Where do we stand with preventing Breast Cancer?

14th Oct 2015 Diseases, Medical News

The month of October is about raising awareness of breast cancer and advocating for early detection. Approximately 1 in 8 women born in the U.S. are at risk for developing this disease. The big question is where do we stand with preventative efforts?

Statistics have shown that the incidence of breast cancer has increased by more than 20 percent worldwide since 2008. We still do not have a cure for breast cancer, but there is strong evidence to suggest that lifestyle and diet may play a large part in the disease process. A study published in the Journal of the American Medical Association (JAMA) in September 2015, found that those women who consumed a Mediterranean diet, which is rich in olive oil, had a significantly decreased risk of breast cancer over those who consumed a low fat diet. This study included more than 4000 women between the ages of 60 and 80 years old. What remains unclear is if the reduction in breast cancer was due to the olive oil alone or if the effect was from the overall diet.

In another study, published in the International Journal of Cancer, a link between metabolic syndrome and increased risk of breast cancer was suggested. Metabolic syndrome may include high glucose levels, high triglycerides, high blood pressure, low HDL (“good cholesterol”), and obesity. All of these factors are strongly tied to diet and lifestyle.

In the latest reported findings, taken from a study that is currently in progress, heavy doses of chemotherapy are no longer warranted in the early treatment of the most common type of breast cancer. This study includes more than 10000 women who have been previously diagnosed with breast cancer. Of those in the low risk group, 99% of survivors had no relapses within 5 years of diagnosis, while 94% were free of any invasive breast cancer. A U.S. company, Genomic Health, claims that their new genomic test can decide whether chemotherapy is warranted for a specific case of breast cancer and whether or not reoccurrence is likely to occur.

Based on current practice and research, it is believed that the risk of breast cancer can be lowered with 5 simple lifestyle changes:

  1.  Healthy diet that is low in processed foods and sugars
  2.  Avoidance of smoking
  3.  Maintaining a healthy weight
  4.  Avoidance of alcohol
  5.  Daily exercise




Toledo E et al. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial. JAMA. 2015 Sept 14:1-9.

National Breast Cancer Foundation, Inc. – http://www.nationalbreastcancer.org/breast-cancer-awareness-month

Predictors of disability among military personnel following a traumatic blast concussion

10th Sep 2015 Medical News

It is no surprise that military personnel who suffer a blast related brain injury are likely to experience post-traumatic stress disorder (PTSD) and depression. A recently published study out of the University of Washington in St. Louis has shown that when these early symptoms, which include anxiety, depression, flashbacks, and PTSD, occur within one week of the injury, they are a better predictor of long term disability than the results of common tests such as memory, thinking, and balance.

The prospective, observational study enrolled 38 U.S. military members who sustained a concussive traumatic brain injury. They were compared with 34 controls. All subjects who suffered injury were evaluated within 7 days at two sites in Afghanistan. The subjects were also re-evaluated again between 6 and 12 months post injury in the U.S. Service member’s ages ranged from 19 to 44 years old. Mental health was evaluated using a standardized military post-traumatic stress disorder questionnaire. Depressive symptoms and post-traumatic stress symptoms were elevated during the initial assessments while cognitive function was worse in subjects with a traumatic concussive injury. After the 6 – 12 month assessments, 63% of the subjects had moderate overall disability versus 20% in the control group. Moderate disability in this case is defined by inability to work in the same capacity as prior to injury, are unable to engage in normal social or leisure activities, and/or have disrupted relationships secondary to mental health disturbances.

It was believed that traditional measures including memory, attention, balance, and coordination would be the best predictors of long term disability. In this study these measures were not correlated with outcomes, but rather the psychological symptoms that were better predictors. It is unknown whether the psychological symptoms result from the brain injury, from stress related to war, or from other combined factors.

Having the knowledge that symptoms of PTSD and depression start much sooner than suspected in some cases, psychological evaluations should begin earlier and allow for earlier targeted care. The long term effect of this is unknown, but may offer the best chance to improve the quality of life. Researchers from the study also are planning to apply these findings in future studies looking at concussive brain injuries in the civilian world.

This study was conducted by investigators at the University of Washington in St. Louis and The U.S. Naval Medical Center in Portsmouth, Virginia.


MacDonald CL, Adam OR, Johnson AM, Nelson EC, Werner NJ, Rivet DJ, Brody DL. Acute post-traumatic stress symptoms and age predict outcome in military blast concussion. Brain. 2015 Mar 4.

TitleGlobal study of disease and disability

21st Aug 2015 Medical News

A very interesting and eye opening study was published this month in THE LANCET in regards to the burden of disease across the world. Collaborators involved in the study analyzed over 35,000 sources of information on injury and disease from 188 countries with populations greater than 50,000 people between 1990 and 2013. Three hundred and one acute diseases, chronic diseases and injuries were included. Additionally 2337 sequelae that results from one or more of the studied disorders was also reviewed. There were many interesting findings. First and foremost, only 1 in 20 people had no health problems in 2013. Over 2.3 billion people (approximately 1/3 of the population) were experiencing more than 5 health ailments!

When researchers looked at the leading causes of years spent in less than optimum health, low back pain, depression, iron-deficient anemia, neck pain, and age related hearing loss have remained on top for nearly 23 years. The study collaborator’s attributed aging as the primary source leading to increasing disease and injury rates.

The study methodology including a review of published systematic reviews, re-analysis of household survey, data taken from hospital discharges, and from other administrative databases. Case reports to the World Health Organization (WHO) were also utilized. Disease estimates were calculated using a Bayesian meta-regression method. Bayesian refers to a method in statistics that utilizes probabilities of events. This allowed for computation of incidence and prevalence statistics for each country and time period. Specific data analyzed showed that under the category of acute disease, upper respiratory illness, interstitial nephritis, urinary tract infection, Dengue, pancreatitis, intestinal obstruction, and unintentional suffocation had the highest rates of increasing incidence during the study period. Similarly, for chronic disease (present for greater than 3 months), oral disorders, neurologic disease, skin disorders, musculoskeletal disorders, neglected tropical diseases, gynecologic disorders, and vision loss had the highest age-standardized rates.

Of the key findings noted from the study, rates of disability are declining at a much slower rate than mortality rates.

The data from this enormous research study have shown that there are many large causes of disability, or less than optimal health, that are largely preventable but require a greater focus or rates will continue to climb.

The study was funded by the Bill and Melinda Gates Foundation. The study funder reportedly had no role in the study design, data collection, data analysis, or data reporting.


Are low levels of Vitamin D associated with the development of dementia?

14th Aug 2015 Diseases, Medical News

A research study from the University of Exeter, published in the Journal of Neurology found a strong relationship between the development of Alzheimer’s disease and other forms of dementia and low levels of Vitamin D. The study included over 1600 adults over 65 years old who participated in the U.S. Cardiovascular Health Study. Participants of the study had their blood samples collected at the start of the study and mental status was assessed nearly 6 years later. Adults who had moderate Vitamin D deficiency had a 53% increased risk of developing dementia of any kind and 69% risk of develop Alzheimer’s disease. For those who were found to be severely Vitamin D deficient, there was a 125% risk of developing dementia and 122% increased risk of developing Alzheimer’s disease.

For the purposes of this study, a Vitamin D level of less than 50 nmol/L appeared to be threshold at which the risk of Alzheimer’s disease and other forms of dementia increased. This study is the largest yet to identify this association.

What remains unknown is the true cause and effect of this. It is unknown if increasing levels of Vitamin D would actually lower the risk of Alzheimer’s or dementia. More than 5 million people in the U.S. are affected by Alzheimer’s disease as the most common form of dementia. Worldwide, it estimated than over 44 million suffer from some form of dementia and this number is expected to grow with an aging population.

The authors of the study concluded that further studies are needed to establish whether the consumption of certain foods or taking a Vitamin D supplement can delay or prevent the onset of Alzheimer’s and dementia. The main source of Vitamin D for many is exposure to sunlight. However, the aging process results in skin that is less efficient at converting sunlight in a usable form of Vitamin D. Therefore, further supplementation through diet may be necessary to achieve adequate levels.

A group from the University of Guelph in Ontario, Canada has recently developed a mobile tracking application (‘App’) to help calculate intake of Vitamin D from food sources and exposure to sunlight. Using this newer technology as a tool may help users identify if they are below levels of adequate Vitamin D intake and lead to healthier behaviors.

References: Littlejohns TJ, Henley WE, Lang IA, Annweiler C, Beauchet O, Chaves PH, Fried L, Kestenbaum BR, Kuller LH, Langa KM, Lopez OL, Kos K, Soni M, Llewellyn DJ. Vitamin D and the risk of dementia and Alzheimer disease. Neurology. 2014 Sep 2; 83(10):920-8.

Goodman S, Morrongiello B, Simpson JR, Meckling K. Vitamin D intake among young Canadian adults: validation of a mobile Vitamin D Calculator App. Journal of Nutrition Education and Behavior. 2015; 47(3): 242.

Potentially fatal bacteria along the coast of Florida

07th Aug 2015 Diseases, Medical News

A potentially deadly bacteria has made it way to Florida beaches. The Vibrio vulnificus bacterium has infected at least seven people and killed two this year in Florida. The two fatal cases have occurred in Brevard and Marion counties.

The bacterium, which appears to be activated by exceptionally warm weather, normally does not pose a risk to a healthy person. However direct contact between seawater and any open cuts or wounds can cause infections and skin ulcers. Sickness can also develop from ingestion of seawater or from eating raw seafood. Abdominal pain, diarrhea, and vomiting are the primary symptoms from ingestion. Redness, swelling, fevers, and chills progressing to life threatening septic shock can occur from a wound infection.

Vibrio vulnificus is a salt requiring gram negative bacteria that is commonly found in marine environments. According to the CDC, bloodstream infections are fatal 50% of the time. Between 1988 and 2006, over 900 cases of Vibrio vulnificus infections were reported along the states that border the Gulf of Mexico. Thirty-two cases of Vibrio vulnificus infection were identified in Florida last year. It is estimated that over 85% of cases occur between May and October when the coastal waters are the warmest.

The diagnosis is made by history assessment and testing. Blood, wound, and stool cultures should be ordered for those who have a history of possible exposure and exhibit clinical symptoms. Medical management includes the use of antibiotics and monitoring of any open wounds. In rare cases, surgical debridement and/or amputation may be necessary for severely infected wounds with extensive soft tissue spread.

Prevention of infection focuses on avoiding entry into the water if any open wounds or cuts are present. Avoid eating raw shellfish. Boiling or frying shellfish for an extended period of time is recommended.

The combination of gene therapy and an adeno-virus vector to treat eye inflammation

31st Jul 2015 Medical News

More than 12 million American’s suffer from dry macular degeneration. This is an eye disease in which the retina deteriorates from the formation of small yellow deposits known as drusen. This leads to drying out of the macula causing it to lose its function. While many with dry macular degeneration may have good central vision, they may have limitations and difficulty with reading, limited vision at night and loss of vision may still occur. Macular degeneration tends to progress slowly in time. This is a common problem for people over the age of 50 years old.
Recently, researcher’s at the University of Florida have found what they believe is a promising treatment to limit inflammation that leads to macular degeneration. The researcher’s used an adeno-viral vector (AVV) to deliver an inflammation blocking protein into the eye. The protein comes from a myxoma virus that is normally found in rabbits found in parts of Europe in Australia. This gene inhibits the body’s immune response that causes inflammation that leads to eye disease.
Researchers also found that this is effective in cases of uveitis which is an inflammation within the middle levels of the eye.
At present, there is no FDA approved treatment for dry macular degeneration. Some of the published recommendations to manage symptoms of macular degeneration include the use of over-the-counter supplements, specific foods which are rich and antioxidants, the use of Lutein, smoking cessation, controlling hypertension, and the use of blue blocker sunglasses. Uveitis has typically been treated with long-term use of steroids. This does increase risks of developing glaucoma.
This new potential treatment may last a lifetime and only requires a single treatment based on current research. Adeno-associated virus vectors may prove to be the next-generation of treatments for many chronic diseases as they were able to deliver anti-inflammatory genes to diseased and damage parts of the body.
Further research is planned after these recent results in a mouse model were published. The study from the University of Florida was funded by grants from the National Eye Institute, and National Institute of Allergy and Infectious disease, The Macula Vision Research Foundation and the Florida Biomedical Research Foundation.

IIdefonso CJ, Jaime H, Rahman MM, Li Q, Boye SE, Hauswirth WW, Lucas AR, McFadden G, Lewin AS. Gene delivery of a viral anti-inflammatory protein to combat ocular inflammation. Human Gene Therapy. 2015 Jan; 26(1):59-68.

Identification of Genes that are Associated with Type 1 Diabetes

18th Jun 2015 Diseases, Medical News

Genetic susceptibility to Type 1 diabetes has been an area of intensive research since the 1970s. Despite the literature identifying over 40 different genes that are associated with type 1 diabetes, there has remained missing pieces within the puzzle until now. A University of Florida research group headed by a genetics expert, published a recent study in the journal, Nature Genetic, has narrowed number of genes that are involved in type 1 diabetes.

Type 1 diabetes which is also called juvenile diabetes, as it can occur in children and teenagers, is an insulin-dependent type of diabetes. In Type 1 diabetes, the body attacks its own insulin producing cells of the pancreas known as islets. Without proper functioning islets, the body is unable to normalize blood sugar. As a result, the body’s own cells starve from a lack of glucose. This may result in damage to the eyes, kidneys, nerve cells and heart.

The Research team from UF collected data from over 27,000 people including those with type 1 diabetes and screened for differences in DNA that are involved in Type I diabetes.  Using a technique known as fine mapping, the team was able to narrow down the number of disease causing DNA variations which are known as Single Nucleotide Polymorphisms from the thousands to 5 or less. The findings are considered landmark and can now be used by clinicians and other researchers to direct treatment to prevent the onset of autoimmune disease. This can lead to the development of new treatments and therapeutic agents.

In addition to the research team from the University of Florida, researchers from the Massachusetts Institute of technology (MIT), Harvard University and the University of Cambridge in England were also involved.

According to Dr. Patrick Concannon, Director of the University of Florida Genetics Institute “it’s a game-changer for Type 1 diabetes”




University of Florida – March 2014

Vitamin D: More than just a vitamin

12th Mar 2015 Medical News

While many think of vitamin D as a just another vitamin, the reality is that it is a strong hormonal regulator. The body produces vitamin D from direct exposure to sunlight which trigger synthesis of vitamin D. Vitamin D can also be obtained from food sources and through supplementation. One of the main roles of Vitamin D is to promote calcium absorption and is involved in the formation of new bone. The true significance of vitamin D as a regulator of other functions including modulating cell formation, immune function, and reducing inflammation within the body, has come to light in many recently published studies.


In one of the most recent publications, researchers looked at vitamin D levels in children and teenagers and found that those with low levels had greater risks of atherosclerosis as adults. This study included over 2148 volunteers who had vitamin D levels during childhood years and then had carotid intima-thickness assessed between the ages of 30 to 45. Thickening of the arteries is believed to be a strong risk factor for cardiovascular disease

Juonala M, Voipio A, Pahkala K, Viikari JS et al. Childhood 25-OH levels Vitamin D Levels and Carotid Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study. Journal of Endocrinology and Metabolism. 2015 Feb 10.

Taken from a randomized, double blind, placebo controlled study that was published in the American Journal of Clinical Nutrition looking at the role of Vitamin D in preventing influenza, the group that was given 1200 IU of Vitamin D3 had comparatively lower rates of flu (influenza A) versus placebo. The study also suggested lowered rates of asthma attacks in children.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of Vitamin D supplementation to prevent seasonal influenza A in schoolchildren. American Journal of Clinical Nutrition. 2010 May; 91(5): 1255-1260.

In a 2014 published study from the University of London, researchers conducted a randomized trial, looking at the use of Vitamin D levels in patients with COPD. The findings of this study which included 240 patients showed that adequate Vitamin D supplementation can reduce COPD flare-ups by 40%

Martineau AR, James WY, Hooper RL, Barnes NC, Jolliffe DA et al. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDico): a multicentre double blind, randomized control trial. The Lancet. Respiratory Medicine. 2014 Dec 1. Pii: S2213-2600(14).

A recent study (2015) presented at the American Stroke Association’s annual meeting that looked at 100 patients who suffered an ischemic stroke. Those with low levels of Vitamin D (<30 ng/mL had a greater risk of developing a stroke and had approximately a two times greater area of stroke related brain dead tissue versus those with normal vitamin D levels. http://newsroom.heart.org/news/low-vitamin-d-predicts-more-severe-strokes-poor-health-post-stroke

Researchers from the University of California published a meta-analysis that encompassed over 32 studies that looked at Vitamin D levels and mortality. The findings show that those with inadequate Vitamin D levels (< 30 ng/mL) were 90% more likely to die prematurely when compared with those who had levels over 30 mg/Ml

Garland CF, Kim JJ, Mohr SB, Gorham ED, Grant WB, Givannuci El, Baggerly L, Hofflich H, Ramsdell JW, Zeng K, Heaney RP. Meta-analysis of all-cause mortality according to serum 25-hydroxvitamin D. American Journal of Public Health. 2014 Aug; 104(8):e43-50.

These are just a handful of the studies looking at the interaction between levels of Vitamin D and various disease processes.

A compound related to Vitamin B3 may prevent hearing loss

A recent study published in Cell Metabolism by researchers from Weill Cornell Medical College and the Gladstone Institutes have identified a simple compound that may help prevent hearing loss. The compound nicotinamide riboside (NR) is a precursor to vitamin B3.

Noise induced hearing loss is a problem that can affect anyone at any age. The National Institutes on Deafness and Other Communication Disorders (NIDCD) estimates that more than 26 million Americans between the ages of 20 and 69 suffer from noise induced hearing loss. Hearing loss can result from a one-time exposure to an intense sound or from continuous exposure to loud sounds. Continuous or prolonged exposure to sounds over 85 decibels can cause hearing loss.

The process of hearing is based on a series of events that convert sound waves into electrical signals. Vibrations travel to the inner ear causing wave like ripples within the fluid inside the cochlea. There are tiny hair cells sitting along the top of inner membrane. These hair cells move up and down pushing against the sterocilia which transmits a signal to the auditory system within the brain. It is believed that exposure to loud noise can cause to damage to the junction where the nerves and hair cells meet, resulting in hearing loss.

Previous studies had identified that a chemical compound known as nicotinamide adenine dinucleotide (NAD+), which is chemically related to NR in this study, did protect nerve cells from injury however, it is an unstable compound. Using this information, researchers tested NR in lab mice and found that regardless whether the compound was given before or after exposure, NR did prevent hearing loss. It is believed that NR increases the activity of a protein known as SIRT3 (sirtuin 3) which is located within the mitochondria of the cells and is involved in regulating function.

The results of this study appearing to be promising. The researchers believe that the compound NR may also be useful for treating other disorders that are also mediated by the activity of protein sirtuin 3 such as hypertension, diabetes, and other metabolic syndromes.


National Institutes on Deafness and Other Communication Disorders (NIDCD)

Brown KD, Maqsood S, Huang JY, Pan Y, Harkcom W, Li W, Sauve A, Verdin E, Jaffrey SR. Activation of SIRT3 by the NAD+ precursor nicotinamide riboside protects from noise-induced hearing loss. Cell Metabolism. 2014 Dec 2; 20(6): 1059-1068.

Scoliosis Associated with Friedreich’s Ataxia

The incidence of Friedreich’s Ataxia (FA) is approximately one in every 50,000. It is known that most symptoms associated with FA occur during the first decades of life. Many lose their ability to walk by age 25. Friedreich himself noted the presence of scoliosis along with other symptoms in 1875. Scoliosis is associated with FA and is often seen early on in the developmental process. A search of the literature finds that the prevalence of scoliosis among those with FA has been reported in the range of 63 to 100%1, 2, 3

There is some debate noted on whether FA should be classified as a neuromuscular scoliosis or idiopathic type. For the most part, scoliosis associated with FA is similar to other neuromuscular forms such as muscular dystrophy which features a progressive thoracolumbar curve and severe muscle weakness. Labelle et al (1986) concluded that scoliosis associated with FA behaved more like an idiopathic form as the curves were not necessarily rapidly progressive, were similar curve patterns, were not associated with muscle weakness, and age at onset was a key indicator of progression4. This was based on a retrospective review of 56 cases with an average of nine years of follow-up after the diagnosis was made. This is contrary to the findings of Milbrandt et al (2008) who felt the curve patterns were more in-line with neuromuscular type scoliosis.

The current literature does reflect bracing does not appear to halt progression of most curves that have been studied. A posterior spinal fusion has become the main treatment choice for surgical management of progressive curves associated with FA. Previously, hook and wire constructs were utilized but has fallen out of favor due to inability to maintain correction. Many of the curves are double major type with kyphotic deformity. Restricted lung disease associated has been reported as a secondary complication in cases with significant kyposcoliotic deformity. Cardiac co-morbidities are also associated with FA and must be considered when contemplating surgical management.

Despite known complications associated with FA, reported outcomes from posterior fusion surgery have demonstrated successful correction of the major deformity and fusion rates at an average of 3 years of follow-up.

1 Milbrandt TA, Kunes JR, Karol LA. Friedreich’s ataxia and scoliosis: the experience at two institutions. Journal of Pediatric Orthopedics. 2008 Mar; 28(2) 234-238.

2 Daher YH, Lonstein JE, Winter RB, Bradford DS. Spinal Deformities in patients with Friedreich ataxia: a review of 19 patients. Journal of Pediatric Orthopedics. 1985 Sep-Oct; 5(5): 553-557.

3 Cady RB, Bobechko WP. Incidence, natural history, and treatment of scoliosis in Friedreich’s ataxia. Journal of Pediatric Orthopedics. 1984 Nov; 4(6) 673-676.

4 Labelle H, Thome S, Duhaim M, Allard P. Natural history of scoliosis in Friedreich’s ataxia. JBJS. 1986 Apr; 68(4): 568-572.