Life expectancy for people with HIV approaching that of general population.


A new study suggests the life expectancy of Canadians and Americans who are HIV positive is closing in on that of the general population.

The study says that a 20-year old diagnosed with HIV today can expect to live into their early 70s.

A couple of decades ago, a diagnosis of HIV was a death sentence for most who received it.

But with the discovery and improvement of antiretroviral drugs, HIV has become a chronic disease for most who have access to and can afford the medication.

A leading HIV researcher, Dr. Julio Montaner, says the findings of the study are excellent news.

Montaner is director of the B.C. Centre for Excellence in HIV/AIDS, which led the research collaboration that produced the study, which is published in the journal PLoS One.

He says the longevity gains have been remarkable. In 2000, a 20-year-old newly diagnosed with HIV could expect to live another 36 years. By 2006, that figure had climbed to 51 years.

“I don’t think, in all honesty, that there has been an area of medicine that has undergone a revolutionary evolution over our lifetime as HIV has,” Montaner says.

Dr. Ann Stewart, medical director of Toronto’s Casey House, agrees.

Casey House started 25 years ago as a hospice for dying AIDS patients. As treatment has prolonged the lives of the community it serves, the facility has transitioned into a hospital that offers care for people living with HIV.

Stewart says the findings of the study mirror what Casey House staff see in their patient population. But she warned that the picture is not an “unclouded” one — HIV-positive people often develop the health problems of age faster than those who are not infected.

So heart problems, cancers and the onset of dementia that might be expected in the late 60s, 70s or even 80s in HIV-negative people can show up in the 50s for HIV-positive people, she says.

“It’s much better than it was, for sure. For sure. But it’s not without challenges,” Stewart says.

“You can have HIV and live a wonderful life. But there’s certain complications and challenges associated with it as there are with other chronic diseases that you’re going to struggle with. So it’s not an unclouded sky.”

Insomnia Cure Boosts Success of Depression Treatment.


reating persistent insomnia at the same time as depression could double the chances that the mood disorder will disappear, a new study shows.

Doctors have long reported a link between insomnia — the inability to sleep — and depression, but many thought that depression led to insomnia. Now, experts suspect sleep problems can sometimes precede depression.

If other ongoing studies confirm these results, it might lead to major changes in depression treatment, experts added. Such changes would represent the biggest advance in depression treatment since the antidepressant Prozac was introduced in 1987, The New York Times reported.

“The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia,” Colleen Carney, lead author of the small study, told the Times.

The study was funded by the U.S. National Institute of Mental Health.

The insomnia treatment relied on talk therapy, rather than sleep medication, for 66 patients.

Insomnia and depression are both common problems, and often interact, explained Dr. Steven Feinsilver, director of the Center for Sleep Medicine at Mount Sinai School of Medicine in New York City. He was not involved in the study.

“Clearly, poor sleep can cause depression and depression can cause poor sleep,” he said.

Evidence does exist that for many people, symptoms of insomnia precede symptoms of depression by a few years, Feinsilver noted. “This could be taken to mean either that insomnia causes depression or that insomnia is the earliest symptom of depression,” he said.

This study may help untangle that relationship. It “suggests that specifically treating the insomnia with behavioral techniques can substantially improve the outcome of patients with depression,” Feinsilver added.

For the millions of people with depression, the findings offer a ray of hope.

“This relatively simple technique for treating insomnia could be tremendously helpful for those with this common psychiatric illness,” Feinsilver said.

More than 20 million Americans suffer from depression — disabling feelings of sadness and despair that don’t go away, according to the U.S. National Library of Medicine. More than half of those with depression also suffer from insomnia.

The research team, from Ryerson University in Toronto, found depression lifted significantly among patients whose insomnia was cured. The insomnia treatment consisted of four talk therapy sessions over eight weeks, according to the Times.

During the sessions, patients were given certain instructions: set a specific wake-up time and don’t veer from it; get out of bed when awake but don’t eat, read or watch TV; and refrain from taking any daytime naps.

Almost 90 percent of patients who responded to the insomnia therapy also saw their depression lift after taking an antidepressant pill or an inactive placebo for two months. That was about double the rate of those who could not shake their sleeplessness, the news report said.

Study participants had to have had a month of sleep loss that had an effect on their jobs, family life or other relationships.

A smaller pilot study conducted at Stanford University produced similar findings, the Times reported.

Carney was to present the latest research Saturday at a conference of the Association for Behavioral & Cognitive Therapies, in Nashville, Tenn., the newspaper reported.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal.

The Discovery of Insulin.


Before the discovery of insulin, diabetes was a feared disease that most certainly led to death. Doctors knew that sugar worsened the condition of diabetic patients and that the most effective treatment was to put the patients on very strict diets where sugar intake was kept to a minimum. At best, this treatment could buy patients a few extra years, but it never saved them. In some cases, the harsh diets even caused patients to die of starvation.

pancreasDuring the nineteenth century, observations of patients who died of diabetes often showed that the pancreas was damaged. In 1869, a German medical student, Paul Langerhans, found that within the pancreatic tissue that produces digestive juices there were clusters of cells whose function was unknown. Some of these cells were eventually shown to be the insulin-producing beta cells. Later, in honor of the person who discovered them, the cell clusters were named the islets of Langerhans.

In 1889 in Germany, physiologist Oskar Minkowski and physician Joseph von Mering, showed that if the pancreas was removed from a dog, the animal got diabetes. But if the duct through which the pancreatic juices flow to the intestine was ligated – surgically tied off so the juices couldn’t reach the intestine – the dog developed minor digestive problems but no diabetes. So it seemed that the pancreas must have at least two functions:

  • To produce digestive juices
  • To produce a substance that regulates the sugar glucose

This hypothetical internal secretion was the key. If a substance could actually be isolated, the mystery of diabetes would be solved. Progress, however, was slow.

Banting’s Idea

In October 1920 in Toronto, Canada, Dr. Frederick Banting, an unknown surgeon with a bachelor’s degree in medicine, had the idea that the pancreatic digestive juices could be harmful to the secretion of the pancreas produced by the islets of Langerhans.

He therefore wanted to ligate the pancreatic ducts in order to stop the flow of nourishment to the pancreas. This would cause the pancreas to degenerate, making it shrink and lose its ability to secrete the digestive juices. The cells thought to produce an antidiabetic secretion could then be extracted from the pancreas without being harmed.

Early in 1921, Banting took his idea to Professor John Macleod at the University of Toronto, who was a leading figure in the study of diabetes in Canada. Macleod didn’t think much of Banting’s theories. Despite this, Banting managed to convince him that his idea was worth trying. Macleod gave Banting a laboratory with a minimum of equipment and ten dogs. Banting also got an assistant, a medical student by the name of Charles Best. The experiment was set to start in the summer of 1921.

Banting and Best with a diabetic dog
Banting, right, and Best, left, with one of the diabetic dogs used in experiments with insulin.
Credits: University of Toronto Archives

The Experiment Begins

Banting and Best began their experiments by removing the pancreas from a dog. This resulted in the following:

  • It’s blood sugar rose.
  • It became thirsty, drank lots of water, and urinated more often.
  • It became weaker and weaker.

The dog had developed diabetes.

Experimenting on another dog, Banting and Best surgically ligated the pancreas, stopping the flow of nourishment, so that the pancreas degenerated.

After a while, they removed the pancreas, sliced it up, and froze the pieces in a mixture of water and salts. When the pieces were half frozen, they were ground up and filtered. The isolated substance was named “isletin.”

The extract was injected into the diabetic dog. Its blood glucose level dropped, and it seemed healthier and stronger. By giving the diabetic dog a few injections a day, Banting and Best could keep it healthy and free of symptoms.

Banting and Best showed their result to Macleod, who was impressed, but he wanted more tests to prove that their pancreatic extract really worked.

Banting and Best's laboratory Banting’s and Best’s laboratory, where insulin was discovered. 
Credits: University of Toronto Archives

Extended Tests

For the increased testing, Banting and Best realized that they required a larger supply of organs than their dogs could provide, and they started using pancreases from cattle. With this new source, they managed to produce enough extract to keep several diabetic dogs alive.

A dog and a cowThe new results convinced Macleod that they were onto something big. He gave them more funds and moved them to a better laboratory with proper working conditions. He also suggested they should call their extract “insulin.” Now, the work proceeded rapidly.

In late 1921, a third person, biochemist Bertram Collip, joined the team. Collip was given the task of trying to purify the insulin so that it would be clean enough for testing on humans.

During the intensified testing, the team also realized that the process of shrinking the pancreases had been unnecessary. Using whole fresh pancreases from adult animals worked just as well.

Testing on Humans

The team was eager to start testing on humans. But on whom should they test? Banting and Best began by injecting themselves with the extract. They felt weak and dizzy, but they were not harmed.

Collip continued his work to purify the insulin. He also experimented with trying to find the correct dosage. He learned how to diminish the effect of an insulin overdose with glucose in different forms. He discovered that the glucose should be as pure as possible. Orange juice and honey are good examples of foods rich in glucose.

A human and honeyIn January 1922 in Toronto, Canada, a 14-year-old boy, Leonard Thompson, was chosen as the first person with diabetes to receive insulin. The test was a success. Leonard, who before the insulin shots was near death, rapidly regained his strength and appetite. The team now expanded their testing to other volunteer diabetics, who reacted just as positively as Leonard to the insulin extract.

The Nobel Prize

The news of the successful treatment of diabetes with insulin rapidly spread outside of Toronto, and in 1923 the Nobel Committee decided to award Banting and Macleod the Nobel Prize in Physiology or Medicine.

The decision of the Nobel Committee made Banting furious. He felt that the prize should have been shared between him and Best, and not between him and Macleod. To give credit to Best, Banting decided to share his cash award with him. Macleod, in turn, shared his cash award with Collip.

The Nobel Prize in Physiology or Medicine for insulin has been much debated. It has been questioned why Macleod received the prize instead of Best and Collip. However, Macleod played a central role in the discovery of insulin. It was he who supported the project from the beginning. He supervised the work and it is also most likely that Macleod’s contacts in the scientific world helped the team in getting a speedy recognition of their discovery.


Frederick G. Banting and John Macleod were awarded the Nobel Prize in Physiology or Medicine in 1923 “for the discovery of insulin.”

The Legacy of Insulin

Banting, Macleod, and the rest of the team patented their insulin extract but gave away all their rights to the University of Toronto, which would later use the income from insulin to fund new research.

Very soon after the discovery of insulin, the medical firm Eli Lilly started large-scale production of the extract. As soon as 1923, the firm was producing enough insulin to supply the entire North American continent.

Although insulin doesn’t cure diabetes, it’s one of the biggest discoveries in medicine. When it came, it was like a miracle. People with severe diabetes and only days left to live were saved. And as long as they kept getting their insulin, they could live an almost normal life.

Active Cooling Improves Transport of Infants With Hypoxic-Ischemic Encephalopathy.


Newborns with hypoxic-ischemic encephalopathy (HIE) do better with active cooling during transport, a new paper says.

Servo-controlled active cooling during transport of full-term infants with HIE improved their temperature stability and reduced their transfer time in comparison to passive cooling, researchers said October 21 in Pediatrics.

All babies cooled using the active approach were within the target temperature range when they arrived at the regional unit for treatment, versus 39% of the passively controlled infants, Dr. Topun Austin of Rosie Hospital in Cambridge, UK, and his colleagues found.

HIE occurs in two of every 1,000 newborns in developed countries, and in 10-20 per 1,000 babies in the developing world, Dr. Austin explained in an interview with Reuters Health. Therapeutic hypothermia, which involves cooling babies from their normal temperature of 37 degrees C to 33.5 degrees C, has been shown to help prevent brain damage in these infants.

“If you cool them by just a few degrees, a lot of these babies will have a normal neurological outcome at 18 months,” the investigator said. “It’s quite a dramatic improvement with quite an inexpensive treatment.”

One approach to cooling babies with HIE is to simply remove their clothes, Dr. Austin added, but this “passive cooling” approach can lead to overcooling. With active cooling, the baby is placed on a fluid-filled mattress. A rectal probe monitors the infant’s temperature, and the mattress is automatically heated or cooled to ensure that the target temperature is maintained.

Until now, no studies have compared outcomes with passive vs active cooling. To do so, Dr. Austin and his team reviewed data from a regional neonatal transfer team for 134 infants. The first 64 were treated with passive cooling; the other 70 infants were treated with active cooling after the purchase of a servo-controlled mattress.

Cooling started at an average of 46 minutes of age for the active group, vs 120 minutes for the control group. Median stabilization time was 153 minutes for the control group versus 133 minutes for the active group, while age at arrival was 504 minutes for the control group and 452 for the active group.

Dr. Austin and his colleagues are now investigating strategies for identifying infants with HIE as early as possible.

“It is important for the policy maker to make active cooling available during transport and maybe in the areas at medium and far distance from the referral centers,” said Dr. Mohamed Tagin, a neonatal fellow at the Hospital for Sick Children in Toronto, in email to Reuters Health. Dr. Tagin did not participate in the new study.

“I do agree that the active cooling process should be monitored at a tertiary care facility where appropriate monitoring and expertise are available for such complicated management,” Dr. Tagin added. “It is however very important to commence cooling as soon as the criteria for moderate to severe HIE have been fulfilled, given the available evidence about the improvement of the long-term outcome for those newborns.”

Dr. Tagin continued, “It is important when we discuss the issue of cooling to highlight that patient identification and early management is the most important step and often times it is done by a midwife or a family physician far away from further support. As the situation is stressful enough to those individuals, I believe there should be a system in place to give clear advice over the phone and maybe this already should be preceded with some training to different scenarios.”

But while active cooling should be the standard of care, he said, in the meantime “cooling should not be delayed, and passive cooling with frequent / continuous monitoring should be commenced once the patient has been identified.”

MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study.


Background

Essential tremor is the most common movement disorder and is often refractory to medical treatment. Surgical therapies, using lesioning and deep brain stimulation in the thalamus, have been used to treat essential tremor that is disabling and resistant to medication. Although often effective, these treatments have risks associated with an open neurosurgical procedure. MR-guided focused ultrasound has been developed as a non-invasive means of generating precisely placed focal lesions. We examined its application to the management of essential tremor.

Methods

Our study was done in Toronto, Canada, between May, 2012, and January, 2013. Four patients with chronic and medication-resistant essential tremor were treated with MR-guided focused ultrasound to ablate tremor-mediating areas of the thalamus. Patients underwent tremor evaluation and neuroimaging at baseline and 1 month and 3 months after surgery. Outcome measures included tremor severity in the treated arm, as measured by the clinical rating scale for tremor, and treatment-related adverse events.

Findings

Patients showed immediate and sustained improvements in tremor in the dominant hand. Mean reduction in tremor score of the treated hand was 89·4% at 1 month and 81·3% at 3 months. This reduction was accompanied by functional benefits and improvements in writing and motor tasks. One patient had postoperative paraesthesias which persisted at 3 months. Another patient developed a deep vein thrombosis, potentially related to the length of the procedure.

Interpretation

MR-guided focused ultrasound might be a safe and effective approach to generation of focal intracranial lesions for the management of disabling, medication-resistant essential tremor. If larger trials validate the safety and ascertain the efficacy and durability of this new approach, it might change the way that patients with essential tremor and potentially other disorders are treated.

Source: Lancet

You Are Stardust: Teaching Kids About the Universe in Stunning Illustrated Dioramas.


youarestardust1 youarestardust2 youarestardust3 youarestardust4 youarestardust5

“Every tiny atom in your body came from a star that exploded long before you were born.”

“Everyone you know, everyone you ever heard of, every human being who ever was … lived there — on a mote of dust suspended in a sunbeam,”Carl Sagan famously marveled in his poeticPale Blue Dot monologue, titled after the iconic 1990 photograph of Earth. The stardust metaphor for our interconnection with the cosmos soon permeated popular culture and became a vehicle for the allure of space exploration. There’s something at once incredibly empowering and incredibly humbling in knowing that the flame in your fireplace came from the sun.

That’s precisely the kind of cosmic awe environmental writer Elin Kelsey and Toronto-based Korean artist Soyeon Kim seek to inspire in kids in You Are Stardust (public library) — an exquisite picture-book that instills that profound sense of connection with the natural world. Underpinning the narrative is a bold sense of optimism — a refreshing antidote to the fear-appeal strategy plaguing most environmental messages today.

Kim’s breathtaking dioramas, to which this screen does absolutely no justice, mix tactile physical materials with fine drawing techniques and digital compositing to illuminate the relentlessly wondrous realities of our intertwined existence: The water in your sink once quenched the thirst of dinosaurs; with every sneeze, wind blasts out of your nose faster than a cheetah’s sprint; the electricity that powers every thought in your brain is stronger than lightning.

But rather than dry science trivia, the message is carried on the wings of poetic admiration for these intricate relationships:

Be still. Listen.

Like you, the Earth breathes.

Your breath is alive with the promise of flowers.

Each time you blow a kiss to the world, you spread pollen that might grow to be a new plant.

The book is nonetheless grounded in real science. Kelsey notes:

I wrote this book as a celebration — one to honor the extraordinary ways in which all of us simply are nature. Every example in this book is backed by current science. Every day, for instance, you breathe in more than a million pollen grains.

Source: http://www.brainpickings.org