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Newsletter

April 2008

Volume 2, No 4

                    Use The Person That Physicians Rely On - A RN -    

 
Alopecia in Women


 

"Hair is considered one of the most defining aspects of human appearance. Through out history, hair length, style, and color have been used to make statements about virility, sexuality, religion, military status, and more. Alopecia, or hair loss, is a common and distressing problem and is often met with feelings of grief and a lost sense of "self" (Cash et al., 1993). Women with alopecia must not only face the loss of their hair, but they often feel isolated, embarrassed to seek care, and may be frustrated by misdiagnosis or poor treatment options. Clinicians play a key role in providing women with a thorough evaluation, a specific diagnosis, evidence-based treatment options, and counseling.

During our lifetime, each hair follicle undergoes continuous cycles of growth. The rest of hair that is seen is called the hair shaft. That which is below the surface of skin is the follicle. Hair loss can occur due to disturbances of the hair cycle, damage to the hair shaft, or disorders affecting the follicle. A systematic approach to the patient with hair loss will enable the clinician to classify and diagnose the hair problem accurately in the majority of cases. The correct diagnosis is based on a detailed history, physical examination, and in some cases, scalp biopsy and pertinent laboratory tests.

Medical History

The medical history is of utmost importance in identifying the cause of hair loss. A detailed history includes the chief complaint, past medical history, medications (including supplements), allergies, family history, and diet. In a woman, a history of menses, pregnancy, and menopause should also be assessed.

Clinical Examination

 A thorough examination of the hair typically involves an assessment of the patient's global appearance.  What is the texture, color, and length of the hair? These features often modify or alter the appearance of hair thinning and should be documented as part of the exam. Hair distribution over the rest of the body is assessed to see if there is too little or too much hair in other areas. Acne or other signs of virilization are also noted.

Scalp Biopsy

Scalp biopsies can be used to make or confirm a diagnosis of alopecia and can be essential in guiding therapy. A four millimeter punch biopsy which includes subcutaneous fat is needed to ensure sampling of the entire follicular unit and any anagen follicles. Horizontal sections are becoming the method of choice for dermatopathologists as they offer the advantage of evaluating large numbers of follicles simultaneously, determining hair density, etc.

Lab Tests

A careful history can help in directing what laboratory tests to order. A basic evaluation including thyroid stimulating hormone, serum iron, and ferritin may be necessary to exclude thyroid dysfunction and iron deficiency anemia. In women with androgenetic alopecia and virilizing signs such as acne, hirsutism, and/or irregular menses, a basic endocrine panel consisting of free testosterone, prolactin, 17-hydroxy progesterone, and cortisol to rule out hyperandrogen states is advised. In cases of scarring alopecia secondary to discoid lupus erythematous, an antinuclear antibody analysis is warranted. If there is any clinical suspicion of syphilitic alopecia, a rapid plasma reagin test is necessary.

Source:  Medscape Articles

Synthetic Vitamin D Shows Anti-Cancer Effect and No Toxicity in Mice and Rats

Researchers at Rutgers University have developed a form of active vitamin D called Gemini 0097 that dramatically reduced the growth of both ER-positive and ER-negative breast cancer cells and showed no toxicity in rats and mice. Dr. Nanjoo Suh presented the results of her team's study at AACR yesterday.

The active form of vitamin D is a hormone synthesized by the skin, liver, and kidneys from dietary precursors. Epidemiological studies have shown that people deficient in active vitamin D have a higher risk of colorectal, breast, prostate, and other cancers.

However, high doses of vitamin D in its active form can cause an imbalance in other electrolytes, including toxic levels of calcium in the blood. For this reason, researchers have been testing analogs of vitamin D, chemically modified forms of the vitamin that have a slightly different molecular structure.

Investigators found that while rates of invasive breast cancer decreased significantly for Caucasian women by the end of 2003, the incidence rates did not change significantly for African American, American Indian/Alaskan Native, or Asian American/Pacific Islander women.

 "This racial disparity is consistent with the hypothesis that discontinuation of hormone replacement therapy (HRT) may have caused the dramatic reduction," stated the authors in their abstract presented at AACR.

African Americans are less likely to develop breast cancers that are receptive to estrogen Dr. Huo explained, so they were harmed less by taking hormones and benefited less by discontinuing them.

Source:  National Cancer Institute

http://www.cancer.gov/ncicancer
bulletin/NCI_Cancer_Bulletin_
041508/page5#c

      
 

FDA MedWatch- Herbal Science International, Inc. Recalls Dietary Herbal Supplements Because They May Present A Serious Health Hazard To Consumers‏

Herbal Science International, Inc. and FDA informed consumers and healthcare professionals of a nationwide recall of twelve dietary supplements that contain ephedra, aristolochic acid or human placenta because they may present a serious health hazard to consumers. FDA has long regarded dietary supplements containing ephedra, a botanical that contains ephedrine alkaloids, as a potential health hazards because the alkaloid raises blood pressure and otherwise stress the circulatory system. These effects are linked to adverse health effects like heart attacks and stroke. FDA issued a rule in February 2004 prohibiting the sale of dietary supplements containing ephedrine alkaloids because they present an unreasonable risk of illness or injury.

Two of the recalled products contain aristolochic acid which is a potent carcinogen and nephrotoxin. This chemical can cause serious kidney damage and has been associated with several occurrences of kidney failure. The twelfth recalled product contains human placenta, an ingredient which may transmit disease. Dietary supplements that contain human placenta may not be lawfully marketed in the United States. No illnesses have been reported in connection with the recalled products and distribution of all of the products has ceased. Consumers should immediately discontinue use of the recalled products and return the product(s) to their place of purchase.

Source:  The Food and Drug Administration.

 

 
Total Body Formula, Total Body Mega Formula Found to Contain Hazardous Levels of Selenium‏

The FDA notified healthcare professionals and patients that it has found hazardous levels of selenium in samples of certain flavors of the dietary supplement products "Total Body Formula" and "Total Body Mega Formula." Analyses of samples by FDA have found most of the samples contain extremely high levels of selenium -- up to 200 times the amount of selenium indicated on the labels of the products. The FDA has received 43 reports of persons from nine states who experienced serious adverse reactions using these products. The adverse reactions generally occurred after five to 10 days of daily ingestion of the product, and included significant hair loss, muscle cramps, diarrhea, joint pain, deformed fingernails, and fatigue. Consumers should stop taking the products and consult their healthcare professional if they experience any adverse events associated with the use of the products.

Source:  F.D.A.

Peripheral Artery Disease

The most common symptoms of PAD are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.

The pain of PAD usually goes away when you stop exercising, although this may take a few minutes. When muscles are being used, they need more blood flow. That means if there’s a blockage due to plaque buildup, the muscles won’t get enough blood during exercise to meet their needs. That’s what causes the pain, which is called “intermittent claudication”. The term comes from the Latin word meaning “to limp.”

 Many people with PAD have no symptoms or mistake their symptoms for something else. 

 Symptoms of Severe PAD are:

1.  Leg pain that doesn't go away when you stop exercising.
2.  Foot or toe wounds that won't heal or heal very slowly.
3.  Gangrene.
4.  A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body.

Many people dismiss leg pain as a normal sign of aging. You may think it’s arthritis or sciatica or just “stiffness” from getting older. PAD leg pain occurs in the muscles, not the joints. Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you're having any kind of recurring pain, talk to your healthcare professional and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your healthcare professional about PAD even if you aren't having symptoms.

Risk Factors for PAD

 Certain risk factors for PAD can't be controlled, such as aging or having a personal or family history of PAD, cardiovascular disease or stroke. However, you can control many risk factors including:

1.  Cigarette Smoking
2.  Obesity
3.  Diabetes Mellitus
4.  Physical Inactivity
5.  High Blood Cholesterol
6.  High Blood Pressure

Treatments
 1.  Diet
2.  Exercise
3.  Smoking Cessation
4.  Medications
5.  Procedures such as stent
     placement , angioplasty
     and clot removal treatment.

Source:  American Heart Association