E-route to cigarette


Is e-cigarettes a gateway to smoking traditional cigarettes? According to a US study published in the journal Tobacco Control, teens who vape are almost three times more likely to switch to regular cigarettes within a year.

Researchers surveyed 2,338 high school students, average age 15, about their vaping and smoking habits, once in 2013 and then a year later.

At the time of the first survey, 31 per cent of the teens used e-cigarettes and 15 per cent smoked regular cigarettes. A year later, 38 per cent had tried vaping and 21 per cent had smoked.

Compared to teens who had never smoked in the first survey, those who had used e-cigarettes were nearly three times more likely to report smoking traditional cigarettes in the second survey.

Any use of e-cigarettes in 2013 was linked to smoking regular cigarettes one to four times a year later.

However, smoking e-cigarettes did not help those who smoked regular cigarettes to reduce the habit, as often touted by advocates of e-cigarettes.

More than two-thirds of the students surveyed thought vaping was healthier than smoking.

"Adolescents who use e-cigarettes are more likely to start smoking cigarettes. This result together with other findings suggests that policies restricting adolescents' access to e-cigarettes may have a rationale from a public health standpoint," the study concluded.


Asthma through mom

Taking the widely used painkiller paracetamol (acetaminophen) during pregnancy can increase the risk of asthma in children, according to a Norwegian study published in the International Journal of Epidemiology.

The study focused on 1,14,500 children and their mothers. The researchers compared associations between several conditions during pregnancy that may require the use of paracetamol and asthma developing in the children at ages three and seven.

The study found that 5.7 per cent of the children had asthma at age three, and 5.1 per cent had asthma at age seven. Prenatal exposure to paracetamol was associated with a 13 per cent increased risk of asthma at age three and the risk increased with greater exposure.

The association remained whether the mother used it for influenza, fever, or pain, suggesting that it was due to paracetamol use itself and not the health condition for which it was used.

Did You Know
Staying socially active after retirement is linked to higher quality of life and lower risk of premature death. For people who were members of two social groups before retirement and continued with it post retirement, the risk of death over the next six years was 2 per cent; the risk rose to 5 per cent if they dropped one membership and 12 per cent if they lost both group memberships.
BMJ Open


Both prevent stroke

Stenting and surgery are equally safe and effective at lowering the risk of stroke from a narrowed carotid (neck) artery, according to the results of a ten-year study published in the New England Journal of Medicine.

Plaque can build up in the carotid artery that runs up on either side of the neck, causing narrowing or hardening of the arteries. This can reduce blood flow and cause clotting, leading to stroke. Surgery involves removing the narrowed segment of the artery. During stenting, a tiny tube is placed in the narrowed area of the neck artery to open it up.

The researchers followed 2,502 people, with an average age of 69, for up to ten years post surgery or stenting.

There was no significant difference between patients who underwent stenting and surgery in their risk of stroke, myocardial infarction, or death. During the follow-up, about 7 per cent of patients in both groups suffered a stroke. Re-narrowing of the neck arteries occurred in about 1 per cent of patients per year in both groups.

Equal benefits were seen among older and younger patients, men and women, patients who had previously suffered a stroke and those who had not.

"This very low rate shows these two procedures are safe and are also very durable in preventing stroke. Now the patient and the physician have the option to select surgery or stenting, based on that individual patient’s medical condition and preferences,” said the lead researcher.


Light therapy for jet lag

Exposure to short flashes of light while sleeping on the night before travel can help prevent jet lag, Stanford University researchers report in the Journal of Clinical Investigation.

“This could be a new way of adjusting much more quickly to time changes than other methods in use today,” said the study author.

Current light-therapy treatments to help a person’s circadian rhythm adjust to a new time zone involves sitting in front of bright lights for hours at a time during the day.

Light therapy works best at night even though our eyes are closed. The transfer of light to the brain tricks a person’s biological clock into adjusting to an awake cycle even when asleep. The brain is fooled into thinking that the day is longer even though you are sleeping. And the light flashes don't disrupt sleep either.

“For moving your system to a later time, such as would be necessary when travelling east-to-west, light during the first few hours of the night is ideal. For moving your system to an earlier time, such as would be necessary when travelling west-to-east, light during the last few hours of the night is ideal.”

The new technique can also help people with other kinds of sleep cycle disruptions, such as medical residents and shift workers with varying work/sleep schedules.


Breast, thyroid cancer link

Women who survive breast or thyroid cancer have an increased risk for developing the other as a secondary malignancy, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.

The researchers analysed 37 published studies in which women who had survived either breast or thyroid cancer developed the other type later.

Overall, women who had survived breast cancer were 1.55 times more likely to develop thyroid cancer compared to women who never had breast cancer. And women who had survived thyroid cancer had a 1.18 times greater risk of developing breast cancer than women who never had thyroid cancer.

“This is a real risk. People who have had one of these cancers need to be aware that they are at higher risk for developing the other cancer. It should just become one of the common discussions between a patient and her doctor," the study author cautioned.

The researchers suggested several theories for the link. Survivors of either cancer are more likely to adhere to screenings and regular followups with their doctors so that the other cancer is identified early.

Hormonal factors may also explain the link. Exposure to oestrogen and thyroid-stimulating hormone may contribute to either cancer.

Radiation therapy often used to treat breast cancer has been shown to increase the risk for lung, oesophageal and blood cancers, and sarcomas. Radiation exposure can also contribute to thyroid cancer. But shielding the thyroid from radiation exposure during chest radiation can minimise the risk.

Also, radioactive iodine used to treat thyroid cancer can lead to the development of other cancers, including breast cancer.

Genetic factors may also explain the connection.


Heart attack and gender

Cardiovascular disease is the leading cause of death among women globally; in fact, it kills more women than men. But heart disease is often under-researched, under-diagnosed and under-treated in women.

The causes and symptoms of heart attack are different in men and women and they tend to be deadlier in women.

To raise awareness and address the key gender differences, the American Heart Association (AHA) has issued a scientific statement in the journal Circulation.

Causes for heart attack such as types of plaque buildup in the arteries can differ between the sexes. Compared to men, women are less likely to have severe blockages that require stents; yet blood flow could be compromised due to an intense spasm in the artery or tear in the artery, leading to a heart attack.

While chest pain or discomfort is the most common heart attack symptom for both men and women, women are more likely to have other atypical symptoms such as shortness of breath, back, neck, arm or jaw pain, indigestion, nausea and vomiting.

In fact, about 42 per cent of women with heart attacks do not experience chest pain and they may not seek immediate medical help. Even if they seek help, doctors may misdiagnose it. This delay in treatment can contribute to higher mortality rates among women, especially younger women.

Risk factors such as high blood pressure and diabetes contribute to heart attack more strongly in women than in men. Diabetes raises young women's heart disease risk up to five times higher compared to young men.

The recommended medications after a heart attack are often underused in women compared to men, and women are less often referred for cardiac rehabilitation after a heart attack. Even if it is prescribed, women are less likely to complete it.

Women fare much worse than men after a heart attack and are more likely to die from it; 26 per cent of women die in the first year after a heart attack compared to 19 per cent of men.

“Women should not be afraid to ask questions—we advise all women to have more open and candid discussions with their doctor about both medication and interventional treatments to prevent and treat a heart attack,” said writing group chair Dr Laxmi Mehta.

Did You Know
Children who are breastfed beyond their first birthday should be given vitamin D supplements even if they are also eating solid food.
American Journal of Public Health


Predictive contacts

A contact lens with a built-in sensor could help identify which glaucoma patients have a higher risk of disease progression.

Glaucoma is a leading cause of blindness globally. It can cause high pressure in the eye, or intraocular pressure that damages the optic nerve. Currently doctors routinely check eye pressure to monitor disease progression. However, these tests can provide only a single snapshot in time and are impossible to check at night when eye pressure usually rises.

The contact lenses can solve the problem by continuously monitoring the patients.

The contact lens, Sensimed Triggerfish, was tested on 40 patients aged 40-89 with open-angle glaucoma. At least eight standard eye tests were done on these patients over two years to identify disease progression. Half of them had slow disease progression, while the other half had fast disease progression.

The patients were asked to wear the contact lens for 24 hours, including when they slept. The lens has a sensor that detects changes in lens curvature, which indicates eye pressure. When the curve changes, an electrical signal is sent to a wireless device that records the signals and shows eye pressure changes over time.

Patients with higher spikes overnight and a greater number of peaks in their signal profile had faster glaucoma progression.

The readings can help doctors better estimate the risk of progression and also to evaluate glaucoma treatments.

“What we see in these measurements is a signature that indicates which glaucoma patients will get worse and which are relatively stable, which you can’t do with a one-time eye pressure measurement. This could be very useful if you want to know whether a new medication is working for a patient. You can see how their eye is reacting to the therapy in a much more meaningful way,” said the study author.

Memory burn out

Proton pump inhibitors (PPIs), a popular class of heartburn medications—omeprazole, pantoprazole, lansoprazole, esomeprazole, or rabeprazole—used to treat heartburn and other gastrointestinal diseases, can increase the risk of dementia in the elderly.

For the German study published in the journal JAMA Neurology, researchers studied 73,679 people, aged 75 and older, without dementia at the start of the study. Over the course of the study (2004 - 2011), 29,510 participants were diagnosed with dementia. Regular PPI users had at least a 44 per cent increased risk of dementia compared with those not taking the drugs.

PPIs appear to increase the levels of beta amyloid, a damaging protein associated with Alzheimer's disease. PPI use can also lead to vitamin B12 deficiency, which has been associated with cognitive decline.

Two recent studies have linked overuse of PPIs to heart disease and chronic kidney disease.

“The avoidance of PPI medication may prevent the development of dementia,” the study concluded.

Did You Know
Taking the antidepressant venlafaxine, a serotonin-norepinephrine reuptake inhibitor, was linked to a more than 70 per cent increased risk of excess bleeding following labour. But the more commonly used class of antidepressants called selective serotonin reuptake inhibitors that includes citalopram, escitalopram, fluoxetine, paroxetine and sertraline did not increase the risk for postpartum haemorrhage.
Obstetrics & Gynecology


Egg not a villain

Eggs have often been considered a villain of the heart. But not anymore. A Finnish study published in the American Journal of Clinical Nutrition suggests that eggs and other high cholesterol food do not increase the risk of heart disease.

The study followed 1,032 men ages 42 to 60 without heart disease at the onset for an average of 21 years. About one-third of them carried the APOE4 gene known to increase the risk of heart disease.

The dietary habits of the participants were assessed at the start. On an average, they consumed about 398 milligrams of dietary cholesterol per day. No one reported eating more than one egg a day. An egg has about 180mg of cholesterol.

During followup, 230 men developed heart disease. But neither total dietary cholesterol nor consumption of eggs had any impact on cardiovascular disease, even among APOE4 carriers.

Dietary cholesterol also did not have any bearing on the risk for hardening of the arterial walls.

“Egg or cholesterol intakes were not associated with increased cardiovascular disease risk, even in APOE4 carriers (i.e., in highly susceptible individuals),” the study authors conclude.

Promising results

"The early data is unprecedented," said Dr Stanley Riddell, an immunotherapy researcher and oncologist, as he presented the results of an immunotherapy technique called adoptive T cell therapy in treating hard-to-treat blood cancers that failed to respond to chemotherapy, radiotherapy and bone marrow transplants.

Genetically modified T-cells were used in 29 terminally-ill leukaemia patients, and 27 of them sustained remissions. Nineteen of 30 non-Hodgkin's lymphoma patients experienced partial or complete responses.

But the treatment is not without risks: seven of the patients required intensive care, and another two patients died.

The technique involves removing blood sample from the patient. Immune cells called T-cells are separated. The cells are then modified in the laboratory by genetically engineering with synthetic molecules called chimeric antigen receptors that help them identify and kill cancer cells. These modified cells are allowed to multiply and are then injected back into the patient.

"We have very high rates of complete responses in patients that have failed all other conventional therapies, including bone marrow transplantation," the researcher added.


Honey, it's anti-fungal

A study from The University of Manchester has found that a medicinal type of honey is effective against a fungus that can cause blindness or even death.

Different concentrations of Surgihoney, a biologically engineered honey, were tested on the fungus Fusarium found on plants and in soil and known to cause devastating infections in humans.

Even the lowest concentration had a significant effect in breaking down the cell wall of the fungus, demonstrating its potential as a treatment option for patients.

"Chronic infections, such as those found in long-lasting wounds, comprise about 60-80 per cent of infectious diseases in humans and the way fungi invades wounds is associated with the use of broad-spectrum antibiotics. However, we know that biofilms—thin layers of microorganisms, which group together—contribute to the severity and delayed healing of chronic wounds.

“Through my research I wanted to show the potential for honey as a healing agent to break through these biofilms and in doing so increase the process of healing. What I found amazing is that honey actually works better than some antifungals,” said the researcher.

Did You Know
India had the highest number of stillbirths and neonatal deaths in the world in 2015 with an estimated 5,92,100 stillbirths and 6,95,900 neonatal deaths. Nigeria ranked second in stillbirths, followed by Pakistan, while Pakistan had the second highest number of neonatal deaths, followed by Nigeria.
The Lancet


Get moving

Need motivation to get off the couch? A study in the journal Neurology finds that poor physical fitness in middle age may be linked to a smaller brain volume 20 years later, suggesting accelerated brain ageing.

For the study, 1,583 participants without dementia or heart disease took a treadmill test to assess their fitness at age 40. Twenty years later, they repeated the test and also had MRI brain scans.

Fitness level was estimated based on the length of time it took their heart rate to reach a certain level while on the treadmill. Every eight-unit decrease in performance on the treadmill test corresponded to a drop in brain volume equivalent to two extra years of brain ageing, two decades later.

When people with heart disease or high blood pressure were excluded, a similar drop in fitness was associated with reductions of brain volume equal to one year of accelerated brain ageing.

“These results suggest that fitness in middle age may be particularly important for the many millions of people around the world who already have evidence of heart disease,” the lead researcher said.

The study adds to growing evidence that heart health can impact brain health. Exercise can increase blood flow and oxygen delivery to the brain and improve neuroplasticity, factors that can slow brain ageing and prevent cognitive decline later on.

“Promotion of midlife cardiovascular fitness may be an important step towards ensuring healthy brain ageing,” the study concluded.


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