Too Many Sugary Sodas Might Harm Your Kidneys

Too Many Sugary Sodas Might Harm Your Kidneys

News Picture: Too Many Sugary Sodas Might Harm Your Kidneys

THURSDAY, May 14, 2020 (HealthDay News) — Drinking lots of sweetened soda may increase the risk of developing chronic kidney disease, two new studies find.

“Consumption of 500 milliliters [16.9 fluid ounces] of a commercially available soft drink sweetened with high-fructose corn syrup increased vascular resistance in the kidneys within 30 minutes,” the researchers found.

In a second study, the investigators found changes in blood flow in the kidneys was caused by the corn syrup, not the caffeine, in the soda.

The two studies included a total of 25 healthy men and women, with an average age of 22 to 24.

Christopher Chapman, of the University at Buffalo in New York, and colleagues explained that vascular resistance occurs when blood vessels constrict, reducing blood flow in the kidneys and increasing blood pressure and impairing kidney function.

“Collectively, our findings indicate that [high-fructose corn syrup]-sweetened soft drink consumption increased renal vasoconstrictor tone at rest and during sympathetic activation,” the study authors said in a news release from the American Physiological Society.

The report was published online recently in the American Journal of Physiology–Renal Physiology.

Nearly 37 million Americans suffer from chronic kidney disease, according to the National Kidney Foundation. The foundation estimates kidney disease kills more people than breast cancer or prostate cancer.

— Steven Reinberg

MedicalNews
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QUESTION


The only purpose of the kidneys is to filter blood.
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References


SOURCE: American Physiological Society, news release, May 6, 2020

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Italian Doctors Detail Cases of Inflammatory Condition in Kids With COVID-19

Italian Doctors Detail Cases of Inflammatory Condition in Kids With COVID-19

News Picture: Italian Doctors Detail Cases of Inflammatory Condition in Kids With COVID-19

WEDNESDAY, May 13, 2020 (HealthDay News) — As New York City officials grapple with the sudden appearance of a rare inflammatory condition in children exposed to COVID-19, a new Italian report describes similar cases that have cropped up in that country.

The researchers say their findings provide “the first clear evidence” of a link between the new coronavirus and this inflammatory condition.

Between Feb. 18 and April 20, there were 10 cases of young children hospitalized with an inflammatory condition that resembles Kawasaki disease in the Lombardy region of northern Italy. In the five years leading up to the middle of February, only 19 children in the region had ever been diagnosed with the condition.

Those recent cases represent a 30-fold increase in the number of cases, but it’s difficult to draw firm conclusions with such small numbers, the scientists noted.

Eight of the 10 children hospitalized after Feb. 18 were found to have antibodies to the new coronavirus. All 10 children survived, but they had more severe symptoms than those diagnosed with Kawasaki disease in the previous five years.

“We noticed an increase in the number of children being referred to our hospital with an inflammatory condition similar to Kawasaki disease around the time the SARS-CoV-2 outbreak was taking hold in our region,” said study co-author Dr. Lucio Verdoni, from the Hospital Papa Giovanni XXIII in Bergamo, Italy.

“Although this complication remains very rare, our study provides further evidence on how the virus may be affecting children. Parents should follow local medical advice and seek medical attention immediately if their child is unwell. Most children will make a complete recovery if they receive appropriate hospital care,” Verdoni said.

The findings were published May 13 in The Lancet medical journal.

The study comes as New York officials are seeing similar cases in that state: More than 100 children have been confirmed to have contracted the condition. Three of the patients, two grade schoolers and a teenager, have died, The New York Times reported. None of them were known to have any preexisting condition.

Of the 102 cases, 71% were admitted to intensive care units, and 43% remain hospitalized, New York Gov. Andrew Cuomo said Wednesday. “As a parent, I can tell you, this is a parent’s worst nightmare,” he added.

Sixty percent of the children showing symptoms of the syndrome tested positive for the virus, while 40% tested positive for COVID-19 antibodies.

“We have been behind this virus every step of the way and even as we are now beginning to see the numbers on the decline, the virus is still surprising us,” Cuomo said. “Initially, we thought COVID-19 didn’t affect children, and now we’re dealing with a disturbing issue where we have about 100 cases of an inflammatory disease in children that seems to be created by the virus.”

A small number of cases have also been reported in other states, including California, Louisiana and Mississippi, the Times reported. And at least 50 cases have been reported in European countries, including Britain, Italy, France, Spain and Switzerland.

Kawasaki disease typically affects children under the age of 5, causing blood vessels to become inflamed and swollen. Typical symptoms include fever and rash, red eyes, dry or cracked lips or mouth, redness on the palms of the hands and soles of the feet, and swollen glands.

About a quarter of patients have heart complications, but the condition is rarely fatal if patients receive appropriate treatment in a hospital. It’s not known what triggers Kawasaki disease, but it’s believed to be an immune overreaction to an infection.

The Italian researchers said that coronavirus-related cases should be classified as “Kawasaki-like disease,” because the symptoms in these 10 children were different and more severe than in cases that occurred before the pandemic.

They also warned that other countries affected by the coronavirus pandemic might expect to see a similar rise in cases similar to Kawasaki disease.

“Our study provides the first clear evidence of a link between SARS-CoV-2 infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus,” lead author Dr. Lorenzo D’Antiga, of Hospital Papa Giovanni XXIII, said in a journal news release.

Study co-author Dr. Annalisa Gervasoni, a pediatric specialist at Hospital Papa Giovanni XXIII, added, “In our experience, only a very small proportion of children infected with SARS-CoV-2 develop symptoms of Kawasaki disease. However, it is important to understand the consequences of the virus in children, particularly as countries around the world grapple with plans to start relaxing social distancing policies.”



QUESTION


What is the Wuhan coronavirus?
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In an accompanying editorial, Russell Viner, president of the Royal College of Pediatrics and Child Health and professor of adolescent health at University College London’s Great Ormond Street Institute of Child Health, wrote that while the study “suggests a possible emerging inflammatory syndrome associated with COVID-19, it is crucial to reiterate — for parents and health care workers alike — that children remain minimally affected by SARS-CoV-2 infection overall.”

According to Viner, “Understanding this inflammatory phenomenon in children might provide vital information about immune responses to SARS-CoV-2 and possible correlates of immune protection that might have relevance both for adults and children. In particular, if this is an antibody-mediated phenomenon, there might be implications for vaccine studies, and might also explain why some children become very ill with COVID-19.”

— Robert Preidt

MedicalNews
Copyright © 2020 HealthDay. All rights reserved.

References


SOURCE: The Lancet, news release, May 13, 2020

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Sudden Obsessions, Tantrums: What Is PANS in Kids?

Sudden Obsessions, Tantrums: What Is PANS in Kids?

News Picture: Sudden Obsessions, Tantrums: What Is PANS in Kids?By Amy Norton
HealthDay Reporter

TUESDAY, May 12, 2020 (HealthDay News) — Researchers may have gained new insights into a mystifying condition that causes children’s behavior to change so severely and abruptly, it can be like they woke up as a different person.

The condition is known as pediatric acute-onset neuropsychiatric syndrome, or PANS. It is diagnosed when a child has a dramatic — sometimes overnight — onset of psychiatric and neurological symptoms.

The primary ones are obsessive-compulsive behaviors and fears over food that cause the child to stop eating. But affected children also have issues ranging from depression and dramatic mood swings, to difficulty with school work, sleep disturbances, bedwetting and behavioral regression — reverting to preschool temper tantrums and separation anxiety, for example.

PANS is still a mystery, but researchers suspect it begins with an infection, which causes a misguided immune system attack on the brain.

But while a PANS diagnosis is sometimes made, it is also controversial. Some doctors attribute the symptoms to psychological causes, and many have never heard of PANS.

“Families can have a hard time getting medical services,” said Dr. Jennifer Frankovich, one of the lead researchers on the new study. “When they come in to see the doctor, they can look like they’re frantic, telling this unbelievable story of their child changing overnight.”

But Frankovich and her Stanford University colleagues now have evidence of subtle abnormalities in the brains of children diagnosed with PANS. The differences are not obvious enough to be seen on standard MRI brain scans; they are instead detectable within the “microstructure” of brain areas believed to be involved in PANS.

That’s not proof that the brain differences cause the symptoms, said Frankovich, a clinical associate professor of pediatrics at Stanford.

But it is evidence that something is happening in the brain. And it’s possible the differences are caused by inflammation, said Dr. Kyle Williams.

Williams, who was not involved in the study, is director of pediatric neuropsychiatry and immunology at Massachusetts General Hospital in Boston.

“We’re operating under the hypothesis that [PANS] is an inflammatory process,” Williams said. And that theory includes using anti-inflammatory medications, such as corticosteroids, to treat the condition.

If studies can determine that any brain differences in kids with PANS are related to inflammation, Williams said, “that would give us even more rationale for using anti-inflammatory treatments.”

The roots of PANS go back to the late-1980s, when researchers began to observe that symptoms of obsessive-compulsive disorder (OCD) in children could sometimes appear out of nowhere. And it often happened after a bout of strep throat, a bacterial infection.

The theory is that in some kids — perhaps those with a genetic vulnerability — the infection leads to an abnormal immune system attack on parts of the brain. A subgroup of PANS is known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.

But, Williams said, not all cases of PANS can be linked to an earlier strep infection, and researchers suspect that other infections are at work, too.

When it comes to diagnosis, doctors look at symptoms — with the sudden onset being key. Frankovich said that parents may describe it as the child they’d always known “being kidnapped.”

PANS symptoms also follow a relapsing-remitting course, she noted, with periods of improvement followed by a new flare-up.

Williams said that trying to link the onset of the symptoms to an infection is also important, to help differentiate it from pediatric OCD.

For the new study, the Stanford researchers analyzed MRI brain scans from 34 children with PANS and 64 kids without the condition. The PANS group had no obvious brain injuries, but a closer analysis revealed something subtler.

Using a software program, the researchers found that in children with PANS, there was more movement of water molecules through certain brain structures. They included the basal ganglia, which is involved in movement, learning and emotion; and the amygdala, which is considered the brain’s fear center.



QUESTION


The abbreviated term ADHD denotes the condition commonly known as:
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It’s not clear what it all means, and the findings need to replicated in another study, Frankovich said.

If the results are confirmed, Williams said that could pave the way for using brain scans to help diagnose PANS.

Frankovich said that another question for the future is whether the brain differences are permanent. “We don’t know if this goes away when kids get better,” she said.

The findings were published online recently in JAMA Network Open.

MedicalNews
Copyright © 2020 HealthDay. All rights reserved.



References


SOURCES: Jennifer Frankovich, M.D., clinical associate professor of pediatrics, Stanford University School of Medicine, and pediatric rheumatologist, Stanford Children’s Health Immune Behavioral Health Clinic, Stanford, Calif.; Kyle Williams, M.D., Ph.D., director of pediatric neuropsychiatry and immunology, Massachusetts General Hospital, Boston; May 4, 2020, JAMA Network Open, online

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Blood Vessels of Obese Teens Age Prematurely

Blood Vessels of Obese Teens Age Prematurely

News Picture: Blood Vessels of Obese Teens Age Prematurely

THURSDAY, May 7, 2020 (HealthDay News) — Obesity, type 2 diabetes or high blood pressure increase teens‘ risk of premature blood vessel aging, a new study finds.

“Our study demonstrates that the slow changes in blood vessels that lead to the development of atherosclerosis [narrowing of the arteries] begins early in life,” said lead author Justin Ryder. He’s an assistant professor of pediatrics at the University of Minnesota Medical School, in Minneapolis.

The study included 141 teens with normal weight, 156 obese teens, and 151 teens with type 2 diabetes who were followed for five years. The teens’ average age was nearly 18 when the study began.

After five years, the teens with either obesity, type 2 diabetes or high systolic blood pressure were much more likely to have thicker and stiffer carotid arteries than teens with normal weight. The carotid artery is the main blood vessel that leads to the brain.

Obesity, type 2 diabetes and high blood pressure are major risk factors for heart attack and stroke later in life, noted the study authors. The findings were published May 6 in the Journal of the American Heart Association.

“Having obesity, type 2 diabetes or high systolic blood pressure were each independently associated with and equally predictive of having thicker and stiffer arteries among this group of young people,” Ryder said in a journal news release.

“What surprised our team the most was that participants with higher systolic blood pressure compared to their peers in the study had a very similar risk as those with obesity or type 2 diabetes for thicker and stiffer blood vessels over time,” he added. (Systolic blood pressure is the first number in a blood pressure reading.)

Ryder said obesity needs to be tackled seriously.

“Although type 2 diabetes is treated aggressively in the U.S., obesity needs to be treated just as vigorously because it has the same increased risk for premature aging of the blood vessels, which is an early sign of cardiovascular dysfunction and a precursor to cardiovascular diseases in adulthood,” he said.

— Robert Preidt

MedicalNews
Copyright © 2020 HealthDay. All rights reserved.




QUESTION


Some children are overweight because they have big bones.
See Answer

References


SOURCE: Journal of the American Heart Association, news release, May 6, 2020

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Flipping the Odds: Turning Patients Prone Helps Fight COVID-19

Flipping the Odds: Turning Patients Prone Helps Fight COVID-19

News Picture: Flipping the Odds: Turning Patients Prone Helps Fight COVID-19By Alan Mozes
HealthDay Reporter

WEDNESDAY, May 6, 2020 (HealthDay News) — A new analysis suggests there may be a simple, noninvasive technique that could delay, or even eliminate, the need for ventilation in COVID-19 patients.

It’s called “proning.” And it appears to be remarkably effective at boosting “blood oxygen saturation” levels, often called sats, among COVID patients struggling with abnormally low levels (known as hypoxia).

“Proning is basically having patients turn over onto their stomach or onto their side while lying down,” explained study author Dr. Nicholas Caputo. He’s the associate chief at New York City Health and Hospitals/Lincoln Medical and Mental Health Center’s department of emergency medicine.

How does it work? Gravity, says Caputo. “It makes sense anatomically,” he noted, “because when your body is parallel to the ground all the organs lay off of it like on a clothes line. So, by flipping over or to your side you open up the areas, like your lungs, that would otherwise be compressed when you’re on your back.”

But when the coronavirus pandemic first struck, proning was not a go-to intervention, Caputo noted. Instead, U.S. patients with severely low sats — sometimes coupled with abnormally rapid and shallow breathing and troubling lung X-rays — were often quickly put on ventilators.

Generally speaking, mechanical ventilators — though invasive — can be lifesavers for patients who can’t breathe on their own, Caputo said.

The problem? “ER physicians knew that if we just intubated everyone we would run out of ventilators in a few days,” he noted. “And then there was also the early data coming out of Europe that was showing that there was a very high mortality rate among ventilated COVID patients.”

In fact, that latter concern was backed by recent findings involving roughly 2,600 COVID patients at Northwell Health System in New York City. The study found that while the overall death rate was 21%, it shot up to 88% among those placed on ventilators.

The other twist was that many COVID patients come to the ER with very low blood sats, but are otherwise functional. They have none of the signs of respiratory distress that low sats are expected to generate. This raised additional questions about whether quick ventilation was the best way to handle these “happy hypoxemics.”

“We knew something wasn’t quite right,” said Caputo, “and we wanted to figure out what we could do to prevent patients from being ventilated in the first place.”

So between March 1 and April 1, Caputo and his team set out to test the effectiveness of proning as a means for elevating sat levels and halting a worsening of symptoms among 50 adult COVID-19 patients.

All had hypoxia, with sats below 90%. Sat levels can be registered by means of a finger-clip device called a pulse oximeter, with a normal reading falling between 95% and 100%.

More than three-quarters of the patients (80%) were also struggling with abnormally rapid and shallow breathing, and 44% were already taking supplemental oxygen before going to the ER.

Those who weren’t already taking supplemental oxygen were given some. Yet, while those patients did improve a bit, all 50 were still struggling with dangerously low sat levels ranging from 75% to 90%.

So Caputo and his team turned to proning. “We didn’t move them ourselves,” he noted. “We had patients self-prone by turning themselves.”

The result? After just five minutes of proning, sat levels rose to a near-normal mean of 94%. And in the end, about three-quarters of the patients never had to be put on a ventilator.

Still, about a quarter of the patients ultimately failed to regain normal sats, and those 13 patients had to be intubated within 24 hours of hospital admission.

“Also, this was an observational study,” Caputo stressed, “not a controlled investigation with a comparison group.” That, he said, makes it premature to conclude that proning definitively staved off ventilation and boosted survival.

“We need more research,” he acknowledged. “But proning is such a low-risk procedure that I would definitely say that this is certainly worth considering going forward.”

The findings were published recently in the journal Accident Emergency Medicine.

Two experts not involved in the study cautiously agreed.

“A lot of the benefit of proning has been anecdotal,” cautioned Dr. Armeen Poor, an attending physician in pulmonary critical care medicine at Metropolitan Hospital Center in New York City.

“And while oxygen saturation is an important number, it’s not the be-all of clinical status. Also, we don’t know what the consequences or trade-offs are. For example, a quarter of these patients still needed to be intubated. Did the delay in making that happen cause them harm?” Poor said.

“But I would say that the risk of proning is pretty minimal,” he added. “And we are seeing that some patients get remarkably better with proning, without being intubated. So, if someone is awake and they’re ok to do it, and it doesn’t make them more uncomfortable, then it’s not an unreasonable thing to try.”



QUESTION


What is the Wuhan coronavirus?
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Dr. Albert Rizzo, chief medical officer of the American Lung Association, seconded the thought.

“This has been a learning process for all of us as to the exact physiology of what this virus does to the lungs,” he noted. “For example, we’re seeing that the lungs of COVID-19 patients are not as stiff as we typically see in other patients with pneumonia. And that means that proning could be a sufficient way to increase oxygen flow, without needing the pressure of a ventilator.

“And being able to hold off on using a ventilator does have a lot of plusses to it, because on a ventilator patients can’t communicate,” Rizzo said. “And even the process of putting it [the ventilator] in exposes frontline health care workers to greater risk themselves. And yes, unfortunately, once COVID-19 patients go on a ventilator many of them never come off. So, if we can use gravity to help improve outcomes, all the better.”

MedicalNews
Copyright © 2020 HealthDay. All rights reserved.

References


SOURCES: Nicholas Caputo, M.D., associate chief and attending physician, department of emergency medicine, New York City Health and Hospitals/Lincoln Medical and Mental Health Center, and associate professor, clinical emergency medicine, Weill Medical College of Cornell University, Bronx, N.Y.; Albert Rizzo, M.D., chief medical officer, American Lung Association; Armeen Poor, M.D., attending physician, pulmonary critical care medicine, Metropolitan Hospital Center, New York City, and assistant professor, medicine, New York Medical College; April 22, 2020, Accident Emergency Medicine

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