Wednesday, September 29, 2010

It’s THAT time again…..

Flu IQ

Every fall doctors and nurses talk about getting a flu shot and every year patients have lots of questions about the flu shot. What is it? Do I need it? Who shouldn’t get it? What’s with the nasal vaccine? Should my kids get it? Can it hurt me? So here are some answers!

1. What is in the Flu Vaccine?
The flu vaccine is a medicine that is very similar to the influenza virus itself. When your body sees gets vaccinated your immune system learns how to fight off viruses that are like those in the vaccine. That way when you get exposed to the flu your body already knows how to handle it and you do not get sick.

 2. What about the Swine Flu (H1N1)?
Every year people at the United States Center for Disease Control try to figure out which flu viruses will be the worst and most dangerous. Last year they left one out, the H1N1 swine flu. That is why last year there were 2 different flu shots. This year they included the H1N1 swine flu into the regular seasonal flu vaccine. There are also other strains of flu in this year’s vaccine.

3. What is the Nasal Flu Vaccine (FluMist)?
FluMist is actually a live flu that is changed so that it does not make you sick. It is a nose spray instead of a shot. You must be over age 2 and younger than 49 to get this form of flu vaccine. However, some people should not get this form of vaccine. Kids with asthma, and people with poor immune systems and risk for complications from flu as well as people who have close contact with other people who have poor immune systems.

4. Who should get it? See list here
Odds are you should get a flu vaccine. The Center for Disease control includes more people every year in the group that should get vaccinated. Everyone who is over 6 months old who does not have a medical reason that they can’t get the vaccine should get it. People who are allergic to eggs can’t get the flu vaccine. Kids getting the flu vaccine for the first time need two doses!  Rates of infection are highest among children, but the risks for complications, hospitalizations, and deaths from influenza are higher among persons aged 65 years and older, young children, and persons of any age who have medical conditions that place them at increased risk for complications from influenza.

5. But I got it LAST YEAR!
I know! You have to get it EVERY YEAR. The pesky thing about the flu is it changes every year and so your flu vaccine from last year isn’t protecting you anymore.

6. Should I get it if I am pregnant, breast-feeding or trying to get pregnant?
YES! It is super important to get the flu vaccine when you are pregnant. For reasons that we don’t understand pregnant women are very susceptible to getting very sick and even dying from the flu. It makes many women nervous to get vaccines if they are pregnant but, there is no evidence that the vaccine hurts the baby.  In fact, not getting can result in harm to both mother and fetus!

7. What happens if I don’t get it?
If you do not get vaccinated there is a higher risk of getting flu and of having complications from the flu. The flu can cause serious medical problems and death. These include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

8. Are there risks associated with getting the flu vaccine? Here's safety information from the CDC  There are risks to the flu vaccine. There is a rare neurological problem called Guillain-Barré syndrome, which about 1 in 100,000 people will get with the flu vaccine.

9. Who is contraindicated to get this? People with egg allergies; infants under 6 months; individuals who got Guillain Barre (neurologic disease) within six weeks of getting immunized; moderate or severe infection (with/without fever) People in this last category need to resolve their infection before they get immunized.

There are flu shots all over, if you have a doctor, call your doctor to ask abour flu shots. You may also be able to get one at work or school. They have flu shots in grocery stores and pharmacies as well!

So go get your flu shot….And Remember ….

                                                               The FLU ends with U!
The FLU Ends with U. Learn more:

For more information on the flu vaccine and immunization try:

Monday, September 20, 2010

Active Lifestyle May Help Counter Obesity Genes

TUESDAY, Aug. 31 (HealthDay News) -- Exercise can reduce a person's genetic predisposition to obesity by 40 percent, finds a new English study.
Researchers looked at 20,430 people in Norwich and focused on genetic variants known to increase the risk of obesity. Most people had inherited 10 to 13 of these variants from their parents, but some had more than 17 while others had fewer than six.
The participants also provided information about their levels of physical activity.
Overall, each additional obesity-related genetic variant was associated with an increase in body mass index (BMI) equivalent to 445 grams (0.98 pounds) for a person 1.70 meters (5 feet, 6 inches) tall. BMI is a measurement that takes into account a person's height and weight.
However, this effect was greater in sedentary people than in active people, the researchers found. For those with a physically active lifestyle the increase was 379 grams (0.84 pounds) per genetic variant. That's 36 percent less than the increase of 592 grams (1.3 pounds) per genetic variant for inactive people.
The researchers also found that each additional obesity susceptibility variant increased the odds of obesity by 1.1-fold. But this risk was 40 percent lower for active people compared to inactive people, the findings revealed.
The study shows that adopting a healthy lifestyle can benefit people at increased genetic risk of obesity, the authors explained.
"Our findings further emphasize the importance of physical activity in the prevention of obesity," “Our research proves that even those who have the highest risk of obesity from their genes can improve their health by taking some form of daily physical activity. People don’t have to run marathons to make a difference either - walking the dog or working in the garden all counts. It goes to show we’re not complete slaves to our genetic make-up and really can make a big difference to our future health by changing our behaviour." Dr. Ruth Loos, of the Medical Research Council's epidemiology unit in Cambridge and colleagues wrote in the August 31st 2010 article published online in PLoS Medicine.

The U.S. National Heart, Lung, and Blood Institute offers a Guide to Physical Activity.
Download  BMI calculator here
Women and overweight obesity data info here and resources here
                  Women lag in time spent in leisure activity (weights, calisthenics) as compared to men,  2008 data

Saturday, September 11, 2010

Anti-HIV gel is declared breakthrough for women

By Steve Sternberg, USA TODAY

Researchers say they've achieved the first AIDS prevention breakthrough for women.
More than a decade of failure and frustration ended Monday with a report that a new vaginal gel gives women the power to reduce their risk of contracting HIV and genital herpes without relying on their male partner to use a condom.
The experimental gel is made with Gilead Sciences' antiviral drug tenofovir, which is widely used for treating HIV, the virus that causes AIDS. Applying the 1% tenofovir gel 12 hours before and 12 hours after sex reduced a woman's risk of HIV infection by 39% over the course of 2½ years.
The gel also reduced the risk of genital herpes by 51%, an unexpected bonus because women with herpes are twice as likely to be infected with HIV.
"We now have a product that can potentially alter the epidemic and save millions of lives," says Quarraisha Abdool Karim of the University of KwaZulu-Natal in South Africa, who co-wrote the study with her husband and university colleague, Salim Abdool Karim.
At this level of protection, the researchers say, widespread use of the gel could prevent 1.3 million infections and more than 800,000 deaths in South Africa alone over the next 20 years. The findings were to be released today at the 18th International AIDS Conference in Vienna and in the online edition of Science.
AIDS researchers and advocates who have grown accustomed to failure, or worse — one promising vaginal gel actually was found to boost the risk of infection — hailed the report.
"This is good news," says Yasmin Halima, director of the Global Campaign for Microbicides, an advocacy group that has championed the approach. "Women are vulnerable to HIV across the world. Just having condoms for men is not really a viable option."
In the study, 889 sexually active women ages 18 to 40 were given either the tenofovir gel or a placebo. Thirty-eight of the women in the tenofovir group were infected with HIV, compared with 60 in the placebo group. Of 434 women who did not have herpes at the start of the trial, 29 of those using tenofovir became infected vs. 58 using a placebo.
The gel worked best in the women who used it most consistently. Women who used the gel at least 80% of the time were 54% less likely to become infected, cutting their risk of HIV by more than half.
Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, says the study marks a "significant conceptual advance" in efforts to give women the tools they need to protect themselves.
"The level of protection isn't as high as we hoped it would be," Fauci says, "but there are a lot of things we can do to change that. The degree of the effect was related to the degree (to which women used the gel.) You may want to use it more often. You may want to put it in a vaginal ring."
Halima noted that the pipeline of microbicides may include drug combinations similar to those now used for HIV treatment. Fauci says his institute is sponsoring a complex trial that compares patients using tenofovir gel daily with those taking oral tenofovir or Truvada, a combination of tenofovir and Emtriva, also made by Gilead Sciences. Results won't be available for at least a year, he says.
Read more here

Bloggers Note - Despite significant challenges in developing an immunization for HIV, this advance may be critical to saving lives for women.  Additionally, this success will stimulate industry and research for additional advances.

HIV terminology
HIV positive - evidence of exposure to HIV
AIDS - evidence of disease from HIV infection
ARVs antiretrovirals;
HAART Highly Active Anti-Retroviral Therapy (HAART) consists of 3 or more highly potent anti-HIV drugs (usually need three to 'contain' the virus and prevent development of resistance)        Click below to enlarge

NRTIs, NNRTIs, PIs and Others

Thursday, September 9, 2010

Distress and Sexual Health

Female Sexual Dysfunction includes disorders of desire; arousal; orgasm and sexual pain. Desire disorders include hypoactive sexual desire disorder and sexual aversion disorder. To make the diagnosis of Hypoactive Sexual Desire Disorder two key elements must be in place (hypoactive sexual desire and marked distress - personally or interpersonally as a result of the condition) Additionally, we exclude depressed desire that is due to medications, substances or general medical conditions or those due to another Axis I disorder.
How prevalent a problem is this? Research tells us that there is a range 9-26% and a mean of about 10% of women with HSDD.(Leiblum)- this include premenopausal and postmenopausal women.
Is this an isolated sexual health concern? No - data shows that women with HSDD are generally less healthy than their non-HSDD counterparts. They have less vitality, more bodily pain, poorer physical, social, emotional functioning. It is likely that women will come into the office with diffuse feelings of body aches and feeling unwell as part of their presentation. Sexual health affects both the physiology and psychology of women.
What's the physiology of sexual function in women? The physiology is that of central neuroendrocrine function matched with peripheral intact anatomic and vascular function. Centrally - Desire is augmented by excitation that is driven by dopamine, norepinephrine, testosterone, estrogen and inhibited by serotonin and prolactin. Arousal adds nitric oxide and acetycholine with the above factors and has the same inhibitory ones. Orgasm has oxytocin as an excitatory hormone. External genitalia needs estrogen, testosterone and progestin to function. Vasocongestion needs working and responsive vasculature- thus nitric oxide, norepinephrine, cholinergic fibers and prostaglandin E are excitatory with serotinin as inhibitory.
How do these factors play a role in diagnosis and interventions? Anything that decreases dopamine (or increases serotinin) will have adverse sexual side effects. Anything that lowers testosterone - like hyperprolactinemia, opiates or menopause - will also lower sexual functioning.
What diseases can decrease desire or arousal? Chronic diseases such as Diabetes, Thyroid disease, Cardiovascular Disease, Depression and Renal Failure. Other illnesses - adrenal disease, head injury, neurologic diseases including hyperprolactinemia, bilateral oophorectomy and incontinence can do so as well. (Basson)
What medication or substances adversely effect sexual health? Perhaps most well known are antidepressants that block reuptake of serotinin (SSRIs; SNRIs) Other psychiatric medicines such as benzodiazepines; antipsychotics; mood stabilizers and anti epileptics can do so. Less well known, perhaps, are H2 blockers, NSAIDs, oral contraceptive, thiazide diuretics, non-selective beta agonists. Additionally narcotics and other hormones (estrogen, progestins, anti androgens, GnRH agonists) are involved (Clayton, Kingsberg.) It is important, up front, when we prescribe these medications to make patients aware of the potential side effect!
How do I screen? If you wait for most women to ask about this, there are numerous reasons why they won't ("It is appropriate to talk to the doctor about this?" "How do I discuss this?""Maybe there isn't anything I can do?") The literature shows that docs have to ask and patients want us to. (Stengel) In the ideal, we should include sexual health screening at least on annual exams. There are  tools and surveys you can use: Brief Sexual Symptoms Checklist for Women (Hatzichristou); Decreased Sexual Desire Screener (Clayton); Female Sexual Distress Scale - Revised (DeRogatis)
What can we do about it? First off, sexual health tracks with physical health. So many of the same lifestyle issues we discuss (regular exercise, healthy nutrition, weight loss, smoking cessation, minimizing intake of alcohol) all help sexual health. There are some medications that are used - though none currently FDA approved (and there others in the pipeline to watch for) but most patients are likely to benefit from counseling (education, personal, couples, cognitive behavioral, mindfulness, etc.), lifestyle changes and medication.
The most commonly used medication is bupropion (which increases dopamine and NE)- which is used for non-depressed women with HSDD (it can also be used with depressed women, as well) Testosterone has been used - and a gel is in the pipeline. A melanocortin receptor agonist (this stimulates dopamine) is also in the pipeline.

It seems odd that few people would perceive erectile dysfunction (and associated distress) as 'not real' or not a significant health concern, yet there are those who feel that female sexual dysfunction is somehow different. Women may be more complex, physiologically and psychologically when it comes to sexual health. Remember, if a woman with diminished desire isn't bothered by it, then neither are we! But for many women, sexual health is part of overall health. Physicians need to learn about this health issue, develop skills in communication about sexual health and ask patients on a regular basis. By doing this, we can uncover health concerns that may appear to be 'playing in the background' - yet are the health burden at the heart of the problem.

Leiblum SR, et al. Menopause. 2006;13:46-56.
Basson R, Schultz WW. Lancet. 2007;369:409-424.
Clayton A, Hamilton D. Psychiatr Clin N Am. 2010;33:323-338.
Kingsberg S, Janata J. Urol Clin N Am. 2007;34:497-506.
Stengel C. Martinez L. Accessed August 2010.
Hatzichristou D, et al. J Sex Med. 2010;7:337-348
Clayton A, et al. J Sex Med. 2009;6:730-738
DeRogatis L, et al. J Sex Med. 2008;5:357-364