Diabetes

Thousands of people in the uk have type 2 diabetes which remains undiagnosed. Millions of people are also at risk of diabetes, however, this can be reduced by exercise and diet.
Type 1 diabetes mostly impacts young people and children; it is commonly diagnosed at 10-14 years old. It is an autoimmune disease which destroys the insulin-producing beta cells in the pancreas.

Type 2 diabetes makes up 90% of those with diagnosed diabetes. It is more common in older people, and is a multifactorial disease caused by genetics and environment together, including obesity, excessive and unhealthy eating, a lack of exercise and stress. It is characterised by insulin resistance- the inability of insulin to move glucose into the cells for effective metabolism.  This results in overproduction of insulin, then a progressive decline in insulin production.

At- risk groups: type 2 diabetes
-The main modifiable risk factor is being overweight. Others include poor diet and lack of physical activity. Non-modifiable risk factors include factors such as ethnicity, and sex.
-Type 2 diabetes is 6 times more common in south Asian ethnicities, and 3 times more common in African / African-Caribbean ethnicities than general population. Women who have a history of gestational diabetes have 30% risk of developing type 2 diabetes.
-It is recommended that those with a glycated haemoglobin (HBAlc) of 42-47 mmol/mol (6.0-6.4%) should be considered as ‘high risk’.
-Patients with an impaired glucose tolerance or raised fasting glucose have an increased risk of progression to type 2 and other vascular complications.
-Some patients may have blood glucose levels above the normal defined range, but not high enough for a diagnosis of  type 2 diabetes. These are said to have ‘impaired glucose regulation’, or ‘prediabetes’.
-Prediabetes= greater risk of progressing to type 2 / developing CVD than the general population.

Type 1 diabetes
This condition has less clear risk factors than type 2. 85% of type 1 cases are in patients with no family history, however there is a genetic link. Those with variations in the HLA-DQA1, HLD-DQB1 and HLA-DRB1 genes have a higher risk of type 1 diabetes. Those with a family history with type 1 are 15X more likely to develop the condition.

Environmental factors: exposure to Coxsackie B4 virus, rotavirus, and cytomegalovirus may increase the risk of developing the condition

Signs and symptoms of diabetes
There is a great lack of awareness of what they are. Up to half of type 2 diabetic patients will already have complications of diabetes by the time they are diagnosed. As a result, the first presentation of type 2 may be a medical emergency, eg stroke, heart disease, blindness, renal disease, peripheral vascular disease which could require limb amputation. Some new cases of type 1 diabetes in children/ young people will present with diabetic ketoacidosis; a complication if diabetes characterised by v high blood glucose levels, presence of ketones in the blood/urine, and acidosis. This is a life-threatening condition; Those with diabetic ketoacidosis need emergency treatment with IV insulin and fluids, close monitoring in hospital and support.  People and parents need to raise awareness of signs of diabetes.

Signs of type 1 and type 2 diabetes can be spotted more easily by considering   the ‘4 T’s’: Toilet, Thirsty, Tired, Thinner. These signs occur more slowly in type 2 diabetes and they may be missed.
-Toilet: If a patient is developing diabetes, they pass more urine than normal (polyuria). They may need to use the toilet at night, wet the bed, or for babies have heavier nappies. This is because the glucose in the blood exceeds the renal glucose threshold, and is therefore excreted in the urine, causing water to also come out in the urine
Thirsty: As a result of polyuria, they will feel thirsty and drink more. Polyuria and polydipsia are osmotic symptoms.
Tired: The patient will lack ability to utilise glucose for energy, causing tiredness.
Thinner: The body attempts to compensate for a lack of glucose in cells by metabolising protein and fat, resulting in weight loss.
-Diabetics may get blurred vision, caused by a change in lens refraction because of hyperglycaemia. This normally improves once a patient’s glucose levels are normalised, and those recently diagnosed with diabetes shouldn’t buy new glasses for the first 3 months after diagnosis.
-Diabetics are also at risk of recurrent infections (particularly fungal infections and urinary tract infections) which can be causes by higher blood and urine glucose concentration, because it impairs phagocyte activity and causes poor wound healing.

Screening and diagnosis

-Population screening not recommended by UK National Screening Committee. Despite this, NICE recommends type 2 risk assessment is done in:
-Non-pregnant adults aged over 40
-Aged 25-39 if South Asian, Chinese African-Caribbean, black African, and other high risk black and minority ethnic groups
-Adults with conditions increasing the risk of type 2, eg: CVD, hypertension, obesity, stroke polycystic ovary syndrome, a history of gestational diabetes
-NICE states that community pharmacy staff should carry out these risk assessments and refer anyone with a high score to their GP for blood sugar tests. Staff in pharmacies that can’t carry them out should advise about using validated self-assessment tests.
-Those suspected to have type 2 should be assessed further to confirm the diagnosis

Those with diabetes normally have:
-raised HbA1c   (more likely to be higher in type 2)
-glucose present in urine
-type 1: ketones in urine and blood
-A diagnosis of diabetes is given if they have the symptoms, and one of the below…
-A random plasma glucose ≥ 11.1 mmol/ L
-A two-hour plasma glucose ≥ 11.1 mmol/L (taken 2 hours after a 75g glucose challenge in an oral, glucose tolerance test
-A fasting plasma glucose ≥ 7.0 mmol/ L
-HbA1c ≥ 6.5% (48 mmol/mol) on two separate occasions (usually taken 2-4 weeks apart)
-A diagnosis of prediabetes is given if they have one of:
-A fasting plasma glucose of 6.1-6.9 mmol/L
-A two-hour plasma glucose of 7.8-11.0 mmol/L
-HbA1c of 6.0-6.4% (42-47 mmol/mol) on one occasion
-Those with predibetes should be advised to improve their life-style, particularly diet and more exercise.

Pharmacists can play a vital role in preventing diabetes, by spotting the signs in patients, initiating tests and referring to appropriate professionals if needed. They should recommend anyone with 2 or more risk factors to undergo diabetes screening tests every 3 years.

Hackett, E and Crasto, W. (2014). Identifying patients with diabetes. The pharmaceutical journal, 293(7835), pp 494-496

A cure for HIV

Human immunodeficiency virus (HIV) damages cells in the immune system, and reduces your ability to fight everyday infections and disease.

HIV can be managed by antiretroviral therapy (ART) – medications which stop replication of the virus, allowing the immune system to repair itself.
Although ART makes HIV undetectable and can prevent transmission of the virus, it is still latent in cells, meaning it hasn’t been completely eradicated. It also requires long-term administration, which is costly, and can have side effects.

I recently read an article written by Sophie Cousins, regarding cancer treatments being used for a cure for HIV. It explains research that is being carried out into using immunoboosting therapies used in cancer treatment, to manage HIV.

Similarities between the barriers to a cure to HIV and cancer have been identified, such as the reappearance of malignancies, even whilst undergoing cancer treatments, which resembles the persistence of HIV. Cells infected with HIV proliferate in the same way as tumour cells do, and both show signs of inflammation during this proliferation. Some of the same markers are found in HIV and tumour cells. Markers are substances that are produced in response to or by the virus/disease.

Checkpoint inhibitors are a new type of immunotherapy drug, used for treatment of metastatic melanoma. One of these, called anti-PD-1 is being investigated, in the hope that it works in the same way for HIV, as it does in cancer. It works by blocking a signal, which would have stopped T cells from attacking the cancer. In Melbourne, research is being done to discover whether anti-PD-1 can reverse HIV latency, boost the immune system, and therefore cure HIV.

However, research in San Francisco reveals it may not work for everyone, and anti-PD-1 therapy can have side effects like autoimmune diseases of the skin and gut (when the immune system attacks healthy cells by recognising them as foreign). CAR T cell therapy is also being investigated as a possible HIV treatment. It treats leukaemia, by using genetically modified versions of the patients’ immune cells. It is currently being studied in HIV in animals.

 

 

A bra that could save lives

An 18 year old boy from Mexico and his 3 friends have invented the ‘Eva Bra’,  which could potentially detect breast cancer. Julian Rios Cantu was motivated to invent this bra by his mother- when he was 13, she was diagnosed with breast cancer which resulted in a double mastectomy.

So how does it work?
Cancerous tumours tend to cause skin to have a different temperature because of abnormal blood vessel systems and increased blood flow. Biosensors in the Eva Bra measure these temperatures and record them in an app. The app then alerts the user to any alarming results. To obtain accurate measurements, women should wear the bra for 60-90 minutes per week.

the Eva Bra is currently only at the prototype stage, but it will undergo more tests to investigate whether it really is a reliable way to detect cancer. Julian’s company called Higia Technologies won the top prize at the Global Student Entrepreneur awards last week, and they won £15,500 to develop their idea. 

Trials must be done before this bra can be approved by cancer experts as a method of detecting the tumours. Although increased blood flow  and higher temperatures of skin is a common effect of cancerous tumours, it is not entirely a reliable method of diagnosing cancer. However, if further tests of the Eva Bra prove it to be successful, it could be extremely beneficial as detecting breast cancer at the earliest stage could save lives. Julian and his friends hope to make the Eva Bra a product fit for sale by the end of next year.

Dying of boredom

Although scientists haven’t yet found what completely causes boredom, there is research that shows patients with damage to their prefrontal cortex are more likely to become bored easily. The prefrontal cortex is also known to control our perception of time, which explains why when we are bored, we perceive time to pass more slowly.

So is it really possible to die of boredom?
People with damage to the prefrontal cortex are not only prone to boredom, but also experience greater urges to take risks.

When we experience a new situation that we enjoy, a neurotransmitter named dopamine is released into the prefrontal cortex, which triggers a response that causes us to feel excitement and joy. People who feel boredom easily may have lower levels of dopamine, meaning it takes more to trigger this response. This explains why people with a predisposition to boredom are naturally more willing than others to participate in activities that have a high risk of danger.

 Of course boredom can’t cause death directly, but the link between boredom and risk-taking can lead to life threatening situations. Boredom-prone people are more likely to participate in activities involving drugs, alcohol, and hazardous sports. Other research has shown that these people are also at a greater risk of mental health issues such as anxiety, depression and paranoia.

Preventing boredom
The reason we get bored is simply because we feel that the activity we are doing lacks value, either because it is unenjoyable, too easy, too difficult, or uninteresting. A tedious task may be prevented from becoming boring by thinking of it in an optimistic way; contemplate the usefulness or meaningfulness that the activity may have.

Does football cause brain injury?

Research has been done at the Institute of Neurology in London, which has found that professional football could be linked to a specific injury of the brain, also found more commonly in boxers.

The brains of six professional footballers who have played for an average of 26 years were examined in autopsies. In four of these males, signs of CTE were found; an injury common in boxers but uncommon in the general population. Chronic traumatic encephalopathy (CTE) is a form of dementia which is caused by repeated blows to the head.  There are many symptoms including memory loss, disorientation, parkinsonism and dysarthria.

Repetitive brain trauma also leads to a build up of tau protein. This  slowly kills brainay cells leading to brain damage, most commonly Alzheimer’s disease (which was also found in the four brains).

The image on the right shows brains and microscopic sections of: a brain with no tau protein deposition and no clinical condition (far left), a brain with a large amount of tau protein deposition (middle), and a brain with severe deposition of the protein belonging to a patient with severe dementia (right).

But how does this relate to football? Repeated heading of the ball and other head impacts are thought to have caused the CTE present in the four males which were examined. The Professional Football Association have set to ban children under the age of 10 in America from heading the ball, due to fears of brain damage.

Although the research shows health risks associated with playing football at a high level, there is opposing evidence which shows footballers  have lower risks of cardiovascular disease, and will live longer lives. It is also unlikely that the injuries which come from recreational football will cause long term problems like professional football possibly can. Moreover In addition to the signs of CTE in the four men, the autopsy also showed blood vessel damage (a cause of dementia), meaning that professional football playing was not the only contributing factor to the brain injury.