary nature of bunions, more comfortable shoes or orthopedic inserts can provide a degree of relief. Ice packs applied to the feet and over-the-counter pain relievers can help alleviate the pain, with cortisone injections to help restore and ease proper movement. In fact, if the condition is treated early enough, this may be all that’s needed—eventually, the foot returns to its usual shape, the bump disappears, and things are back to normal, as long as the feet are treated right.

However, in extreme cases where there is significant deformity due to the condition being ignored for too long, or if there is severe pain that interferes with ordinary activity, surgery may be needed. Fortunately, this doesn’t have to be a tremendous ordeal. Surgeons can realign the toes properly in a simple outpatient procedure, often with a short recovery time.

Mononucleosis

A viral infection transmitted through saliva, mononucleosis is usually quite minor. That’s because the Epstein-Barr virus responsible for it is quite common, meaning most people have developed a resistance for it. Indeed, the disease is common in older teenagers, in part because the prevalence and easy transmissibility (including in saliva) of the virus means almost all 15- to 17-year-olds are exposed to it sooner or later.

Epstein-Barr is actually one of the most common viruses infecting humans; 95 percent of people are infected at some point before the age of 40, though only in some cases does it develop into mononucleosis, usually younger people who have no immune response yet. Symptoms include swollen lymph nodes and tonsils, fatigue, headache and sore throat, and general malaise, with some people developing hepatitis or enlargement of the spleen.

The primary way the virus is transmitted is through saliva, either by sharing food dishes, utensils, and cups or by more direct means. The only way to stop the spread of the virus is by avoiding transmission; there is no vaccine. There’s no real treatment either, except rest and plenty of fluids. Medical care is usually focused on the secondary infections such as strep and tonsillitis. These are treated as usual with antibiotics; penicillin cannot be given to people with mononucleosis, otherwise patients will develop a rash, so other types of antibiotics that aren’t related to penicillin are used instead. To treat the swelling and inflammation, corticosteroids such as prednisone are used. Over-the-counter pain relievers and gargling with salt water serve to treat the symptoms of the disease.

Although people who get mononucleosis—as well as most people who don’t—develop an immune response to the Epstein-Barr virus, it can cause illness in later life as well. The virus is associated with some types of cancer, and recently scientists have found that reactivation of Epstein-Barr is linked to heart disease. This reactivation is often a sign of stress, and in fact this is believed to be a major part of the connection between stress and susceptibility to heart disease. When the virus reactivates as a result of the host experiencing stress, it causes inflammation, which in turn leads to cardiac malfunction.

Ultraviolet Light And Your Eyes

After going out on a boat in Portugal, CNN anchor Anderson Cooper woke up at night with a burning sensation in his eyes and found that he was blind. Like most people, he had learned as a child not to stare directly at the sun. However, also like most people, Cooper didn’t realize how dangerous the sun’s ultraviolet light can be to your eyes, and what steps need to be taken to avoid it.

Cooper is one of a growing number of people who have experienced eye damage from ultraviolet light. He was lucky; he could see again less than two days later. Ultraviolet-induced photokeratitis can persist far longer than that, and can even cause permanent damage to vision. Symptoms include tears and moisture, pain and discomfort, narrowed pupils, and eyelid twitching. Reflected sunlight can cause photokeratitis as much as direct, as can using arc welding equipment without proper eye protection.

Ultraviolet light isn’t visible to people—though it is to bees—but it still packs a punch. It’s a slightly shorter wavelength than visible light, and it comes from the sun like visible light does. In addition to photokeratitis, it can damage vision in several other ways:

  • Ultraviolet light is a major cause of skin cancer, to which the thin skin of the eyelids is particularly vulnerable.
  • The leading cause of blindness is clouding of the lens of the eye, or cataracts. Research shows that exposure to ultraviolet light increases the formation of cataracts.
  • Age-related macular degeneration, deterioration of the center part of the retina, is another leading cause of blindness. Ultraviolet light damaging the retina is believed to be a contributing factor to this deterioration.

You can protect yourself with sunglasses—a precaution Cooper says he had failed to take—but not all shades offer the same level of protection. There’s no standard labeling, but anything that says it offers ultraviolet protection probably does offer some degree. Polarized lenses shield your eyes from glare. Make sure you have lenses big enough to offer complete protection.

From Mental Illness To Bacterial Infection

A few years ago, a new ally emerged in the battle against antibiotic-resistant bacteria. A drug called thioridazine used to be used to treat schizophrenia, but it has fallen out of favor for mental illness in recent years. Now scientists think they have a better understanding of why thioridazine works on conditions such as MRSA that do not respond to most antibiotic treatments. There are new indications that the medication is helping to break down cell walls in infectious bacteria even when those bacteria are resistant to ordinary antibiotics. That means that this medication can be used even for hardened strains of illnesses.

Thioridazine was introduced in 1978 for patients with schizophrenia. Though often effective for that condition—as well as insomnia and heroin withdrawal symptoms—there were some concerns about side effects. Many patients reported agitation and restlessness, in many cases leading them to stop taking the drug. Patients also reported drowsiness, dizziness, and vertigo, as well as mouth tremors. Moreover, long-term use was found to carry some risks of heart diseases and vision problems, since it was found that excess thioridazine is stored around the heart and behind the retinas of the eyes. Because of these and other concerns, thioridazine was largely dropped as a schizophrenia treatment by 2005.

The researchers who discovered the mechanism point out that thioridazine doesn’t kill the bacteria on its own; it makes the heretofore resistant bacteria once again vulnerable to antibiotics. It does this by removing the amino acid glycine from the bacterial cell walls. This weakens the walls, making it possible for antibiotics to get in and kill the cells even when resistance has developed.

The next step, according to members of the research team, is to determine what properties of thioridazine have this effect, and attempt to isolate them. That way, either antibiotics themselves can be redesigned to target glycine as well, or a medication can be developed that eliminates glycine, but without the other effects of thioridazine. The elements that make it an effective treatment for schizophrenia can also make it dangerous for people without the mental illness, and the side effects are also a concern. Researchers will be investigating ways to selectively eliminate the drug’s anti-psychotic properties.