Monday, May 17, 2010


Diseases such as inflammatory bowel disease (IBD) were rare before the 1920's, when public health efforts began making strides in cleaning up our water supply,modernizing the treatment of sewage, and improving farming practices.These changes certainly benefited us by reducing or eliminating exposure to many disease-causing pathogens, they also had the unintended consequence of removing exposure to beneficial or even necessary organisms.
People lived closer to the soil in the past, without indoor plumbing and with direct exposure to animals. The result was near universal colonization with helminths, which are complex wormlike animals that inhabit the gastrointestinal tracts of mammals. Like the many bacteria also found in the gut, some helminths can cause disease in a host animal but many are relatively harmless and, in fact, are important regulators of the immune system.
According to Dr. J. Weinstock , a gastroenterologist at Tufts University, " helminths exert a powerful effect on immunity in the host, primarily by inducing the regulatory arm of the immune system, which is important in reigning in the effector ' fight and kill ' arm of the immune system." The regulatory arm hones and shapes the immune response to bacteria, viruses, and parasites, quelling the effects of the effector arm so as to prevent needless tissue damage by turning against the host.
Diseases such as IBD, asthma, rheumatoid arthritis, and multiple sclerosis remain uncommon in less-developed parts of the world where helminthic colonization is still widespread.
Interestingly, petrified human stool many thousands of years old has been found to contain helminth eggs, and autopsies of mummies have found traces of helminths. In fact, the frozen iceman Otzi, found in the northern Alps in 1991 where he had lain in a glacier since 3300 B.C., had T. trichiura in his gut.
Int. J. Parasitol. 2007;37:457-64
Gut 2005;54:87-90
Ann. Rheum. Dis. 2008;67:518-23

Mild Traumatic Brain Injury Detected

Mild Traumatic Brain Injury (mTBI) can be detected using diffusion tensor imaging (DTI) which is an application of MRI that is sensitive
to the direction of the movement of water molecules through tissue.In the intact brain, the primary direction of movement is parallel to axonal bundles, which is caled anisotropy.But when these axons are damaged, the movement becomes less aligned with the bundles.If there is a change in the direction of diffusion of water due to microscopic damage , it is reflected in a decrease in anisotropy.This finding may allow the diagnose of patients with mTBI in whom routine MRI scans are often normal.
Radiology 2009;252 (3) :816-824


BELL'S PALSY RECOVERY more likely with corticosteroids (higher doses of more than 450 mg ).Adding antiviral drugs (acyclovir is generic and therefore less expensive) may have additional benefit but this was of borderline statistical
significance. JAMA 2009;302(9):985-993

Monday, May 10, 2010


Mary Todd Lincoln suffered from debilitating headaches ( possibly migraine ) throughout her adult life. "Abraham Lincoln Vampire Hunter" by Seth Grahame-Smith


Telcagepant (MK-0974), the first orally bioavailable neuropeptide calcitonin gene-related peptide (CGRP) receptor antagonist, relieved pain and other migraine symptoms.
Merck is in phase III of the clinical development of this drug and is addressing dose dependent liver toxicity. Neurology2009;73:970-977


Ethical issues are discussed in the management of the demented patient at
The appropriate form of treatment for most patients with advanced dementia is palliative care in which measures that maintain comfort are emphasized and whose goal is to improve quality,not the quantity, of life


The American academy of Neurology has updated its 1999 guidelines to the treatment and managegment of amyotrophic lateral sclerosis (ALS), highlights include:
1.Riluzole should be offered to slow disease progression
2.PEG tube to stabilize weight and prolong survival
3.NIV (non-invasive ventilation) for respiratory insufficiency to slow the decline in FVC (forced vital capacity) and improve quality of life
4.Creatine(5-10 mg) or high-dose vitamin E should not be given
5.Sialorrhea (increased salivation) can be reduced with botox type B
Neurology 2009;73:1218-1226 and 1227-1233


Leptin (secreted by fat cells to balance body energy and weight) may be a risk factor for AD.
The higher the leptin level the lower the risk for dementia JAMA 2009;302(23):2565-2572


Keep tabs on on all genetic discoveries in AD at
As of January, 1,356 studies have lead to the id of 660 genes and 2,822 polymorphisms

Oral Therapies for MS

The Findings:
Oral fingolimid vs. interferon beta 1A : at one year ,no difference in disability at one year. Fingolimid 0.5 mg/d 52% reduction in relapse rate ; 1.25 mg/d 38% reduction
Fingolimid superior to placebo re: new lesions
Cladribine vs placebo, significant reduction in brain lesions on MRI