Too many women with PCOS go undiagnosed

https://goo.gl/86qr9a

Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. It can put those affected at risk for serious health conditions including high blood pressure, heart disease and diabetes. PCOS can also cause infertility, a loss of hair on the scalp, excess body hair, acne and weight gain.

The disorder affects between 7 and 10 percent of women of childbearing age.

I am one of them.

During my sophomore year of college, I noticed I was getting more acne around my chin and jawline, but attributed the breakouts to high levels of stress, abnormal sleep habits, poor diet and alcohol. My teenage years were plagued by irregular, heavy periods and obvious mood swings.

Sitting in my doctor’s office, alongside my mother, I was diagnosed with PCOS after a dermatologist with the disorder suggested I get an ultrasound. I was 19. I was told I would face fertility issues. To reduce side effects, I was prescribed birth control. That was it. The conversation ended there.

I wasn’t informed of the common mental-health issues associated with PCOS. I didn’t know depression and anxiety — both of which I experienced a few years later — are reported by women with the disorder at a higher rate.

I didn’t know the unwanted facial hair under my chin was a common symptom. Instead I joked the hair was a reflection of my grandmotherly habits.

The number one issue facing women with PCOS is awareness, or lack thereof, says Megan Stewart, founder of the PCOS Awareness Association. Stewart says the absence of information surrounding the disorder comes from staunch disagreements among those within the medical profession.

“A lot of medical professionals aren’t well versed [with PCOS],” says Stewart. “So when they see the symptoms, they may equate it to thyroid complications, or even Hashimoto’s disease.” She also attributes the more than 50 percent of women with PCOS who go undiagnosed to the same disconnect.


FDA Approves Benralizumab for Severe Asthma

https://goo.gl/SJYzT3

The FDA has approved AstraZeneca's biologic drug benralizumab (Fasenra) for the add-on maintenance treatment of patients age 12 years and over with severe asthma with an eosinophilic phenotype, the drugmaker announced late Tuesday.

Approval was based on pivotal trials showing up to a 51% reduction in the annual asthma exacerbation rate versus placebo in patients with uncontrolled, severe asthma and high levels of eosinophilia. The drug also showed an overall adverse event profile similar to that of placebo in the trials, and users had median 75% reductions in daily oral corticosteroid use.


We heard you — incontinence affects men too. Here’s what you need to know

https://goo.gl/rLgRGP

As men age, the simple act of urinating can get complicated. Prostate surgery often leaves men vulnerable to leakage when they cough, sneeze, or just rise from a chair. Or the bladder may become impatient, suddenly demanding that you find a bathroom right now. “Thousands of years ago, it was not as much of an issue,” observes Dr. Anurag Das, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center. “There were lots of trees, and you could just find one and go.”

But tricky bladders can be whipped into shape. The first step is a careful assessment of what triggers those difficult moments. Often your doctor can suggest helpful strategies and possibly medication to improve urinary control.

Urinary incontinence means the accidental or involuntary loss of urine from the bladder. Many cases involve slight “dribbling.” The most common types are urge incontinence and stress incontinence. The usual causes of urge incontinence in men are involuntary contractions of the bladder muscles (overactive bladder). This is sometimes related to long-term blockage from an enlarged prostate. “You feel the urge to go but you start leaking before you make it,” Dr. Das says. “It could be a few drips, or it could be a larger amount if you can’t find the bathroom in time.” Many men notice that certain triggers set off their urge incontinence, such as hearing running water, entering a cold room, rising after sitting, or even just inserting the key in your home’s door lock.

Stress incontinence refers to urine leakage that occurs when coughing, sneezing, lifting a heavy object, or other activity. In men, this is usually caused by problems in the rings of muscle, or sphincters, that squeeze closed to seal off the bladder.

“If they are weak or damaged, then coughing, sneezing, running, or jumping can cause leakage,” Dr. Das says. In men, the most common cause of stress incontinence is sphincter damage after prostate surgery. Radiation treatment for prostate cancer can also cause it. The doctor will ask questions to figure out what may be causing the problem and how severe it is. You may be asked to go home and keep a voiding diary, which is a careful record of how often you need to urinate and the circumstances or triggers that lead to leakage.

Here’s what you can do



Scientists save child’s life by growing him new skin

https://goo.gl/RoG24j

Doctors created enough skin to cover 80 percent of the body of a seven-year-old boy with a genetic disease — and it saved his life.

This isn’t the first time that doctors have used genetic engineering to grow new skin, but past attempts only grew a little bit. This time, doctors were able to cover nine square feet of the patient’s body. The boy, who has a genetic skin disease called junctional epidermolysis bullosa (JEB), had been expected to die. Now, two years after the surgery, he lives a normal life and is able to play sports and exercise, the doctors say. The results were published today in the journal Nature.

People with JEB have a genetic mutation that makes their skin blister easily and makes them more likely to develop cancer. (About 500,000 people worldwide have the condition.) The boy in today’s study developed a bacterial infection that made him lose skin on over two-thirds of his body, leaving him bright red and raw. He was sent to the burn unit at the Germany’s Children’s Hospital at Ruhr University. He was in a lot of pain, and doctors “had a lot of trouble keeping this kid alive,” Tobias Rothoeft, a doctor at the hospital, said in a press briefing.

As a final attempt, the doctors contacted Michele de Luca, director of the Center for Regenerative Medicine at the University of Modena and Reggio Emilia in Italy. de Luca had previously done a similar skin graft on legs, but nothing of this scale. First, his team took skin cells from the boy, including some stem cells, the immature cells that have the ability to develop into many different types of cells and keep growing. Next, they used a harmless virus to deliver a normal version of the gene into the skin cells, so that the genetically engineered cells did not have the mutation anymore. The engineered skin cells and stem cells were then used to grow skin in the lab. The skin was finally grafted back onto the kid's body.

The boy was in the hospital for more than eight months, but now he is healthy. The regenerated skin is good quality, says Rothoeft, and it allows him to do things like normal kids, without the painful blisters he had before. The study shows that just a few long-living stem cells can grow and maintain skin for a long time, de Luca said in the press briefing, which is hopeful for future skin grafts. Now, he is initiating further clinical trials for the therapy.


Six Ways Amazon Could Up-End the Pharmacy Business

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https://goo.gl/sKJU3W

In June, the online retail giant moved into the roughly $800 billion U.S. grocery space by buying Whole Foods Market Inc. Drugs, a $450 billion industry in the U.S., are likewise most often sold from brick-and-mortar stores. Shoppers filling prescriptions frequently pick up toiletries, beauty supplies and dish soap — all retail items Amazon already sells. And the distribution chain for drugs has lots of middlemen whose markups Amazon can seek to undercut.

No wonder shares of drugstore chains CVS Health Corp. and Walgreens Boots Alliance Inc. have dropped sharply since analyst speculation about Amazon entering the pharmacy business intensified last month. On Monday, CVS Health said it would begin same-day delivery in several cities in early 2018, an apparent defensive move. Amazon has never commented on its pharmacy ambitions.

Drugs, which are light and don’t require in-person selection, “are a perfect match” for Amazon, said SSR Health analyst Richard Evans in a recent report.

Here are six ways the retailer could overturn the American pharmacy market:

1. Use its shipping power to destroy rivals
2. Become the ultimate buyer of cheap generics
3. Turn Whole Foods into Whole Drugs
4. Or buy into the pharmacy business
5. Or launch a startup of its own
6. “Alexa, refill my Lipitor”


Allergy Experts: Single Drug Best for Allergic Rhinitis

https://goo.gl/M5i9fy

When it comes to treating seasonal allergies, one drug is often better than two: updated guidelines for the treatment of teen and adult patients with allergic rhinitis recommend initial treatment with an intranasal corticosteroid alone without an oral antihistamine.

The guidelines, appearing in the Annals of Allergy, Asthma and Immunology, follow a comprehensive review by a joint task force of the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology 


341 Days Without a C. difficile Infection: How Mercy Health – St. Anne Hospital Reduced C. difficile Infection Rates to Zero

It can be done.....
https://goo.gl/8E3m2w

C. difficile (C. diff) is the most common cause of healthcare–associated diarrhea in U.S. hospitals. Reducing healthcare-acquired Clostridium difficile infections (CDIs) is a complex and evolving battle. But it’s a battle that can be won. At Mercy Health — St. Anne Hospital, a 100-bed community hospital in Toledo, Ohio, my team and I used a multi-component strategy to reduce CDI rates and from July 2016 to July 2017 successfully eliminated all healthcare-associated CDI cases.

Prior to 2015, St. Anne Hospital had 40% more infections than predicted from baseline. Aiming to improve, my team and I worked with administration at both the hospital and system level to reduce the hospital’s rate of CDI. We began by initiating a “days since last” approach on the hospital’s daily safety call. Each unit shared their daily CDI-related information including number of patients on the unit with known or suspected CDI, number awaiting specimen collection or results, and what day of hospitalization CDI was confirmed. While this call was effective in bringing CDI to the forefront of attention, more needed to be done.

In 2015, we started tracking CDI cases by their location in the hospital. This showed nearly all cases of CDI patients spent time in the ICU, so my team and I ensured each ICU room underwent additional steps in terminal cleaning using bleach and UV light. In addition, we implemented a policy that required the cleaning of suspected and confirmed CDI patient rooms with bleach, exchanging privacy curtains, and cleaning with UV light at every transfer or discharge, regardless of location. This policy also emphasized routine bleach cleaning of areas within the ICU that were prone to frequent touch such as the nurses’ station, hallway handrails, and door handles.

We educated healthcare personnel on appropriate testing, the accuracy of PCR testing, and proper specimen collection. We then implemented policies to assess for diarrhea and C. difficile risk factors at the time of admission. Patients were asked about recent antibiotic use, healthcare visits, and diarrhea. Finding patients with diarrhea and at least one other risk factor would prompt the nurse to immediately isolate the patient and obtain an order for a stool specimen. Isolation was discontinued only if C. difficile was not detected by PCR in the ordered stool specimen, or if the patient did not have watery stool in a 24-hour period. The pediatric Bristol scale helped standardize the description of stool consistency by both staff and patients.

Simultaneously, the hospital’s Infection Prevention and Pharmacy departments implemented an antimicrobial stewardship program (ASP). This program engaged both clinicians and hospital leadership such as the CEO, CMO, infectious disease physicians, and managers from departments of quality, lab, nursing, and education. The ASP staff reviewed charts for duplication of antimicrobials and de-escalation when appropriate. The use of order sets with appropriate antibiotics for diagnoses such as sepsis, community-acquired pneumonia, and UTI was encouraged for emergency department use as well as for admission orders.

The final component of the intervention involved changing contact precaution signs placed outside of CDI rooms and adding a weekly glove and gown compliance report to the safety calls. The new contact precaution signs emphasized strict adherence to the use of gowns and gloves, hand hygiene, and bleach disinfection of shared patient care items before use by another patient.

Through these efforts, my team and I were able to reduce our hospital’s expected number of CDIs to 55% less than predicted in 2016. We are delighted to report that for the first half of 2017, we had no cases of CDI at all.


U-M leading drive to cut opioids given after surgery

https://goo.gl/iMRdg5

"Epidemic" is a tough word, and one often overused.

But it's now clear that we are now facing an enormous and relatively new public health epidemic from the overuse of and our growing addiction to opioid drugs.

And they aren’t all coming from back-alley pushers. Though the exact proportions are not clear, a significant percentage of opioids that enter the supply chain are prescribed by physicians, either to reduce postoperative pain or to help patients with mood disorders.

Research conducted by the University of Michigan further shows that about one-in-10 people who were not on opioid drugs before surgery became dependent on them.

Naturally, a lot of the stuff that does get into the black market comes from pharmacy “pill mills,” corrupt doctors and faked prescriptions and drug dealers. Maybe 35 percent of all prescriptions written are for "acute care" and involve postoperative pain relief, dentistry and emergency medicine ‒ long-accepted medical practice.


My feeling of guilt for being disabled

https://goo.gl/XqZujG

Whilst I struggle to cope with constant pain, fatigue and disability, the worst thing is My feeling of guilt for being disabled.

I am very fortunate to have found true love, even now I still have the feelings for my wife as I did when we were first dating, I love her but I am also in love with her and I can’t help but smile when I see her.

We struggle financially, we don’t have a social life and we don’t go on holiday and for that I feel like I have let my wife down. I love her and I want her to have an amazing life, I want her to have nice things and I want her to see this world. However because I am basically housebound, we don’t see very much.

Yes being disabled has robbed me of the ability to walk, it has turned me into quite a grumpy old git and it has meant that I have lost many things. However the effect it has had on my wife is the hardest thing to cope with.

This week we discussed about maybe having to swallow our pride and seek the help of a food bank, my wife is a proud woman and her thoughts on that was evident on her face.

We live in a 3 bed bungalow, it took my wife a long time to find somewhere for us to live after our previous landlord announced he was selling up. Many people turn their noses up at those of us that are reliant on welfare, this is partly due to the stigma of being on welfare and also down to the fact that councils now advise tenants to refuse to move out when a landlord asks, they say to take it right up to getting an eviction notice. This of course helps those facing losing a property, giving them more time, but it causes landlords to resent these tenants.

Rent in this part of the country is quite high, our property is £900 pcm and believe me when I say that is cheap, the property is fairly run down, we get damp, the front door has a half-inch gap top and bottom allowing a draft in and the bottom of the door is so rotten you can poke a hole in it. However it is a roof over our heads.

We get as allowed by the Local Housing Allowance rates £606 every 4 weeks which is £7878 a year, we have to pay £10,800 and of course now you don’t get the full council tax amount and that has to be topped up!


Gut bacteria 'boost' cancer therapy

https://goo.gl/Doa8QU

Both studies were on patients receiving immunotherapy, which boosts the body's own defences to fight tumours.

It does not work in every patient, but in some cases it can clear even terminal cancer.

One study, at the Gustave Roussy Cancer Campus in Paris, looked at 249 patients with lung or kidney cancer.

They showed those who had taken antibiotics, such as for dental infection, damaged their microbiome and were more likely to see tumours grow while on immunotherapy.

One species of bacteria in particular, Akkermansia muciniphila, was in 69% of patients that did respond compared with just a third of those who did not.

Boosting levels of A. muciniphila in mice seemed to also boost their response to immunotherapy.

Meanwhile, at the University of Texas MD Anderson Cancer Center, 112 patients with advanced melanoma had their microbiome analysed.

Those that responded to therapy tended to have a richer, more diverse microbiome than those that did not.

And they had different bacteria too. High levels of Faecalibacterium and Clostridiales appeared to be beneficial, while Bacteroidales species were bad news in the study.

Tissues samples showed there were more cancer-killing immune cells in the tumour of people with the beneficial bacteria.

The team then performed a trans-poo-sion, a transplant of faecal matter, from people to mice with melanoma.

Mice given bacteria from patients with the "good" mix of bacteria had slower-growing tumours than mice given "bad" bacteria.

Dr Jennifer Wargo, from Texas, told the BBC: "If you disrupt a patient's microbiome you may impair their ability to respond to cancer treatment."

She is planning clinical trials aimed at altering the microbiome in tandem with cancer treatment.

She said: "Our hypothesis is if we change to a more favourable microbiome, you just may be able to make patients respond better.

"The microbiome is game-changing, not just cancer but for overall health, it's definitely going to be a major player."