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MS Research Update: Pulse therapy for breakthrough multiple sclerosis

A small pilot study from the University of Southern California suggests a pulse adrenocorticotropic hormone (ACTH) therapy could be effective in patients with breakthrough multiple sclerosis attacks while on beta-interferon. “Breakthrough” attacks that occur after starting a disease modifying therapy (DMT).

 

The study compared the safety and benefits of monthly pulse ACTH to monthly methylprednisone (MP) pulse in patients on beta-interferon. Over 15 months, researchers found that those treated with ACTH had fewer relapses and fewer psychiatric side effects. ACTH gel is currently used to treat MS relapses, but researchers note it may be able to alter the body’s immune responses beyond producing steroids.

 

As I discussed with the Medscape reporter, Megan Brooks, last week, the results of this study are ....

MS Research Update: Salt and Multiple Sclerosis

Increased dietary salt was reported to increase the immune attack on myelin in three studies this week. All three were published in the journal Nature.

  1. A study by Kleinewietfeld, et al, looked at TH17 cells, which is a type of lymphocyte that is highly inflammatory and that causes substantial tissue damage. These cells were grown in cultures in the lab. Some had normal and others high salt levels in their cultures. Those grown in a high salt environment had increased markers for inflammation. This seemed to be due to activation of one particular set of chemical signals in the cell, called the p38/MAPK pathway. They also looked at mice with an MS-like disease called experimental allergic encephalomyelitis (EAE). Mice fed a high salt diet had worse EAE than those fed a normal diet.
  2. A study by Wu, et al, also looked at TH17 cells. An analysis was done on genes associated with activation of TH17 cells, and SGK1 was identified as an important protein in this process. The SGK1 pathway was found to be more active if cells were cultured in a high salt environment. This was then studied in mice with EAE. Mice fed a high salt diet had more severe EAE. Blocking the SGK1 pathway seemed to reverse the effect of the high salt diet on the EAE.
  3. A study by Yosef, et al, also looked a the genes associated with activation of TH17 cells. They identified 22 sets of related genes that increased TH17 cell activity and 5 that decreased activity.

TH17 cells are highly inflammatory and likely contribute to the severe damage done to tissues in a number of diseases. Their precise role in MS is not fully understood, but it is believed that ...

What is Gastroenteritis?

This past week, Britain’s Queen Elizabeth II was hospitalized with a “stomach bug”. Gastroenteritis (also called the “stomach flu”) is the second most common illness in the United States. So, chances are good that your family has been affected by gastroenteritis already this year!

What are the symptoms of gastroenteritis?
Gastroenteritis is inflammation of the stomach and intestines causing symptoms of diarrhea, vomiting, cramping, and fever. If a person is not able to keep up with fluid losses from diarrhea and vomiting, then they can become dehydrated. Gastroenteritis occurs year-round and affects people of all ages. Those who are young, old, or have a suppressed immune system are more susceptible to severe gastroenteritis and to dehydration.

What causes gastroenteritis?
The majority of cases are caused by a viral infection (occasionally, a bacterial infection) transmitted through contact with another sick person or contaminated food/drink.

I have gastroenteritis, how can I feel better?
Rest and fluids! Staying hydrated is the most important step to controlling gastroenteritis. Some good options for staying hydrated include sports drinks or oral rehydration solutions (such as Pedialyte in drug and grocery stores).

I typically do not recommend any anti-diarrheal medications as this may even prolong the illness. In addition, antibiotic therapy is not helpful unless a specific bacterial cause is identified.

When should I call my doctor?
If you have questions or concerns you should always call your provider. However, things to watch for if you have gastroenteritis include:

How to deal with minor breakouts or major acne

Most of us experience acne at some point in our lives. It is most common in adolescents and young adults, but various forms can affect people well into adulthood. Knowing what you can treat with over the counter products and when to see a physician is the first step to improving acne.

The most common form of acne is comedonal acne and is characterized by whiteheads and blackheads. The next most common is inflammatory acne where deeper, pinker bumps appear on the skin. Milder cases of both comedonal and inflammatory acne can often times respond to over the counter (OTC) treatment with salicylic acid cleansers and topical benzoyl peroxide products. If you try OTC treatment for 6-8 weeks and see good benefit, you can avoid a trip to the doctor and keep using the OTC products.

More severe comedonal or inflammatory acne will commonly not respond to OTC treatment or get limited benefit. If a 6-8 week treatment trial with OTC products doesn’t control your acne, it’s time to see a doctor. There are...

How much tremor is too much?

Tremor is a normal physiologic reaction to anxiety or stress, but it is not normal to have a tremor when performing typical daily activities.

People who develop a tremor while eating, drinking, writing or doing other common activities may have a movement disorder called Essential Tremor. This is actually the most common movement disorder, and can affect up to 4% of people over age 40. People who have this disorder can take medications to help minimize the tremor, but they don't often reduce the tremor by more than about half. Deep brain stimulation (DBS) is an excellent treatment option for people with severe tremor, and can nearly eliminate the tremor in many patients. Many patients aren't sure when their tremor is severe enough to warrant surgery, and much of our conversation in the office is to help answer this question.

There is no one answer that is right for everyone, but for me it has to do with how well someone is actually doing in their daily life:

Tips for dealing with dust allergy

Although it’s hard to imagine, we are living and sleeping with thousands of little bugs called dust mites.

For many people, ignorance is bliss, but for those who are allergic, these bugs can cause lots of problems. Dust mite allergy symptoms include eye redness and discharge, itching, sneezing, congestion and trouble breathing. Dust mites are a problem all year long, but can be more obvious in the winter when people spend more time indoors.

Dust mites like to burrow into soft surfaces, like carpets, curtains, pillows, mattresses and stuffed animals. It is impossible to completely kill all dust mites, but here are six ways to minimize exposure:

Preventing progression of Barrett's esophagus to cancer without surgery

Many people wonder what the treatment for Barrett's Esophagus (BE) is. Treatment for BE without dysplasia consists primarily of controlling esophageal acid exposure, usually with once a day proton pump inhibitor (PPI) medications like omeprazole (Prilosec®). Occasionally, twice a day dosing or even anti-reflux surgery may be necessary to completely control acid reflux. Unfortunately, suppressing acid does not usually cause the Barrett’s tissue to regress or even prevent it from progressing to cancer.

If dysplasia is found on any biopsies, treatment recommendations change:

  • Low-grade dysplasia: Close surveillance with endoscopy every 6-12 months or ablation.
  • High-grade dysplasia: Endoscopic therapy to destroy Barrett’s tissue or surgery.
  • Early cancer: Endoscopic removal of focal cancer followed by tissue destruction or surgery

Experiments performed 20 years ago showed that in most people, once the Barrett’s tissue has been removed or destroyed, normal squamous tissue tends to regrow in the area as long as acid reflux is suppressed.

Endoscopic tissue destruction can be performed many ways:

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