Bridging a "weird" loss of memory of the cause, cognitive impairment

Coronary artery bypass graft (CABG) offers a new chance of life for thousands of people each year whose hearts do not get the blood they need to function properly. But he was also accused of "brain fog", memory loss and thinking skills following the procedure of some people. These cerebral disorders are often called cognitive impairment.

The operation itself can not be to blame, according to a review of the Annals of Internal Medicine today. To review, a team of researchers, mainly the Department of Veterans Affairs American Affairs synthesized data from 17 clinical trials and observational studies well designed four adults 65 years. Most study participants had undergone bypass surgery, but some had other procedures-usually related to the heart to replace a valve or treat atrial fibrillation.

The researchers concluded that the medium and long-term cognitive impairment after cardiovascular procedures "can be rare." However, they recommend that anyone considering open heart surgery or other major cardiovascular procedure should discuss the possibility of cognitive impairment with your surgeon.

Researchers applaud his attempt to answer this important question. But there were several important limitations to their results, even if they chose only the best studies:

* The studies used different methods to compare the procedures and cognitive changes after surgery. 
*  "Cognitive impairment" is sometimes loosely defined. 
*  Those potentially increased risk of cognitive impairment after a procedure were excluded, either from the study or not identified as a subgroup.
*  The studies did not look at other factors affecting the rapid cognitive decline, such as depression, hypertension, diabetes and levels of education and social support.

These limits mean the results are not the final word on the connection between bypass surgery and cognitive impairment. But they must reassure people who need this.

Bypass and brain
 If you have heart disease significantly improved by surgery or another invasive procedure that will get the benefit is likely to outweigh the risk of cognitive impairment. In addition, the risk of cognitive impairment may be greater than the drug therapy of surgery.  

For example, people with severe narrowing of their carotid arteries are less likely to have a stroke (one of the main causes of cognitive impairment) if they have a procedure to resolve the problem rather than controlled with medication.

Note that the most important causes of memory loss and a decline in thinking skills are lifestyle choices that harm the brain, not heart surgery.

Whatever your age and your current health condition, you can reduce your risk of cognitive impairment

    *  A Mediterranean-style diet
    *  Staying physically active, with time spent each day for exercise
    *  No Smoking
    *  Maintain a healthy weight
    *  Keep blood pressure under control
    *  Maintain moderate drinking (if you drink) - which means no more than two drinks per day for men and no more than one per day for women.

Read More

Vision goggles use starting at an early age

When children are packed for summer camp, not always sunglasses supply list. But I made them a priority for my 12 year old son Carson, who has just started the rowing camp in Florida, for two reasons:

   * Our eyes are the most vulnerable to ultraviolet rays of the sun in our teens, 20s, and 30s, but the damage does not usually appear until later in life.

   * The sun's rays are especially strong around reflective surfaces.

"If you spend time near the water, the beach or in the snow, sunlight bouncing off these surfaces and in the eye," said Dr. Louis Pasquale. It is an ophthalmologist at Harvard-affiliated Massachusetts Eye and Ear Infirmary.

The sun's ultraviolet rays can damage the eyes. However, experts do not know exactly how UV rays damage the eyes, and some even wonder if the sunlight directly causes common eye conditions such as cataracts, glaucoma and macular degeneration according to Dr. Pasquale.  

Cataracts are a clouding of the eye, causing blurred vision. Glaucoma is an increased pressure in the eye, which can damage the optic nerve and cause blindness. The macular degeneration progressively destroys the macula, the part of the eye which provides central vision.

But there is good evidence that exposure to sunlight may cause exfoliation syndrome, which, in turn, can lead to impaired vision. As I write in the June 2015 Harvard Health Letter, exfoliation syndrome involves the production of small flakes of dandruff and inside of the eye. As they accumulate, these scales can clog the natural drainage of the eye, which can lead to other problems.

Overall, the exfoliation syndrome is the most common identifiable cause of secondary open-angle glaucoma and secondary angle closure glaucoma. exfoliation syndrome is also linked to cataracts and possibly macular degeneration. "Research has shown that women between the ages of 15 and 24 spend 10 hours a week in the sun seems to have a double risk of exfoliation syndrome compared to those who spend two or three hours a week in the sun," says Dr. Pasquale. 

Use goggles
 Protect your eyes from harmful sun rays is a good strategy at any age. You do not have to spend a bundle to get a good pair of sunglasses. But you must know what to look for in the lenses. Most important: protection against ultraviolet rays, UVA and UVB. You want a lock 95% to 100%. Also look for polarized lenses; to reduce glare from water, sand and snow.

But buyer beware: the manufacturers are not required to disclose or UV protection guarantee. "You can be sure that a pair of cheap pharmacy sunglasses really give protection, even if it promises a lock on the label," says Thomas Merrill, a Massachusetts Eye and Ear Infirmary optics. It is recommended go to an optical shop where you can get a guide to help you choose a good quality product. Even if you do not need a pair of sunglasses, you can still benefit from counseling to experts, especially if you already have eye damage.

If you wear glasses and you do not want to buy sunglasses, buy sunglasses that fit over your regular glasses. "This gives protection against the top and sides, and is more comfortable for the eyes, especially if you're in the water," says Merrill. A couple of these usually cost around $ 50.

Add early detection, as
 In addition to protecting your eyes against ultraviolet rays, another way to stop the cataracts, glaucoma and macular degeneration to steal your vision is to find these conditions before they cause problems. You can do this with a complete eye exam. This involves dilating the eyes to open students to a doctor can examine the back of the eye in the retina. He or she will also check the pressure in your eyes, look at his muscle structure and function and correct vision problems if necessary.

The American Academy of Ophthalmology recommends a comprehensive review of both for four years for those between 40 and 55 years, every one to three years for those aged 55-65, and every one to two years for people 65 years or older. People with risk factors for eye problems - people with diabetes, for example - may need more frequent exams view. Young adults need comprehensive eye examinations less often - at least once between the ages of 20 and 29, and at least twice between the ages of 30 and 39. Children and adolescents should have their eyes examined every one two years by your family doctor, and visit an ophthalmologist if you need evaluation.

Eye protection minors

Carson decided he needed sunglasses - especially a pair that looked cool. We went hunting for sports glasses with UV protection, which we found rather quickly. Not break the bank, and gave me some peace of mind that my child's eyes are protected while cutting through the water. 

Read More

Special magnetic resonance image was able to identify the risk of stroke in people with atrial fibrillation

Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can make you feel bad. What's worse, it can cause potentially disabling or fatal strokes.  

A special MRI may - emphasize "may" - help identify people with atrial fibrillation who are at high risk of having a stroke. This could help many people with this condition to avoid taking warfarin or other drugs to prevent formation of clots life.

A normal heartbeat starts in a group of cells called pacemakers. It is located on the upper right part of the heart (the right atrium).  

These cells generate a pulse of electricity that flows to the rest of the heart and causes a coordinated heartbeat. In people with atrial fibrillation, the electrical signals are due to areas outside the pacemaker.  

These signals are fast and irregular. So instead of hiring at a steady pace, the right and left atria quiver. This can allow blood in the atria instead of flowing smoothly through the heart and body.
When blood pools in the atria, it can form small clots. If one breaks away in the heart and enters the circulation, it may occur in the brain, causing a stroke.

Researchers at the Johns Hopkins School of Medicine wanted to see if the image could identify people with atrial fibrillation who were at high risk of stroke. They conducted standard MRI hearts of 149 men and women with atrial fibrillation, and use special software for motion tracking to evaluate images.  

Analyses revealed specific changes in the muscles of the left atrium, which increased the risk of stroke in certain volunteers. These changes are not associated with age or other stroke risk factors. The results were published online April 27 in the Journal of the American Heart Association.

Calculating the risk of stroke in atrial fibrillation

It would be nice to have a way to identify individuals with atrial fibrillation are at high risk of stroke and are at low risk. The Hopkins study provides a step in that direction. But it is too early to include MRI as part of the standard evaluation of people with atrial fibrillation - not to mention that these scans significantly increase the cost of these evaluations. For now, doctors continue to use standard tools to help determine the risk of stroke. 

If you have atrial fibrillation, the risk of stroke is higher if you:

 1.   They are 65 years old or more, and even more if you have 75 years or more

 2.   They had a stroke or mini stroke stroke (transient ischemic attack or TIA) in the past

 3.   It has heart failure

 4.   Have blood vessels throughout the body shrunk by presented cholesterol plate (vascular disease)

 5.   He has diabetes

 6.   She is a woman.
Experts have developed a tool called the CHA2DS2-VASc score to calculate the risk of stroke in people with atrial fibrillation. It is estimated that this risk taking into account age and sex; the presence or absence of heart failure, hypertension, constriction of blood vessels, and diabetes; and if you have had a previous stroke, TIA, or blood clots. A low score indicates that may not be necessary warfarin or other blood-thinning medications. 

You can calculate your CHA2DS2 VASc-line score.

A day, the use of MRI or other technique at the image of the heart is probably important in the assessment of atrial fibrillation. But not in the short term.
Image:www.dailymail.co.uk
 

Read More

Prostate cancer lives from birth: slow and benign growth or rapid and dangerous growth

This year, more than 238,000 American men are diagnosed with prostate cancer. In most cases, the cancer is small knots of abnormal cells grow slowly in the size of the prostate gland of a walnut. For many men, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and represent a serious risk to health and longevity.

There is growing evidence that early treatment with surgery or radiation ultimately prevents relatively few men die of prostate cancer while leaving many with urinary or erection problems and other side effects. As a result, more men may be willing to consider a strategy called active surveillance, in which doctors monitor low risk closely and consider treating cancer when the disease appears to make threatening gestures towards the growth and spread.

This week, a study by Harvard researchers found that the aggressiveness of prostate cancer at diagnosis appears to remain stable over time for most men. If this is true, then the appropriate treatment can be reserved for the most likely to be a threat cancers, while men may reasonably choose to watch and wait for other purposes.

"If you chose active surveillance, then it might make you feel more confident in your decision," said Kathryn L. Penney, Sc.D., professor of medicine at Harvard Medical School and lead author of a report published today in the journal Cancer Research.

Early lethality established cancer 

The study analyzed changes in the aggressiveness of cancer in men diagnosed with prostate cancer between 1982 and 2004. All the men had their prostates removed after diagnosis, and biopsies were taken from the glands. The Harvard team revisited the samples and classified using a tool called the Gleason score, which assigns a number 2-10 based on how abnormal the cells look under a microscope. A high score or "high-grade cancers," tend to be the most deadly.

During the study period, fewer men were diagnosed with prostate cancer, the latter advanced that had spread beyond the prostate gland. This reflects the increasing use of the antigen (PSA) for prostate-specific prostate cancer diagnosis earlier and earlier. In contrast, the proportion of high-grade cancer, as measured by the Gleason score, was relatively stable rather than becoming progressively more aggressive. Previous studies have seen a similar trend.

"This is a very interesting study that confirms what previous studies have found," says Dr. Marc B. Garnick, prostate cancer specialist at Harvard-affiliated Beth Israel Deaconess Medical Center, who was not involved in the study. "There may be rare exceptions, but in most cancers born with a Gleason score in particular."

This means that most prostate cancers that seem to be increasingly at diagnosis might as well stay long enough that the man is likely to die of other causes before the cancer spreads beyond the slow prostate. "Those who are poor and lazy is likely to cause problems in the life of a man," says Dr. Garnick, editor of the Annual Report on Prostate Disease, Harvard Medical School. In addition, it adds, most prostate cancers are also born this way and behave aggressively.

Gleason is one of the best predictors of death from prostate cancer. "Men with low-grade disease are much less likely to die from prostate cancer than men with high-grade cancer," says Penney. He cautioned, however, that the study focused on men as a group, and in this population Gleason seemed quite stable. "You can see the progression of an individual, but we believe it is not common," she said. "We can not rule out this possibility in our study."

How to enable monitoring jobs 

The Gleason score is only one way that doctors monitor prostate cancer during active surveillance. They also monitor the periodic biopsies and measured PSA levels, which may increase if the cancer begins to spread in the prostate. 

Doctors may recommend treatment earlier if PSA begins to rise rapidly or if a follow-up biopsy revealed more widespread than or score in prostate cancer Gleason. This is an inexact science that depends on the skill and experience of the physician and the will of a man waiting for signs that cancer is a clear threat before opting for the treatment and its potential side effects.

Penney said she and her colleagues at Harvard are among the many scientists are now looking for better ways to predict prostate is likely to be the deadly cancer that can be monitored and untreated. The answer can be found in the genetic changes in the cancer cells of the prostate indicating greater threat. But a better way to predict who tend to use lethal prostate cancer is far from guaranteed.

"Some [researchers] believe that it is not possible," said Penney. "After the cancer is diagnosed, so many things can change in unknown ways." Diet, exercise and other lifestyle factors, for example, could affect whether the cancer at low risk prostate to become more aggressive or threatening weather. 

Read More