According to a study of more than 31,000 children and adults by scientists at Albert Einstein College of Medicine of Yeshiva University, physicians should diligently monitor Vitamin D levels in patients being treated with oral steroids.

“When doctors write that prescription for steroids and they’re sending the patients for lab tests, they should also get the vitamin D level measured,” Amy Skversky, the lead author said.

The researchers examined data collected from participants who had participated in the National Health and Nutrition Examination Survey 2001-2006.

About one percent of the participants answered “yes” when asked if they had used oral steroids during the previous 30 days, whereas eleven percent of the self-reported steroid users had severely low vitamin D levels compared to a severe vitamin D deficiency of 5 percent for people not taking steroids, which showed a two-fold increased risk for severe vitamin D deficiency.

The risk of deficiency was particularly pronounced in steroid users under the age of 18, who were 14 times more likely to have a severe vitamin D deficiency compared with young non-steroid users.

The findings of the study have been published in the 28th September online edition of The Journal of Clinical Endocrinology and Metabolism.


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Homocystein is an amino acid that is produced by
the body. It is natural to have some homocysteine in the body but elevated
homocysteine levels can cause health hazards like heart attack, stroke and
venous thrombosis (blood clots in veins).

Thus there is a direct association between
elevated homocysteine levels and the increased risk of coronary heart disease.
Studies have estimated that a reduction of 3 μmol/L in serum homocysteine would decrease risk of coronary heart
disease by 18 percent and stroke by 24 percent after a mean follow-up of 7·3
years. However, this association
was more pronounced in populations with low dietary folate consumption.
In regions with established policies of
population folate supplementation, no coronary benefits were observed from
lowering of homocysteine.

Some studies have associated the MTHFR 677C→T polymorphism with raised
homocysteine concentration and increased risk of stroke. MTHFR is a gene called
methylenetetrahydrofolate reductase. It provides instructions for making an
enzyme that plays an important role in a chemical reaction involving B-vitamin

In order to
investigate the potential modifying effect of folate status on the association
between the MTHFR 677C→T
variant and stroke risk, a collaboration of genetic studies including data for
homocysteine concentration and stroke events was established. The finding of
this genetic analysis was compared with a meta-analysis of randomised
controlled trials of homocysteine-lowering treatments on stroke risk.

Researchers established genetic studies
consisting of 237 datasets including 59,995 individuals with data for
homocysteine and 20885 stroke events. On comparing the genetic findings with a
meta-analysis of 13 randomised trials of homocysteine lowering treatments and
stroke risk, the following results were found –

The effect of the MTHFR 677C→T variant on homocysteine concentration was larger in
low folate regions than in areas with folate fortification.

It was highly dependent on probable folate
status category.

In regions with no supplementation with folic
acid, for eg; Asia, participants homozygous for the T allele had higher
concentrations of homocysteine than did those homozygous for the C allele. The
effect was reduced in studies undertaken in geographical regions with policies
of folic acid fortification like America, Australia, and New Zealand.

Patterns were similar when heterozygous
individuals were compared with those homozygous for the C allele, although the
magnitude of the genetic effect was smaller.

In regions without
folic acid fortification, the odds of
stroke was 1·68 for comparison of individuals with the TT genotype and those
with the CC genotype. This increase in risk was substantially larger than that
noted in regions with low folate intake and regions with mid folate intake or
folate fortification.

Even though there is a strong evidence of an
increased risk of stroke associated with the MTHFR 677C→T variant, reduction of homocysteine concentration
might not necessarily reverse the risk of stroke in adult life
. Such conclusions can be derived from randomised trials of interventions
such as folic acid that reduce the concentration of homocysteine.

It is important to
emphasis on few differences between the evidence obtained from randomised
trials and genetic studies. Firstly, most trial evidence arose from settings in
which policies of folic acid fortification were well in place. Secondly, genetic
studies reflect lifetime exposure to the phenotype resulting from the genetic
variant, since randomization to the allele variants occurs at conception.
Third, the number of stroke events in trials is substantially lower than that
included in the genetic analyses. Fourth, evidence from randomized trials is
derived mainly from individuals with established vascular disease, whereas that
from genetic studies is mainly population-based. Therefore, genetic evidence
should be regarded only as an approximate guide to the risk reduction achieved
by modification of homocysteine concentrations in randomised trials.

It should also be
considered that MTHFR 677C→T, a
genetic instrument used to evaluate the effects of homocysteine on stroke risk,
has poor specificity and it can not be denied that the genetic effect of
MTHFR could be because of some mechanism other than homocysteine.
the effect seen in low folate regions could be due to selective reporting bias
in the subtype of stroke reported in genetic case-control or cohort studies i.e
if stroke subtype was differentially reported according to continent and was
associated with MTHFR genotype,
the observed signal could be inflated.

The researchers
conclude ‘In regions with increasing levels or established policies of
population folate supplementation, evidence from genetic studies and randomised
trials is concordant in suggesting an absence of benefit from lowering of
homocysteine for prevention of stroke. Further large-scale genetic studies of
the association between MTHFR 677C→T and stroke in low folate settings are
needed to distinguish effect modification by folate from small-study bias. If
future randomised trials of homocysteine-lowering interventions for stroke
prevention are undertaken, they should take place in regions with low folate

Source: Holmes MV, et al. Effect modification by population
dietary folate on the association between MTHFR genotype, homocysteine, and
stroke risk: a meta-analysis of genetic studies and randomised trials. Lancet.
2011 Aug 13;378(9791):584-94. Epub 2011 Jul 29.


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The report by Surgeons from Boston Medical Center (BMC) also found the incidence of hypoglycemic events increased with aggressive glycemic control.

Currently, 40 percent of all patients undergoing CABG suffer from diabetes, and this number is quickly rising. Traditionally these patients have more complications following surgery, including greater risk of heart attacks, more wound infections and reduced long-term survival.

In the study, eighty-two diabetic patients undergoing CABG were prospectively randomized to receive either aggressive glycemic control or moderate glycemic control using continuous intravenous insulin solutions beginning at anesthesia and continuing for 18 hours after surgery.

Researchers found that there was no difference in the incidence of major adverse effects between the two groups.

“Aggressive glycemic control did not result in any significant improvement of clinical outcomes than can be achieved with moderate control,” said Lazar, who is also a professor of cardiothoracic surgery at Boston University School of Medicine.

“Although aggressive glycemic control did increase the incidence of hypoglycemic events, it did not result in an increased incidence of neurological events,” he added.

The study has been published in the journal Annals of Surgery.


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Diabetes has become increasingly common in the United States and the world, according to background information in the article. Elevated levels of hemoglobin A1c (a measure of blood glucose levels and control over two to three months), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) are associated with an increase in the risk of complications. Reducing the levels decreases those risks, but the article notes that most patients with diabetes do not have these levels under control. Currently, treatment guidelines do not include recommendations for how frequently physicians should see patients with diabetes, although recommended intervals for testing and adjustments to medication may range from every two to three days for insulin to every three months for hemoglobin A1c. “However,” the authors write, “benefits of more frequent provider encounters may not be limited to treatment intensification and testing.”

Fritha Morrison, M.P.H., from Brigham and Women’s Hospital, Boston, and colleagues conducted a retrospective cohort study to determine whether more frequent encounters with a physician help patients improve control of diabetes. The authors analyzed data from 26,496 adult patients with diabetes and elevated hemoglobin A1c, BP and/or LDL-C levels who visited primary care physicians affiliated with two Boston hospitals for at least two years between January 2000 and January 2009. Treatment goals at the beginning of the study were hemoglobin A1c of less than 7 percent, BP of less than 130/85 mm Hg (millimeters of mercury) and LDL-C of less than 100 mg/dL (milligrams per deciliter). The researchers assessed the relationship between the frequency of clinician encounters (defined as notes in the medical record) and time to control of hemoglobin A1c, BP and LDL-C.

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“It was decided this evening after a meeting that three coffee shops will move from the city centre to the outskirts in the south,” Gertjan Bos, spokesman for Maastrict mayor Onno Hoes, told AFP.

Yearly, some two million visitors frequent the city’s 14 coffee shops, many of them from across the nearby borders with Belgium and Germany, bringing in an estimated 250 million euro ($339 million dollars) in revenue, Bos said.

But the influx of drug tourists has placed a major strain on the city’s 120,000 residents with frequent traffic jams, nocturnal disturbances and an increase in aggressive drug pushers harassing tourists.

Bos said a deal was reached with owners of three coffee shops, the “Smokey”, “Mississippi” and “Missouri”, to move about three kilometres (1.8 miles) outside the city centre to establish a “coffee corner” catering for foreign tourists.

Marc Josemans, president of the Maastricht Association of Coffee Shops, said his association was happy with the deal, which however would only take effect in 2013. “It shows that we can find creative ways of dealing with the problem,” he said. Four other coffee shops are to follow in the future, he said.

On 1 October however, coffee shop operators will be imposing a ban on lighting a joint in their shops unless patrons can prove they were from the Netherlands, Belgium or Germany in an attempt by owners to reduce problems.

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The technology offers the first way to measure ‘exactly how you slept,’ its inventor, Ben Rubin, told the Daily Mail.

Rubin claims the gizmo can even improve your sex life.

The headband has two silver patches to monitor your brain waves, and show whether you are in ‘deep sleep’ or are dreaming.

The app even offers advice on what might be disturbing your sleep, from snoring partners to over-lit bedrooms.

The gadget measures tiny electrical impulses in your skin that reflect what’s going on in your brain – ‘scoring’ you with a ‘ZQ’ score for how much deep sleep and REM sleep you get.

“If you’re a young, healthy person, you should be scoring 100,” says Rubin.

The app is easy to read, with different colour bars representing different ‘types’ of sleep.

It also offers sleep advice if you feed it with data such as your caffeine intake.


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Prehypertension is clinical category created by experts in 2003 to describe patients whose blood pressure was elevated, but still considered within normal range. Hypertension or abnormally high blood pressure is a major risk factor for cardiovascular disease and strokes, but much less is known about the health threat posed of prehypertension, which is defined by a systolic pressure reading between 120 and 139 mmHg (the top number) and a diastolic reading between 80 and 89 mm Hg (the bottom number)

“The experts reasoned that, generally speaking, the higher the blood pressure, the greater the risk of death and disease, possibly starting from within the normal blood range,” said Bruce Ovbiagele, MD, professor of neurosciences at UC San Diego School of Medicine and senior author of the study.

However, Ovbiagele said, conclusive evidence was lacking, “so we decided to compile all the published studies in the scientific literature to date, and using statistical techniques find out if there is indeed a higher risk of future stroke in people with prehypertension, the extent of that risk, and whether particular characteristics were associated with higher stroke risk.”

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The first results of the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study appear online today in The Lancet Neurology.

“We know that people with type 2 diabetes have a much higher risk of dementia and memory loss than people without diabetes,” said Jeff D. Williamson, M.D., chief of the Department of Geriatrics and Gerontology and principal investigator of the study”s coordinating center at Wake Forest Baptist. “What we didn”t know was, if you intensively control blood sugar levels in people who have had a history of trouble controlling them, does the added cost and effort to control blood sugar result in a slowed rate of memory loss? After conducting this study, there remains no evidence that it does.

“We also learned, however, that the intensive blood sugar control does preserve brain volume,” added Williamson, director of the Roena Kulynych Center for Memory and Cognition Research at Wake Forest Baptist. “What that means for the long term preservation of cognitive function of these patients, we”re still trying to figure out.”

The ACCORD-MIND trial is a national study sponsored by the National Heart Lung and Blood Institute – part of the National Institutes of Health – designed to examine the effects of different glucose-lowering strategies on the risk for cardiovascular disease.

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Two mechanisms for learning in the brain

In the hippocampus, two different mechanisms for the long-term storage of new information are at work . Long-term potentiation leads to an increase in the communication between nerve cells. Long-term depression, on the other hand, weakens the connections between the cells. „According to our results, cell populations react with potentiation at the beginning, for instance when we enter a new room “, explains Manahan-Vaughan. „Long-term depression then allows us to refine this new cellular information and encode the details and characteristics of the room.”

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The new study found that 11 percent children who are victims of diabetes also suffer from asthma.

Most children are victims of Type 1 diabetes, although Type 2 is also becoming common among children.

“Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated,” researchers said.  


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