Greater awareness needed on risks that Addison’s disease poses to patients

Two new studies presented at the European Congress of Endocrinology in Rotterdam show the possible dangers facing patients with Addison’s disease are higher than previously thought. The new research shows that Addison’s patients, who have low levels of cortisol produced by the adrenal glands, are more likely to get infections which may provoke life-threatening adrenal crises.

Addison’s disease is caused by low levels of the hormone cortisol, produced by the adrenal glands. Without treatment, the condition can be fatal. Patients with Addison’s disease can suffer a range of symptoms, including fatigue, dizziness, weight loss, muscle weakness, mood changes and the darkening of regions of the skin if they don’t receive treatment. The most famous Addison’s disease sufferer was John F Kennedy, but it is a comparatively rare condition, affecting about 1 person in 15,000.

Dr Stefanie Hahner, working at University of Würzburg, Germany, looked at the incidence of adrenal crisis in 472 German patients with Addison’s disease. An adrenal crisis is a potentially life-threatening condition which occurs when cortisol levels fall dangerously low, requiring an immediate injection of hydrocortisone. Dr Hahner found that 62 of the patients had an adrenal crisis over the two-year period of the prospective study, with almost two-thirds of those needing to be hospitalised and 9.5% being treated in intensive care. Two patients died from adrenal crises during the study. The study also found that many patients were unprepared to deal with the threat to life presented by crises and further patient education programmes may be warranted.

-Researcher Dr Stefanie Hahner said :
“The number of adrenal crises was higher than we expected from previous studies. Infectious disease provoked 39% of the crises, with psychological stress also causing problems. Ninety-five percent of the patients were aware of the dangers of an adrenal crisis, but only 28% had the emergency injection set. This shows that these crises are largely caused by infectious diseases and stress, but also that patients need to be better prepared to respond to the crises when they arise and that infectious disease has to be treated early and aggressively in this patient group.”

In another study presented at the European Congress of Endocrinology from the University of Utrecht, The Netherlands, Dr Lisanne Smans showed that patients with Addison’s disease were more at risk of suffering infections than the rest of the population.

She identified 390 Addison’s patients from pharmacy records and compared the risk of infections and hospital admissions. Dr Smans found that the risk of infectious disease was 1.5 times that of a control population, (overall incidence rate of 59.2/100 person-years). In addition, Addison’s patients were significantly more likely to be hospitalised for infectious disease than control groups (3.8/100 person years for Addison’s patients, versus 0.8/100 person years for control groups).

-Researcher Dr Lisanne Smans commented:
“We need to raise awareness amongst doctors and patients of the risk of infections in Addison’s patients compared to the general population. We now want to move on to see whether influenza vaccinations can help this patient group.”

-Commenting on the two papers, Professor Peter Trainer, Chair of the European Congress of Endocrinology Programme Organising Committee, said

“These studies reinforce our knowledge of the risks that infections pose to patients with Addison’s disease and serious consequences that can arise. We need to look at ways of making both the medical community and patients more aware of the appropriate medical action needed to treat an adrenal crisis. This really is a case where quick action can save lives. All patients with Addison’s disease should carry an emergency kit containing a hydrocortisone injection that can be given immediately if they fall ill.”

Blood test markers link polycystic ovary syndrome with cardiovascular risk

A new study presented at the European Congress of Endocrinology shows that women with polycystic ovary syndrome (PCOS) show higher levels of blood markers associated with cardiovascular disease (CVD) than control groups. These markers show up during a woman’s earlier life, but might indicate a greater CVD markers show up during a woman’s earlier life, but might indicate a greater CVD risk in later life.

PCOS is a common ailment, affecting between 5-10% of women of reproductive age, meaning that there are millions of PCOS sufferers in Europe. Symptoms vary, but women with PCOS can suffer from ovarian cysts, irregular (or missing) periods, acne, higher than normal androgen levels and excess facial and body hair. PCOS may be associated with obesity and/or insulin resistance and is also one of the main causes of female infertility.

Past studies have shown no conclusive link between PCOS and these risk markers. Doctors can test for cardiovascular risk markers during the normal reproductive period of a woman’s life. These markers don’t directly predict cardiovascular risk, but higher levels of these markers are associated with cardiovascular risk in the future. This means that women with raised levels of these markers will, in later years, tend to have a higher rate of cardiovascular disease than is found in the general population.

Working at the Aristotle University of Thessaloniki, Greece, Dr Konstantinos Toulis and co-workers Assistant Professor Dimitrios Goulis and Professor Basil Tarlatzis, carried out a major ‘study of studies’ (meta-analysis) on risk markers for cardiovascular disease in women with PCOS.

They reviewed 130 previous studies, involving in total 6260 women with PCOS and 4546 controls. They looked at whether the levels of biochemical blood markers for CVD differed in women with PCOS compared to controls. They found that 7 of the 10 markers they looked at were elevated in women with PCOS (see table below), meaning that these women might be more susceptible to developing heart disease.

As yet the researchers don’t know if these elevated risk markers lead directly to a higher level of heart disease in PCOS women, but this is the next thing they hope to investigate.

-Researcher Dr Konstantinos Toulis said:

“This analysis shows that increased levels of risk markers for cardiovascular disease are firmly associated with PCOS. PCOS is a difficult condition to study, because the range and severity of symptoms vary so much that it has been difficult to draw conclusions. Recently an expert panel1 reviewed the evidence and concluded that women with PCOS did seem to have an elevated risk of cardiovascular disease in later life. This meta-analysis of biochemical markers shows that the CVD risk factors are present in earlier life, and that they seem to be independent of other factors which can lead to cardiovascular disease in later life, such as obesity. The association between CVD risk and CVD markers depends on the nature of the individual marker and the magnitude of the difference; this, plus the fact that there are several of these biochemical markers raised, is what makes this a potential warning.

“Cardiovascular disease is the number one cause of death for women in the western world, and as so many women suffer from PCOS, then any increase in cardiovascular disease risk may translate into later problems for an appreciable amount of women. We need to remember that at the moment this is just an association between the biochemical markers and cardiovascular disease in PCOS women, rather than proof of a cause and effect. We do need to follow this up by looking at women with PCOS and cardiovascular disease, and seeing if they had shown higher levels of the risk markers.”

Rosa Pérez explica en su videoblog cómo sería la correcta limpieza de los oidos

Nuestros oídos merecen un cuidado especial. No voy a hablar de problemas que nos puedan ocasionar, sino de su higiene.
Una higiene correcta puede evitar problemas futuros según afirma Rosa Pérez en su videoblog( http://t.co/SEDx2Na.)
El conducto auditivo tiene forma de embudo. Dentro de él, en el llamado conducto auditivo, se forma cera que sirve de defensa ante agresiones externas, como cuerpos extraños o insectos que puedan entrar en él.
Se forma cera a diario y también se va eliminando de forma natural a través del oído y hacia el exterior. Si introducimos cualquier objeto en el oído, arrastramos esta cera y podemos causarnos una lesión.
En cambio, podemos limpiar el pabellón auricular tras la ducha, con un bastoncillo, sin apretar, secando los pliegues y retirando la cera que ha quedado en el exterior.
También es adecuado el uso de un irrigador de agua marina una o dos veces por semana, para retirar el exceso de cerumen y evitar la formación de tapones de cera.
Se puede usar en bebés a partir de los 6 meses, su uso es seguro y sencillo.
Ni se debe aplicar si tienes dolor en los oídos, infección (otitis), tímpano perforado o si te has sometido a una cirugía de oído recientemente, tampoco si tienes un tapón de cera o problemas de equilibrio.
Si eres diabético o tienes un trastorno en la inmunidad debes consultar con un profesional sanitario. Te indicará la mejor manera de cuidar tus oídos.
La piel de la parte externa del oído, el llamado pabellón auricular, puede verse afectada por dermatitis y procesos descamativos.
Si observas problemas en la piel de tus oídos, debes acudir a un profesional sanitario

**Publicado en: www.elblogderosa.es

Video games may help clear airway of cystic fibrosis patients

Video games controlled by the player's breath can encourage youths with cystic fibrosis to use techniques that can help keep their airways clearer, according to a study to be presented Saturday, April 30, at the Pediatric Academic Societies (PAS) annual meeting in Denver. Cystic fibrosis, one of the most common chronic lung diseases in children and young adults, causes mucus to build up in the lungs and digestive tract. To clear mucus from the airways, patients must do breathing exhalation maneuvers called "huffing" several times a day. Many children, however, refuse, preferring to play video games instead, according to Peter M. Bingham, MD, lead author of the study.
"These are kids who are often lonely and frustrated with their medical treatments, and who turn to video games for fun," said Dr. Bingham, associate professor of neurology and pediatrics at the University of Vermont and pediatric neurologist at Fletcher Allen Health Care.
The researchers decided to capitalize on their patients' penchant for video games by designing software that encourages them to use the breathing techniques. Instead of using a handheld controller, the game is controlled by a digital spirometer, a device that measures how fast and how much air the player breathes out.
In one game, created by students at Champlain College in Vermont, the player's breath drives the movement of a race car down a track and allows the player to fill up the gas tank and wash the car. In another game, the player explores a wilderness, looking for treasure. When the player encounters an animal covered in slime, he or she blows the slime off the animal to earn more treasure.
"The medical goal of the games was to increase breathing maneuvers that respiratory therapists believe can help keep the airways of cystic fibrosis patients clearer," Dr. Bingham said.
Before the study began, 13 children ages 8-18 years underwent pulmonary function tests. Then they participated in a game phase and a control phase for two to four weeks each. During both phases, they were given a computer and spirometer. During the game phase, they also had access to the games that were controlled by the spirometer.
Results showed that few subjects were carrying out the recommended huffing with any regularity before the study. During the study, subjects were huffing more than they did before the study, although there was no difference in the amount of huffing in the game period compared to the control period.
"Both parts of the study apparently got subjects focused on and involved with using the spirometer to do the recommended forced exhalations," Dr. Bingham said.
A surprising result was that even though subjects used the spirometer during game play and the control period, their ability to take a deep breath (termed vital capacity) improved significantly only after game play.
"We aren't sure why that improvement happened," Dr. Bingham said, "but it could be that the player's ability to carry out the vital capacity test improved simply because they were practicing this skill more often, and not because of an actual improvement in their lungs."
"In sum, we think that these results show that using spirometer games can be a good way to involve children in respiratory therapy," he said. "I think it's ethical and appropriate to meet kids 'where they are' with some engaging, digital games that can help them take charge of their own health."

**Source: American Academy of Pediatrics

Maternal obesity puts infants at risk

Babies born to obese mothers are at risk for iron deficiency, which could affect infant brain development, according to a study to be presented Saturday, April 30, at the Pediatric Academic Societies (PAS) annual meeting in Denver. In nonpregnant adults, obesity-related inflammation hinders the transport of iron through the intestine, increasing the risk of iron deficiency anemia. When a woman is pregnant, iron is transferred through the intestine to the placenta, but it is not known how maternal obesity affects newborn iron status. Fetal iron status is important because 50 percent of the iron needed for infant growth is obtained before birth.
In this study, researchers studied 281 mother/newborn pairs. The women's body mass index was calculated before delivery, and a score of 30 or above was defined as obese. Investigators also determined infants' iron level by analyzing umbilical cord blood.
Results showed evidence of impaired iron status in newborns of women who were obese.
"These findings are important because iron deficiency in infancy is associated with impaired brain development, and we should understand all risk factors for iron deficiency in infancy," said Pamela J. Kling, MD, FAAP, principal investigator and associate professor of pediatrics/neonatology at the University of Wisconsin-Madison.
The researchers are investigating why obesity during pregnancy is a risk factor for poorer iron status at birth, Dr. Kling said.
"In nonpregnant adults, obesity has been linked to poorer dietary iron absorption and to diabetes, so both factors may contribute," she said. "Additionally, the link may be due to larger fetuses, because obesity during pregnancy results in larger fetuses, and iron needs are proportional to fetal size."
The study results also have important implications because the prevalence of obesity in women of childbearing age is increasing.

*Source: American Academy of Pediatrics

Study is the first to link sleep duration to infant growth spurts

A study in the May 1 issue of the journal Sleep is the first to show that increased bursts of sleep among infants are significantly associated with growth spurts in body length. Results show that infants had irregular bursts of sleep, with 24-hour sleep duration increasing at irregular intervals by an average of 4.5 hours per day for two days. The number of sleep episodes per day also increased in intermittent bursts of an average of three extra naps per day for two days. These peaks in total daily sleep duration and number of sleep episodes were significantly associated with measurable growth spurts in body length, which tended to occur within 48 hours of the recorded bursts of sleep. Further analysis found that the probability of a growth spurt increased by a median of 43 percent for each additional sleep episode and 20 percent for each additional hour of sleep.
"The results demonstrate empirically that growth spurts not only occur during sleep but are significantly influenced by sleep," said principal investigator and lead author Dr. Michelle Lampl, Samuel Candler Dobbs Professor in the department of anthropology at Emory University in Atlanta, Ga. "Longer sleep corresponds with greater growth in body length."
Lampl added that the results may be particularly helpful for parents, who can become easily frustrated by the variability and unpredictability of an infant's sleep patterns.
"On a practical, everyday level, it helps parents understand their infant's behavior and patterns," she said.
The study involved 23 parents who consistently recorded daily sleep records for their infant, providing 5,798 daily records for analysis. The median age of the 14 girls and nine boys at study onset was 12 days. All infants were healthy at birth and free of colic or medical complications during their first year. For a duration ranging from four to 17 continuous months, growth in total body length was assessed using the maximum stretch technique, which was performed semi-weekly for 18 infants, daily for three infants and weekly for two infants.
According to Lampl and co-author Michael Johnson, PhD, professor of pharmacology in the University of Virginia Health System, the exact nature of the relationship between sleep biology and bone growth is unclear. However, they noted that the secretion of growth hormone is known to increase after sleep onset and during the stage of slow wave sleep. This change in hormonal signals during sleep could stimulate bone growth, which would support anecdotal reports of "growing pains," the aching limbs that can wake children at night.
Although a statistically significant relationship between bursts of sleep and growth spurts was found in all infants, the correspondence was imperfect. Some sleep alterations occurred without a growth spurt, and not every growth spurt was preceded by a burst of sleep.
Lampl and Johnson speculate that in some cases growth may have occurred in other parts of the body. For example, another new study they are publishing this month found that infant head circumference grows in intermittent, episodic spurts. They also suggest that sleep may be only one component of an integrated, physiological system that underlies growth timing.
The study is also significant, added Lampl, because it adds a novel finding to the interdisciplinary, multi-faceted body of research targeted at answering the question, "Why do we sleep?"
"It opens another door to understanding why we sleep," she said. "We now know that sleep is a contributing factor to growth spurts at the biological level."

**Source: American Academy of Sleep Medicine

EDs should be aware of sexually transmitted infection risk in patients

All adolescent females who show up in the emergency department (ED) complaining primarily of lower abdominal pain and/or urinary or genital symptoms should be tested for sexually transmitted infections (STIs), according to the authors of a study to be presented Saturday, April 30, at the Pediatric Academic Societies (PAS) annual meeting in Denver. Previous studies have shown that when adolescents seek treatment for symptoms suggestive of an STI, they are not always tested, partly because health care professionals may not be aware of the risk of STIs in these patients. If not identified and treated, STIs can have serious long-term consequences such as infertility, ectopic pregnancy, chronic disease and death in babies, and cervical cancer. The presence of an STI also can increase the likelihood of acquiring HIV.
Researchers, led by Monika Goyal, MD, sought to determine how common STIs are in symptomatic adolescent females. Over the six-month study period, 236 females ages 14-19 years who sought treatment at a pediatric ED for symptoms of lower abdominal, pelvic or flank pain and/or genitourinary complaints were tested for three of the most common STIs: Neisseria gonorrhoeae , Chlamydia trachomatis and Trichomonas vaginalis .
Results showed that 26.3 percent of the patients had an STI. The most common was chlamydia (20 percent), followed by trichomoniasis (10 percent) and gonorrhea (3.5 percent). In addition, 19 percent of patients infected with chlamydia also had trichomoniasis, while 6.7 percent had both chlamydia and gonorrhea.
"Adolescents represent a high-risk group for sexually transmitted infections, and many providers are unaware of this association and the consequences that potentially occur due to infection," said Dr. Goyal, instructor of pediatrics and attending physician in the Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania.
In addition, other studies have shown that adolescents often do not have a primary care doctor and go to the ED for medical care instead.
"Therefore, ED providers should be assessing STI risks in adolescents who come to the ED for care, as this may be the only point of contact of these patients and an opportunity to intervene," Dr. Goyal said.

**Source: American Academy of Pediatrics