Ticks can transmit Lyme disease like new

There are several good reasons to keep ticks from your body. One of them is that they are scary and suck blood. Another is that they can transmit Lyme disease do not differ 14. A report published online this week in the Annals of Internal Medicine describes the new disease transmitted by ticks in North America, which is caused by a bacterium called Borrelia Miyamotoi.

The microbe was first identified in Japan in 1995. The first report of infecting humans, he came to Russia in 2011. The cases began to appear in the northern United States in 2013.Miyamotoi Borrelia is a spiral shaped bacterium that is related to the one that causes Lyme disease, another infection transmitted by ticks. Miyamotoi Borrelia infection often causes relapsing fever and headaches, muscle aches and chills. The rash does not usually cause "door" seen in some people with Lyme disease.

According to the Annals report, nearly a quarter of people diagnosed with the disease Borrelia Miyamotoi are so sick they need to be hospitalized. The best therapy to date is the oral antibiotic doxycycline. That's good news, because doxycycline is also an effective treatment against the bacteria that cause Lyme disease and anaplasmosis, another disease transmitted by ticks.

On the increase?

Experts are not sure how the disease is common Borrelia Miyamotoi. In the Annals report, lead author Dr. Philip Molloy Imugen, a clinical laboratory in Norwood, MA, and colleagues have found evidence of bacteria in 0.8% of blood samples tested for possible infection transmitted box. Other tick-borne diseases are two to three times more common than that.

The disease is not on the radar of many doctors. When they see someone with symptoms suggestive of Lyme disease, which can have the person proves that the disease but test negative. It is also likely that some people who develop the disease Borrelia Miyamotoi never see a doctor, and consider the flu.   

Better safe

Borrelia Miyamotoi lives in deer ticks. These small hard ticks disability, Lyme Disease (which is caused by an associated bacterium, Borrelia burgdorferi) have also been extended. The best way to avoid contracting one of these diseases, or from each other by ticks, is to keep ticks from your body and check yourself for ticks after you have been walking in through green areas, where it is likely to live ticks.

Types of ticks and the diseases they cause vary across the country. Familiar with what are likely to be present where you live.

Here are eight tips to protect yourself against ticks: 

Wear light-colored clothing. Light colors, it is easier to spot ticks, especially small deer ticks.

Pants tucked into socks. It is not a flattering look. But returning pants into socks do not create a physical barrier against ticks.

Use insect repellent. DEET, the active ingredient in many insect repellent ingredient, is somewhat effective against ticks in normal concentrations. It may take a higher concentration of DEET - between 30% and 40% - really keep them away. Permethrin is a strong chemical that kills ticks and repels. Products containing permethrin can be sprayed on clothes, not skin.

Stay in the middle of the road. Ticks can not fly or jump. So you can only get in you if you make contact with the type of environment in which they live. They prefer wetlands, often shaded, wooded, with lots of leaves, plants and low shrubs.

Check yourself and your children, especially the legs and groin. Most ticks are probably collected in the legs, then climb in search of dinner. The shower is a good place to wage a struggle against ticks. Feel for new bumps on the skin soaped-up.

Put the clothes in the dryer. Deer ticks can survive washing in hot water, but an hour in a dryer will kill. 

Think sunny. Ticks do not do well in dry, open areas. Set garden furniture and the edge of the playing field woodland shade. If you are a picnic, find a piece of manicured lawns or open field.

Protect your dog, too. Deer ticks can hang dogs as well as humans. Groom your dog daily and check for ticks. A variety of sprays, collars and topical products are available to kill or repel ticks. Vaccines are available for dogs.

Check first aid

Usually, a tick must be attached to your skin for about 24 hours to miyamotoi Borrelia or other microbe tick into the bloodstream.

If you find a tick attached to your skin, take off immediately, but gently and softly. Use tweezers to grasp the tick as close to the skin. You can also use a needle to gently pry.

If the tick is inflated, it may have been set for some time. Contact your doctor. He or she may recommend a dose of antibiotics, especially if the tick-borne diseases are common where you are. 

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Cognitive behavioral therapy offers drug-free method for the treatment of insomnia

Insomniacs watery eyes well aware that sleep problems are not limited to night hours. In fact, people who have difficulty falling or staying asleep often feel lousy all day.

Many people with insomnia turn to sleeping pills, which often have undesirable side effects. Few know about the as effective therapy that targets the cause of insomnia without drugs.   

Called cognitive behavioral therapy for insomnia, or CBT-i therapy, talk therapy teaches short term people change thinking patterns and unproductive habits that stand in the way of sleep a good night. While this therapy can "cure" insomnia, will not give you the tools to better manage.

In an opinion article in the Annals of Internal Medicine this week, the researchers combined data from 20 different trials of CBT-i which more than 1,100 people with chronic insomnia. On average, people treated with CBT-I almost fell asleep 20 minutes faster and spent 30 minutes less awake during the night compared to those who undergo CBT-i.

These improvements are as good or better than those observed in people taking sleeping prescription drugs such as zolpidem (Ambien), eszopiclone (Lunesta). And unlike drugs, the effects of CBT-i lasts even after the end of therapy, at least six months, according to a study.

Dr. Stephen Amira, a psychologist at Harvard-affiliated Brigham and Women's Hospital who specializes in CBT-i, says many of his patients have tried sleeping pills in the past but are worried or concerned about the side effects depending too them. "They seek a natural response to give them control over their sleep without having to depend on drugs," he said.

Learning to sleep

What is CBT-i imply? Normally it will meet with a therapist once a week for an hour, for six to eight weeks. It could complete a sleep diary and learn strategies to help you change the way you sleep.A common recommendation of CBT-i is out of bed and do something relaxing if you do not sleep within 20 minutes of rotation. The idea is to associate the bed of relaxation and comfort, no frustration and concern.

Learn relaxation techniques such as mindfulness meditation (which can improve insomnia itself, as I described in a previous post) is another key element of CBT-i. Being able to evoke a relaxed state of mind is especially beneficial for those suffering from insomnia because, as says Dr. Amira, "sleep is one of the few things in life that becomes more difficult and more easy, you work at it. "People with insomnia tend to also be concerned with sleep and apprehension about the consequences of sleep deprivation - a phenomenon known as "insomniaphobia" by the sleep specialist Dr. John Winkelman Harvard. A therapist can help you replace negative thoughts (such as "I will be tired, I'm having a bad day at work tomorrow!") With more positive ("My job does not depend on the amount of sleep I get this night" ).

Most health insurance plans cover the TCC-i, which is under the coverage of mental health. Only one problem: not many therapists are trained in this particular type of talk therapy. Even in the medical mecca of Boston, only five doctors offer CBT-i.

You can find a list of certified specialists across the country from the American Board of Sleep Medicine and the Society of Behavioral Sleep Medicine. If therapy face-to-face is not an option, you can purchase an online version of the technique. The best studied program is called Healthy Sleep Using the Internet, or Shuti (www.shuti.me). A study funded by the government to test the effectiveness of Shuti in people with insomnia - including those who have other medical conditions - is currently under construction. 

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Oral appliances can work for mild apnea, but no severe sleep

As a child, I was fascinated by the comic strip Blondie, which featured the adventures of the Bumstead family. Dagwood, the awkward father snored at night by emitting a loud "SKNXXX" -So that his wife, Blondie, he buried his head in the pillows. The next day, could find Blondie Dagwood nap on the couch instead of mowing the lawn, or your boss might catch him dozing on your desktop. 
 

Years later, I realized that Dagwood was not just a vague avoid its obligations. Probably he had obstructive sleep apnea - a disease that was not identified until decades after Blondie debut in the comics.

The search for an effective treatment, easy to use for sleep apnea has been going on for years. The gold standard is a breathing machine called a continuous positive airway pressure (CPAP). A report published online this week in Archives of Internal Medicine describes a mouth guard-like device that can work for people with mild sleep apnea, but it can not be useful for Dagwoods the world.

Dangers of apnea and corrections

People with obstructive sleep apnea are never completely relaxed because they receive sleep a full night. Your airways tend to shrink during sleep, and the air trying to pass. (Snoring occurs when air is forced through clogged passages.) People with this condition may breathe shallowly or stop breathing several times an hour. Whenever the level of oxygen in the blood decreases, the central nervous system that causes to take in a big breath, which may seem a gasp. Many people with obstructive sleep apnea are not aware that they briefly awaken several times during the night.Sleep apnea may increase blood pressure. It has also been linked to the development of other cardiovascular conditions. 

CPAP is the first successful approach to the treatment of obstructive sleep apnea. CPAP keeps the airway open by increasing the pressure at which air moves through them. It is effective, but requires a pump for generating an air pressure, a flow tube and a mask attached to the tube that fits over the nose. Up to 40% of people who try CPAP not stay with it. Those who leave often say that CPAP mask is claustrophobic, the tube gets in their way while they sleep, or the hum of the machine's hard to tolerate. Its bedfellows also tend to complain devices.  

18 million Americans suffer from obstructive sleep apnea are a powerful incentive for handset manufacturers, and there are countless alternatives to CPAP in the market and in development. Some of them are even seeking sponsors to raise funds on websites. New treatments approved by the FDA include Pro - nose plugs that create pressure when air is exhaled and Winx - a device that sucks the front tongue to keep the airway open. But they are expensive and can not be covered by insurance. Mandibular advancement appliances - a form of dental night guard - have been around for a while. They are the only alternative to CPAP that can be covered Medicare and other insurers. 

Can replace CPAP night guards?

Oral devices are designed to position the lower jaw slightly forward and downward. This opens the airway. These devices are simple, portable and quiet, but can be almost as expensive as CPAP. And mounting evidence suggests that they are not as effective for people with moderate to severe obstructive sleep apnea. The new study in the Archives of Internal Medicine suggests that for people with less severe obstructive sleep apnea, devices can provide some relief. But this work also shows how difficult it is to show a slight improvement of obstructive sleep apnea and how difficult it is to measure the improvement in people with a case of Benin him.

A team of Swedish researchers recruited 96 men and women with sleep apnea. Half using a bespoke mandibular advancement device as they slept. The other half a placebo used for night duty. At the end of the four month study, people who use custom device had greater improvements in obstructive sleep apnea, snoring and restless legs than those using the placebo device.  

They also had a small improvement in daytime sleepiness, but so did those on placebo. In addition, more than half of those using placebo thought the device was so effective that they wanted to continue using it."The study may say more about the power of placebos on the effectiveness of oral appliances, like many people using improved devices ineffective reported," said Dr. Lawrence Epstein, a sleep medicine specialist at Brigham and Harvard affiliate Women's Hospital.

"It was a study of a single oral appliance and many different styles, so it is difficult to draw conclusions on all devices of this study," says Dr. Epstein. There are also some limitations the study. It included a large number of people have little or no mild obstructive sleepiness sleep apnea that may be due to time that the device could not be processed. In addition, it may have been enough people in the study showing a small change in sleepiness.  

Do you think you have sleep apnea?

By some estimates, half of all people with sleep apnea do not know they have it. If you are a snorer or regularly adjust during the day, there are two things you can do on your own to counter sleep apnea - Sleep on your side and take off a few pounds if you are overweight.

If this does not work, talk to your doctor about whether it makes sense to be tested for sleep apnea. The table below can help you decide if the sleep apnea test is right for you.  

  

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A tight glycemic control of type 2 diabetes linked to fewer heart attacks and strokes

Diabetes damages each part of the body, the brain in the feet. A high blood glucose, characteristic of diabetes wreaks havoc on blood vessels. It makes sense that keeping blood sugar levels under control to prevent damage related to diabetes - but how to push blood sugar is an open question.

A study published in today's issue of the New England Journal of Medicine (NEJM) provides reassuring evidence that tight glucose call control is good for the heart and circulatory system.

"Strict control of blood glucose represents a new era in diabetes care," said Dr. David Nathan, professor of medicine at Harvard Medical School and director of both the Clinical Research Center and the Center for Diabetes Massachusetts General Hospital. 

The hazards of high levels of blood sugar
 Type 2 diabetes is characterized by high levels of blood sugar. Over time, hypertension sugar damages small blood vessels throughout the body. This is called microvascular disease. The damage can lead to kidney failure, nerve pain, amputations and blindness.

But the main cause of complications and death in people with diabetes is cardiovascular disease, which affects larger blood vessel of the body. (This is also known as macrovascular disease.) About two-thirds of people with diabetes die from heart disease, stroke and other cardiovascular problems.A good measure of sugar in the blood is tested for hemoglobin A1c (HbA1c).  

Reveals the average concentration of sugar in the blood of a person over the previous three months. People without diabetes have HbA1c 5.7%; HbA1c of 6.5% or more usually indicates diabetes.

For some people with type 2 diabetes, a healthy diet and regular exercise can keep the blood sugar under control, but many also need medication. People with diabetes are normally invited to aim for tight control of blood sugar, resulting in an HbA1c below 7%.

Research has shown that tight blood glucose control can reduce the risk of microvascular complications. But the effect of tight control of blood sugar in cardiovascular diseases was murkier. The new report suggests NEJM tight blood sugar control also has cardiovascular benefits.

The benefits of tight control
 The report is 10 years followed Veterans Affairs Diabetes Trial. This study involved 1,791 veterans with type 2 diabetes who were on average 60 years. These veterans were randomized to therapy "intensive" intended to put sugar in the blood to a lower target HbA1c, or "standard" therapy with a higher HbA1c target. In each group, the level of sugar in the blood objective was achieved with a combination of oral drugs for diabetes and insulin injections, if necessary.

During the trial of five and a half days, the intensive therapy group had an average HbA1c level around 6.9%. The standard treatment group had a mean HbA1c of approximately 8.4%.More than 1,600 trial participants were followed for five years. Meanwhile, the researchers compared the number of participants had a cardiovascular event such as heart attack or stroke between intensive therapy and standard therapy groups.

The results were encouraging for both physicians who defended the control of blood sugar and people tight with diabetes who have worked hard to achieve. Heart attack and stroke risk in the strict control group was 17% lower than in those whose blood sugar floated a little higher. This translates into about 9 fewer heart attacks and strokes per 1,000 people. 

Metabolic memory
 The studio had another positive result. It reinforced what Dr. Nathan calls "metabolic memory". As he explains, "an early intervention period appears to have lasting effects over time."The active part of the VA trial lasted about five and a half years. After that, the health care of veterans were more supervised by the team of the research study. In three years, the average HbA1c in the intensive therapy group had slipped up, reducing the level difference between the intensive group and 1.5% standard to somewhere between 0.2% and 0.3 %. Yet the intensive therapy group continued to reap cardiovascular benefits years later.

The effect of intensive treatment do not last forever, says Dr. Nathan. At some point, he says, "metabolic memory becomes metabolic amnesia." But the more you keep your blood sugar under tight control, the more benefits tend to last. 

Balancing Act
 Although tight control of blood sugar can help prevent diabetes-related damage, it has some drawbacks. People in order to strict control may experience low blood sugar episodes in the blood (hypoglycemia), which can be very dangerous. Tight control can also be difficult, sometimes requiring several medications that can have adverse side effects of their own.

Previous research had suggested that people with longstanding diabetes and heart disease may not benefit from established a strict glycemic control as well as people with newly diagnosed diabetes. But the new report NEJM shows that it is never too late to control blood sugar.  

Veterans who participated in this study had poorly controlled diabetes for several years before the start of the study. And 40% had cardiovascular disease when they enrolled in the trial. So not only intensive treatment to reduce the risk of cardiovascular disease, it was in the elderly longtime diabetes, many of which already had heart problems.

Good control of blood glucose is important for all people with diabetes. Current guidelines from the American Diabetes Association recommends a target HbA1c less than 7%. But the guidelines also recognize that there is no single rule size. If you have diabetes, check with your doctor if tight control of blood sugar is good for you. 

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The combination of ezetimibe and a statin to lower cholesterol reduces the risk of heart attack or stroke

High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But it remains an open question: How low should you go? New research published online today in the New England Journal of Medicine suggests that less is better.

Cholesterol and Cardiovascular Disease

Cholesterol circulates in the blood in two fundamental particles: high density lipoproteins (HDL) and low density lipoprotein (LDL). It neutralizes HDL cholesterol in the blood circulation and within the walls of the artery and it takes to the liver for disposal. This so-called "good" cholesterol helps reduce the risk of heart disease. LDL is often called "bad" cholesterol, increasing the risk of heart disease. When too much circulating LDL, some of which carries cholesterol is deposited on arterial walls. These deposits, called plaque, can lead to heart attack or stroke.

Keep your lower LDL levels is essential to maintain the health of your heart. The pillars to control LDL reduce saturated and trans fats in your diet, maintain a healthy body weight and exercise regularly. When these lifestyle changes are not enough to lower LDL cholesterol, doctors usually prescribe drugs called statins. Statins reduce the amount of LDL in the blood by reducing hepatic LDL production. Because the liver needs cholesterol for a variety of tasks, it responds by pulling LDL in the blood.

Some people can not tolerate statins due to effects such as muscle pain or weakness, memory problems or confusion, or even the development of diabetes in some people the other. For others, a statin alone may not be effective in controlling LDL, even when taken in high doses. In these circumstances, you need alternatives to statins to control LDL. 

Write IMPROVE-IT

Ten years ago, an international team of researchers led by Dr. Christopher P. Cannon, a cardiologist and professor of medicine at Harvard Medical School, began a trial called reduction improves outcomes: Vytorin Efficacy International Trial or improving IT for short. They recruited more than 18 000 men and women who are recovering from a heart attack. Half of the participants started taking a statin. The other half began taking a statin ezetimibe (Vytorin), a drug that lowers LDL cholesterol by blocking cholesterol absorption in the intestines.

After an average of six years, the statin-plus-ezetimibe group had an average LDL level of 54 milligrams per deciliter of blood (mg / dL) - well below what was once considered a "good" LDL - and 32.7% of the group had had a stroke or a heart attack recurrence. Those in the only statin group had a higher average level of LDL (70 mg / dl), and 34.7% of them had had another heart attack or stroke. Side effects are not high in the group of statins and ezetimibe statin alone group.

The difference in cardiovascular events between groups may seem low, but even a reduction of 2% spread in the population of the United States could make a significant breach of deaths and disability from cardiovascular diseases. 

What this means to you

All participants improve-IT started taking a statin or ezetimibe shortly after suffering a heart attack statins. As with any study, it is possible that the results are applicable to this group. But it also makes sense that the results would apply to large groups of people who have heart disease or at risk of it.For many years, the guidelines on the reduction of LDL cholesterol offered specific targets. They recommended that LDL levels be kept below 100 mg / dl, with an optional lens below 70 mg / dL. New guidelines launched in 2013 are no longer focused on the target levels.  

Instead, they recommend different intensities of LDL-lowering therapy according to the cardiovascular risk profile of a person. The higher the risk, the more intensive LDL-lowering therapy should be. The IMPROVE-IT experts findings may have to rethink that approach.  

Beyond statins

In the future, a new class of potent LDL-cholesterol agents, called PCSK9 inhibitors, can fundamentally change the way LDL was reduced in people with heart disease or at risk of it. Until then, ezetimibe and a statin can be a very good option taken. New research published today not only the documents that ezetimibe lowers LDL cholesterol, but also reduce the risk of heart attack or stroke. The new findings provide a strong rationale for the use of ezetimibe a statin alone is not enough. 

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