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Posted: 30 Apr 2014 09:00 AM PDT

PEOPLE who boosted their coffee intake by "moderate to large" doses in a US-based study had a lower risk for adult-onset diabetes than those with stable consumption, researchers said recently.

An analysis of studies that tracked the diet and lifestyles of more than 120,000 health sector workers showed that those who increased their daily caffeine dose by about 1.5 cups a day over a four-year period had an 11% lower chance in the subsequent four years of developing type 2 diabetes, the team found.

This was in comparison to those whose intake remained constant.

"Furthermore, those who had moderate to large decreases in intake (about two cups a day) had an 18% higher risk," revealed a research team in Diabetologia, the journal of the European Association for the Study of Diabetes.

"Changes in coffee consumption habit appear to affect diabetes risk in a relatively short amount of time," concluded the team led by Shilpa Bhupathiraju of the Harvard School of Public Health in Boston.

Those with the highest coffee consumption, three cups or more per day, had the lowest risk of type 2 diabetes – 37% lower than those who consumed a cup or less per day, said the paper, backing other studies that linked coffee to lower diabetes risk.

The findings were based on monitoring more than 95,000 women enrolled in two nurses' health studies in the United States, and nearly 28,000 male participants in a separate health professionals' study.

It measured their consumption patterns for four years, and then looked at subsequent diagnoses of type 2 diabetes.

The outcome may reflect a "true change in risk", but may also be explained by people cutting out coffee after being diagnosed with conditions like high blood pressure or elevated cholesterol associated with risk for type 2 diabetes, said the study authors – one of whom had received funding from coffee-vending company Nestec for a different study.

Experts who analysed the new research for the Science Media Centre said the team had merely evaluated potential short-term benefits and provided no evidence that long-term coffee intake lowered diabetes risk.

The research measured changes in consumption rather than absolute intake, said the analysts.

"No recommendations for coffee intake can be derived from this paper," said a summary, adding the statistical analysis of the data was "potentially misleading".

The researchers had found that neither changes in consumption of tea, nor of decaffeinated coffee, was associated with risk of type 2 diabetes – a high blood sugar disease often linked to obesity. – AFP Relaxnews

It's not bipolar ... it's PANS

Posted: 30 Apr 2014 09:00 AM PDT

Misdiagnosed bipolar: One girl's struggle to get the right treatment.

ONE day, Tessa Gallo was a typical sixth-grader, performing in school plays, running on the track team, goofing around with her two sisters and giggling with girlfriends at sleepovers.

The next, said her mother, Teresa, "She was psychotic and mentally retarded."

In bizarre and frightening scenes, Tessa acted as frantic as a caged animal, darting out of the family car into traffic, jumping fences and hiding in neighbours' bushes.

At times, she seemed catatonic, with food falling out of her mouth because she somehow couldn't swallow. She repeated the same few sentences over and over, worried about her braces, wanting to go home.

And finally, she said nothing at all. For nine months, Tessa stopped talking. Not a word.

Bipolar diagnosis ... was wrong

Doctors diagnosed her with bipolar disorder, prescribed psychiatric drugs that didn't work and sent the San Jose family on a nightmarish odyssey through psych wards, group homes and isolation rooms.

Then, suddenly, more than 10 months into the Gallos' terrifying ordeal, a pair of Stanford University doctors told the family that Tessa wasn't bipolar at all. She was probably suffering from a tragically misdiagnosed condition that mimics mental illness in a way doctors are only starting to understand.

"I've seen cases like this before," Dr Jennifer Frankovich of Lucile Packard Children's Hospital told the Gallos. "I think I can bring her back."

What Frankovich, a paediatric rheumatologist, and Dr Kiki Chang, a child psychiatrist, concluded was that Tessa likely had an infection or other trigger that caused her immune system to mistakenly attack her brain, dramatically changing Tessa's behaviour overnight.

It's a condition called PANS – paediatric acute-onset neuropsychiatric syndrome – that in some cases, if caught early enough, could be cured by commonly used antibiotics.

Without early treatment, they say, children can suffer needlessly.

It would take a mother's stubborn devotion and the conviction of two doctors willing to stake their reputation on a controversial treatment to bring Tessa back from the brink.

At the same time, they believe cases like Tessa's could help unlock the mysteries of the brain and reveal how something as common as an infection could be behind a growing number of psychological disorders.

More about PANS

PANS is so new and so misunderstood, that there are no reliable estimates of how many children are affected.

A US PANS parent support group believes the number nationwide could be more than 150,000, or about a quarter of the children who have obsessive compulsive disorder or other tics.

But sceptics within the medical community question whether PANS even exists.

At the Gallo home in the east San Jose foothills, Teresa Gallo dumps out a shopping bag filled with half-empty bottles of Tessa's psychiatric drugs. Nothing worked. Not the Ativan or Lexipro for her anxiety. Not the Haldol to calm her and curb her aggression. Not the Ambien to help her sleep. They just made Tessa more manic. Her bright blue eyes turned dull and vacant.

Before Tessa's illness, life was good for the Gallo family: Teresa worked as a Weight Watchers leader, her husband as an engineer, their three daughters attended Catholic school.

They loved to entertain in their backyard and keep up with Tessa's Girl Scouts and track meets. The household was happy and bustling.

That changed on July 8, 2011. The couple was on a vacation in New Orleans when Teresa received a call from her mother, who was watching the girls in San Jose.

"Tessa's not sleeping. She's not eating. She seems obsessed about her teeth," her mother, Kathy Downing, said. "You need to come home."

They took Tessa, who was 13, to the emergency room, where doctors asked whether Tessa had suffered something traumatic. Nothing, Teresa said. Tessa was given anti-anxiety medication and told to go home.

Day by day, Tessa's behaviour grew worse. Riddled with obsessive behaviours, she wiped her hand across her face repeatedly. The teenager who was once so concerned with her hair and hygiene wouldn't bathe.

When Teresa put Tessa in the shower and shampoo in her hand, Tessa would drop her arm to her side, the shampoo running down her leg.

She cried non-stop. She started to hit her mother and family members until they were bruised. Teresa lay in bed with her all night, trying to calm her and make sure she didn't run out of the house.

They were lucky to sleep two hours.

Tessa barely ate. She became dehydrated. Her lips cracked and bled.

So desperate after one month, Teresa begged the staff at Valley Medical Center in San Jose to admit her daughter. They were reluctant, saying all they had was an eight-by-eight windowless room. But they could keep her briefly, monitored and safe.

It took five large male attendants to restrain the flailing, angry wisp of a girl.

"Stay back, stay back!" one of them yelled as they carried the kicking and screaming child away.

Teresa crumbled to the floor. "It was the first and only time in my life I just dropped," Teresa said, "the vision of her being taken away like that and hoping it was the right decision."

Across the Bay Area, four psychiatrists diagnosed Tessa with bipolar disorder and one suggested it might be schizophrenia.

There were months at psychiatric wards and tortured stops at group homes, from Concord to San Mateo to Fremont.

There were long stretches at home, locked with a caregiver in the family room so Tessa wouldn't escape.

They shut off the water because Tessa was drinking obsessively. She even drank liquid soap and a bottle of nail polish remover.

Finally, 10 months after Tessa's first episode and six months after Teresa first sought him out, Chang's office called. The noted paediatric bipolar expert could see Tessa.

Heavily sedated, she curled up on the exam room floor and drooled.

Teresa explained how her daughter had changed overnight, how nothing helped, how hopeless they felt. Chang listened closely, studied Tessa, then told them something shocking.

"This is not bipolar," Chang said. "This is an autoimmune disease, and I'm so sorry it took me this long to see you."

He made her an appointment with Frankovich, the rheumatologist with whom he was working to help diagnose and treat PANS cases.

When Tessa met Frankovich for the first time, she socked her in the arm.

It was 2012 and Chang and Frankovich were preparing to open the world's first PANS clinic, but the hospital provided only enough funding to operate a half-day a week out of a room in the rheumatology department.

Soon, there were 60 patients and a five-month waiting list. The two doctors, plus their mostly volunteer staff, began working nights and weekends answering desperate calls from parents and pleading with insurance companies to fund novel treatments.

Biological trigger

Since her medical school days at the University of Nevada in the 1990s, Frankovich had a hunch that a biological trigger could be underlying some psychiatric diseases. Once during her rotation through the psych ward back then, a boy who had the flu suddenly turned psychotic.

"I remember being on the ward and telling these families there's nothing we can do. Your child has a mental illness and has to go to the mental ward," Frankovich said in a recent interview. "It never felt right to me, but I had to say it because that was what I was trained to say."

But there had to be a connection, she thought.

About the same time, at the US National Institute of Mental Health outside Washington, Dr Susan Swedo was grappling with the same phenomenon.

While many children exhibited signs of extreme anxiety and obsessive compulsive disorder, the ones who were particularly puzzling had symptoms that appeared almost overnight, within 24 to 48 hours. Parents described their children as acting like they were "possessed".

Swedo linked the sudden onset of these OCD symptoms to the strep infection and in 1998 coined the term PANDAS – paediatric autoimmune neuropsychiatric disorders associated with strep. But some children had all the signs of PANDAS without the strep infection, and in 2010 she broadened the diagnosis to include the possibility of other infections triggering psychosis, calling it PANS.

Tessa's is an extreme case and Frankovich is the first to admit there's a lot she and Chang don't understand. But when she began treating Tessa with the same autoimmune and anti-inflammatory therapies she used on her lupus patients – whose immune systems become hyperactive and attack healthy tissues – Tessa started getting better.

"Nothing worked for 10 months in the psych wards," Frankovich said of Tessa, "but after three days of an infusion of steroids, it was a pretty dramatic improvement that was sustained."

At home in the Gallo house, Tessa was coming back to life. She could write and draw again. Her OCD symptoms calmed. And finally, after several months of silence, Tessa spoke.

"I'm hungry," she said next to a fountain outside Lucile Packard hospital. "I want to go home."

In her euphoria, Teresa called her family and summoned Frankovich, who came running from a nearby building and shared in the tears.

"I love you," Tessa told her mum, as the two tightly hugged.

But as surprising as it started, Tessa's ability to speak lasted only two hours.

"My husband missed it. My parents missed it," Teresa said. "It was heartbreaking and she didn't speak for another five or six months."

Last hope

More heartbreak followed. Tessa regressed further, as doctors tried to wean her from steroids. For the first time, she started hearing voices.

Frankovich knew she needed more aggressive measures to bring Tessa back. In December 2012, after much debate within Stanford itself, agreement was reached to conduct a three-day treatment called plasmapheresis that would run Tessa's blood through a machine to clean out toxic antibodies, followed by a powerful immune-suppressing drug called Rituximab.

The goal was stop her immune system from attacking her brain, but suppressing the immune system leaves the body vulnerable to fatal infection, Frankovich said. "We can't justify using this medicine unless all the doctors involved say there's no hope for the child."

By that point, Tessa was in such a bad mental state she was living in a group home with five autistic boys and teens.

When the Gallos brought Tessa in for the procedure, she was kicking and screaming. Teresa needed to hold her down while doctors strapped Tessa to the table.

"This was literally what we thought was Tessa's last hope," Teresa said. She prayed it would work.

The early signs of success were subtle. That first night, Tessa slept until morning for the first time in months.

By February 2013, she was talking again, and singing. In June, she moved back home.

"Watching Tessa come out of this was like watching a child come out of a coma," Teresa said.

The once shy girl became an outgoing jokester.

The illness robbed Tessa of more than two years of schooling, but she remembered all her times tables. She attends a special education class at Mount Pleasant High School.

She still gets mild cases of OCD, but they're manageable. Her family is vigilant about infections and wears medical masks at the first sign of sniffles.

She had another flare in December, but more immunosuppressants brought her about 80-90% back. She is still a Girl Scout, plays softball on Sundays and joins a hip hop class on Wednesdays.

A boy from her class invited her to the school prom. She plans to wear a light blue dress. – San Jose Mercury News/McClatchy Tribune Information Services

Depression: Sad hearts lead to bad hearts

Posted: 30 Apr 2014 09:00 AM PDT

Depression increases heart failure risk by 40%, and reducing stress that triggers depression may improve outlook.

MODERATE to severe depression increases the risk of heart failure by 40%, a study of nearly 63,000 Norwegians has shown. The findings were presented recently at EuroHeartCare 2014.

EuroHeartCare is the official annual meeting of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC).

This year's meeting was organised jointly with the Norwegian Society of Cardiovascular Nurses and was held April 4-5 in Stavanger, Norway.

Lise Tuset Gustad, first author of the study and an intensive care nurse at Levanger Hospital in Norway, said: "We found a dose-response relationship between depressive symptoms and the risk of developing heart failure. That means that the more depressed you feel, the more you are at risk."

She added: "People who have lost interest in things they used to enjoy, such as reading or watching a television series, may have the early signs of depression. It's a good idea to see your doctor in these early stages for some advice on how to reduce your depression levels."

This is one of the first large, prospective studies to investigate whether depression increases the risk of developing heart failure.

Data were collected during the second wave of a large epidemiological study in Nord-Trøndelag county, Norway, called the Nord-Trøndelag Health Study (HUNT study). Nearly 63,000 of the 97,000 citizens in the county agreed to take part.

When the second wave of the HUNT study began in 1995, information was collected including body mass index, physical activity, smoking habits and blood pressure.

Depression was assessed and ranked for severity using the Hospital Anxiety and Depression Scale.

Every Norwegian citizen receives a unique 11-digit number at birth which is used at hospitals and the National Cause of Death Registry. The researchers used this number to track which patients were hospitalised with heart failure or died from heart failure during the 11-year study.

During the study period, nearly 1,500 people developed heart failure. Compared to residents with no symptoms of depression, people with mild symptoms had a 5% increased risk of developing heart failure and those with moderate to severe symptoms had a 40% increased risk.

Gustad said: "Depressive symptoms increase the chance of developing heart failure, and the more severe the symptoms are, the greater the risk. Depressed people have less healthy lifestyles, so our analysis adjusted for factors such as obesity and smoking that could cause both depression and heart failure. This means we can be confident that these factors did not cause the association."

She added: "There is effective treatment for depression, particularly if people get help early. The early symptoms of depression include a loss of interest and loss of pleasure in things that have normally been interesting or given pleasure.

"If you feel like that, speak to your friends, and if it lasts for a month, see your doctor or nurse. Depression can be treated easily in the early stages and many people don't need medication. Talking to a professional may be all you need."

Gustad continued: "Depression triggers stress hormones. If you're stressed, you feel your pulse going up and your breath speeding up, which is the result of hormones being released. Those stress hormones also induce inflammation and atherosclerosis, which may accelerate heart diseases.

"Another mechanism could also be because depressed people find it more difficult to follow advice about how to take medications and improve their lifestyle."

She concluded: "Depression is disabling. It blocks people's ability to take their medications as prescribed, stop smoking, improve their diet or exercise more. Hospitals in Norway specialise in either somatic or psychiatric illness and there is little communication between them. Patients at all hospitals should be screened for depression to help them recover from existing illnesses, avoid developing new ones and have a more enjoyable life." – European Society of Cardiology

Kredit: www.thestar.com.my

Khamis, 1 Mei 2014

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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