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Cardiovascular Imaging

Breastfeeding For More Than 12 Months Leads To Higher IQ Scores And Higher Income At Age 30

Babies breastfed for a year or more have better performance on intelligence tests, greater school achievement, and higher monthly incomes as 30-year-olds. 

“Those subjects who were breastfed for 12 months or more had higher IQ, a difference of 3.7 points, more years of education, and higher monthly income, a difference of about $100 per month, than those who were breastfed for less than one month,” said Dr. Bernardo Lessa Horta, associate professor at Federal University of Pelotas in Brazil, in a podcast with Lancet Global Health. (For the study, “breastfed for less than a month” included children who were never breastfed at all.)

The study was launched in 1982 in Pelotas, Brazil. A full 30 years later, the researchers returned to the participants and collected information on their IQ scores, educational attainment, and monthly income. Of the original 5,914 neonates enrolled, the researchers were able to track a substantial portion: 3,493 total participants.

Importance of the Study

While past research has found higher intelligence scores among breastfed babies, what is so significant about this study is the researchers were able to collect more complete information on breastfeeding duration and also followed for a longer period. And, by using a population-based birth cohort, the breast feeding practices had no association with income level. Most of the evidence of higher intelligence test scores among breastfed babies comes from high-income countries, where middle-class and higher-class mothers are more likely to breastfeed their babies than lower income mothers — certainly in the United States, breastfeeding ratesreflect this trend. (The Centers for Disease Control and Prevention reports higher income and older mothers are more likely to breastfeed than their peers.)

With evidence coming from first-world countries “where breastfeeding is positively associated with higher socioeconomic status,” Horta explained, “there’s always a question of whether the effect that has been observed in other studies is a consequence of breastfeeding by itself or has the result been confounded by socioeconomic status.” Specifically, higher income babies are most likely eating better quality food and this could be impacting IQ test scores.

However, in Pelotas, it is rare for mothers to not breastfeed, so the evidence from this study, which included follow-up on more than 60 percent of the original participants, is inclusive and irrespective of income.

Asked why breastfeeding would result in higher IQ, Horta unhesitatingly told the Lancet, “Breast milk is rich in long-chain saturated fatty acids and this is essential for brain development.” And from there, he believes, future earning-power is a given. “The positive effect of breastfeeding on IQ leads to a higher income,” he added.

Source: Victora CG, Horta BL, de Mola CL, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. The Lancet. 2015.


Pomegranates are one of the healthiest and most healing fruits available today. They are rich in vitamin C, K, B-complex and minerals such as copper, calcium, and potassium. Pomegranates are an excellent weight loss food and also benefit the body by boosting the immune system, improving circulation, and offering protection from cancer and Alzheimer’s disease. Pomegranates are packed with antioxidants and particularly one called Punicalagin which has been shown to effectively reduce the risks of heart disease by scavenging harmful free radicals from the body. Punicalagin also has potent anti-microbial properties making pomegranates fantastic in warding off bacterial and viral infections.

Pomegranates act like a natural aspirin in the body and help to prevent blood clots. Pomegranates are also the perfect “brain food” as they help to increase cognitive function and memory recall. Pomegranates are also great for joints and may help to prevent cartilage deterioration making them essential for the prevention of osteoarthritis. Pomegranates contain powerful anti-inflammatory compounds which makes them a highly beneficial food for those with autoimmune disorders such as fibromyalgia, COPD, bursitis, Lyme disease, rheumatoid arthritis, Chronic Fatigue Syndrome, and lupus. Consuming pomegranates or their juice daily has been shown to effectively protect against diabetes, lymphoma, urinary tract infections, and breast, colon, lung, and prostate cancer. Pomegranate juice has also been shown to keep PSA levels stable in men thereby reducing the need for further treatments such as hormone therapy or chemotherapy. Pomegranates have also been shown to help lower LDL (bad) cholesterol and raise HDL (good) cholesterol as well as lowering systolic blood pressure for those who need it. Pomegranate juice is excellent for dental health and has been shown to naturally prevent dental plaque and gum disease. Pomegranate seed oil is an excellent source of essential fatty acids and can be taken internally or applied topically to the skin to help improve skin elasticity, skin tone, and skin conditions such as eczema, psoriasis, and sunburn. It is also excellent for revitalizing hair and protecting it from damage. Pomegranates, their seeds, and juice can all be found at the supermarket or your local health food store.

South African Doctors Perform World’s First Penis Transplant

South African doctors have successfully performed the world’s first penis transplant on a young man who had his organ amputated after a botched circumcision ritual, a hospital said on Friday.

The nine-hour transplant, which occurred in December last year, was part of a pilot study by Tygerberg Hospital in Cape Town and the University of Stellenbosch to help scores of initiates who either die or lose their penises in botched circumcisions each year.

“This is a very serious situation. For a young man of 18 or 19 years the loss of his penis can be deeply traumatic,” said Andre van der Merwe, head of the university’s urology unit and who led the operation said in a statement.

The young patient had recovered full use of his manhood, doctors said, adding that the procedure could eventually be extended to men who have lost their penises to cancer or as a last resort for severe erectile dysfunction.

“There is a greater need in South Africa for this type of procedure than elsewhere in the world, as many young men lose their penises every year due to complications from traditional circumcision,” Van der Merwe said.

The patient, who is not being named for ethical reasons, was 21 years old when his penis was amputated three years ago after he developed severe complications due to a traditional circumcision as a rite of passage into manhood.

Finding a donor organ was one of the major challenges of the study, a statement by the university said.

The donor was a deceased person who donated his organs for transplant, doctors said without elaborating.

Each year thousands of young men, mainly from the Xhosa tribe in South Africa, have their foreskins removed in traditional rituals, with experts estimating around 250 losing their penises each year to medical complications.

Initiates are required to live in special huts away from the community for several weeks, have their heads shaved and smear white clay from head to toe and they move into adulthood.

Another nine patients will receive penile transplants as part of the study, doctors said, but it was not clear when the operations could be carried out.

Hyponatremia Frequent After Surgery for Traumatic Hip Fracture

Hyponatremia is common after surgery for traumatic hip fracture, according to a new retrospective review.

“This study provides evidence that an average post-operative drop in serum sodium concentration should be expected in this patient group,” Dr. James Edward Rudge and Dr. Daniel Kim of City Hospital, Sandwell and West Birmingham Hospitals NHS Trust write in their report, published online June 7 in Age and Ageing.

From 15% to 30% of hospital inpatients develop moderate hyponatremia (130-135 mmol/l), while the electrolyte disorder can also be a late complication of surgery, the researchers write. Hyponatremia is also common after orthopedic surgery, they add.
To examine the incidence of hyponatremia after hip fracture surgery as well as risk factors for the disorder, Dr. Rudge and Dr. Kim looked at 254 patients who underwent hip surgery after trauma in their unit in 2012. Mean serum sodium dropped by 1.8 mmol after surgery. Twenty-seven percent of patients developed moderate hyponatremia, while 9% developed severe hyponatremia (< 130 mmol/l).

Patients on selective serotonin reuptake inhibitors, those on proton pump inhibitors, and those on an increasing number of medications were all significantly more likely to develop hyponatremia, the researchers found. There was no association between gender, operative procedure, fracture type, ethnicity, or American Society of Anesthesiologists’ grade. Average hospital stay was 30 days for the hyponatremic patients, versus 21 days for the normonatremic patients.

The rate of postoperative hyponatremia in the current study was higher than seen in past studies, the researchers note; one study found a 6% risk in orthopedic surgery patients for the first six days after surgery, while another found 3% in the first three days after surgery. The second study, they note, also found most cases of hyponatremia occurred in hip fracture patients. “The current study provides evidence that this subset of orthopedic patients is at greater risk of post-operative hyponatremia,” the authors write.

“The operative process itself may be a risk factor and all patients should be considered at risk of developing the condition,” they conclude.

Sleep-Wake Disorder Drug Hetlioz Gets Nod in Europe

The European Medicines Agency (EMA) has recommended marketing authorization for tasimelteon (Hetlioz), a melatonin-receptor agonist, for the treatment of adults with a chronic circadian rhythm condition called non–24-hour sleep-wake disorder (non-24).

Tasimelteon would represent the first European Union (EU) treatment for non-24, the agency said in a press release.

The drug was approved early last year by the US Food and Drug Administration (FDA), also the first FDA approval of a treatment for the disorder.

Non-24 is a rare condition that occurs almost exclusively in blind people. Because they don’t perceive light, these patients fall asleep and wake up at different times compared with the general population, often in a pattern that is closer to a 25-hour clock.

As a result, they have problems adjusting to the standard timetable of everyday life, often being awake or asleep at unusual times. Many experience excessive daytime sleepiness, which affects their quality of life and ability to follow a normal daily schedule.

Melatonin, produced by the pineal gland during hours of darkness, plays a key role in coordinating the body’s sleep cycle by acting on receptors in the brain.

The effectiveness of tasimelteon was demonstrated in two clinical trials. These studies showed that treatment resulted in significant improvement compared with placebo, both in increasing night-time sleep and decreasing daytime sleep duration.

The most common adverse effects include headache, drowsiness, and nightmares or unusual dreams.

Orphan Drug
In 2011, tasimelteon received an orphan designation in Europe. This designation and the associated incentives, such as scientific advice, are among the most important instruments to encourage the development of medicines for patients with rare diseases, said the press release.

The opinion adopted by the Committee for Medicinal Products for Human Use (CHMP) at its meeting this month is an intermediary step on Hetlioz’s path to patient access. This opinion will now be sent to the European Commission for the adoption of a decision on EU-wide marketing authorization.

Once marketing authorization is granted, each Member State will decide on price and reimbursement, considering the potential role/use of this medicine in the context of the national health system of that country.

The marketing authorization applicant for Hetlioz is Vanda Pharmaceuticals Limited, United Kingdom. In the United States, the drug is manufactured by Vanda Pharmaceuticals Inc, Washington, DC.

According to the FDA, up to 100,000 Americans have non-24 and can’t perceive enough light to establish a normal night sleep schedule. If prescribed tasimelteon, they should take this drug at the same time every night before bedtime and limit activities after taking it.

Bone Loss May Indicate Poor Heart Health in Dialysis Patients

High parathyroid hormone levels and bone loss may predict progression of coronary artery calcification (CAC) in patients receiving dialysis, according to a study published online April 2 in the Journal of the American Society of Nephrology.

“We discovered that high parathyroid hormone and the consequential bone loss are major risk factors for progression of vascular calcifications,” Hartmut H. Malluche, MD, from the Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, commented in a news release.

“These two factors were heretofore not appreciated and were independent from traditional known risk factors,” he added.
Elevated parathyroid hormone levels cause the release of calcium from bone, leading to bone loss and thinning. Most patients receiving dialysis for chronic kidney disease have CAC. CAC increases the risk for cardiovascular events, which in turn cause the majority of deaths in patients with CKD, the authors note.

Therefore, Dr Malluche and colleagues recommend monitoring bone loss with measurements of parathyroid hormone or bone mineral density (BMD) as a way to predict progression of CAC in patients receiving dialysis.

Between August 2009 and April 2013, the researchers enrolled 213 participants from 38 dialysis centers in Kentucky. Participants underwent measurement of routine laboratory tests, serum markers of bone metabolism, and CAC at baseline and 1 year. The researchers also evaluated BMD at both points using dual-energy X-ray absorptiometry scans and quantitative computed tomography. They assessed CAC using multislide computed tomography of the heart and CAC square root of coronary artery calcification volume, an analytic technique that accounts for variability in scanning.

About 80% of participants had CAC at baseline, and almost 50% of these had measurements suggesting high risk for cardiovascular events. One third of participants had osteoporosis.

Independent positive predictors of baseline CAC included coronary artery disease, diabetes, length of time receiving dialysis, age, and concentration of fibroblast growth factor 23, which regulates serum phosphate levels and helps maintain bone strength. In contrast, BMD of the spine inversely predicted baseline CAC.
CAC progression at 1 year occurred among three quarters of the 122 patients who completed the study. Independent risk factors for CAC progression included age, osteoporosis (β = 4.6; 95% confidence interval, 1.8 – 7.5; P = .002), and baseline total or whole parathyroid hormone more than nine times the normal value, after adjusting for age (β = 6.9; 95% confidence interval, 2.4 – 11.4; P = .003).

The researchers note several limitations for the study, including exclusion of about 20% of screened patients because of severe comorbidities or impaired mental status. In addition, the prospective, short-term nature of the study precluded determination of disease mechanisms and long-term relationships.

Dr Malluche noted in the press release that important links may exist between the level of calcification in bones and calcifications in blood vessels.

“Studies need to be done to find out whether prevention of bone loss will reduce progression of vascular calcifications,” he emphasized.

EGFR Testing Not Done in 25% of Lung Cancer Patients

Many patients with advanced non-small cell lung cancer (NSCLC) are missing out on a crucial genetic test to determine whether they would benefit from more targeted therapy, new research suggests.

A survey of more than 550 oncologists around the world revealed that EGFR genetic testing is not being conducted in about 25% of patients with NSCLC. And even when the test is requested, treatment is started before the results are back in one-quarter of cases.

The research was presented at the 2015 European Lung Cancer Conference in Geneva.

Guidelines from the International Association for the Study of Lung Cancer (IASLC) recommend that all patients diagnosed with advanced NSCLC, except those with squamous cell carcinoma, undergo EGFR testing, and that the results be used to guide treatment decisions.

Recent research has indicated that matching EGFR mutation status to specific tyrosine kinase treatments can improve overall survival.

However, the IASLC guidelines are not being followed in a number of cases, said lead researcher James Spicer, MD, PhD, reader in experimental oncology at King’s College London at Guy’s Hospital in the United Kingdom.
“Not only were some suitable patients not tested at all for tumor EGFR mutations, some patients did undergo testing but the treatment decision about whether to give an EGFR inhibitor or chemotherapy as first-line treatment was taken without reference to the result,” he said in a statement.

A representative sample of 562 oncologists from Canada, France, Germany, Italy, Japan, South Korea, Spain, Taiwan, the United Kingdom, and the United States completed an online survey from December 2014 to January 2015.

The survey assessed the prevalence of mutation testing, attitudes and barriers to testing, and the way the results affect the choice of therapy for patients with advanced NSCLC.

Dr Spicer and colleagues found that EGFR testing was requested before the administration of first-line therapy for 81% of patients with stage IIIb/IV NSCLC. The most common reason for not ordering a test was that the patient had the wrong type of histology.

“Most centers, especially the big academic centers, know enough about those patients not to waste resources on testing for a mutation that they are very unlikely to find,” Dr Spicer explained.

“Sure enough, the most likely reason that our respondents cited for not testing was that patients have the wrong type of tumor to have a mutation…and that’s fine,” he told Medscape Medical News.

The next most common reason was a lack of diagnostic material. The tumor is difficult to access, so “by the time we’ve decided that it’s a lung cancer in the pathology lab, there isn’t enough cellular material left to extract the DNA and do this sort of genetic testing,” he pointed out.

“But that should be less and less of a problem in the modern era, because we getting better at obtaining biopsies with newer techniques, and we’re getting better at doing the test with more sensitive genetic tests,” he added.

The survey revealed a number of other reasons for not ordering EGFR testing, which Dr Spicer described as “a bit more worrisome.” These included cases in which a patient was deemed unfit to undergo testing.

Not testing someone who is wheelchair-bound or breathless, and thereby not offering the most appropriate treatment, which could quickly improve a patient’s health status, “is really not good modern oncology,” he noted.

“Maybe there’s an area of education around prescribers that still needs to be done,” he added.

Two other reasons cited for not offering EGFR testing — patients were smokers or were too old — go against the guidelines. Many smokers do undergo EGFR mutation, and elderly patients can tolerate, and might benefit from, tyrosine kinase therapy, Dr Spicer noted.

Finally, a major reason cited for not ordering EGFR testing was the long turnaround time. Dr Spicer said he can “sympathize”; the turnaround time is weeks at some centers.

For patients who underwent testing, the oncologist received the results before first-line therapy was initiated in 77% of cases (ranging from 51% in France to 89% Japan). In 23% of cases, first-line therapy was initiated before the test results were available.

“It’s a bit paradoxical,” Dr Spicer said, “to go to the trouble of doing the test and starting the patient on treatment before the mutation test is back.”

“Because these targeted drugs are only licensed by the regulators in the presence of a mutation, if you’re starting before the mutation result is back, then it’s presumably not the targeted drug that you’re starting them on,” he said.

Respondents reported initiating therapy before EGFR results were available because the test took too long or because the patient wanted to start therapy immediately.

According to the survey, 23% of oncologists do not consider EGFR mutation subtypes when making their treatment decisions, but 49% do.

When choosing a first-line therapy for NSCLC patients, a clinically relevant increase in overall survival was cited by 75% of oncologists.

“Overall, it looks like people are getting it right,” Dr Spicer said. However, “there are some significant areas where we could, perhaps, improve things by offering more patients the test and then doing more with that result.”

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