Finasteride - Generic Propecia

Eating white and oily fish regularly may provide protection against type 2 diabetes, but eating shellfish may have the opposite effect, a study from the UK hints.

The study team noted about 25 percent less risk type 2 diabetes among men and women who reported eating one or more, as opposed to fewer, servings of white or oily fish each week.

Unexpectedly, however, they found that men and women who ate similar amounts of shellfish — primarily prawns, crab, and mussels — had about 36 percent increased risk of developing type 2 diabetes.

But “it may not be the ’shellfish’ per se which increased the risk for diabetes,” Dr. Nita Forouhi, of Addenbrooke’s Hospital, University of Cambridge, noted in an email to Reuters Health.

Rather, the cooking and preparation methods used in the UK, for example, oils used when frying or butter- and mayonnaise-based sauces served with shellfish, may increase cholesterol intake which, in turn, may raise diabetes risk.

Forouhi and colleagues assessed the weekly intake of shellfish plus white fish such as cod, haddock, sole, and halibut, or oily fish such as mackerel, kippers, tuna, and salmon, reported by 9,801 men and 12,183 women. The study participants were 40 to 79 years old at the time and had no history of diabetes.

Over an average of 10 years, 725 of these men and women developed type 2 diabetes.

Both the lower risk linked with white and oily fish and the greater risk tied to shellfish intake remained when the investigators allowed for a range of diabetes risk factors including physical activity, obesity, alcohol use, and fruit and vegetable intake.

The investigators emphasize that the link between shellfish intake and diabetes risk requires further investigations in other populations. This observed link, Forouhi commented, “does not imply that one is the cause of the other.”

The findings on white and oily fish “reinforce the public health message to consume fish regularly,” the investigators conclude, while the shellfish findings should be studied further.

Tissue plasminogen activator (tPA) treatment benefits stroke patients when used up to 4.5 hours after a stroke, according to German researchers who said their findings provide further evidence to increase the tPA treatment window from the current three hours to 4.5 hours.

Previously published findings from the ECASS III study indicated that tPA treatment led to better outcomes than placebo in stroke patients treated from three hours to 4.5 hours post-stroke.

In this new study, Dr. Werner Hacke, of the University of Heidelberg, and colleagues conducted a secondary analysis of ECASS III data using different endpoints. They focused on the efficacy and safety of tPA treatment (using alteplase) and also looked for any factors or patient subgroups that might affect treatment outcome.

The study included 418 patients who received alteplase from three hours to 4.5 hours after a stroke, and 403 patients who received a placebo. The results showed a clear benefit from treatment with alteplase in all types of patients, including those younger and older than 65 years, men and women, and those with or without a history of diabetes, stroke or high blood pressure.

The researchers also found that alteplase was beneficial, regardless of the severity of the stroke.

“Our results support the use of this thrombolytic drug in the extended period across a broad range of patient subgroups who meet the requirements of the European product label but miss the approved treatment window of 0-3 hours,” Hacke and colleagues wrote. “Even with these encouraging findings, the most important principle of acute stroke intervention should, however, not be lost — i.e., time remains critical and fast treatment still provides the greatest chance of recovery.”

The study was released online Oct. 20 in advance of publication in the December print issue of The Lancet.

“Thrombolytic therapy benefits patients, should be given as early as possible, offers sustained benefit, and is cost-effective,” Dr. Patrick Lyden, of Cedars-Sinai Medical Center in Los Angeles, wrote in an accompanying editorial.

“The physician must, as always, diligently undertake a careful history and physical examination, look at the non-contrast brain CT scan carefully, and follow the appropriate protocol. All of these steps will result in substantial benefit to public health and will safely benefit many patients. But ‘time is brain,’ and therapy must be given as soon as possible after the patient arrives — there is indeed not a moment to lose.”

An international team led by a National Institutes of Health researcher has found that carriers of a rare, genetic condition called Gaucher disease face a risk of developing Parkinson’s disease more than five times greater than the general public. The findings were published today in the New England Journal of Medicine.

In previous studies, several genes have been linked to Parkinson’s disease. However, researchers say their work conclusively shows that mutations in the gene responsible for Gaucher disease are among the most significant risk factors found to date for Parkinson’s disease. The discovery was made by investigators from the National Human Genome Research Institute (NHGRI) and the National Institute on Aging (NIA), both parts of the National Institutes of Health, in collaboration with scientists from 16 research centers across four continents.

“This analysis illustrates how studying a rare but important disorder, like Gaucher disease, can provide powerful clues about more common disorders, such as Parkinson’s disease,” said NHGRI Scientific Director Eric Green, M.D., Ph.D. “Understanding the genetic basis of rare conditions can thus provide insights into normal cellular and biological processes, which in turn may lead to improved diagnostic and therapeutic strategies.”

Parkinson’s disease, a neurological condition that typically causes tremors and stiffness in movement, affects about 1 to 2 percent of people over the age of 60. The chance of developing Parkinson’s disease increases with age and involves a combination of environmental risk factors and genetic susceptibility.

Gaucher disease occurs when an individual inherits two defective copies of the GBA gene, which codes for an enzyme called glucocerebrosidase. This enzyme breaks down a fatty substance called glucocerebroside, which, when not properly disposed of, can harm the spleen, liver, lungs, bone marrow and, in some cases, the brain. The enzyme functions in a part of the cell called the lysosome, where cellular components are broken down, or metabolized, for recycling.

In the past, it was thought that people who carry just one altered GBA gene were unaffected. However, in recent years, research groups at NHGRI and elsewhere have completed small studies suggesting that carriers of GBA alterations may have an increased risk of developing Parkinson’s disease.

“The opportunity was right to amass the data into one powerful study,” said Ellen Sidransky, M.D., senior investigator in NHGRI’s Medical Genetics Branch, who is the lead author of the study and coordinated the effort. “Our analyses of the accumulated data provide a convincing association between GBA alterations and Parkinson’s disease.”

The research team examined the frequency of GBA alterations in 5,691 patients with Parkinson’s disease, including 780 Ashkenazi Jews, a population in which a particular type of Gaucher disease is more prevalent. Those data were matched against 4,898 unaffected volunteers, called controls, which included 387 Ashkenazi Jews.

At least one of the two common GBA alterations was found in 3.2 percent of Parkinson’s patients and 0.6 percent of controls. Among the Ashkenazi subjects, 15.3 percent of those with Parkinson’s disease carried a GBA alteration compared to 3.4 percent of Ashkenazi controls.

In addition to screening for the two common alterations, five of the research centers sequenced the entire GBA gene in 1,642 non-Ashkenazi patients with Parkinson’s disease and 609 non-Ashkenazi controls. Using this more thorough method, they found many additional alterations associated with Parkinson’s disease, and showed that 7 percent of patients carried an alteration, indicating that it is important to look beyond the two common alterations to gain a true picture of risk in the general population.

Besides significantly increasing the risk of Parkinson’s disease, GBA alterations also appear to increase the likelihood of early disease onset. According to the new study, Parkinson’s patients with GBA alterations developed symptoms an average of four years earlier than other Parkinson’s patients.

Overall, the researchers found that the association between GBA and Parkinson’s disease is not confined to any single ethnicity or to specific GBA mutations, though they did find that some gene alterations are seen more frequently in certain populations. Compared with the general population, in which GBA alterations occur in fewer than one out of 100 people, GBA alterations occur in at least one out of 16 people of Ashkenazi descent. However, many GBA mutation carriers as well as patients with Gaucher disease never develop Parkinson’s disease, so this appears to be only one of several risk factors involved.

Further research is in progress to understand the full spectrum GBA alterations, their biological significance and their association with both Parkinson’s and Gaucher disease. The researchers are also pursuing ways to provide more accurate guidance based on the findings for genetic counseling and for the development of new therapeutic strategies for these disorders.

Along with NIH, the study included research centers in New York City, Jacksonville, Fla. and Seattle, as well as in Brazil, Canada, France, Germany, Israel, Italy, Japan, Norway, Portugal Singapore and Taiwan. The data were collected and analyzed at NHGRI.

People who are super obese and those with the most chronic health problems face an increased risk for dying within a year after weight-loss surgery, a new U.S. study has found.

The research involved 856 men and women who had bariatric (weight-loss) surgery at 12 Veterans Affairs medical centers between 2000 and 2006. They averaged 54 years old and had an average body-mass index (BMI) of 48.7. BMI is a measurement based on height and weight, and a BMI of 40 or greater is considered class 3 or morbid obesity.

About 36 percent of the group was considered super obese, with a BMI of 50 or higher. In addition, 8 percent also had such chronic diseases as diabetes and heart disease.

During the follow-up, 54 people died, including 1.3 percent who died within 30 days of their surgery, 2.1 percent who died within 90 days of surgery and 3.4 percent who died within a year, the study found.

Those who were super obese and those with co-existing chronic diseases had the highest risk for early death. Super obese people accounted for 30 of the 54 deaths and had 30-day, 90-day and one-year death rates of 2 percent, 3.6 percent and 5.2 percent, respectively. People with co-existing health problems had death rates of 1.5 percent after 30 days, 5.8 percent after 90 days and 10.1 percent at one year.

The chances of dying after bariatric surgery may be greater for people who are super obese, according to the researchers, because the added abdominal fat makes the procedure more difficult, wound complications and blood clotting are more likely and they’re more apt to have obesity-related illnesses.

“The results of this study should inform discussions with patients with regard to the potential risks and benefits of bariatric surgery,” wrote co-author Dr. David Arterburn, of Group Health Research Institute in Seattle, and his colleagues in their report, published in the October issue of Archives of Surgery.

“These findings also suggest that the risks of bariatric surgery in patients with significant comorbidities, such as congestive heart failure, complicated diabetes and chronic obstructive pulmonary disease, should be carefully weighed against potential benefits in older male patients and those with super obesity,” they concluded.