Blood Tests Archives - Bill Chesnut MD

Adult HPV Vaccine Age, Guidelines

“The HPV vaccine is having a significant effect of decreasing cervical cancer. More recently HPV is associated with oral cancer and anal cancer.

HPV goes through latex And many of other sexually transmitted diseases do not. Many adults don’t know that the “safe sex” procedures they use may not work with HPV.

This recent review of this CDC information says that the vaccine has a low side effect rate in adults. The CDC data is established up to age 26. The CDC cannot recommend the vaccines for older adults. Adults older than 26 years who are sexually active should examine this data and balance that with their HPV risks.

Gardasil 9 has the broadest range of efficacy. The Prevents infection by 9 different types of HPV virus. These 9 types account for 90% of cervical cancers.” Bill Chesnut M.D.

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· Why Adults Should Get the HPV Vaccine
· When Should Adults Get the HPV Vaccine?
· Are There Any Adults Who Should Not Receive the HPV Vaccine?
· What Are the HPV Vaccine Ingredients?
· What Are the Risks and Side Effects of the HPV Vaccine?
Human papillomavirus (HPV) is the virus that causes cervical cancer in women and genital warts in men and women. The HPV vaccine effectively prevents infection with the HPV types responsible for most cervical cancers and can also prevent genital warts. HPV vaccination is most effective during childhood or adolescence, but adults can also benefit from the HPV vaccine.

Why Adults Should Get the HPV Vaccine

HPV infection is extremely common; most sexually active people will be infected with HPV at some point in life. HPV infection usually causes no symptoms, but can cause genital warts and anal cancer in both women and men. HPV can also cause throat cancer.

In women, HPV infection can cause cells in the cervix to grow abnormally. In a small fraction of women, these HPV-induced changes will develop into cervical cancer. About 12,000 women are diagnosed with cervical cancer each year and about 4,000 women die from the condition.

The HPV vaccine prevents infection by the HPV types responsible for most cervical cancers. There are three available forms of the HPV vaccine:

Cervarix: Prevents infection by HPV-16 and HPV-18. These two HPV types cause 70% of all cervical cancers. It is used for the prevention of cervical cancer and precancers.
Gardasil: Prevents infection by HPV-16, HPV-18, and also HPV-6 and HPV-11, the two HPV types that cause 90% of genital warts. It is used to prevent cancers and precancers of the cervix, vulva, vagina, anus, penis, and throat.
Gardasil 9: Prevents infection by the same HPV types as Gardasil, plus HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58. Collectively, these types are implicated in 90% of cervical cancers.
All HPV vaccines are extremely effective at preventing infection by the HPV types they cover. Getting the HPV vaccine reduces a woman’s risk of cervical cancer and precancerous growths substantially. Men cannot develop cervical cancer, but the HPV vaccine may prevent genital warts, anal cancer, and the spread of HPV to sexual partners. Gardasiland, Gardasil 9 are approved for males ages 9 through 26.

The HPV vaccine does not treat or cure an HPV infection in women or men who are already infected by one of these HPV types.

When Should Adults Get the HPV Vaccine?

The CDC recommends that all women ages 26 years and younger receive three doses of the HPV vaccine. The CDC recommends that all men ages 21 years and younger receive three doses of the HPV vaccine. It is an option for all men, but is recommended for men who have sex with men or who have a compromised immune system (including HIV) who are ages 26 and younger.

CDC guidelines recommend the three doses of the HPV vaccine should be given as follows:

First dose: ideally at ages 11 or 12
Second dose: one to two months after the first dose
Third dose: six months after the first dose
Some adults may have received doses of the HPV vaccine in childhood or adolescence. All three doses should be given to get the most protection from HPV infection. Re-vaccination in adulthood is recommended if the vaccination schedule was not completed.

Are There Any Adults Who Should Not Receive the HPV Vaccine?

Certain people should not get the HPV vaccine or should wait before getting it:

Anyone who has had a life-threatening allergic reaction to a previous dose of the HPV vaccine
Anyone who has had a previous life-threatening allergic reaction to an ingredient in the HPV vaccine
Pregnant women
Anyone with a moderate or severe illness; people who feel mildly ill may still receive the HPV vaccine.
The HPV vaccine is not known to be harmful to pregnant women or their babies. However, until more information is known, pregnant women are advised not to receive the HPV vaccine. Women who are breastfeeding can safely receive the HPV vaccine.

The HPV vaccine’s safety and effectiveness have not yet been studied in adults older than age 26. Until that information is available, the HPV vaccine is not recommended for adults older than age 26.

What Are the HPV Vaccine Ingredients?

The HPV vaccine contains no viruses and is not made from human papillomavirus. The active ingredients in the HPV vaccine are proteins that are similar to those found in the human papillomavirus. Genetically modified bacteria produce the proteins, which are then purified and mixed into a sterile, water-based solution.

What Are the Risks and Side Effects of the HPV Vaccine?

In clinical trials and in real-world use, the HPV vaccine appears to be very safe. More than 40 million doses of the vaccine — mostly Gardasil, which was approved in 2006 — have been given in the U.S. Cervarix was approved in 2009 and Gardasil 9 was approved in 2014.

From 2006 to 2014, there were about 25,000 reports to the government of HPV vaccine side effects. Over 90% of these were classified as nonserious. The most common side effects of the HPV vaccine are minor:

About one in 10 people will have a mild fever after the injection.
About one person in 30 will get itching at the injection site.
About one in 60 people will experience a moderate fever.
These symptoms go away quickly without treatment. Other mild-to-moderate side effects resulting from the HPV vaccine include:

Nausea
Fainting
Headache
Arm pain

Severe side effects, or adverse events, are uncommonly reported and have included:

Blood clots
Seizures
Guillain-Barre syndrome
Chronic inflammatory demyelinating polyneuropathy
Systemic exertion intolerance disease (formerly called chronic fatigue syndrome)
Death
Government, academic, and other public health investigators could not identify the HPV vaccine as the cause of any severe adverse event. There were 117 deaths as of September 2015, none of which could be directly tied to the HPV vaccine. The conclusion of public health investigators was that the HPV vaccine was unlikely to be the cause of these events. Such events occur at a certain rate in any group of tens of millions of people. The vaccination before each adverse event seemed to be a simple coincidence.

Low AMH hormone levels predict faster bone loss

“The antimullerian hormone is a simple blood test that measures ovary function. This discovery shows the connection of hormone deprivation at menopause and major bone loss in women. I have posted extensively elsewhere on this site about post-menopausal deprivation being associated with a major bone loss between menopause and age 60. There is increasing evidence for hormone replacement hormone therapy to increase this bone loss.” Bill Chesnut, MD.

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Low AMH hormone levels predict faster bone loss. AMA News 5.12.16

Lower levels of a hormone produced by the ovaries is associated with a woman’s risk for bone loss during menopause, according to a recent study. Researchers at the University of California Los Angeles found testing levels of anti-mullerian hormone in women who are pre- or early-menopausal shows their likely rate for bone loss, suggesting early intervention may be possible to slow or prevent the condition. Anti-mullerian hormone is produced by cells in the ovarian follicles and is a marker for ovarian health, which the new study linked to decline in bone density of the spine and femur, researchers said in a press release. Bone strength in older ages and the ability to avoid devastating hip and spine fractures depend equally on peak bone mass achieved in young adulthood and the amount of bone lost during and after the menopause transition, Dr. Arun Karlamangla, a professor at UCLA, said in a press release in April, when the study was presented at the Endocrine Society’s 2016 annual conference. For the study, which was published on the society’s website ahead of the conference, researchers analyzed data for 474 women in the Study of Women’s Health Across The Nation who were between 42 and 52 years old, in pre- or early-perimenopause, had an intact uterus with at least one ovary and were not taking supplemental hormones. The researchers found that each fourfold decrease in anti-mullerian hormone was linked to a 0.15 percent faster decline in bone density of the spine and a 0.13 percent per year faster decline in density of the top of the femur, the femoral neck. The same decrease in the hormone was also linked to an 18 percent increase in odds of faster-than-average decline in bone density of the spine and 17 percent increase in odds for decline of the femoral neck. The researchers suggest early intervention — with treatments including increasing exercise or calcium and vitamin D intake — could help stave off bone loss for women at higher risk during menopause. This study’s findings open up the possibility of identifying the women who are going to lose the most bone mass during the transition and targeting them before they have lost a substantial amount of bone mass, Karlamangla said. .

Anti-smoking medications may not increase risk of mental health disorders

“This finding of no connection between Wellbutrin and its cousin Chantix and new mental health issues makes sense. Wellbutrin has been used a long time with fewer side effects than originally expected. It is available as a generic a lower costs. If you know a smoker, pass the good word along.” Bill Chesnut, MD

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Anti-smoking medications may not increase risk of mental health disorders

The AP (4/23, Johnson) reported, “Seven years after US regulators slapped their strictest warning on two popular smoking-cessation medicines citing risks of suicidal behavior, a large international study found no such risk.”

According to HealthDay (4/23, Preidt), a new, FDA-requested, 8,000-participant study published online April 22 in The Lancet suggests anti-smoking medications Chantix (varenicline) and Wellbutrin (bupropion) “don’t appear to raise the risk of serious mental health disorders such as depression, anxiety and suicidal thoughts.” An accompanying editorial observed the study shows “neuropsychiatric adverse events occurring during smoking cessation are independent of the medication used.”

AMA news _4.25.16

Insufficient maternal D3 during pregnancy may increase the risk of MS in offspring.

“Know your Vitamin D3 total blood test level! Don’t assume it is normal only because you live a normal life. My view is that every adult should have one “screening” blood test of their Vitamin D3. Its easy, cheap and risk free to correct. The Mayo Clinic in their wellness division thinks there patients do best if there Vit D3 test (250hydroxy Vitmain D3 total) is around 5- ng/dl. I have seen many orthopedic problems resolve when correcting a Vitamin D deficiency.” Bill Chesnut, MD.

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JAMA NEUROLOGY

Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort _ Original Investigation | March 07, 2016 Kassandra L. Munger, ScD¹; Julia Åivo, MD²; Kira Hongell, MD²; Merja Soilu-Hänninen, MD²; Heljä-Marja Surcel, PhD³; Alberto Ascherio, MD, DrPH^1,4

Importance Vitamin D has been associated with a decreased risk of multiple sclerosis (MS) in adulthood; however, some, but not all, previous studies have suggested that in utero vitamin D exposure may be a risk factor for MS later in life.

Objective To examine whether serum 25-hydroxyvitamin D (25[OH]D) levels in early pregnancy are associated with risk of MS in offspring.

Design, Setting, and Participants Prospective, nested case-control study in the Finnish Maternity Cohort conducted in May 2011. We identified 193 individuals with a diagnosis of MS before December 31, 2009, whose mothers are in the Finnish Maternity Cohort and had an available serum sample from the pregnancy with the affected child. We matched 176 cases with 326 controls on region of birth in Finland, date of maternal serum sample collection, date of mother’s birth, and date of child’s birth.

Main Outcomes and Measures Maternal serum 25(OH)D levels were measured using a chemiluminescence assay. The risk of MS among offspring and association with maternal 25(OH)D levels were the main outcomes. Conditional logistic regression was used and further adjusted for sex of the child, gestational age at the time of sample collection, and season of sample collection to estimate the relative risks and 95% CIs.

Results Of the 193 cases in the study, 163 were female. Of the 331 controls in the study, 218 were female. Seventy percent of serum samples were collected during the first trimester of pregnancy. The mean (SD) maternal vitamin D levels were in the insufficient vitamin D range, but higher in maternal control than case samples (15.02 [6.41] ng/mL vs 13.86 [5.49] ng/mL [to convert to nanomoles per liter, multiply by 2.496]). Maternal vitamin D deficiency (25[OH]D levels <12.02 ng/mL) during early pregnancy was associated with a nearly 2-fold increased risk of MS in the offspring (relative risk, 1.90; 95% CI, 1.20-3.01; P = .006) compared with women who did not have deficient 25(OH)D levels. There was no statistically significant association between the risk of MS and increasing serum 25(OH)D levels (P = .12).

Conclusions and Relevance Insufficient maternal 25(OH)D during pregnancy may increase the risk of MS in offspring.

Neanderthal DNA may predispose some people to nicotine addiction, mood disorders

“This is a study of 28,000 people by evolutionary geneticists. It helps understand that some of the maladies we have some from “bad code.” The original study is here for more details: http://science.sciencemag.org/content/351/6274/737.full .” Bill Chesnut, MD

Nicotine addiction and mood disorders associated with Neanderthal Genes. “Neanderthal DNA may predispose some people to nicotine addiction, mood disorders.”

The Washington Post (2/11, Nutt) reports in “Speaking of Science” that the “first-ever study directly comparing Neanderthal DNA to the human genome confirmed a wide range of health-related associations.” Lead author John Capra, PhD, an evolutionary geneticist at Vanderbilt University, said, “Our main finding is that Neanderthal DNA does influence clinical traits in modern humans.” The article explains that “snippets of Neanderthal DNA contribute to the contemporary risk for myriad ills, including heart attack, nicotine addiction, and mood disorders as well as incontinence, foot calluses and precancerous skin lesions.”

The Wall Street Journal (2/11, Long, Subscription Publication) reports that to arrive at these conclusions, the researchers compared electronic health records from 28,000 people of European ancestry with genomes from fossilized Neanderthal bones. The study was published online in the journal Science.

Study offers clues to genetic abnormality of C4 genes associated with schizophrenia

“The January 2016 AMA newsletter reports DNA testing showing an abnormality of the C4 genes associated with a much higher incidence of schizophrenia. Other recent publications report improvements in schizophrenia if treatment began early and involve the family.” Bill Chesnut, MD

Study offers clues to biology behind schizophrenia

On its front page, the New York Times (1/27, A1, Carey, Subscription Publication) reports that a new study published online Jan. 27 in Nature takes “a significant step toward understanding the cause of schizophrenia,” providing “the first rigorously tested insight into the biology behind any common psychiatric disorder.”

In “Science Now,” the Los Angeles Times (1/27, Healy) reports, “After conducting genetic tests on nearly 65,000 people, the scientists followed a trail of clues to a group of genes in the” major histocompatibility complex (MHC) “called C4 genes.” Investigators “found that people with certain variants of C4 genes had unusually high odds of developing schizophrenia, even in the absence of other genetic risks.” By demonstrating “a link between C4 and synaptic pruning,” the study “builds on theories that the over-editing of brain connections in late adolescence might be ‘a contributing cause’ of schizophrenia.”

The Washington Post (1/27, Nutt) reports in “Speaking of Science” that in people “with schizophrenia, a variation in a single position in the DNA sequence marks too many synapses for removal and that pruning goes out of control,” resulting in “an abnormal loss of gray matter.” According to the Post, the “study offers a new approach to schizophrenia research, which has been largely stagnant for decades.”

AMA News 1.28.16

US cholesterol levels continue to decline

“Good news! We are getting better. Congratulations everybody!” Bill Chesnut, MD

US cholesterol levels continue to decline, CDC reports

The Columbus (OH) Dispatch (12/2, Crane) reports that “Americans’ collective cholesterol levels have continued to dip, reaching a 15-year low in 2013 and 2014, a development likely brought on in large part by an increased use of statins.” The data, from the CDC, indicate “that 11 percent of U.S. residents had high total cholesterol in that two-year period, down from nearly 13 percent in 2011-12.”

TIME (12/2) points out that “changes to guidelines for prescribing statins by the American Heart Association and the American College of Cardiology” two years ago “led to a dramatic expansion of who is prescribed the” medications.

HealthDay (12/2, Reinberg) reports that “lead researcher Margaret Carroll, a survey statistician at CDC’s National Center for Health Statistics (NCHS), speculated that more people are having their cholesterol checked and are being treated.”

AMA News, December, 2015.

Who should use statins?

“Statins are even more important than previously thought. More people qualify for them. They have side effects, including muscle cramps. Know the side effects you might have while you take these marvelous health aides.” Bill Chesnut, MD

USPSTF releases draft recommendation on who should use statins

The AP (12/22, Neergaard) reports that the US Preventive Services Task Force (USPSTF) has issued a draft recommendation on “who qualifies for cholesterol-lowering stains.” In the new “draft guidelines” released Dec. 21 for public comment, the USPSTF “says the…medications will be of most benefit to some people ages 40 to 75 whose risk of cardiovascular disease over the next decade is at least 10 percent.” According to the AP, the task force recommendations “are similar to…2013 guidelines from the American Heart Association and American College of Cardiology.”

TIME (12/22, Park) reports that physicians can assess patients’ “10-year risk by plugging certain information into a web-based calculator formulated by the” AHA and ACC. Two years ago, “the two groups debuted” a “revised algorithm, along with their recommendation that people with a 7.5% or greater risk of heart events in the next 10 years consider taking a statin to reduce that risk.” The USPSTF, however, “concluded that people with a 10% or greater risk of heart problems in the next 10 years, based on the 2013 AHA-ACC calculator, and who have diabetes, high cholesterol, high blood pressure or who smoke, can lower their risk of having a heart attack or stroke by a ‘moderate amount’ by taking a statin.”

HealthDay (12/22, Thompson) reports that the “panel added that people with a 10-year risk of heart attack and stroke between 7.5 percent and 10 percent might also benefit from statins, and should discuss the matter with their” physician.

New blood test improves prostate cancer screening

“This report is from a European medical news source. I include it here because the research is done at the Karolinska Institute in Sweden. This prestigious organization has been at the forefront of many medical discoveries for at least 50 years. I included the URL below so you can read the original report and research further. Detection of prostate cancer aggressiveness is a core area of research for many reasons. One reason is so we don’t over-treat prostate malignancies that are not aggressive and not life threatening. If you have a prostate and are at least middle-aged, keep up with this new information.”
Bill Chesnut, MD.

New blood test improves prostate cancer screening

http://www.euronews.com/2015/11/12/new-blood-test-improves-prostate-cancer-screening/

Researchers from the Karolinska Institutet in Sweden have developed a new blood test for prostate cancer, which they claim is more reliable and better at detecting aggressive cancer than PSA, the test usually performed.

According to the scientists, the new test, which has been tried on some 60,000 men, detects aggressive cancer earlier and reduces the number of false positives and unnecessary biopsies.

Hans Gustafson took part in the trial, and the blood test changed his life — he received treatment on time and is now healthy: “This test meant a better and longer life for me. I can also enjoy seeing my grand-children grow up. That’s something I’m very happy about,” he said.

Current testing for prostate cancer relies on measuring blood levels of a protein called prostate specific antigen (PSA). But this can be unreliable, resulting in some men having unnecessary biopsies and can lead to men being diagnosed and treated for harmless forms of cancer.

To develop a more accurate test, the Swedish scientists combined PSA measurement with the analysis of some 200 genetic markers as well as clinical data such as age, family history and previous prostate biopsies. Their findings were published in the scientific journal The Lancet Oncology)00361-7/abstract.

Second most common cancer

“There’s huge interest abroad and we’ve been in contact with several countries, the U.S, Britain, Norway and Denmark. They’re prepared to start trying it (the test) as early as next year,” said Henrik Grönberg, professor of cancer epidemiology at Karolinska Institutet.

More than 1 million men worldwide are diagnosed with prostate cancer each year. After lung cancer, it’s the second most common form of the disease in men.

As they grow older the numbers are rising quickly and it’s estimated that within 20 years, the global burden of prostate cancer “will have doubled”: http://www.nature.com/pcan/journal/v18/n3/full/pcan20159a.html#bib2 to more than 2 million cases.

Scientists hope the new test will improve detection and allow earlier treatment.

Association of Seafood Consumption, Brain Mercury Level, and APOE ε4 Status With Brain Neuropathology in Older Adults

“About the safety of eating seafood: Seafood consumption has been a concern because of the increased levels of mercury in fish. This study shows that moderate intake of seafood may produce a decreased chance of developing Alzheimer’s disease.”

The best way to absorb the several findings of this critical study is this YouTube video by one of the authors at Rush Medical Center in Chicago and published in the Journal of the American Medical Association Network. First rate research. https://www.youtube.com/watch?v=m9MncHHHXpA .” Bill Chesnut, MD

Martha Clare Morris, ScD¹; John Brockman, PhD²; Julie A. Schneider, MD, MPH^3,4,5; Yamin Wang, PhD¹; David A. Bennett, MD^3,4; Christy C. Tangney, PhD⁶; Ondine van de Rest, PhD⁷

JAMA. 2016;315(5):489-497. doi:10.1001/jama.2015.19451.

Importance Seafood consumption is promoted for its many health benefits even though its contamination by mercury, a known neurotoxin, is a growing concern.

Objective To determine whether seafood consumption is correlated with increased brain mercury levels and also whether seafood consumption or brain mercury levels are correlated with brain neuropathologies.

Design, Setting, and Participants Cross-sectional analyses of deceased participants in the Memory and Aging Project clinical neuropathological cohort study, 2004-2013. Participants resided in Chicago retirement communities and subsidized housing. The study included 286 autopsied brains of 554 deceased participants (51.6%). The mean (SD) age at death was 89.9 (6.1) years, 67% (193) were women, and the mean (SD) educational attainment was 14.6 (2.7) years.

Exposures Seafood intake was first measured by a food frequency questionnaire at a mean of 4.5 years before death.

Main Outcomes and Measures Dementia-related pathologies assessed were Alzheimer disease, Lewy bodies, and the number of macroinfarcts and microinfarcts. Dietary consumption of seafood and n-3 fatty acids was annually assessed by a food frequency questionnaire in the years before death. Tissue concentrations of mercury and selenium were measured using instrumental neutron activation analyses.

Results Among the 286 autopsied brains of 544 participants, brain mercury levels were positively correlated with the number of seafood meals consumed per week (ρ = 0.16; P = .02). In models adjusted for age, sex, education, and total energy intake, seafood consumption (≥ 1 meal[s]/week) was significantly correlated with less Alzheimer disease pathology including lower density of neuritic plaques (β = −0.69 score units [95% CI, −1.34 to −0.04]), less severe and widespread neurofibrillary tangles (β = −0.77 score units [95% CI, −1.52 to −0.02]), and lower neuropathologically defined Alzheimer disease (β = −0.53 score units [95% CI, −0.96 to −0.10]) but only among apolipoprotein E (APOE ε4) carriers. Higher intake levels of α-linolenic acid (18:3 n-3) were correlated with lower odds of cerebral macroinfarctions (odds ratio for tertiles 3 vs 1, 0.51 [95% CI, 0.27 to 0.94]). Fish oil supplementation had no statistically significant correlation with any neuropathologic marker. Higher brain concentrations of mercury were not significantly correlated with increased levels of brain neuropathology.

Conclusions and Relevance In cross-sectional analyses, moderate seafood consumption was correlated with lesser Alzheimer disease neuropathology. Although seafood consumption was also correlated with higher brain levels of mercury, these levels were not correlated with brain neuropathology.