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Archive for May, 2008

13 May 2008, The Independent.

He laughs and plays like any one-year-old. But a rare condition means Ceri Hughes won’t see her son’s face light up with joy.

“Moebius syndrome was first described in 1888 by a German neurologist called Paul Julius Moebius. It is a rare condition and although it is always obvious from birth, it is often not diagnosed until the infant is many weeks or even months old.

  • The main problems include paralysis of the muscles that control movements of the face and eyes.
  • The paralysis happens because the nerves that make these muscles move, called the seventh and sixth cranial nerves, are abnormal.
  • The abnormality always involves the nerves before the baby is born and doctors do not always know how it has happened.
  • Sometimes a magnetic resonance imaging [MRI] brain scan will show a defect in the brain stem, but often the MRI scan is normal.”

Children with Moebius syndrome may also have other problems, including involvement of other cranial nerves and particularly those involved with hearing, tongue movements and feeding. Children may also have malformations of one or both hands or arms, and, less frequently, of the feet or legs.

“Some children may also have slow development and learning difficulties when they start school,” says Dr Appleton. “Currently, there is no treatment that can make the facial muscles move normally or correct any limb malformations, but there are medical and surgical treatments that can improve the movement of the eyes.”

As there are so few people with this condition, the best source of practical information has been other parents and people with the syndrome whom I have met through the Moebius Research Trust (MRT). The idea of the research trust was hatched after two families, from different ends of the country, met at a conference held by the Moebius Support Group.

It became apparent that…..

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BMJ, published 27 May 2008.

Editorials.
By: Jeremy Fairbank, professor of spinal surgery, Nuffield Orthopaedic Centre, Oxford OX3 7L

  • Prolapsed intervertebral disc is common.
  • Disc prolapse is genetically driven—twin studies indicate that at least 60% of the variance can be explained on genetic grounds and not by the commonly assumed environmental factors (work, trauma, exposure to excessive driving, smoking, and so on).

Current guidelines indicate that radicular pain should improve within six to eight weeks with conservative management.

  • Surgery should be performed before eight weeks only in patients with progressive neurological deficit, which can be detected by magnetic resonance imaging.

If symptoms persist, evidence supports surgery after eight weeks.

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The last gasp: Health Secretary signals new smoking curbs

By Ben Russell, Political Correspondent, The Independent.
Monday, 26 May 2008

Cigarettes will be banned from public display in shops and vending machines are to be scrapped under dramatic new plans designed to curb smoking among young people.

Packets of 10 cigarettes will also be outlawed under proposals to be published later this week by the Health Secretary, Alan Johnson.

A consultation paper includes plans to force cigarettes to be kept “under the counter” out of public view, Mr Johnson said.

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Soft-drink giant to do away with sodium benzoate ‘where technically possible’, in the wake of IoS story that highlighted the potential dangers

By Martin Hickman, Consumer Affairs Correspondent, The Independent
Sunday, 25 May 2008

Coca-Cola, the world’s biggest soft drinks company, is phasing out a controversial additive that may cause hyperactivity and DNA damage. By August, no cans of Diet Coke should contain the preservative sodium benzoate.

Coca-Cola wants to remove E211 (sodium benzoate) from other products where possible. But the company said there were no satisfactory alternatives yet for its high-acid drinks Fanta and Dr Pepper. The substance also remains in rival drinks such as Irn-Bru, Pepsi Max and Lucozade.

Sodium benzoate occurs naturally in some fruits but is used in far higher concentrations to stop fizzy drinks from going mouldy. In an Independent on Sunday exclusive last May, Professor Peter Piper, a chemistry expert at Sheffield University, warned that it could switch off cellular power in yeast and might do similar damage in humans. He called for the Food Standards Agency to fund research into the subject.

Sodium benzoate was also one of seven E-numbers found to worsen hyperactivity in a study by Southampton University. If combined with vitamin A, sodium benzoate can form a potentially carcinogenic substance, benzene.

Coca-Cola said it had removed sodium benzoate from Diet Coke production in January. The company said: “We are looking to phase out the use of sodium benzoate where …..

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BMJ 2008;336:1144 (24 May).

An increasing number of children are taking drugs for hyperactivity.

Removing colours and preservatives is a relatively harmless activity, so a properly supervised and evaluated trial period of eliminating them should be part of standard treatment, says an editorial by Andrew Kemp, professor of paediatric allergy and clinical immunology at the University of Sydney.

  • Whether preservatives and colourings cause or exacerbate hyperactive behaviours is an important question for many paediatricians and parents.
  •  A recent randomised placebo controlled trial in 297 children aged 3-9 years provides evidence of increased hyperactive behaviour after they ate a mixture of food colourings and a preservative (sodium benzoate).
  • In contrast to many previous studies, the children were from the general population and did not have attention-deficit/hyperactivity disorder.

The trial found an adverse effect of the mixture on behaviour as measured by a global hyperactivity aggregate score. The daily dose approximated that found in two 56 g bags of sweets.

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Using electroconvulsive therapy for depression remains controversial. Dr Max Pemberton examines the evidence.

Depression kills. Suicide in the UK constitutes nearly one per cent of deaths from all causes every year.

It is the single biggest killer of young men after road traffic accidents, and the 2001 Confidential Enquiry into Maternal Deaths found that suicide was the leading cause of maternal mortality in the UK.

But depression is treatable. But there remains a small cohort of people for which standard treatment does not work, and it is in this group that electroconvulsive therapy (ECT) is sometimes used. In fact, empirical evidence has shown it is the most effective treatment for severe depression, meaning people can resume work and relationships. Around 80 per cent who fail to respond to standard treatments for depression respond to ECT.

It is particularly useful in older patients who present with severe forms of depression where they are so depressed they refuse food and drink, appear confused or paranoid, or ………….

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CHICAGO – There’s a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year — a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.

Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.

And when the pain is too much………

 

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Taylor Smith, from Barrow-in-Furness in Cumbria, has been diagnosed with Niemann-Pick Type C, also known as Children’s Alzheimer’s.
Stephanie O’Hara, 22, Taylor’s mother, described the disease as like “living with a timebomb”.
She said:………….

 

The disease means that the toddler is likely to develop signs of dementia before he becomes a teenager, although the symptoms can appear at any time.

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BMJ 2008;336:1062-1066 (10 May).
Clinical Review

By: J R Fraser Cummings, specialist registrar, Satish Keshav, consultant gastroenterologist, Simon P L Travis, consultant gastroenterologist (Gastroenterology Unit, John Radcliffe Hospital, Oxford)

Summary points

  • Biological therapies have radically changed the management of Crohn’s disease but must be used judiciously with great awareness of possible adverse events
  • Treatment strategies for the disease are rapidly evolving, with immunomodulator and biological therapy being considered in patients who have indicators for developing early severe disease
  • Clinical indicators of a poor prognosis (at diagnosis) include perianal or stricturing disease, weight loss >5 kg, or the need for steroids
  • Treatment of active disease with mesalazine is little better than placebo; mesalazine is used mainly to reduce the risk of relapse after small intestinal resection
  • Access to specialist services, parallel medical and surgical clinics, nurse specialists, dietitians, pharmacists, and other allied professionals is as important as the medication

Publication of standards of care should drive improvement in the care and provision of resources for patients with Crohn’s disease

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BMJ 2008;336:598-600 (published 6 March 2008)

Research
Gary Parkes, general practitioner, Trisha Greenhalgh, professor, Department of Primary Care and Population Sciences, University College London; Mark Griffin, lecturer in medical statistics, and Richard Dent, consultant chest physician department of chest medicine

Conclusion: Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.

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