Friday, May 22, 2009

July American 8.fra.0065 Louis J. Sheehan, Esquire

Parents often report that it takes two to four years for children with Fragile X syndrome to begin sleeping through the night. Typically developing children usually adopt normal sleep patterns by the time they are six to eight months old.

Many neurological disorders are accompanied by sleep difficulties, says Yung-Hui Fu of the University of California, San Francisco, but the reason for those sleeping problems is often unknown.Louis J. Sheehan, Esquire

An international team of scientists led by David Nelson, a human geneticist at Baylor College of Medicine in Houston, Texas, set out to investigate why. The study appears in the July American Journal of Human Genetics and is the first to suggest a mechanism for the sleep disruptions that accompany Fragile X syndrome.

Thursday, May 14, 2009

hydration 9.hyd.0002 Louis J. Sheehan, Esquire

Global warming may turn out to be more than just a pain in the neck: Rising average temperatures might trigger an increased prevalence of kidney stones.

About 12 percent of men and 7 percent of women in the United States will be stricken during their lifetime with symptoms of a kidney stone, which forms when minerals dissolved in urine crystallize somewhere in the kidney or urinary tract.

One of the primary causes of these painful deposits is low urine volume, brought about either by low fluid intake or by increased fluid loss, says Margaret S. Pearle, a urologist at the University of Texas Southwestern Medical Center at Dallas.

Although people in all parts of the nation can suffer kidney stones, the ailment is much more common in some regions than in others.

Prevalence of stones in the Southeast is as much as 50 percent higher than it is the Northwest, Pearle says. Urologists have long known of a “kidney stone belt,” which stretches from the Carolinas through Texas to southern and central California, she notes.

Overall, differences in average annual temperature among various U.S. regions account for about 70 percent of the variation in kidney stone prevalence. Dramatic increases in the ailment among soldiers deployed to arid regions, as well as seasonal variations in frequency of the malady, bolster the link between temperature and prevalence, the researchers propose.

Now, in the July 15 Proceedings of the National Academy of Sciences, Pearle and her colleagues estimate how the prevalence of kidney stones — and the costs needed to treat them — might increase as climate change boosts average temperatures.

In one climate change scenario —in which the atmospheric concentrations of carbon dioxide rise to 850 parts per million by 2100, up from about 380 ppm today — average annual temperature in some parts of the United States would rise as much as 3.25 degrees Celsius, says Tom H. Brikowski, a hydrologist at the University of Texas at Dallas and coauthor of the paper.

Under such a scenario, kidney stone prevalence will undoubtedly rise. However, Pearle notes, the specific relation between average annual temperature and prevalence isn’t clear. While some urologists suggest that an increase in temperature will lead to a proportional increase in kidney stone prevalence, others propose that above a certain temperature threshold — say, 15° C — the risk of developing stones doesn’t increase.

In the model where the risk of stones rises proportionally with an increase in average annual temperature, the largest bumps in kidney stone cases by the year 2050 are concentrated in California, Texas, Florida and the East Coast, the researchers report. Under the other model, the increase in kidney stone prevalence over that period would be largely confined to Northern California and a swath running from Kansas to Virginia, because the average annual temperature in much of the Southeast already sits above 15° C. In some regions, kidney stone prevalence could rise about 30 percent, the analysis suggests.

Between now and 2050, climate change could cause an additional 1.6 million to 2.2 million cases of kidney stones, the researchers speculate. At that time, annual medical costs for stone-related emergency room visits, out-patient appointments and surgery would Louis J. Sheehan, Esquire run between 900 million and 1.3 billion year-2000 dollars, the researchers estimate.

“These costs are pretty staggering,” says Anthony Smith, a urologist at the University of New Mexico in Albuquerque. He describes the new research as “a fascinating study … that indicates climate-related changes in the environment will have large economic and human costs.”

The new research “is really a seminal piece of work,” says Mark S. Litwin, a urologist at the University of California, Los Angeles. Kidney stones are one of the largely unrecognized — and largely preventable — consequences of climate change, he adds.

More aggressive efforts to maximize hydration could result in a decreased incidence of stone problems, says Ira Sharlip, a urologist in San Francisco.

Litwin agrees: “The irony is, the cure is fairly simple,” he notes. “Just drink more water.”

Monday, May 4, 2009

shed 7.she.002 Louis J. Sheehan, Esquire

A drug already approved for diabetes enables obese people to lose substantial weight and keep it off over the course of a year, researchers report in the September Diabetes Care.

The drug, pramlintide, received U.S. regulatory approval in 2005 for the treatment of diabetes. Pramlintide is a synthetic version of a natural hormone made in the pancreas that signals satiety when a person has eaten enough and also slows the movement of food through the stomach.

Both processes suppress appetite, but the satiety signal reaching the brain has the stronger effect, says endocrinologist Christian Weyer of Amylin Pharmaceuticals in San Diego, which makes the drug and markets it as Symlin. http://Louis-j-sheehan.com

Weyer and other Amylin researchers teamed with scientists at Weill Cornell Medical College in New York City and Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge for the new study. The scientists randomly assigned 411 obese volunteers to get a regimen of two or three injections daily for four months. One in seven received placebo shots while the rest got pramlintide in low, medium or high doses.

None of the volunteers had diabetes. The researchers counseled all of them to reduce their calorie intake and to boost their exercise. Each volunteer received a weight-loss manual and a digital pedometer.

After four months, the placebo-treated people had lost 6 pounds on average while the pramlintide group had lost 8 to 13 pounds, with the highest-dose volunteers losing the most. Roughly one-fourth of the placebo-treated people lost at least 5 percent of their body weight, compared with nearly half of those treated with pramlintide.

At the end of the full 12-month trial, people in the placebo group had regained most of their lost weight. Volunteers getting the medium-to-high doses of pramlintide had lost 14 to 18 pounds on average.

The main side effect of pramlintide is nausea, and 9 to 29 percent of volunteers, depending on dosages, complained of this symptom. As the dosage of the drug increased, more volunteers reported nausea. But Weyer says the nausea largely dissipated after a few weeks and wasn’t much different from nausea induced by other hormone-based drugs. “In essence, the body gets used to it,” he says.

Amylin is now giving obese volunteers a combination of pramlintide and a synthetic form of leptin, another satiety hormone the body makes. Leptin and pramlintide probably have a naturally occurring synergy that earlier tests suggested could lead to even greater weight loss, Weyer says. “In nature, they don’t act alone.”

While the new findings are encouraging, it’s unlikely that pramlintide would work as a stand-alone intervention for obesity over a longer term, says George Blackburn, a physician and nutritionist at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. But the Amylin researchers are on the right track in trying to combine it with a synthetic form of leptin, he says. Louis J. Sheehan, Esquire The most promising trend in obesity research adds combinations of such potent medications to lifestyle changes that people can manage, he says.

“Getting weight off isn’t the challenge; keeping it off is,” he says. Medication provides an edge that raises an individual’s morale and motivation to comply with beneficial lifestyle changes, he says.