Sex differences may be found in COPD
Posted by on December 26, 2014 - 4:29pm

Chronic Obstructive Pulmonary Disease, the third leading cause of death in the U.S., was thought to primarily affect men.   But in recent years, the number of women with COPD has significantly increased and today more women than men die of COPD.  This increase was originally thought to be a latent effect due to the  increase in smoking in women in the 1060's but new research suggests that some other sex effects may be in play.

One of the challenges of uncovering sex differences is sometimes technology.  Today, a new technical, computerized method ---integrative network inference analysis--- is providing new insight into potential mechanisms for sex differences in COPD.  Scientists are able to chart different genetic patterns within likely networks for each sex using sputum and blood.   Using this technique, researchers at Harvard have identified functionally related sets of genes that are different in women and men with COPD.   These methods are beyond the scoop of this writer but the lesson here is that every day researchers are using more and more complex applications to better understand the impact of  biological sex on disease.

Sex difference exist in all body systems and the need to support sex inclusive research is critical.

Source:  http://www.biomedcentral.com/1752-0509/8/118

Compounded Bioidentical Hormone Therapy under scrutiny
Posted by on December 20, 2014 - 4:23pm
 Unsubstantiated claims, lack of scientific safety and efficacy data, and lack of quality control continue to surround custom-compounded bioidentical hormone products and yet, many women seem to believe that they are somehow "safer" than lab synthesized hormones.   FDA-approved hormone therapy provides tested and regulated therapy without the risks of unregulated and untested custom preparations that often include custom compounded therapies.

Bioidentical hormones, a marketing term not recognized by the US Food and Drug Administration (FDA), refers to exogenous hormones biochemically similar to those produced within the body and includes 17A-estradiol (predominant estrogen before menopause), estrone (predominant estrogen after menopause), estriol (from placenta), progesterone (ovaries, placenta, and adrenal glands), testosterone (ovaries and adrenal glands), and their conjugates.[1] These are derived from soy and yam precursors and must be chemically processed to make them able to be absorbed by the human body.

Hormones that meet the definition of bioidentical are available as FDA-approved prescription therapies and include estradiol (oral, patch, gel, lotion, mist, and vaginal ring, cream, or tablet) and micronized progesterone (oral or vaginal). The FDA has not approved estriol. Custom-compounded bioidentical hormone products are prepared, assembled, and packaged according to a provider's prescription into gels, creams, lotions, sublingual tablets, subdermal implants, suppositories, or troches.[2] Transdermal therapies avoid the first-pass effect through the liver, and there is evidence that they have a lower clotting risk.[3] Progesterone may have fewer negative effects than synthetic progestins on lipids, sleep and mood, and breast (density, tenderness, and cancer risk) when combined with estrogen. No FDA-approved testosterone therapy (bioidentical or otherwise) is available for women.

Lack of Testing for Efficacy, Safety, and Quality Control

The major difference between FDA-approved hormone products meeting the definition of bioidentical versus custom-compounded products is that the former are regulated by FDA, tested for purity, potency, and efficacy, and sold with FDA-approved product information that includes boxed warnings. Efficacy and safety data, required for obtaining particular product indications, have been demonstrated in randomized, clinical trials with peer-reviewed published reports for FDA-approved bioidenticals but not for custom-compounded products.[4,5]

No large, long-term studies have been done to determine the effectiveness, safety, or adverse effects of custom-compounded bioidentical hormones. In 2008, because of lack of scientific data on estriol, FDA stated that pharmacies should not compound drugs containing estriol unless the prescriber has a valid investigational new drug application.[4]

To read the entire article, visit  Menopause.  To learn more about your options during menopause visit MenopauseNU.org developed by the Women's Health Research Institute at Northwestern University.

 

 

 

Improving Health for LGBT Patients
Posted by on December 18, 2014 - 3:27pm

Feinberg School of Medicine faculty helped create the Association of American Medical Colleges’ (AAMC) first guidelines for medical schools on improving health care for people who are lesbian, gay, bisexual, transgender (LGBT), gendering nonconforming or born with differences of sex development (DSD).

“This resource guide is important because these populations have been historically disproportionately harmed or neglected in the medical system,” said Alice Dreger, PhD, professor of Clinical Medical Humanities and Bioethics at Northwestern University and member of the AAMC Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development. “By being a part of this committee I hope I am helping to seed a new generation of doctors who will know how to really help patients in these populations.”

The guide, “Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD,” provides information about the health needs of individuals from those populations, and about the role of academic medicine and the health care system in supporting them.

Click HERE to read the full release.

 

Fireworks fly when sperm fertilizes egg!
Posted by on December 16, 2014 - 3:26pm
Sparks literally fly when a sperm and an egg hit it off. The fertilized mammalian egg releases from its surface billions of zinc atoms in "zinc sparks," one wave after another, a Northwestern University-led interdisciplinary research team has found. Researchers at Northwestern developed technology that captured images of these fireworks.  According to Dr. Teresa Woodruff, PhD part of the team studying this phenomenon and director of the Women's Health Research Institute at NU, "The amount of zinc released by an egg could be a great marker for  identifying a high-quality fertilized egg, something we haven't been able to do.  Once we can, fewer embryos would need to be transferred during fertility treatments."
View a WGN-TV segment on the new discovery HERE.
The study is publishing in the Dec. 15 by the journal Nature Chemistry.
Read more and view pictures HERE.
Medicine, Pregnancy and Breastfeeding
Posted by on December 6, 2014 - 9:33am

Some women need to take medicines during pregnancy for health problems like diabetes, depression, morning sickness or seizures. Always talk with your doctor, nurse, or pharmacist before taking any medicines, vitamins or herbs. Don't stop taking your prescription medicines unless your health care provider says that it is OK.

Lots of women need to take medicines while they are pregnant. Learn how you can sign-up for a pregnancy registry to share your experience with medicines.

Use these resources to help you talk with your health care provider about the medicines you take during your pregnancy.

Prostate cancer treatment often ignores bone health
Posted by on December 4, 2014 - 10:07am

Men being treated with hormone therapy for prostate cancer are not  always getting bone-strengthening drugs they may need according to a Canadian study reported in a research letter in JAMA.  A potentially serious side effect of the androgen-deprivation therapy often prescribed to prostate cancer patients is an increased risk of bone loss and fracture. Several consensus guidelines recommend bisphosphonate therapy for men receiving hormones but the new study found that the bone strengthening treatment was underused even in men with osteoporosis.

Tips to eat, drink and still be "merry" during the holidays--the natural way.
Posted by on December 2, 2014 - 2:49pm

Holiday celebrations lead to a bit of overindulgence but you can stay in good cheer with tips from Melinda Ring, M.D., medical director of the Osher Center for Integrative Medicine at Northwestern University.

  • Upset stomach: Ring's favorite way to stave off the effects of overindulging: Dilute 1 to 2 teaspoons of unfiltered apple cider vinegar -- known to aid digestion -- in a glass of water and sip before you head to the party buffet.
  • Back pain: "Musculoskeletal tension in the shoulders and back is common during the holidays, thanks to the extra heel-wearing and package-lugging," Dr. Ring says. Don't carry too much at once; pick up a foam roller to release tight spots; and rock cute medium-high heels if you'll be on your feet all night.
  • Insomnia: If never-ending to-dos are dancing in your head at bedtime, Ring suggests having a snack rich in tryptophan and complex carbs. Try a couple of slices of leftover turkey in a small whole-wheat wrap or a slice of cheese with whole-grain crackers.
  • Heartburn: "Rich treats like buttery cookies and greasy meats can relax your lower esophageal sphincter and cause acid reflux," Dr. Ring says. "Try a marshmallow root or slippery elm supplement beforehand to coat and protect your GI tract." (Check with your doc first if you're pregnant, breast-feeding or taking other meds or supplements.)

Source:  Huffington Post

 

Study supports CVD timing hypothesis in menopause
Posted by on November 27, 2014 - 11:22am

Early results of the ELITE study find women who started hormone therapy early after menopause saw a significant slowing of atherosclerotic progression, whereas those who waited more than a decade saw no impact on vascular health, supporting the "timing hypothesis".

"ELITE results are consistent with the majority of the literature that shows that women who are young and/or in close proximity to menopause when starting hormone therapy have reduced coronary heart disease and overall mortality," according to study leader  Howard N. Hodis, MD, of the University of Southern California in Los Angeles, and colleagues.

The Women's Health Initiative, aiming for cardiovascular prevention with menopausal hormone therapy, had raised major concerns about stroke and myocardial infarction (MI) in its somewhat older, later menopause population.  The KEEPS study subsequently showed that for a younger (ages 42 to 58) population, this may not be true.

ELITE was designed to directly test the hypothesis that timing makes all the difference in safety of hormone therapy after menopause.

"I think it's important that clinicians not interpret this as you should start estrogen to try to prevent heart disease, but that the younger, newly menopausal woman who has menopausal symptoms should not be denied hormone therapy because of concerns about heart disease risk, as was seen in older women," JoAnn E. Manson, MD, of Brigham and Women's Hospital in Boston, told MedPage Today.

"There are other factors to take into consideration [such as risk of thrombosis]," she explained. "But because a newly menopausal woman is generally at low absolute risk of heart attack, stroke, thrombosis, all of those outcomes, it tends to be a favorable balance of benefit-to-risk."

While suggestive that early hormone therapy wouldn't have an impact on later heart disease risk, "this trial wasn't large enough to look at clinical events," Manson cautioned.

To learn more about this study, click HERE.   To learn more about Menopause, click HERE.

Primary source: American Heart Association
Source reference: Hodis HN, et al "Testing the menopausal hormone therapy timing hypothesis: The early versus late intervention trial with estradiol" AHA 2014; Abstract 13283.

New drug data finds sex/race inclusion lacking
Posted by on November 25, 2014 - 4:16pm

In response to the call for more sex inclusion data in drug studies, the FDA has developed  Drug Trials Snapshot a pilot project to provide information about the sex, age, race and ethnicity of clinical trial participants for a small group of recently approved drugs. In addition to information about who participates in the trial, each Snapshot also includes information on how the study was designed, results of the efficacy and safety studies and, if known, differences in efficacy and side effects among sex, race and age (referred to as subgroups).

While this is certainly an important step toward inclusion, the recently posted six examples reinforce the lack of racial minorities in all studies and the lack of women in many studies.   These drugs were approved over a two month period in 2014.  In summary, of the six examples provided:

  • All studies, except one, had more males than females in the clinical pool
  • All studies except one, reported that the drug achieved the desired response (efficacy) in both in men and women (one study showed the the drug trended in favor of females though only 23% of the study subjects were female)
  • Four studies indicated the side effect (safety) profile was similar in both sexes; one study did not evaluate safety; and one study found increased risk for women even though only 24% of the study subjects were female).
  • All studies showed a considerable lack of minority race/ethnic participants .

"‘This new report provides a clarion call to action for the scientific, medical and regulatory communities to ensure representational science, medicine and the approval process. By taking strong, decisive action today, we can be assured a healthier tomorrow for all people." says Teresa K. Woodruff, PhD, director, Women's Health Research Institute and a national leader in the movement toward sex equity in science.

 

Tactics to slow cognitive decline due to Alzheimer's
Posted by on November 23, 2014 - 5:33pm

The cognitive decline associated with Alzheimer's Disease (AD) may be related to the particular pathology of this disease which researchers continue to study.  One study at Stanford suggests that if you slow the pathology (biologic)  progression it could slow the path to full dementia.   In other words, if you stay healthier, you may slow the biological process that causes the progression of dementia.  Some suggested tactics:

  • Improve brain health by reducing cardiovascular risks caused by hypertension, diabetes, smoking, and high cholesterol
  • Enhance cognitive reserve through mental stimulation (working, leisure activities and social engagement)
  • Reduce the burden of AD pathology with regular aerobic exercise.

While we haven't found a "cure" for AD yet, it makes sense to try whatever possible to "slow" its devastating effects.   All of these activities have many health benefits, so why not??? Source:  Henderson VW.  Climacteric 2013:17(suppl 2) 38-46.

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