Theravance's CEO Reviews Phase 2b Study 0091 with its LAMA Candidate TD-4208 Results - Transcript

Executives

Mike Aguiar - SVP & CFO

Mathai Mammen - SVP, Research & Early Clinical Development

Rick Winningham - CEO

Analyst

Anant Padmanabhan - Cowen and Company

Steve Byrne - Bank of America

Howard Liang - Leerink Swann

Stephen Willey - Stifel Nicolaus

Theravance, Inc. (THRX) Phase 2b Study 0091 with its LAMA Candidate TD-4208 Results Call September 4, 2013 8:30 AM ET

Operator

Ladies and gentlemen, good afternoon. At this time, I'd like to welcome everyone to the Theravance Conference Call. During the presentation, all participants will be in a listen-only mode. A question-and-answer session will follow the company's formal remarks. (Operator Instructions)

I will repeat these instructions after management completes their prepared remarks. Today's conference call is being recorded. And now, I would like to turn the call over to Mike Aguiar, Senior Vice President and Chief Financial Officer. Please go ahead, sir.

Mike Aguiar

Good morning, everyone, and thanks for joining us. As we discussed the positive top-line Phase 2b study results from a dose ranging 7 day crossover design Phase 2b study of TD-4208. An investigational long-acting muscarinic antagonist administered once-a-day as a nebulized aqueous solution in patients with moderate to severe chronic obstructive pulmonary disease.

With me on the call today is, Rick Winningham, our Chief Executive Officer, and Mathai Mammen, Senior Vice President of Research & Early Clinical Development. We've prepared a few brief remarks for today's call and then we'll open it up for questions.

A copy of the press release and slide presentation can be downloaded from our website or you can call Investor Relations at (650) 808-4100 and we will be happy to assist you.

Before we get started, we would like to remind you that this conference call contains forward-looking statements regarding future events and the future performance of Theravance.

Forward-looking statements include anticipated results and other statements regarding Theravance's goals, expectations, strategies and beliefs. These statements are based upon the information available to the company today and Theravance assumes no obligation to update these statements as circumstances change.

Future events and actual results could differ materially from those projected in the company's forward-looking statements. Additional information concerning factors that could cause results to differ materially from our forward-looking statements are described in greater detail in the company's Form 10-Q filed with the SEC.

Before I turn the call over to Mathai, I would like to remind you that this slide presentation can be accessed from our website and the slide number referenced during the discussion can be located at the lower right corner of each slides. Additionally, we will not be answering any questions on the call today regarding next week's Advisory Committee Meetings on ANORO ELLIPTA as the briefing documents will be posted by the FDA in the next few days.

I'll now turn the call over to Mathai Mammen. Mathai?

Mathai Mammen

Thanks Mike. Good morning everyone and thank you for joining us. I'm very excited to review the results from the Phase 2b study with TD-4208. First by way of background TD-4208 was discovered as part of a major effort we had internally with the multivalent antagonist of the muscarinic receptor family with long receptor half lives. Beta antagonists were intend to have long-action in the lungs and be suitable for inhalation delivery.

The current goal of our LAMA program is to develop a once-a-day inhaled medicine in a nebulizer that offers improved efficacy and tolerability relative to current therapy. And that provides the bases for combination nebulized products with other medicines such as an inhaled corticosteroid. We believe the opportunity for nebulized product is significant and complementary to that addressed by the GSK Theravance collaboration products.

For some COPD patients current handheld devices are simply not suitable. For instance, some patients may lack the physical or mental dexterity to coordinate a single-breadth inhalation. Nebulization may be the preferred delivery mode for such patients. A strict requirement of the LAMA intended for nebulization is chemical stability in aqueous solutions a feature not common to many LAMA.

TD-4208 is a non-esters non-quaternary nitrogen compound that is chemically stable in aqueous solutions. We announced the results last year the single dose study in COPD patients with TD-4208 and ipratropium as an active comparator. As a reminder in that study TD-4208 was fast acting with the speed of onset comparable to ipratropium and demonstrated a significance and durable bronchodilator response using doses of 350 microgram and 700 microgram.

In the study we are reporting today 0091 we have replicated the evaluation of the original dose range together with lower doses in order to better understand the dose response relationship for TD-4208. For this reason we've included six doses over a 30 fold range from 22 microgram to 700 microgram delivered to patients using a well established standard PARI nebulizer device delivering a simple aqueous formulation.

Let's please turn to Slide 3 for a discussion of 0091. This Phase 2b study was a 7-day repeat dose study where every patient received placebo and four of the six dose group in an incomplete block design with a two week washout period between the five periods. The primary endpoint was predefined as a change from baseline in FEV1 trough after day seven dose. On day seven in all periods we collected serial spirometry from patients over the 24 hour period post-dose. The predefined primary endpoints was the change from base line in FEV1 trough on day seven. The key secondary endpoints were peak effect, area under the FEV1 curve or AUC and the weighted mean FEV1 again derived from the day seven spirometry. The weighted mean is an especially important secondary endpoint and is conceptually the average FEV1 change measured over the entire 24 hour period.

Please turn to Slide 4 where I'll summarize the efficacy data. Prior to doing that I first note that we analyzed the data very carefully for any evidences carryover effects from period-to-period and there were none. Now the data. I'm pleased to report that statistically significant effects were seen at all fixed doses studies from 22 micrograms to 700 micrograms. In other words the primary endpoint was reached for all doses study. The placebo adjusted FEV1 changes of trough ranged from 53 ml to 114 ml.

I'm equally pleased to report that we met all secondary endpoints for all six doses with weighted mean FEV1 ranging from 83 ml to 147 ml. We observed that the medium time to reach 100 milliliters improvement in FEV1 range from 30 milliliters to 60 milliliters.

Let's now look at Slide 5 for a deeper look at the bronchodilator responses over the range of doses study. Plotted on the left is the primary endpoint trough FEV1 on day seven verses dose. Plotted on the right is the key secondary endpoint weighted mean FEV1 on day seven versus dose. These two plots provide a comfortingly consistent picture. The placebo response was small. The two lowest doses of 22 micrograms and 44 micrograms provided a bronchodilator response but not likely to be a clinically meaningful one. The highest dose of 700 seem to offer no advantages over the next two highest doses. The dose of 175 microgram seems to be approaching the top of a dose response on these and multiple other measures. These doses are proprietary to rich information set from which we feel able to select the smaller range of doses for additional study.

Please turn to Slide 6. An additional objective of the study was to determine the likelihood that TD-4208 could be appropriately dosed once daily and not more frequently. All the preclinical data are consistent with the compound with an extended pharmacodynamic action in the lung as where the single dose clinical data reported earlier. The data from study 0091 continues to support once daily doses.

As stated previously we collected FEV1 at a number of time points distributed over the 24 hours at the last day of doses. It is instructed the first visually inspect the 24 hour placebo corrected serial FEV1 curves, which are shown here on Slide 6. One can see that the curves are generally flat across the 24 hour dosing in a row for all doses. One sensitive analysis is to look at the area under this FEV1 curve or AUC for the first 12 hours on day seven and compare this value to the AUC in the second 12 hours on day seven. For all doses study and is tabulated here the ratio of the two AUCs was very close to one for all doses meaning that almost all the treatment effects for the first half of the day was preserved in the second half of the day. There are multiple ways to analyze these data and to use data drawn from approved or late stage bronchodilator drugs at calibration. In general, the current data set provides further evidence that TD-4208 has the potential to be dosed once a day.

So in summary of the efficacy data 0091 we have first demonstrated a dose response for TD-4208; second, identified a dose range that is appropriate to include in future studies; and third, observed a constant bronchodilation response relative to placebo across the full 24-hour dosing interval, consistent with the compound that could be dosed once daily.

Now turning to Slide 7, I will summarize safety findings. As I will describe further in the slide to follow, treatment-related adverse events were comparable to placebo. There were no SAEs related to treatment and no discontinuations due to AEs related to treatment. A full review of all labs for all subjects in the study revealed no clinically significant signs. There were no increases in heart rate at any other time points for any of the doses studied related to placebo. There were no ECG changes including arrhythmias and QTc changes at any of the doses at any of the time point. All of these data are consistent with the very low plasma concentrations of TD-4208 measured in the study.

I will now elaborate on AEs on Slide 8. TD-4208 exhibited an AE profile at all doses that were comparable to placebo. Shown here are the tabulated treatment emergent AEs that occurred two or more times in the entire study. The overall percentages of patients reporting any AEs were about 18% on placebo and between 7% and 16% on TD-4208. The two most common AEs were headache and dyspnoea. Generally, TD-4208 was well tolerated in study 0091.

Now let's turn to the final slide. In summary, all doses in this Phase 2b program for TD-4208 met all primary and secondary endpoints providing significant and clinically meaningful bronchodilation at the higher doses. The 24 hour Serial FEV1 profiles are consistent with the once daily regimens. And finally the safety and tolerability of TD-4208 appeared comparable to placebo at the doses study. We look forward to continue to announce this for our new data set in planning next step.

I'd like to end by offering my sincere thanks to the Theravance team that conducted an excellent study and especially to the patients that participated.

And with that I'll turn the call over to Rick. Rick?

Rick Winningham

Thanks, Mathai. In summary, we are very pleased with these study results for TD-4208 a compound discovered and developed by Theravance. Looking forward, Theravance has a number of important events coming out during the remainder of 2013. These include next week's FDA Advisory Committee for ANORO ELLIPTA; potential RELVAR ELLIPTA regulatory events in other regions; Phase 2 results in ADHD for our dual norepinephrine and serotonin reuptake inhibitor; the producer date for ANORO and ELLIPTA in December; and finally the separation of Theravance into two publicly traded entities either late this year or early in 2014.

And now I'd like to turn the call over to the conference facilitator and open the call for questions.

Question-and-Answer Session

Operator

Thank you. (Operator Instructions) We’ll have our first question from Anant Padmanabhan with Cowen and Company. Your line is open.

Anant Padmanabhan - Cowen and Company

I have a couple. First, I was wondering if you could discuss any market research you have and the demand for a nebulized LAMA. What percent of LAMA eligible patients do you think would need nebulized formulation? And then I have a follow-up.

Rick Winningham

Sure. It's a great question. Based on the research that we've conducted to-date in the current market that exist today in the United States, we would estimate between 5% and 10% of patients prefer a nebulized route of administration for the reasons that Mathai highlighted in his remarks.

Anant Padmanabhan - Cowen and Company

And then, could you discuss any plans to do a LABA/LAMA formulation as a nebulizer? And what would be the LABA in this case?

Rick Winningham

Yeah, no, not at this particular point in time I -- we don't have plans to do a LAMA/LABA combination. Yeah our LABA combination work is really focused with GSK. Mathai did highlight in a nebulizer work that we expect to do with an inhaled corticosteroid. So, I think there is an opportunity for that type of work but it's unlikely that we will take on LABA combination because of our agreement with GSK.

Operator

Our next question comes from Steve Byrne with Bank of America. Your line is open.

Steve Byrne - Bank of America

Mathai, can you talk about the dose response curve, is it logical to you that there could be a peak a dose response and that the higher doses some detrimental effect on FEV?

Mathai Mammen

No that wouldn't be physiologically expected or consistent with the behavior antagonist. My expectation is that if you look at from based on all of the published LAMA dose response type data that's out there that these antagonists have a quite a rough dose response curve. We're actually quite pleased that the very low doses as I said in the prepared statements have a minimal effect and the higher doses generally have or somewhere on a max effect. And I explained the kind of ups and downs of the higher doses as noise within the population relatively small set.

Mike Aguiar

Yeah, Steve, this is Mike. I think if you look at a lot of the data here and compare and see with the UMEC data for example it's just not typical to see a really robust very clear dose response curve with the muscarinic antagonist that's not necessarily the way they behave. So I just would reiterate what Mathai said which is we're awfully pleased to see lower doses where there with the level of efficacy albeit below clinical significance so that would clearly find the lower end of where would be looking and then to have several doses that were clinically relevant. So we did exactly what we want it but again I just would not expect the kind of your traditional a highly linear type dose response curve with these compounds that's not really what is seen in the clinics today.

Steve Byrne - Bank of America

Then can you comment on this 114 milliliters of trough FEV how would that compared to the say standard-of-care?

Mathai Mammen

I think the absolute efficacy is highly dependent on the population we see for example with Spiriva there is studies where Spiriva looks to have a 70 milliliters and other studies where it's about 140 milliliters, 150 milliliters. So my own contention is that LAMAs have an efficacy that's quite comparable among the LAMAs and where they actually play out the choice of therapeutic doses dictated by systemic, side effects, tolerability and safety. And so here we were pleased to see that even if the higher doses we had excellent safety and tolerability. So I think we'll be able to get to a place where we'll be able to get all one can out of this mechanism.

Steve Byrne - Bank of America

And Mathai, can you just talk about where you want to go from here with the clinical developments that you've need to do more dose ranging before you go into Phase 3?

Mathai Mammen

So I think that we're -- we've just uncovered the dataset right now and we're looking carefully at the full set of data. I think we've chosen to report top-line here. We need to discuss internally exactly what we would do next before Phase 3. And I'll also note on the previous question one of the features of this compound that we did note at all doses is a very flat dose response curve. So even at the low doses there is very flat dose response curve so that is especially appealing to that.

Operator

(Operator Instructions) Our next question comes from Howard Liang with Leerink Swann. Your line is open.

Howard Liang - Leerink Swann

Will you need to look at the BID dose to show that's split dose BID is the same as QD at twice-a-dose?

Mathai Mammen

Currently the division in the U.S. regulators do ask for a formal QD BID study. So we're not able to say from the current dataset that we're definitively a QD dose drug but we're projecting that it looks pretty good. The flatness of our dose response curves we would project a reasonable chance in a formal QD BID study.

Rick Winningham

Yeah, Howard, it's a great question. I think because of the flatness of the curve over 24 hours that at multiple doses because of the ratio of effect of the second 12 hours to the first 12 hours approaching one, I think this would be a compound that I'm not too concerned about relative to on a twice-a-day versus once-a-day study. I mean, I think we'll have to get into more of the data but based on what we've seen today I think we are pretty confident in the once-a-day profile of this drug so much though that we would necessarily hold up any advance studies based on the completion of that type of a program we would likely do it concurrently with advanced studies.

Howard Liang - Leerink Swann

So and may be you can talk about strategically what you would intend to do with its compound do you eventually want to market it yourself and also and what the requirement of Phase 3 program for something like this to be similar to other COPD drugs in terms of the scope of the program?

Rick Winningham

Yeah. So I think the Phase 3 program likely for a nebulized compound would be similar to other single agent long-acting muscarinic antagonist. I think it's not the Phase 3 program is not overwhelmingly burdensome here for a nebulized product and we do see an opportunity in 5% to 10% of the COPD population that's very complementary to what we're doing with GSK. Where we go some here in terms of partnership I think we'll leave that open right now. I think we're very excited that we've got a drug here it's got a very good profile it behaved exactly as it was designed to do in the discovery program and I think whether we get a partnership whether we do further studies on our own that's sort of yet to be decided.

Operator

Our next question comes from Stephen Willey with Stifel. Your line is open.

Stephen Willey - Stifel Nicolaus

Yeah. Thanks and forgive me if you've already covered this in early part of the call. I think you had made some prior comments I think around once you had confirmed the TD profile of the drug that you would then potentially had some reformulation options as either DPI or an MDI. And I'm just trying to think about it whether or not you guys are bent on just going forward with nebulizer only or would you potentially explore some of these other administration opportunities?

Rick Winningham

No, Stephen, that's correct. The form of the product the physical characteristics of the product support development in nebulizer but also in a DPI or an MDI we have that work ongoing it needless to say it's not as advanced as a nebulized form but we have that work ongoing in the physical properties that compound supported. So overall 4208 were quite broadly excited about what about what this may mean for the future of the company.

Stephen Willey - Stifel Nicolaus

So would you potentially look to explore parallel development pathways whereby you could have both a nebulized formulation and a DPI formulation in development at the same time?

Rick Winningham

Well yeah I think we would explore that I think it's unlikely we would take simultaneous Phase 3 programs as an example and in both the DPI and a nebulizer. But as we gain more confidence with the product in this for me was a critical study in which to gain significant confidence. The work that we put into the DPI and the MDI will increase because of the confidence generated from the study.

Stephen Willey - Stifel Nicolaus

And then just in terms of commentarial opportunities on the collaborative of the strategic firm. I know that there is really not a whole lot of available once daily LABA assets that are out there. I know that you said you weren't going to pursue that well but may be just give us a little bit color in terms of the once daily ICS assets that would be out there strategically or at least that are out there in development?

Rick Winningham

Yeah, I mean I think the assets that are out there or I didn't really don't want to go into a lot of detail on them because I think that's somewhat of a competitive advantage for us in keeping some of that quite. But suffice to say albeit that there are and I think we've seen opportunity with the LAMAs to combine with the potential steroid of a similar duration.

Stephen Willey - Stifel Nicolaus

And then if I could just ask just one quick ANORO question if you don't mind. Have you guys been pretty to all that subpopulation data that I guess GSK claims is used to support the approval of the higher dose?

Mike Aguiar

Yeah, Stephen, this is Mike. I don't want to get too far up here right now with ANORO commentary just because we've got briefing docs that will be posted here in a sort of eminently. So I'm going to punt on any ANORO questions right now. I would just say we remain confident in our dataset and I really wouldn't want to go beyond that right now again the data will be out in a very short order and we'll get a chance to discuss this soon for public view on Tuesday of next week. So I'll punt on that question for now.

Operator

Thank you. It appears we have no further questions on the phone. I'd now like to turn the call back over to Mr. Winningham. Please go ahead, sir.

Rick Winningham

Yeah, thank you very much. I'd like to thank everyone for joining us this morning with us to share this important news and we look forward to providing further updates on Theravance as the year progresses. Have a great day.

Operator

This does conclude today's conference call. We thank you for your participation. You may now disconnect.

Copyright policy: All transcripts on this site are the copyright of Seeking Alpha. However, we view them as an important resource for bloggers and journalists, and are excited to contribute to the democratization of financial information on the Internet. (Until now investors have had to pay thousands of dollars in subscription fees for transcripts.) So our reproduction policy is as follows: You may quote up to 400 words of any transcript on the condition that you attribute the transcript to Seeking Alpha and either link to the original transcript or to www.SeekingAlpha.com. All other use is prohibited.

THE INFORMATION CONTAINED HERE IS A TEXTUAL REPRESENTATION OF THE APPLICABLE COMPANY'S CONFERENCE CALL, CONFERENCE PRESENTATION OR OTHER AUDIO PRESENTATION, AND WHILE EFFORTS ARE MADE TO PROVIDE AN ACCURATE TRANSCRIPTION, THERE MAY BE MATERIAL ERRORS, OMISSIONS, OR INACCURACIES IN THE REPORTING OF THE SUBSTANCE OF THE AUDIO PRESENTATIONS. IN NO WAY DOES SEEKING ALPHA ASSUME ANY RESPONSIBILITY FOR ANY INVESTMENT OR OTHER DECISIONS MADE BASED UPON THE INFORMATION PROVIDED ON THIS WEB SITE OR IN ANY TRANSCRIPT. USERS ARE ADVISED TO REVIEW THE APPLICABLE COMPANY'S AUDIO PRESENTATION ITSELF AND THE APPLICABLE COMPANY'S SEC FILINGS BEFORE MAKING ANY INVESTMENT OR OTHER DECISIONS.

If you have any additional questions about our online transcripts, please contact us at: transcripts@seekingalpha.com. Thank you!

View the original article here

Risk of autism in further children - study findings

Featured Article
Academic Journal
Main Category: Autism
Also Included In: Pediatrics / Children's Health
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
Risk of autism in further children - study findings

A large population-based study from Denmark has followed siblings for the risk for autism spectrum disorders, finding different likelihoods depending on birth year, and also whether brothers or sisters were half- or full-siblings.

The study uses records of all children born in Denmark between 1980 and 2004. It is the first study of its kind, say the authors, to follow such a large number of children - around 1.5 million - and to consider the "recurrence risk" of autism spectrum disorders (ASD) for both full- and half-siblings.

The study - published online in JAMA Pediatrics by researchers from Aarhus University - compared children who had an older sibling with ASD against those whose older sibling did not have ASD.

According to the authors, 30% of all ASD cases are childhood autism, and the prevalence of autism spectrum disorders has increased over the past 20 years.

The study shows that between 1980 and 2004, the recurrence risks for ASDs ranged between 4.5% and 10.5%, higher than the risk of autism spectrum disorders found across the Danish population, of 1.18%.

Additionally, the researchers found there was an almost seven-fold greater risk for an autism spectrum disorder if an older sibling had an ASD diagnosis, compared with families in which the older sibling did not have a disorder.

For children with the same mother, the recurrence risk was 7.5% for full-siblings and 2.4% for half-siblings.

For children with the same father, the recurrence risk was 7.4% for full-siblings, but the researchers not that there was "no statistically significant increased risk" among half-siblings.

The authors note that the reason the risk is higher for half-siblings who share a mother may be due to the fact that they share genes from their mother, and they also share "exposures derived from their mother's intrauterine environment and perinatal history" across her different pregnancies.

An important issue to address from the study, say the researchers, is that parents who have a child with an ASD may choose not to have any more children. This phenomenon is known as stoppage, and they say it may result in an underestimate of the recurrence risk.

The authors conclude the study by saying:

"The difference in the recurrence risk between full- and half-siblings supports the role of genetics in ASDs, while the significant recurrence risk in maternal half-siblings may support the role of factors associated with pregnancy and the maternal intrauterine environment in ASDs."

The results should be reassuring to parents who have a child with an ASD if they are thinking of having other children, note the researchers, because the recurrence risk they found is "substantially lower than recent reports from smaller clinic-based populations."

?Researchers from Duke University recently linked induced labor and autism risk.

How do parents navigate care for their children with disabilities and other needs? Here's a detailed analysis: Getting support for children with disabilities.

Written by Marie Ellis

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our autism section for the latest news on this subject.

“Recurrence of Autism Spectrum Disorders in Fulland Half-Siblings and Trends Over Time,” Therese K. Grønborg, et al., JAMA Pediatrics, doi:10.1001/jamapediatrics.2013.2259, 19 August 2013.

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Ellis, Marie. "Risk of autism in further children - study findings." Medical News Today. MediLexicon, Intl., 20 Aug. 2013. Web.
20 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Risk of autism in further children - study findings'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

New epidemiological study in malignant hyperthermia reinforces the effectiveness of Dantrium® in reducing fatal anaesthetic reaction

Main Category: Pain / Anesthetics
Also Included In: Clinical Trials / Drug Trials;  Surgery
Article Date: 20 Aug 2013 - 1:00 PDT Current ratings for:
New epidemiological study in malignant hyperthermia reinforces the effectiveness of Dantrium® in reducing fatal anaesthetic reaction

For the first time, a new Canadian epidemiologic study reveals that a 15.5 per cent incidence of adverse anaesthetic reactions is triggered by succinylcholine alone. In line with previous findings, the study also further underlines that early recognition and prompt administration of dantrolene intravenous are critical for patient survival and reduction of complications.[1]

The study reviews one hundred twenty-nine proband* survivors of adverse anaesthetic reactions, whose malignant hyperthermia susceptible status was confirmed by caffeine-halothane contracture testing. Among the findings are lower than expected complication rates in anaesthetising facilities using either succinylcholine or volatile anaesthetic drugs.

Importantly, it also reports that dantrolene reduced the incidence of complications (e.g. renal and cardiac dysfunction, disseminated intravascular coagulation) in these patients. If given between 10 and 19 minutes after the start of malignant hyperthermia, the complication rate is under 20 per cent. An escalating relationship between time to administration was identified, showing that complications can reach 100 per cent when the administration of dantrolene was delayed beyond 50 minutes.

This study is worth noting because it also highlights how having dantrolene readily available can reduce the morbidity and mortality caused by malignant hyperthermia and therefore suggests the importance of reviewing stock levels in hospitals.

The incidence of malignant hyperthermia varies greatly among different populations due to genetic diversity. Recent data suggest the genetic predisposition may be as prevalent as 1 in 3,000 people.[2]

Dr Gunilla Islander, Department of Anaesthesia, Lund hospital, Sweden commented; "These new data are very important as they emphasize that survival from a malignant hyperthermia crisis, a rare condition, is highly dependent on early recognition and prompt action, and that the rapid use of dantrolene can ensure patient survival".

In Europe, DANTRIUM® (dantrolene) is commercialised by Norgine B.V. In December 2012, Norgine B.V. with the owners of SpePharm Holding B.V., created a joint venture company, SpePharm AG, which acquired the specialist hospital products of SpePharm Holding B.V. - DANTRIUM® IV, DANTRIUM® capsules, SAVENE®, XEROTIN® and PROTHER®.

About Malignant Hyperthermia
Malignant hyperthermia is an inherited, rare, life-threatening condition. Triggers for malignant hyperthermia include skeletal muscle relaxants such as succinylcholine and certain volatile anaesthetic gasses, one example of which is halothane.

Early recognition of a pending malignant hyperthermia crisis and immediate treatment are essential for the patient's survival.

About dantrolene (DANTRIUM®)
Dantrolene IV is indicated for malignant hyperthermia and acts peripherally to lower the intracellular calcium concentration in the skeletal muscle.

This occurs by decreasing the release of calcium ions from the sarcoplasmic reticulum and inhibiting the influx of calcium into the myoplasm. Therefore, it effectively slows or stops the cycle of malignant hyperthermia.

Dantrolene oral capsule(s) is a muscle relaxant indicated for chronic spasticity. It is the only agent that acts directly at the level of the skeletal muscle and it therefore has a unique place among the muscle relaxants prescribed.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pain / anesthetics section for the latest news on this subject.

*Malignant hyperthermia often has a familial genetic lineage (autosomal dominant). In this study probands are individuals who presented with the first known cases of malignant hyperthermia in their families. These subjects then had a Caffeine-Halothane Contracture Test, a gold-standard test used widely in North America to confirm susceptibility to malignant hyperthermia.

[1] Sheila Riazi et al. Malignant Hyperthermia in Canada: Characteristics of Index Anesthetics in 129 Malignant Hyperthermia Susceptible Probands. Anesth Analg. 2013 Jul 10. [Epub ahead of print], doi: 10.1213/?ANE.0b013e3182937d8b

[2] Glahn et al. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. British Journal of Anaesthesia 105 (4): 417-20 (2010), doi: 10.1093/bja/aeq243

Norgine

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Norgine. "New epidemiological study in malignant hyperthermia reinforces the effectiveness of Dantrium® in reducing fatal anaesthetic reaction." Medical News Today. MediLexicon, Intl., 20 Aug. 2013. Web.
20 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'New epidemiological study in malignant hyperthermia reinforces the effectiveness of Dantrium® in reducing fatal anaesthetic reaction'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Major study links ageing gene to blood cancer

Main Category: Genetics
Also Included In: Lymphoma / Leukemia / Myeloma;  Blood / Hematology
Article Date: 19 Aug 2013 - 2:00 PDT Current ratings for:
Major study links ageing gene to blood cancer

A gene that helps control the ageing process by acting as a cell's internal clock has been linked to cancer by a major new study.

Scientists at The Institute of Cancer Research, London, found a genetic variant that influences the ageing process among four new variants they linked to myeloma - one of the most common types of blood cancer.

The study more than doubles the number of genetic variants linked to myeloma, bringing the total number to seven, and sheds important new light on the genetic causes of the disease.

The research, published in the prestigious journal Nature Genetics, was mainly funded by charities Leukaemia & Lymphoma Research and Myeloma UK, with additional support from Cancer Research UK.

Myeloma affects around 4,700 patients each year, and is caused by genetic mutations in white blood cells, which normally help fight infection and injury. Less than four in 10 sufferers survive the disease for more than five years, and three in 10 die within a year (1).

One genetic marker found by the researchers is linked to a gene called TERC, which regulates the length of the telomere 'caps' on the ends of DNA. In healthy cells, these caps erode over time - causing tissues to age - but some cancer cells seem able to ignore the ageing trigger in order to keep on dividing. If further studies confirm the link, TERC could be a target for future myeloma treatments.

The team found the new markers by comparing the genetic make-up of a total of 4,692 myeloma patients with DNA from 10,990 people without the disease. A previous UK study led by the team, from The Institute of Cancer Research (ICR) and funded by Myeloma UK, found three genetic variants, or 'spelling mistakes' in DNA, which lead to increased risk of developing myeloma.

The team found the new batch of genetic variants by combining their samples with others from researchers in Germany. The combined results gave the scientists more data and therefore greater statistical accuracy.

All of the four new genetic variants are close to genes which are likely to play important roles in causing myeloma.

Study co-leader Professor Richard Houlston, Professor of Molecular and Population Genetics at The Institute of Cancer Research, said:

"Our study has taken an important step forward in understanding the genetics of myeloma, and suggested an intriguing potential link with a gene that acts as a cell's internal timer.

"We know cancer often seems to ignore the usual controls over ageing and cell death, and it will be fascinating to explore whether in blood cancers that is a result of a direct genetic link. Eventually, understanding the complex genetics of blood cancers should allow us to assess a person's risk or identify new avenues for treatment."

In people affected by myeloma, white blood cells called plasma cells grow uncontrollably in the bone marrow and become stuck there, disrupting normal blood production. It can be very painful, and affects bones in multiple parts of the body.

Professor Chris Bunce, Research Director at Leukaemia & Lymphoma Research, said:

"The identification of these risk gene variants offers more compelling evidence that susceptibility to myeloma can be inherited. Myeloma remains incurable and the effect on patients' quality of life can be devastating.

"By showing how these specific genes influence the cancer's development, this research could potentially lead to the development of targeted myeloma drugs in the future. In addition we know that a common condition called MGUS predisposes to the development of myeloma. The identification of additional genetic risk factors in these patients could revolutionise their future management and prospects."

Heather McKinnon, Clinical Research Programme Manager for Myeloma UK, said:

"We are delighted the original study funded by Myeloma UK two years ago into genetic inheritance in myeloma has now led to further important research. The study published in Nature Genetics identifies four more genetic variations in myeloma and for the first time demonstrates an association with ageing. Myeloma UK is committed to supporting this important research and invests in a programme of work at The Institute of Cancer Research."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our genetics section for the latest news on this subject.

(1). Cancer Research UK Myeloma statistics (2009). Accessed online 6 August 2013.

The Institute of Cancer Research

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

The Institute of Cancer Research. "Major study links ageing gene to blood cancer." Medical News Today. MediLexicon, Intl., 19 Aug. 2013. Web.
19 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Major study links ageing gene to blood cancer'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Spouse in pain? Love affects sleep, study shows

Featured Article
Academic Journal
Main Category: Pain / Anesthetics
Also Included In: Sleep / Sleep Disorders / Insomnia;  Bones / Orthopedics
Article Date: 17 Aug 2013 - 0:00 PDT Current ratings for:
Spouse in pain? Love affects sleep, study shows

Spouses who have a close relationship share many things - material and non-material, highs and lows. And when one spouse experiences chronic pain, it can have a ripple effect for the other spouse, affecting sleep and even increasing risks for health problems, say researchers from Penn State University.

A study recently published in the journal PAIN analyzed relationships in which one spouse experienced chronic knee pain. The researchers said they chose knee pain because it oftentimes causes difficulties staying comfortable in bed at night for many patients.

As a result, the team was able to study the effects on the other spouse's slumber.

The researchers, led by Dr. Lynn Martire, had 138 knee osteoarthritis (OA) patients and their spouses complete interviews and 22-day diaries. The subjects were all at least 50 years of age, lived with their partners and were either in long-term relationships or married.

Results from the study showed that the greater a patient's knee pain was at the end of the day, the worse quality of sleep their spouse experienced that night.

By contrast, the researchers noticed that the quality of sleep the spouse experienced did not equate to greater pain for the patient the following day.

So it appears that spouses who have pain are not affected by their partner's lack of sleep, even though the reverse is true.

The effects that the patients' pain had on spousal sleep were not a result of their own disturbances in sleep, the researchers said.

Dr. Martire noted that "spouses whose sleep is compromised may be less able to respond empathically to patients' symptoms and need for support," potentially also putting them at risk for "physical and psychiatric problems."

The researchers predicted that closer relationships would yield stronger results, and they were correct. They found that, with spouses who had a closer relationship, patient pain resulted in "less refreshing sleep for spouses."

The family experts warn that a groggy morning may not be the only effect on the spouses.

Dr. Lynn Martire said:

"Compromised sleep caused by exposure to a loved one's suffering may be one pathway to spousal caregivers' increased risk for health problems, including cardiovascular disease.

Our findings suggest that assessing the extent to which partners are closely involved in each other's lives would help to identify spouses who are especially at risk for being affected by patient symptoms and in need of strategies for maintaining their own health and well-being."

Research published in the Journal of the American Geriatrics Society in 2010 found that people caring for a spouse with dementia were more likely to develop it themselves.

Other research in the same year, however, reported positive elements to caring for a loved one.

Written by Marie Ellis

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our pain / anesthetics section for the latest news on this subject.

The impact of daily arthritis pain on spouse sleep Lynn M. Martire, et al., PAIN, published online 15 August 2013.

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Ellis, Marie. "Spouse in pain? Love affects sleep, study shows." Medical News Today. MediLexicon, Intl., 17 Aug. 2013. Web.
17 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Spouse in pain? Love affects sleep, study shows'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study of melittin-based pore formation has implications for fighting cancer and bacteria

Main Category: Cancer / Oncology
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 17 Aug 2013 - 0:00 PDT Current ratings for:
Study of melittin-based pore formation has implications for fighting cancer and bacteria

A new study by Rice University biophysicists offers the most comprehensive picture yet of the molecular-level action of melittin, the principal toxin in bee venom. The research could aid in the development of new drugs that use a similar mechanism as melittin's to attack cancer and bacteria.

The study appears in the Proceedings of the National Academy of Sciences.

Melittin does its damage by penetrating the outer walls of cells and opening pores that allow the contents of the cell to escape. At low concentrations, melittin forms transient pores. At higher concentrations, the pores become stable and remain open, and at still higher doses, the cell membrane dissolves altogether.

"This strategy of opening holes in the cell membrane is employed by a great number of host-defense antimicrobial peptides, many of which have been discovered over the past 30 years," said Rice's Huey Huang, the lead investigator of the study. "People are interested in using these peptides to fight cancer and other diseases, in part because organisms cannot change the makeup of their membrane, so it would be very difficult for them to develop resistance to such drugs."

But the clinical use of the compounds is complicated by the lack of consensus about how the peptides work. For example, scientists have struggled to explain how different concentrations of melittin could yield such dramatically different effects, said Huang, Rice's Sam and Helen Worden Professor of Physics and Astronomy.

In the new study, Huang and Rice graduate student Tzu-Lin Sun partnered with colleagues Ming-Tao Lee at the National Synchrotron Radiation Research Center (NSRRC) in Hsinchu, Taiwan, and with Wei-Chin Hung at the Republic of China Military Academy in Fengshan, Taiwan. The team used a combination of experiments to zero in on the molecular activity of melittin at the "minimal inhibitory concentration" (MIC), the lowest concentration that's been shown to slow the growth of target cell populations. The MIC for melittin is a dose that results in stable pore formation, rather than complete dissolution of the membrane.

"We want to understand how pore formation works at this critical concentration, including both at the molecular scale -- what are the shapes of the pores themselves -- and the cellular scale -- how are the pores arranged and distributed over the surface of the membrane," Huang said.

To find the answer, the team correlated the results of two different types of experiments. In the first type, which was conducted at Rice, the team used confocal microscopy to film "giant unilamellar vesicles" (GUVs), synthetic membrane-enclosed structures that are about the same size as a living cell. The outer surface of the GUV became green when bound to melittin that was labeled with a fluorescent dye. The GUV was filled with a solution that contained a red fluorescent dye.

In the experiments, Sun used a needle-like glass pipette to partially aspirate and grab dye-filled GUVs, which were then placed into a melittin-infused solution beneath the microscope. Time-lapse videos of the experiments show that dye-labeled melittin begins sticking to the surface of the GUV within seconds. Within about two minutes, so much melittin binds to the outside of the GUV that the outer surface area increases by up to 4.5 percent. At a critical threshold, the expanding surface changes configuration to accommodate the increased load of melittin. At this point, pores form across the entire surface of the GUV. On the video, the bright red dye within the GUV rapidly leaks out at this critical pore-forming stage.

"The experiment shows how the MIC brings about a new physical state that results in cell death," Huang said. "By correlating these findings with other data about the molecular characteristics of the pores themselves, we get the first complete picture of the process of stable, melittin-induced pore formation."

The molecular level data came from a series of X-ray diffraction experiments performed by Lee at NSRRC. In those experiments, samples of multilayered membranes were bombarded with X-rays. Each layer contained an ordered arrangement of pores, and the stacked layers contained a 3-D lattice of regularly arranged pores. By examining how X-rays scattered away from the sample, Lee and Hung were able to determine the precise contours of the melittin-induced pores.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

karate. "Study of melittin-based pore formation has implications for fighting cancer and bacteria." Medical News Today. MediLexicon, Intl., 17 Aug. 2013. Web.
17 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Study of melittin-based pore formation has implications for fighting cancer and bacteria'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study finds physicians need to better recognize use of herbal supplements while breastfeeding

Main Category: Complementary Medicine / Alternative Medicine
Also Included In: Primary Care / General Practice;  Pediatrics / Children's Health
Article Date: 05 Aug 2013 - 0:00 PDT Current ratings for:
Study finds physicians need to better recognize use of herbal supplements while breastfeeding

In an article published in this month's issue of Pediatrics In Review, researchers from Boston University School of Medicine (BUSM) stress the importance of physicians recognizing that many mothers use herbal supplements while breastfeeding in order to make accurate health assessments for both mother and child.

In the US, no existing regulatory guidelines set a standardized risk assessment of herbal supplement use during breastfeeding. Because of the highly limited number of studies on herb use during lactation, numerous resources have mixed reports and safety recommendations, making it confusing for both mother and clinician.

After completing a systematic review of human lactation and herbal medicine literature, the researchers found poor methodology in the few available studies and concluded that further research is needed to assess the prevalence, efficacy and safety of commonly used herbs during breastfeeding.

"It is important for physicians and clinicians to be more aware that mothers are using herbal supplements and how vital it is to ask the mothers, who are seeking a doctor's opinion when having trouble breastfeeding, about their use before making an assessment," said senior author Paula Gardiner, MD, MPH, assistant professor at BUSM and a physician of family medicine at Boston Medical Center.

Although there is little scientific evidence to support the efficacy or safety of herbal supplements, it is a common practice both nationally and internationally.

"The use of herbal supplements while breastfeeding is two-sided - there are benefits, but there are also safety concerns," she added. "About 18 percent of the US population use herbs and dietary supplements. We just want to make sure physicians and clinicians are aware of this prevalent use when communicating with breastfeeding mothers about their health."

Herbal remedies may be used to increase the milk supply, relieve engorgement, treat mastitis, or for other therapeutic uses unrelated to lactation.

"Since there is very limited research, it is difficult to develop accurate information on the safety and effectiveness of specific herbs during breastfeeding," said Gardiner. "It is crucial that more research is conducted in this area, including national prevalence studies and safety and efficacy studies."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our complementary medicine / alternative medicine section for the latest news on this subject.

Gardiner is supported by grant K07AT005463 from the National Center for Complementary & Alternative Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Complementary & Alternative Medicine or the National Institutes of Health.

Boston University Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Boston University Medical Center. "Study finds physicians need to better recognize use of herbal supplements while breastfeeding." Medical News Today. MediLexicon, Intl., 5 Aug. 2013. Web.
5 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Study finds physicians need to better recognize use of herbal supplements while breastfeeding'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study highlights challenges of predicting disease outcomes in a warming world

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Public Health;  Tropical Diseases
Article Date: 14 Aug 2013 - 1:00 PDT Current ratings for:
Study highlights challenges of predicting disease outcomes in a warming world

Climate change is already affecting the spread of infectious diseases--and human health and biodiversity worldwid - according to disease ecologists reporting research results in this week's issue of the journal Science.

Modeling disease outcomes from host and parasite responses to climate variables, they say, could help public health officials and environmental managers address the challenges posed by the changing landscape of infectious disease.

"Earth's changing climate and the global spread of infectious diseases are threatening human health, agriculture and wildlife," said Sam Scheiner, National Science Foundation (NSF) program director for the joint NSF-National Institutes of Health Ecology and Evolution of Infectious Diseases Program, which funded the research.

"Solving these problems requires a comprehensive approach that unites scientists from biology, the geosciences and the social sciences."

According to lead author Sonia Altizer of the University of Georgia, the issue of climate change and disease has provoked intense debate over the last decade, particularly in the case of diseases that affect humans.

In the Science paper, Altizer and her colleagues - Richard Ostfeld of the Cary Institute of Ecosystem Studies; Pieter Johnson of the University of Colorado; Susan Kutz of the University of Calgary and Canadian Cooperative Wildlife Health Centre; and Drew Harvell of Cornell University - laid out an agenda for future research and action.

"For a lot of human diseases, responses to climate change depend on the wealth of nations, healthcare infrastructure, and the ability to take mitigating measures," Altizer said.

"The climate signal, in many cases, is hard to tease apart from other factors like vector control, and vaccine and drug availability."

In diseases affecting wildlife and agricultural ecosystems, however, findings show that climate warming is already causing changes.

"In many cases, we're seeing an increase in disease and parasitism," Altizer said. "But the effect of climate change on these disease relationships depends on the physiology of the organisms and on the structure of natural communities."

At the organism level, climate change can alter the physiology of parasites. Some of the clearest examples are found in the Arctic, where temperatures are rising rapidly. Parasites are developing faster as a result. A lungworm that affects muskoxen, for instance, may be transmitted over a longer period each summer, making it a more serious problem for the populations it infects.

Climate change is also affecting entire plant and animal communities.

Community-level responses to rising temperatures are evident in tropical marine environments such as the coral reef ecosystems of the Caribbean. Warmer water temperatures have directly stressed corals and facilitated infections by pathogenic fungi and bacteria. When corals succumb, other species that depend on them are affected.

The potential consequences of these changes are serious. The combination of warmer temperatures and altered disease patterns is placing growing numbers of species at risk of extinction, the scientists say.

In human health, there is a direct risk from pathogens like dengue, malaria and cholera. All are linked to warmer temperatures.

Indirect risks also exist in threats to agricultural systems and game species that are crucial for subsistence and cultural activities.

The scientists recommend building on and expanding data on the physiological responses of hosts and parasites to temperature change. Those mechanisms may offer clues to how a system will respond to climate warming.

"We'd like to be able to predict, for example, that if the climate warms by a certain amount, then in a particular host-parasite system we might see an increase from one to two disease transmission cycles each year," Altizer said.

"But we'd also like to try to tie these predictions to actions that might be taken."

Some of those actions might involve more monitoring and surveillance, adjusting the timing of vector control measures and adopting new management measures.

These could include, for instance, closing coral reefs to human activity if a disease outbreak is predicted, or changing the planting strategy for crops to compensate for unusually high risks of certain diseases.

The researchers also point out that certain local human communities, such as those of indigenous peoples in the Arctic, could be disproportionately affected by climate-disease interactions.

Predicting where these local-scale effects might be most intense would allow societies to take measures to address issues such as health and food security.

"Involving local communities in disease surveillance," said Altizer, "could become essential."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our infectious diseases / bacteria / viruses section for the latest news on this subject.

Climate Change and Infectious Diseases: From Evidence to a Predictive Framework

Sonia Altizer, Richard S. Ostfeld, Pieter T. J. Johnson, Susan Kutz, and C. Drew Harvell. Science 2 August 2013: 514-519. [DOI:10.1126/science.1239401]

National Science Foundation

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Foundation, National Science. "Study highlights challenges of predicting disease outcomes in a warming world." Medical News Today. MediLexicon, Intl., 14 Aug. 2013. Web.
14 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Study highlights challenges of predicting disease outcomes in a warming world'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device

Main Category: Cardiovascular / Cardiology
Also Included In: Medical Devices / Diagnostics
Article Date: 13 Aug 2013 - 13:00 PDT Current ratings for:
Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device

In a large population of Medicare beneficiaries with heart failure who underwent implantation of a cardiac resynchronization therapy defibrillator, patients who had the cardiac characteristics of left bundle-branch block and longer QRS duration had the lowest risks of death and all-cause, cardiovascular, and heart failure readmission, according to a study in the August 14 issue of JAMA.

"Clinical trials have shown that cardiac resynchronization therapy (CRT) improves symptoms and reduces mortality and readmission among selected patients with heart failure and left ventricular systolic dysfunction. Following broad implementation of CRT, it was recognized that one-third to one-half of patients receiving the therapy for heart failure do not improve. Identification of patients likely to benefit from CRT is particularly important, because CRT defibrillator (CRT-D) implantation is expensive, invasive, and associated with important procedural risks. A primary question regarding optimal patient selection for CRT is whether patients with longer QRS duration or left bundle-branch block (LBBB) morphology derive greater benefit than others," according to background information in the article. QRS duration is a measurement of the electrical conducting time of the heart on an electrocardiogram. Left bundle-branch block is a cardiac conduction abnormality.

Pamela N. Peterson, M.D., M.S.P.H., of Denver Health Medical Center, Denver, and colleagues conducted a study to determine the long-term outcomes of patients undergoing CRT-D implantation and associations between combinations of QRS duration and presence of LBBB and outcomes, including all-cause mortality; all-cause, cardiovascular, and heart failure readmission; and complications. The study included Medicare beneficiaries in the National Cardiovascular Data Registry's ICD Registry between 2006 and 2009 who underwent CRT-D implantation. Patients were stratified according to whether they were admitted for CRT-D implantation or for another reason, then categorized as having either LBBB or no LBBB and QRS duration of either 150 ms or greater or 120 to 149 ms. Patients underwent follow-up for up to 3 years, through December 2011.

Mortality rates in the primary overall study cohort were 0.8 percent at 30 days, 9.2 percent at 1 year, and 25.9 percent at 3 years. Rates of all-cause readmission were 10.2 percent at 30 days and 43.3 percent at 1 year. The researchers found that after adjustment for demographic and clinical factors, compared with patients with LBBB and QRS duration of 150 ms or greater, the other 3 groups had significantly higher risks of mortality and all-cause, cardiovascular, and heart failure readmission. The adjusted risk of 3-year mortality was lowest among patients with LBBB and QRS duration of 150 ms or greater (20.9 percent), compared with LBBB and QRS duration of 120 to 149 ms (26.5 percent), no LBBB and QRS duration of 150 ms or greater (30.7 percent), and no LBBB and QRS duration of 120 to 149 ms (32.3 percent). The adjusted risk of l-year all-cause readmission were also lowest among patients with LBBB and QRS duration of 150 ms or greater (38.6 percent), compared with LBBB and QRS duration of 120 to 149 ms (44.8 percent), no LBBB and QRS duration of 150 ms or greater (45.7 percent), and no LBBB and QRS duration of 120 to 149 ms (49.6 percent).

There were no observed associations with complications.

"Although prior data regarding the effects of CRT as a function of QRS duration are largely limited to meta-analyses of clinical trials, this study provides an important perspective on the role of QRS duration in outcomes after CRT implantation in clinical practice," the authors write.

"These findings support the use of QRS morphology and duration to help identify patients who will have the greatest benefit from CRT-D implantation."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cardiovascular / cardiology section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

MLA

JAMA. "Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device." Medical News Today. MediLexicon, Intl., 13 Aug. 2013. Web.
14 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Study identifies characteristics of heart failure patients more likely to benefit from implantation of cardiac resynchronization device'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Southerners are less trusting, but people who trust are more likely to cooperate to save the environment, baylor study shows

Main Category: Water - Air Quality / Agriculture
Also Included In: Psychology / Psychiatry
Article Date: 03 Aug 2013 - 0:00 PDT Current ratings for:
Southerners are less trusting, but people who trust are more likely to cooperate to save the environment, baylor study shows

Southerners are generally not as trusting as people who live in other parts of the country, but trusting people are more likely to cooperate in recycling, buying green products and conserving water, a new Baylor University study on environmental protection shows.

"A lot of researchers have reported trust as kind of a cure-all for protecting the environment through cooperation. Southerners are just as willing, but less trusting," said lead author Kyle Irwin, Ph.D., an assistant professor in Baylor's College of Arts & Sciences.

"The question our study raised was that if trust isn't a catalyst for environmental cooperation for Southerners, what is?"

The study, published in The Sociological Quarterly, was based on analysis of a data sample of 650 respondents - 238 of them Southerners - from the 2010 General Social Survey, Irwin said. "The South" as defined by the U.S. Census Bureau includes 16 states (listed below) and Washington D.C.

Previous studies by other researchers have shown that trust is important in working together to protect the environment, but the study by Irwin and co-researcher Nick Berigan, Ph.D., a visiting assistant professor at East Tennessee State University, is the first to look at cultural factors, Irwin said.

"Southerners are relatively close-knit and interact within small and dense networks," he said. "Social spheres often overlap: People that work together may go to church together, attend sports events for their kids. This type of network often produces a lot of solidarity and trust within the 'in group,' but distrust toward outsiders."

Compared to Southerners, non-Southerners have a large number of weak and transient friendships. Social networks in the non-South are considered individualistic, and that promotes trust of people who might be considered outsiders, he said.

"There's been a slew of research on the relationship between trust and environmental protection," Irwin said. "The more trust people have, the more willing they are to make sacrifices to hold up their end to solve problems."

But Southerners' cooperation in pro-environment efforts does not hinge on trust as much as non-Southerners' cooperation does.

The new study measured trust with the question of "Generally speaking, would you say that most people can be trusted, or that you can't be too careful in dealing with people?" Among Southern respondents, 24.9 percent of respondents trusted others; 38.7 of non-Southern respondents did so.

The study shows that political views and education are associated with cooperation in the South, with Democrats more willing to make cuts in living standards and more educated people more willing to pay higher taxes to help protect the environment. Also in the South, confidence in the government was associated with greater willingness to pay higher taxes.

Irwin said that further study is needed to draw firm conclusions, but the research suggests that pro-environmental efforts in the South might target Republicans by assuring them that long-term benefits of conservation outweigh short-term costs and are consistent with their values, rather than mandated by those with liberal political views.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our water - air quality / agriculture section for the latest news on this subject.

*States listed as Southern by the U.S. Census Bureau include Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia. Washington, D.C. also is included.

Baylor University

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

University, Baylor. "Southerners are less trusting, but people who trust are more likely to cooperate to save the environment, baylor study shows." Medical News Today. MediLexicon, Intl., 3 Aug. 2013. Web.
3 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Southerners are less trusting, but people who trust are more likely to cooperate to save the environment, baylor study shows'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study finds physicians need to better recognize use of herbal supplements while breastfeeding

Main Category: Complementary Medicine / Alternative Medicine
Also Included In: Primary Care / General Practice;  Pediatrics / Children's Health
Article Date: 05 Aug 2013 - 0:00 PDT Current ratings for:
Study finds physicians need to better recognize use of herbal supplements while breastfeeding

In an article published in this month's issue of Pediatrics In Review, researchers from Boston University School of Medicine (BUSM) stress the importance of physicians recognizing that many mothers use herbal supplements while breastfeeding in order to make accurate health assessments for both mother and child.

In the US, no existing regulatory guidelines set a standardized risk assessment of herbal supplement use during breastfeeding. Because of the highly limited number of studies on herb use during lactation, numerous resources have mixed reports and safety recommendations, making it confusing for both mother and clinician.

After completing a systematic review of human lactation and herbal medicine literature, the researchers found poor methodology in the few available studies and concluded that further research is needed to assess the prevalence, efficacy and safety of commonly used herbs during breastfeeding.

"It is important for physicians and clinicians to be more aware that mothers are using herbal supplements and how vital it is to ask the mothers, who are seeking a doctor's opinion when having trouble breastfeeding, about their use before making an assessment," said senior author Paula Gardiner, MD, MPH, assistant professor at BUSM and a physician of family medicine at Boston Medical Center.

Although there is little scientific evidence to support the efficacy or safety of herbal supplements, it is a common practice both nationally and internationally.

"The use of herbal supplements while breastfeeding is two-sided - there are benefits, but there are also safety concerns," she added. "About 18 percent of the US population use herbs and dietary supplements. We just want to make sure physicians and clinicians are aware of this prevalent use when communicating with breastfeeding mothers about their health."

Herbal remedies may be used to increase the milk supply, relieve engorgement, treat mastitis, or for other therapeutic uses unrelated to lactation.

"Since there is very limited research, it is difficult to develop accurate information on the safety and effectiveness of specific herbs during breastfeeding," said Gardiner. "It is crucial that more research is conducted in this area, including national prevalence studies and safety and efficacy studies."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our complementary medicine / alternative medicine section for the latest news on this subject.

Gardiner is supported by grant K07AT005463 from the National Center for Complementary & Alternative Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Complementary & Alternative Medicine or the National Institutes of Health.

Boston University Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Boston University Medical Center. "Study finds physicians need to better recognize use of herbal supplements while breastfeeding." Medical News Today. MediLexicon, Intl., 5 Aug. 2013. Web.
5 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Study finds physicians need to better recognize use of herbal supplements while breastfeeding'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study offers promising new direction for organ regeneration and tissue repair

Main Category: Biology / Biochemistry
Also Included In: Rehabilitation / Physical Therapy
Article Date: 02 Aug 2013 - 1:00 PDT Current ratings for:
Study offers promising new direction for organ regeneration and tissue repair

Because most human tissues do not regenerate spontaneously, advances in tissue repair and organ regeneration could benefit many patients with a wide variety of medical conditions.

Now a research team led by investigators at Beth Israel Deaconess Medical Center (BIDMC) and Dana-Farber/Boston Children's Cancer and Blood Disorders Center has identified an entirely new approach to enhance normal tissue growth, a finding that could have widespread therapeutic applications.

Their findings were published on-line in the Proceedings of the National Academy of Sciences (PNAS).

Tissue regeneration is a process that is not fully understood, but previous research has demonstrated that endothelial cells lining the insides of small blood vessels play a key role in tissue growth. It is also known that these endothelial cells generate chemical messengers called epoxyeicosatrienoic acids (EETs), which stimulate blood vessel formation in response to tissue injury.

In this new research, first author Dipak Panigrahy, MD, an investigator in BIDMC's Center for Vascular Biology Research, and his colleagues wanted to find out how EETs might participate in organ and tissue regeneration. To answer this question, they created seven different mouse models. The models focused on liver, kidney and lung regeneration; wound healing; corneal vascularization; and retinal vascularization.

"We used genetic and pharmacologic tools to manipulate EET levels in the animals to show that EETs play a critical role in accelerating tissue growth, providing the first in vivo demonstration that pharmacological modulation of EETs can affect organ regeneration," explains Panigrahy, an Instructor in Pathology at Harvard Medical School. Administering synthetic EETs spurred tissue growth in the research models; conversely, lowering EET levels - by either manipulating genes or administering drugs - delayed tissue regeneration.

The team also demonstrated that proteins called soluble epoxide hydrolase (sEH) inhibitors, known to elevate EET levels, promoted liver and lung regeneration. (sEH is the main metabolizing enzyme of EETs.)

"Our results offer a mechanistic rationale for evaluating sEH inhibitors as novel therapeutics for a number of human diseases such as hepatic insufficiency after liver damage and diseases characterized by immature lung development, such as bronchopulmonary dysplasia," says Panigrahy, adding that the use of topical sEH inhibitors on the skin might also be useful for the acceleration of wound healing.

The researchers suspected that EETs were stimulating tissue regeneration by way of blood vessel formation, specifically by producing vascular endothelial growth factor (VEGF) to promote vessel growth. As predicted, when the investigators depleted VEGF in the mice, EETs' effects on organ regeneration disappeared.

"Discovering EETs' role could be of critical importance to help control the repair of liver, lungs and kidneys," says senior author Mark Kieran, MD, PhD, of the Division of Pediatric Oncology at Dana-Farber/Boston Children's Cancer and Blood Disorders Center. "Since diseases of these organs are a major cause of morbidity and mortality in the North American population, the opportunity to modulate the regeneration of healthy tissue could have significant therapeutic implications for many patients." These findings may also apply to conditions or physical defects that lead to the loss of specialized cells in other organ systems, such as the nervous system and the immune system.

The investigators stress that it will be important to determine whether EETs affect other factors, besides VEGF, in influencing tissue repair. Additionally, they add, the beneficial effects of EETs will have to be carefully weighed against their finding that direct administration of EETs can stimulate cancer growth in animal models. Several clinical trials that are currently testing the potential of sEH inhibitors for purposes other than organ regeneration or wound repair could offer valuable insights into the safety of elevating EET levels in patients.

"Although our work suggests synthetic EETs would promote wound healing after surgery, more clinical trials are needed to assess the potential benefits and possible risks of these novel lipids," adds co-corresponding author Darryl Zeldin, MD, Scientific Director for the National Institute of Environmental Health Sciences, part of the National Institutes of Health.

In addition to laying the groundwork for future research, the investigators point out that this study highlights the benefits of experts from varying disciplines and organizations working together, noting that coauthors work in departments ranging from oncology to ophthalmology and from pharmacotherapy to transplantation. They included investigators from Boston Children's Hospital; the Institute for Systems Biology; the University of California, Davis; the National Institute of Environmental Health Science at the National Institutes of Health; the University of North Carolina at Chapel Hill; the Lahey Clinic Medical Center; the University of Texas Southwestern Medical Center; the Fred Hutchinson Cancer Research Center; and Schepens Eye Research Institute/Massachusetts Eye and Ear.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our biology / biochemistry section for the latest news on this subject.

Epoxyeicosanoids promote organ and tissue regeneration, PNAS published online before print July 29, 2013, doi: 10.1073/pnas.1311565110

In addition to Panigrahy, Kieran and Zeldin, coauthors include Bruce D. Hammock (co-corresponding author); Brian T. Kalish, Sui Huang, Diane R. Bielenberg, Hau D. Lee, Jun Yang, Matthew L. Edin, Craig R. Lee, Ofra Benny, Dayna K. Mudge, Catherine E. Butterfield, Akiko Mammoto, Tadanori Mammoto, Bora Inceoglu, Roger L. Jenkins, Mary A. Simpson, Tomoshige Akino, Fred B. Lih, Kenneth B. Tomer, Donald E. Ingber, John R. Falck, Vijaya L. Manthati, Arja Kaipainen, Patricia A. D'Amore, and Mark Puder.

This work was supported by grants from the National Cancer Institute (RO1CA148633-01A4); the Stop and Shop Pediatric Brain Tumor Fund; the C. J. Buckley Pediatric Brain Tumor Fund; the Children's Hospital Boston Surgical Foundation and the Vascular Biology Program; the Robert A. Welch Foundation (GL625910); the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01 025034 and Z01 050167); the National Institutes of Health (R01 GM088199; GM31278; R01 ES002710; R01 ES013933, and CA045548; and the NIEHS Superfund Basic Research Program (NIH Grant P42 ES004699). The work was also supported through the Joshua Ryan Rappaport Fellowship and Howard Hughes Medical Institute Research Fellowship.

Beth Israel Deaconess Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Beth Israel Deaconess Medical Center. "Study offers promising new direction for organ regeneration and tissue repair." Medical News Today. MediLexicon, Intl., 2 Aug. 2013. Web.
3 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Study offers promising new direction for organ regeneration and tissue repair'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here

Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder

Main Category: Dentistry
Also Included In: Pain / Anesthetics
Article Date: 05 Aug 2013 - 1:00 PDT Current ratings for:
Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder

Temporomandibular joint disorder (TMJD) is the most common form of oral or facial pain, affecting over 10 million Americans. The chronic disorder can cause severe pain often associated with chewing or biting down, and lacks effective treatments.

In a study in mice, researchers at Duke Medicine identified a protein that is critical to TMJD pain, and could be a promising target for developing treatments for the disorder. Their findings are published in the August issue of the journal PAIN.

Aside from cases related to trauma, little is known about the root cause of TMJD. The researchers focused on TRPV4, an ion channel protein that allows calcium to rapidly enter cells, and its role in inflammation and pain associated with TMJD.

"TRPV4 is widely expressed in sensory neurons found in the trigeminal ganglion, which is responsible for all sensations of the head, face and their associated structures, such as teeth, the tongue and temporomandibular joint," said senior study author Wolfgang Liedtke, M.D., PhD, associate professor of neurology and neurobiology at Duke. "This pattern and the fact that TRPV4 has been found to be involved in response to mechanical stimulation made it a logical target to explore."

The researchers studied both normal mice and mice genetically engineered without the Trpv4 gene (which produces TRPV4 channel protein). They created inflammation in the temporomandibular joints of the mice, and then measured bite force exerted by the mice to assess jaw inflammation and pain, similar to how TMJD pain is gauged in human patients. Given that biting can be painful for those with TMJD, bite force lessens the more it hurts.

The mice without the Trpv4 gene had a smaller reduction in bite force - biting with almost full force - suggesting that they had less pain. In normal mice there was more TRPV4 expressed in trigeminal sensory neurons when inflammation was induced. The increase in TRPV4 corresponded with a greater reduction in bite force.

The researchers also administered a compound to normal mice that blocked TRPV4, and found that inhibiting TRPV4 also led to smaller reductions in bite force, similar to the effects of the mice engineered without the Trpv4 gene.

Surprisingly, the researchers found comparable bone erosion and inflammation in the jaw tissue across all mice, regardless whether the mice had TRPV4 or not.

"Remarkably, the damage is the same but not the pain," Liedtke said. "The mice that had the most TRPV4 appeared to have the most pain, but they all had similar evidence of temporomandibular joint inflammation and bone erosion in the jawbone as a consequence of the inflammation."

The results suggest that TRPV4 and its expression in trigeminal sensory neurons contribute to TMJD pain in mice. Given the lack of effective treatments for this chronic pain disorder, TRPV4 may be an attractive target for developing new therapies.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our dentistry section for the latest news on this subject.

In addition to Liedtke, Duke study authors include senior pain researcher Yong Chen, Ji Hee Hong, Suk Hee Lee, Puja K. Parekh and Carlene Moore of the Department of Neurology; Amy L. McNulty, Nicole E. Rothfusz and Farshid Guilak of the Department of Orthopaedic Surgery; Fan Wang of the Department of Cell Biology/Neurobiology; and Andrea B. Taylor of the Departments of Community and Family Medicine and Evolutionary Anthropology. Susan H. Williams of the Heritage College of Osteopathic Medicine at Ohio University and Robert W. Gereau IV of the Department of Anesthesiology at Washington University in St. Louis also contributed to this research.

The research was supported by the National Institutes of Health (DE018549, DE19440, DE19440S1, NS48602, AR048182 and DE018549-S); Duke Institute for Brain Sciences; Nicholas School of the Environment, Duke University; and Keimyung University School of Medicine in South Korea.

Duke University Medical Center

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Duke University Medical Center. "Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder." Medical News Today. MediLexicon, Intl., 5 Aug. 2013. Web.
5 Aug. 2013. APA
Duke University Medical Center. (2013, August 5). "Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder." Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/264306.php.

Please note: If no author information is provided, the source is cited instead.

'Study reveals target for drug development for temporomandibular joint disorder (TMJD) - a chronic jaw pain disorder'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here