Drug for weight loss without diet, exercise

Have you heard about Adipotide?  Daily injections of this drug for 4-6 weeks caused 3 different species of primates to shed an average of 11% of their body weight (Barnhart et al.).  Insulin resistance (a condition which leads to diabetes) was also improved after treatment.  Can adipotide help us lose weight without diet or exercise??

Adipotide was originally developed as a cancer therapy.  It targets the protein prohibitin, destroying blood vessels that supply fat tissue, forcing the fat to be metabolized.

The drug can cause dehydration, mineral depletion and kidney lesions- although these effects subside if treatment is stopped.  The other unfortunate news: the primates began to regain weight 4 weeks post-treatment.  And, the drug appears to work only in obese subjects.

Ignore the media frenzy.  Much more research is needed before these findings can be applied to humans. Caution should be applied when expecting adipotide to be the next miracle obesity cure.

 

High cholesterol one source of infertility in men

A study published in the open access journal PLoS One this week suggests high dietary cholesterol may contribute to reduced sperm viability and motility in men.  Ouvrier et al. found that mice with lipid processing disorders fed diets high in cholesterol had significantly less fertilizing potential than mice on a lower cholesterol diet.  These data may translate to men with dyslipidemia or older men attempting to conceive.

New standard for PCOS diagnosis

PCOS may be over-diagnosed by new, more sensitive ultrasounds.

A new study by French researchers suggest the diagnoses for polycystic ovary syndrome (PCOS) may be outdated.  The old criterion: more than 12 follicles per ovary, detected with ultrasound, may no longer be valid given new tools.  In their study of 240 women, Dewailly et al. found that a serum anti-Mullerian hormone (AMH) level of more than 5 ng/ml is much more predictive of polycystic ovary morphology than even a follicle number of greater than 19.

This new tool  is less expensive to perform and would be available to a greater variety of women seeking diagnosis for infertility or mentrual disorders.

Do ultrasounds misdiagnose viable pregnancies as miscarriages?

Early ultrasounds have been used to detect pregnancy viability for the last 20 years.  Now shocking research published by Jeve et al. suggests many pregnancies diagnosed as miscarriages using ultrasonography may be misdiagnosed- leading to the early termination of wanted, viable pregnancies.

When miscarriage is suspected, current practice involves an early ultrasound.  Several measurements are used to diagnose miscarriage, which Jeve et al. argue are outdated.  The size of the gestational sac, embryo crown to rump length and cardiac activity are all measured by an initial and a follow up ultrasound (within 7-10 days).  However, variability in measurements and imprecision of instrumentation/ sonographers can lead to misdiagnosis.

The researchers found that even the most precise measurements: empty gestational sac with a diameter larger than 25 mm and absent yolk sac with mean gestational sac diameter ≥ 20 mm, may misdiagnose miscarriage in 4 out of every 100 cases.

The only conclusive criterion to diagnose miscarriage is the spontaneous expulsion of pregnancy tissue.  The researchers highlight the need for the development of new standards of miscarriage diagnosis by ultrasound in early pregnancy.  A zero false positive rate should be the goal.

Have researchers discovered the key for successful implantation in pregnancy?

Implantation is vital for a successful pregnancy.  Yet the factors that govern this complex process have remained mysterious to researchers, doctors and patients.

Now a team from the UK may have discovered a key protein involved in implantation.

After sperm fertilizes egg, the growing embryo must travel from the mother’s fallopian tube and embed itself in the wall of the uterus.  This is a complex process, as the tissue lining the uterus must be ‘receptive’ to the embryonic tissue, which is seen as ‘foreign’ and could be attacked by the immune system.  SGK1 is a protein expressed by the uterine lining.  It’s involved in sodium transport and cell proliferation, both necessary for implantation (specifically, for the process of decidualization).  Salker et al. found that SGK1 is expressed differently in women who are infertile and women who experience repeat miscarriages, versus fertile women.

Infertile women have significantly higher levels of SGK1 compared to fertile women.  Women with repeated miscarriages have significantly lower SGK1 levels compared to fertile women.  This relationship is preserved in mice- mice lacking SGK1 altogether have a high spontaneous embryo loss whereas mice with a high expression of SGK1 have fewer uterine implantation sites.

A delicate balance of SGK1 is required to allow for an embryo to contact uterine cells AND to allow for continued growth of the embryo and maternal tissues.  The discovery of SGK1 expression may lead to future treatments of women with unexplained fertility and recurring pregnancy loss.

Do women with PCOS have riskier pregnancies?

Polycystic ovary syndrome (PCOS) affects 5-15% of women of childbearing age.  The cause of PCOS is unknown and many women with this syndrome require assistance to become pregnant.

A team of Swedish researchers led by Nathalie Roos tracked 3,787 births by women with PCOS and 1,191,336 births by women without PCOS.  Women with PCOS were more likely to experience pre-eclampsia (adjusted odds ratio: 1.45) and their risk for gestational diabetes was more than doubled (aOR: 2.32). Babies born to women with PCOS had a higher incidence of low APGAR scores at 5 min (aOR: 1.41) and were more likely to be premature (aOR: 1.58).

However, women with PCOS were more likely to have conceived through assisted reproductive technology (ART) (13.7% v 1.5% of women without PCOS) and had a higher prevalence of being overweight (60.6% v 34.8%).  This is important information to consider, as ART and body mass index can be important predictors of pregnancy complications.

It is interesting to note that cesarean section birth was higher in women who experienced PCOS (22.44% vs 14.68%).  Consider what the percentage is of women with PCOS undergoing cesarean section in the United States- where the c section rate regardless of maternal health status approaches 30%.

What can be done to better manage the pregnancies of women with PCOS?  How can pregnant women with PCOS promote their own health?

Eating sweets during pregnancy makes for fat babies?

Sugar intake during early pregnancy may have lasting effects on children’s weight.

In a study presented at the Obesity 2011 Conference this week, Phelan et al. report that excessive sugar and fat intake in the first 13 weeks in pregnancy may result in larger infants.  Women who consumed the highest amount of fast food and whose daily caloric intake was more than 20% “sweets” in early pregnancy were at significantly higher risk of having macrosomic babies at birth.  Interestingly, these babies were still high weight-for-age infants at six months.

The findings of this study must be qualified, however.  The women studied were all classified as “overweight” or “obese” at the onset of the study.  The researchers did not study a similar group of women who were not overweight, but had similar diets.  The role of genetics should be considered in infant size.  As well, the researchers did not report on what differences, if any, existed between breastfed and non-breastfed infants.

Pregnant women should eat as healthfully as possible.  An open dialogue should be encouraged between mothers and maternity practitioners to encourage a healthy diet for mother and child.

A new non-invasive test for male factor infertility developed

Proteins in seminal fluid may identify infertility in men.  A new non-invasive and cost effective procedure developed by Drabovich et al. may be the future of diagnosing and treating azoopermia (absence of sperm in the semen).

Drabovich and her colleagues found that the semen of men after vasectomy or with azoospermia had altered levels of proteins compared to men with normal semen parameters.  In fact, 20 proteins were significantly altered in men without sperm in their semen.

Interestingly, the Leydig (testosterone producing) cell protein SPAG11B is abundant in normal and azoospermatic men while the Sertoli (sperm supporting) cell protein TEX101 is significantly decreased in post-vasectomy and azoospermatic men.  Thus Sertoli cell dysfunction may be one cause of azoopermia.

While more work is needed to fully characterize effected proteins, this method- coined “Multiplex selected reaction monitoring assay”- will be important for the future treatment and diagnosis of many types of male factor infertility.

 

 

Yaz, Yasmin and risk of deep vein thrombosis

You may have heard that women taking Yaz or Yasmin birth control pills are at a higher risk for blood clots than other women. Should you be worried?

Yaz and Yasmin contain drospirenone, a synthetic form of the hormone progesterone. This drug works by preventing ovulation, making cervical mucus unfriendly to sperm and keeping the uterine lining thin to prevent implantation of an embryo.

Four studies cited by the FDA since 2009 have reported that women who take drospirenone are at higher risk for deep vein thrombosis, a life threatening blood clot disorder, than women who take birth controls containing levonogestrel (another synthetic progesterone).

However, the actual risk should be weighted. The risk of blood clots for women taking any oral contraceptive is 6 per 10,000 (0.06%). The risk of blood clots for women taking Yas, Yasmin or other drospirenone birth control is 10 per 10,000 (0.1%).

Women with a family or personal history of blood clots may be at greater risk.  The risk for blood clots while taking oral contraceptives is also increased in women who smoke. Talk to your doctor about your concerns.

 

How will you meet standards of patient satisfaction?

The Centers for Medicare and Medicaid services announced they will withhold 1% of Medicare reimbursements to hospitals that don’t meet standards of patient satisfaction starting in 2013.  This will increase to 2% in 2017. How does your hospital’s value measure up on the HCAHPS survey?

Want to know how your practice compares in a value-based health care purchasing model?  Find out how to improve your performance before you’re affected.