'Love Hormone' May Help Those With Anorexia.

Small, preliminary study found it lowered levels of obsession with images of food and obesity.

THURSDAY, March 13, 2014 (HealthDay News) -- A small, preliminary study hints that a hormone connected to positive feelings could help ease obsessions with food and obesity in people with anorexia.
"Patients with anorexia have a range of social difficulties, which often start in their early teenage years before the onset of the illness," senior study author Janet Treasure, of the Institute of Psychiatry at King's College London, in England, said in a university news release.
"These social problems, which can result in isolation, may be important in understanding both the onset and maintenance of anorexia," Treasure said. "By using [the hormone] oxytocin as a potential treatment for anorexia, we are focusing on some of these underlying problems we see in patients."
Oxytocin is sometimes called the "love hormone." It's released during bonding activities like childbirth and sex, and researchers have linked artificial forms of it to lowering anxiety in people with autism.
In the new study, researchers gave oxytocin or a placebo, via nasal spray, to 31 patients with anorexia and 33 healthy "control" patients. They all were asked to look at sequences of images relating to different types of food, and different body shapes and weights. The researchers measured how quickly participants identified the images. If they had a tendency to focus on the negative images, they would identify them more quickly.
After taking oxytocin, the anorexic patients appeared to be less obsessed about images of food and obesity, the researchers said. The study did not, however, prove a cause-and-effect link between oxytocin and the decreased feelings of obsession.
"This is early stage research with a small number of participants, but it's hugely exciting to see the potential this treatment could have," Treasure said. "We need much larger trials on more diverse populations before we can start to make a difference in how patients are treated."
The study appears in the March 12 issue of the journal Psychoneuroendocrinology.
SOURCE: King's College London, news release, March 12, 2014

HIV Transmission Between Women Rare, But Possible: CDC

THURSDAY, March 13, 2014  -- A case report of a woman who was infected with HIV during sex with another woman shows that such transmission of the virus is possible, health officials say.
The case occurred in Texas in 2012 and involved two women who were a monogamous couple for six months. One of them had HIV, and the other did not. The couple routinely did not take any protective measures during sex, and had engaged in sexual activity that resulted in the exchange of blood through abrasions.
The partner who had been HIV-free became infected. Health officials could find no other HIV risk exposures for the newly infected woman, and concluded that it was likely she was infected by her partner.
While the risk of HIV transmission between female sex partners is low, it can occur when bodily fluids such as menstrual blood and vaginal fluids come into contact with a cut, abrasion or a mucus membrane (the tissue that lines body cavities such as the mouth and vagina), according to the report authors.
The researchers said this case study emphasizes the need for all couples -- including women who have sex with women -- to take measures to prevent HIV transmission. These steps include avoiding all contact between HIV-infected blood or blood-contaminated bodily fluids and broken skin, wounds or mucus membranes.
The report is published in the March 13 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

For Oral Health, Have a Tea Party

 “There are few hours in life more agreeable than the hour dedicated to the ceremony known as afternoon tea.”        Henry James,
He may not have been thinking of oral cancer prevention when he wrote that, but it might be one more reason (as if any were needed) to have a daily cup.
Tea contains polyphenols that, in laboratory and clinical studies, have shown to have protective effects against lung, esophageal, and other cancers. Although numerous studies have examined the relationship between tea consumption and the risk of oral cancer, the results have been inconsistent—some have found a significant risk reduction from drinking tea while others have found no effect.
To determine whether drinking tea might keep mouths healthy, researchers in Qingdao, China, carried out a meta-analysis of 19 prospective and case-control studies of tea drinking and oral cancer conducted worldwide. Taken together, the studies included 4,675 oral cancer cases. Four of the studies found a protective effect of tea drinking against oral cancer whereas the remaining 15 did not.
RELATED: Head and Neck Cancer Resource Center

The authors of the meta-analysis pooled the data from all 19 studies and looked at the risk of cancer according to the level of tea consumption, and found positive results. Subjects who drank the most tea of any type had a 15% reduction in the risk of oral cancer compared with subjects who drank the least (relative risk [RR] = 0.853; 95% CI: 0.779-0.934).
However, not all tea is created equal. In five of the studies, the focus of research was green tea; and in three studies, it was black. Those who drank the most green tea had a significantly reduced risk of oral cancer compared with those who drank the least (RR = 0.798; 95% CI: 0.673-0.947), whereas black tea showed no such effect (RR = 0.953; 95% CI: 0.792-1.146).
The Big Picture
If drinking tea really does help prevent oral cancer, tea-drinking countries ought to have lower rates of the disease. In the United Kingdom, where mean annual tea consumption is 2.74 kg per person, the incidence of oral cancer is 10.4 per 100,000, about 25% lower than in the United States, where we drink a mere 0.33 kg of tea per person. Smoking and alcohol consumption are important risk factors for oral cancer, but in this case they seem to even out: the British smoke less than Americans but drink more—13.37 L of pure alcohol per person per year in the United Kingdom compared with 9.44 L in the United States.
The highest tea-consuming country in the world is Turkey, where they drink a whopping 6.87 kg of tea per person each year. Perhaps partly as a result, they enjoy a low rate of oral cancer—just 4.4 cases per 100,000.Contributing further to the low rate of oral cancer in Turkey may be the low rate of alcohol consumption—2.87 L per person per year.
RELATED: Surgery First Improves Oral Cancer Outcomes

Tea consumption in China is just 0.82 kg per person annually, but most of that is green tea, which may be the reason why oral cancer is relatively infrequent there—3.3 cases per 100,000 annually.
Of course, epidemiologic associations don't prove causation, but they're interesting to contemplate over a nice cup of tea. As the 19th century British writer Sydney Smith said, “I am glad I was not born before tea.”

Polio-Like Syndrome Surfaces in California

Reports of a puzzling polio-like syndrome affecting children in northern California have launched something of media frenzy.
Emmanuelle Waubant, MD, PhD, professor, clinical neurology and pediatrics, University of California at San Francisco (UCSF), said she was surprised by all the attention to this case series, and believes it's because the cases are linked to "children" and "polio," 2 words that set off alarms when used together.
To date, Dr. Waubant and her colleagues have identified 5 children, aged 2 to 16 years, who presented with acute onset of flaccid paralysis affecting 1 or more limbs that reached peak severity within 48 hours of onset. MRI showed non enhancing T2 hyperintensities of the central gray matter; cerebral spinal fluid was normal, albeit mildly pleocytotic.
The cases will be presented at the upcoming 66th Annual Meeting of the American Academy of Neurology (AAN) in Philadelphia, April 26 to May 3.
Doctors initially suspected transverse myelitis, an inflammation of the spinal cord that may cause paralysis, but lack of sensory changes and other telltale neurologic symptoms, plus a negative workup, ruled out this diagnosis, said Dr. Waubant. They also excluded Guillain-Barré syndrome and botulism.
Three of the youngsters had prodromal respiratory illness before their paralysis, which, said Dr. Waubant, "is probably significant." Poliovirus has been eradicated from most of the globe, but other viruses can also injure the lower motor neurons of the spine, leading to a polio-like syndrome.
So far, 2 cases have tested positive for the enterovirus-68, a rare virus that in the past has been associated with polio-like syndrome.
"In the case of an enterovirus, you can have a cold-like presentation," said Dr. Waubant. "We think that if it's a virus [responsible for the symptoms presented], it's probably a virus that is not responsible for paralysis in every single patient that is affected, only in specific patients that have the right biological makeup."
Children Vaccinated
Although the disorder "looks clinically like polio," polio itself was also ruled out because all the children had been vaccinated against the polio virus. "All the cases had a good level of antibodies so they could not be infected with the polio virus," said Dr. Waubant.
There's nothing really to tie these children together except for their clinical presentation. "They had nothing in common," said Dr. Waubant. "It's not a cluster because they came from different areas," although they were from within a 100-mile radius of each other in northern California.
Treatment with steroids, intravenous immunoglobulin, and/or plasma exchange did not appear to have a clinical benefit, with motor function recovery at 6 months described as being poor. "The children have remained quite disabled," she said. "Some have recovered a little bit but the improvement has been from zero to marginal."

Fever During Pregnancy Linked to Birth Defects

Fever during pregnancy may harm offspring health, according to a study published online February 24 in Pediatrics.

Studies in several mammalian models have associated first trimester exposure to elevated maternal temperature with damage to the extra embryonic membranes, placenta, and maternal–fetal circulation, resulting in growth retardation, malformations, and fetal demise, and in the longer-term, to impaired cognitive function. The extent to which these experimental conditions mimic human  prenatal exposures was not clear.

One in 5 women reports fever during pregnancy, but few investigations have systematically examined the outcomes on child health. Therefore, Julie Werenberg Dreier, MSPH, doctoral candidate at the Institute of Public Health, University of Southern Denmark, Esbjerg, and colleagues reviewed evidence from epidemiologic studies to assess the relationship between fetal exposure to maternal fever and health outcomes.
They reviewed 46 cohort or case-control investigations reported in PubMed, Web of Science, and the Cochrane Library that mentioned maternal fever in general populations during the first trimester or preconceptually. They also included some studies referenced within the initially examined ones.
The analysis revealed elevated risk for poor health outcomes among children exposed to maternal fever in utero for 3 common classes of problems: neural tube defects, congenital heart defects, and oral clefts. The researchers identified a 1.5- to nearly 3-fold increased risk with exposure during the first trimester for 9 case-control studies of neural tube defects, 5 case-control studies of oral clefts, and 7 fixed-effects meta analyses of congenital heart defects.
Neural tube defects had the strongest relationship to temperature exposure (odds ratio [OR] pooled, 2.90; 95% confidence interval [CI], 2.22 - 3.79) compared with oral clefts (OR _pooled, 1.94; 95% CI, 1.35 - 2.79) and congenital heart defects (OR
Other outcomes included limb deficiencies, renal defects, anorectal malformation, ear defects, cataracts, and allergic diseases, but few studies were available. The analysis did not find an association between exposure to elevated maternal temperature in utero with spontaneous abortion, stillbirth, or preterm delivery.
Only some studies investigated correlations between magnitude of elevated temperature and outcomes; they did not find any. Some studies showed lowered risk with use of antipyretic medication.
The researchers conclude that they "found substantial evidence to support an adverse impact of maternal fever during pregnancy." They suggest that future studies be conducted prospectively, assess longer-term health outcomes, and consider timing, duration, and extent of fever.
Limitations of the study include the consideration of elevated maternal temperature and not the underlying cause of it (type of infection). The review might also reflect publication bias and heterogeneity among the considered studies (such as prospective vs retrospective).

PROTOCOL ON SEVERE PIH

Order Set for Severe Intrapartum or Postpartum Hypertension

Initial First-Line Management with Labetalol*

1. Notify physician if systolic BP measurement is greater than or equal to 160 mm Hg or if diastolic BP measurement is greater than or equal to 110 mm Hg.
2. Institute fetal surveillance if undelivered and fetus is viable.
3. Administer labetalol (20 mg IV over 2 minutes).
4. Repeat BP measurement in 10 minutes and record results.
5. If either BP threshold is still exceeded, administer labetalol (40 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
6. Repeat BP measurement in 10 minutes and record results.
7. If either BP threshold is still exceeded, administer labetalol (80 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
8. Repeat BP measurement in 10 minutes and record results.
9. If either BP threshold is still exceeded, administer hydralazine (10 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
10. Repeat BP measurement in 20 minutes and record results.
11. If either BP threshold is still exceeded, obtain emergency consultation from maternal–fetal medicine, internal medicine, anesthesia, or critical care specialists.
12. Give additional antihypertensive medication per specific order.
13. Once the aforementioned BP thresholds are achieved, repeat BP measurement every 10 minutes for 1 hour, then every 15 minutes for 1 hour, then every 30 minutes for 1 hour, and then every hour for 4 hours.
14. Institute additional BP timing per specific order.

Abbreviations: BP, blood pressure; IV, intravenously.

*See text for important adverse effects and contraindications.

Data from Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1–S22.

Order Set for Severe Intra partum or Postpartum Hypertension

Initial First-Line Management with Hydralazine*

1. Notify physician if systolic BP is greater than or equal to 160 mm Hg or if diastolic BP is greater than or equal to 110 mm Hg.
2. Institute fetal surveillance if undelivered and fetus is viable.
3. Administer hydralazine (5 mg or 10 mg IV over 2 minutes).
4. Repeat BP measurement in 20 minutes and record results.
5. If either BP threshold is still exceeded, administer hydralazine (10 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
6. Repeat BP measurement in 20 minutes and record results.
7. If either BP threshold is still exceeded, administer labetalol (20 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
8. Repeat BP measurement in 10 minutes and record results.
9. If either BP threshold is still exceeded, administer labetalol (40 mg IV over 2 minutes) and obtain emergency consultation from maternal–fetal medicine, internal medicine, anesthesia, or critical care specialists.
10. Give additional antihypertensive medication per specific order.
11. Once the aforementioned BP thresholds are achieved,repeat BP measurement every 10 minutes for 1 hour,then every 15 minutes for 1 hour, then every 30 minutes for 1 hour, and then every hour for 4 hours.
12. Institute additional BP timing per specific order.

Abbreviations: BP, blood pressure; IV, intravenously.

*See text for important adverse effects and contraindications.

Data from Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1–S22.

New guidelines for stroke prevention, especially in women

11 Feb 14 http://uk.univadis.com/2081/Pages/Detailed.aspx?contentid=1291280&&BackTo=Home

The American Heart Association has issued new guidelines for the prevention of strokes, specifically in women, and published them in "Stroke". While many risk factors are the same among both sexes, hormones, reproductive health and pregnancy play an important role in women, emphasised author Cheryl Bushnell from the Wake Forest Baptist Medical Center in Winston-Salem (North Carolina).

According to the guidelines, women who suffer from high blood pressure before pregnancy should be considered for treatment with low-dose aspirin and/or a calcium supplement to decrease the risk of preeclampsia. In later life, preeclampsia doubles the risk of stroke and quadruples the risk of high blood pressure. Therefore, early treatment of factors such as obesity and high cholesterol is recommended for women who had experienced preeclampsia.

The guidelines state that treatment is strongly recommended for women suffering from high blood pressure during pregnancy, and a therapy should be considered for those with moderately high blood pressure (150-159 mmHg/100-109 mmHg). The authors recommend that women with high blood pressure should not take birth control pills, because this combination could increase the risk of developing a stroke.

Increased attention is indicated in women who smoke and who suffer from migraine with aura. Over 75 year-olds should be screened for atrial fibrillation as this, likewise, increases the risk, said the physicians.