Rare, Medium, or Melanoma

By Tom Secrest

It’s hard to know why it took so long to reach the conclusion announced on 29 July 2009 by the World Health Organization’s International Agency for Research on Cancer (IARC).

If you stop and think about it, a sun bed, or tanning bed, looks a lot like some sort of futuristic device for grilling a very large klobása. Why humans would want to get inside and be bar-b-qued to a golden brown is an interesting social and cultural, question. Perhaps it’s because we believe that once sautéed to perfection, we will look like the models that are used to advertise the tanning beds.

However, the days of being ultravioletly grilled like a kabab may soon be over now that UVA light has made it onto the list of Class (Group) 1 carcinogens. You may recall that sun beds were supposed to be safe since the light bulbs used in sun beds generated more UVA and less UVB light. Vincent Cogliano, PhD, said studies have shown that UVA, UVB, and UVC all cause cancer in animal models and that evidence linking indoor tanning to melanomas was “sufficient and compelling.”

In 2006 the IARC published a report indicating that regular use of sun beds before the age of 30 increased the risk of melanoma by 75%. The group also noted that there has been a change in the character of the melanomas being seen today. The IARC reported that beginning in the early 1990s there has been a significant increase in the number of thicker, more deadly, lesions. Researchers believe that sun beds may have played a major role in both the increase in numbers as well as the change in the character of melanomas. Eleni Linos, MD, DrPh, Stanford University, one of the study co-authors, also noted that there are several studies indicating that tanning is on the increase again, particularly in younger women. The National Institute of Health reported that the number of cases of melanoma among young women tripled between 1973 and 2004. A personal observation, as I looked through Google images for pictures of tanning beds, of the 90 images I viewed, only one featured a male model.

Even before the announcement, Texas lawmakers were considering strengthening legislation that would require anyone under 18 to have a doctor’s permission and be accompanied by a parent in order to use commercial tanning beds. Current Texas law requires children under 18 to have a note of permission from their parent’s, children younger than 16 must be accompanied by a parent, and children under 13 require permission from a doctor.

Naturally there is a tanning bed lobby, who, not surprisingly consider the warnings to be overly alarmist and suggest that like most things, tanning beds, if used properly and in moderation, are safe. As I recall, these comments are strikingly similar to the comments made by the tobacco lobby and the plutonium lobby.

The next time you want something golden brown, consider throwing a steak on the grill and not yourself; there’s nothing wrong with being a whiter shade of pale.

The Lancet Oncology, Aug 2009, A review of human carcinogens – Part D: radiation.

Vocabulary

* medium rare – stredne propecený

* long reach – velký dosah

* tanning – opalující

* recall – pripomenout

* sufficient – dostatecný

* compelling – presvedcivý

* thicker – tlustší, silnejší

* lawmaker – zákonodárce

* considering – vzhledem k, se zretelem na

* strengthening – zesílení, posílení

* require – požadovat (se 4.pádem)

* permission –povolení, svolení

* accompanied – doprovázený

* surprisingly – prekvapive, kupodivu

* strikingly – prekvapive, nápadne

* throwing –házení, vrhání

* shade – odstín, nádech

* pale – bledý

H1N1: Are you at special risk?

Step on a scale and find out.

By Tom Secrest

Question: How do you know if you’re too fat?
Answer: You know you’re too fat if whenever you go to the beach, people rush up and start pouring water over you, while others try to drag you back into the ocean.

As if obesity didn’t present enough health issues by itself, there is now another one to worry about.

The first case of H1N1 in the United States was confirmed on April 15, 2009. By July 10^th the number of confirmed and probable cases had increased to 37,246. Globally the virus has killed almost 500 people, with 211 of those in the U.S. Also on July 10^th directors from all the relevant U.S. health agencies met to strategize for what they expect will be a resurgence of the virus this fall. Current estimates suggest that the resurgence and the availability of the first vaccine will have an uncomfortably close proximity in time, and no one knows for sure which will arrive first, but several things point to the flu. The fall flu season in the U.S. coincides with the beginning of the new school year. Depending on the state, that date can range from August 24 to mid September. The vaccine isn’t scheduled to arrive until the middle of October. If cases begin to appear as predicted, the virus may have at least one month’s head start.

The H1N1 virus is a bit different in that it seems to target younger people, which make schools perfect spreading grounds. However there is another factor that’s going to put both children and their parents at risk. America has been getting fatter and fatter, or to be more politically correct, more and more obese. We often think of young people, even young fat people as being healthy, perhaps not fit, but healthy. The dangers of obesity are generally viewed to come much later in life. However on 11 July, 2009, an advanced report from the CDC hinted that obesity may be emerging as a risk factor for flu complications and death.

The CDC report followed ten H1N1 cases admitted to the University of Michigan Health System hospital intensive care unit between May 26 and June 18, 2009. All 10 cases were severe enough to require the patients to be put on ventilators and six required treatment for acute renal failure. Of the 10 cases, 9 were obese (BMI > 30) and 7 of the 9 were extremely obese (BMI > 40). Of the 10 cases there were 3 deaths. All three deaths involved obese patients and 2 of the 3 were extremely obese. The least obese of the 3 had asthma as an underlying condition and was age 28. The other 2 patients had no underlying medical conditions and were aged 43 and 44. Of the 7 that lived, the report goes to say, none have fully recovered.

The CDC report fell well short of a blanket statement suggesting that obesity is an independent risk factor associated with more severe complications; noting that in previous flu outbreaks, obesity had not be identified as a risk factor. However, in the editorial note the accompanied the report, the CDC observed “the high prevalence of obesity in this case series is striking.”

The same report also suggests that doctors can double the normally prescribed does of Tamiflu (Roche AG) without any additional risks, but stopped short of saying that higher doses should be used in obese patients. Dr. Tim Uyeki, a CDC influenza expert, also noted that, as with H5N1, patients seem to do better when given Tamiflu for periods longer than the recommended five-days.

Current CDC guidance (http://www.cdc.gov/h1n1flu/recommendations.htm#table1) is that adults receive 75 mg, twice a day for 5 days, for treatment or 75 mg, once a day, for prophylaxis. Dosing for children less than 40 kg is weight specific. All ten patients in the above mentioned report received both larger doses of Tamiflu and extended dosing as part of their treatment.

It looks like we now have one more reason to start that diet we have been putting off; and with flu season rapidly approaching, now is as good a time as any to start shedding kilos.

Happy dieting.

The full CDC, July 10, 2009 MMWR Dispatch can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0710a1.htm

Vocabulary

• to pour water (over) – polévat vodou
• to confirm – potvrdit
• to kill – zabíjet
• to expect – očekávat, předpokládat, domnívat se
• resurgence – obnova, oživení
• estimates – odhady
• availability – dostupnost
• uncomfortably – nepohodlně
• proximity – blízkost
• to coincide – shodovat se (časově)
• depending on – v závislosti na
• to spread – rozšiřovat (se)
• to emerge – objevovat se, vynořovat se
• to hint – naznačovat (co)
• underlying – zásadní, výchozí
• recovered – obnovený, zotavený
• to suggest – navrhovat; doporučovat
• outbreak – propuknutí
• accompanied – doprovázený
• striking – pozoruhodný, markantní, překvapivý
• additional – dodatečný, navíc
• dosing – dávkování
• to mention – zmínit, uvést
• reason – důvod, příčina
• approaching – blížící, přibližující
• to shed – shazovat

Music to Soothe the Savage Beast

Music to Soothe the Savage Beast

By Tom Secrest

Everyone has their own particular taste in music. Some like opera, some rock, some jazz, and others like what appears to be random noise played a very high volume, although I think the technical name is hip hop. I only mention the latter because the person who lives in the flat above mine appears to fall into this category.

While my personal physiological reaction to the wall shaking racket coming from above is not what the researchers were talking about in their recent publication in the 30 June, 2009 issue of Circulation, I feel strongly that it should definitely be included in their future research. Working Title: Hip Hop Induced CVA.

Putting my personal issues aside, what the researchers did find was a very positive correlation between music, especially music with distinct dynamics (i.e. crescendos, decrescendos, etc) and heart rate, blood pressure, dermal blood flow, ECGs, and respiration. It might be expected that musicians would be naturally responsive, but the research was carried out on both those with established musical inclinations and those, like me, with no more musical talent than a monkey with a stick. The results, while more pronounced in the musically inclined, were still very much evident in the less musically disposed.

It is generally accepted that music can produce emotional responses, sometimes even strong emotional responses. Music is used by many to relax and reduce stress, while others find certain types of music to be motivational while they exercise at a fitness center. However, Dr. Bernardi and his research group form Pavia University in Italy, took specific steps to minimize the affect of the emotional response variable. Once accounted for, it became clear that, regardless of the perceived emotional response, or lack thereof, there was still a measurable and correlated physiological response to the dynamics of the music.

The current research used subjects between 24 and 26 years old. According to Dr. Bernardi, he next wants to examine the response in older patients, those more than 70. Dr. Bernardi also noted that in the new study, he will include a wider variety of music including rock. Future studies may also include coronary patients with sever functional limitations. In such patients, even modest gains in BP, HR and blood flow could be very significant, noted Dr. Franklin, director of the cardiac rehabilitation laboratories at William Beaumont Hospital, Royal Oak, MI.

Now when you enjoy your favorite piece of music you can relax even more knowing that it is not only good for you psychologically, but good for you physiologically as well. Conversely the next time you are subjected to ear splitting hip hop, consider that you may drop dead from a stroke or your heart may explode in you chest. It's all part of the musical score of life.

Vocabulary

* to soothe – mírnít, uklidnit, utišit

* savage – divoký, neurvalý, krutý

* appears to be – zdá se být

* random – náhodný, libovolný

* shaking – otrásání

* racket – hluk, randál, rámus

* putting aside – zde: nechme stranou

* heart rate (HR) – srdecní frekvence

* distinct – zretelný, presný

* blood pressure (BP) – krevní tlak

* blood flow – tok krve

* established – zavedený, vžitý, tradicní

* pronounced – vyhranený, výrazný

* disposed – mající sklon, disponovaný

* regardless – bez ohledu na, navzdory všemu

* wider – širší

* even modest gains – i malé zvýšení

* conversely – obrácene, naopak

* to split – štepit, pukat, trhat

* to consider – zvažovat, brát v úvahu

* chest – hrud

Live Long and Prosper

Live Long and Prosper

By Tom Secrest

The words in the title are typical words of parting in Vulcan society and were used most famously by Mr. Spock, Vulcan’s best known ambassador. However, if Vulcans had lived in Greece, they might very well have changed it to “Eat a Mediterranean Diet and Prosper,” which, if loosely translated, means about the same thing, but clearly lacks the panache.

In a recent study (24 June 2009, BMJ) the Mediterranean Diet was carefully dissected to reveal which of its rudiments provide the greatest benefits. While much of the information is widely know, and generally accepted, the study put numbers to what heretofore had been accepted wisdom based on anecdotal evidence. In order of contribution: (i) moderate alcohol consumption (23.5%), (ii) less meat (16.6%), (iii) more vegetables (16.2%), (iv) more fruits and nuts (11.2%), (v) olive oil (10.6%), and (vi) more legumes (9.7%). Dr. Dimitrios Trichopoulos (Harvard School of Public Health, Boston, MA) noted that while this study did not evaluate causes of death, previous studies in the same cohort have shown that the Mediterranean diet has the greatest impact on cardiac mortality.

The study also suggests that no one element is likely to have a significant impact. There is some evidence to indicate that sum may be greater than the parts. Although, what was interesting is that the benefits still seem to be present despite the fact that the stereotypical image of Greeks was confirmed by the study. Researchers observed that being overweight or obese was not at all uncommon and smoking, especially among men, was common.

What was a bit unexpected was that more cereal products and reduced diary intake seemed to have little impact on longevity, and interestingly, as it turns out, you can eat fish until you turn into a tuna, but the effects will be negligible.

So thanks to the ‘French paradox,’ we can raise a glass of wine and toast to our health; and after you have finished a sumptuous Mediterranean meal with your friends, enjoyed a moderate amount of alcohol, laughed, joked and sang, and the time has come for fare-thee-wells, boldly say what no man, or woman, has ever said before, “Eat a Mediterranean Diet and Prosper.”

Vocabulary

* however – nicméne, at tak nebo tak

* loosely – približne, volne

* panache – elegance, švih, šmrnc,

* reveal – odhalit

* rudiments – základy, zde: prvky, soucásti

* widely – obecne

* heretofore – až dosud

* anecdotal – neoficiální

* legumes – lušteniny

* element – prvek, složka, faktor

* unexpected – neocšekávaný

* longevity – dlouhovekost

* negligible – zanedbatelný

* sumptuous – nákladný, prepychový

* boldly – bez obalu, odvážne, drze

How to Catch High Blood Pressure

How to Catch High Blood Pressure

By Tom Secrest

The word cytomegalovirus (HCMV or HHV-5), which means ‘big cell virus’ in Greek, may sound a little disquieting, but for most people it produces only a mild infection with minor, virtually insignificant, symptoms. As a member of the Human Herpes family of viruses (HHV-5), it is characterized by its ability to remain latent for years or even decades.

Estimates suggest that 50% to 80% of adults have been infected with this virus. Most people seem to have been infected during childhood. When symptoms do occur, they often take the form of infectious mononucleosis marked by a prolonged, low-grade fever and mild hepatitis.

Generally, serious infections are only associated with those who have compromised immune systems. HCMV is also part of a group called TORCH infections; TORCH being an acronym for Toxoplasmosis; Other diseases (e.g. HIV, Syphilis, Hep. B); Rubella; Cytomegalovirus; and Herpes simplex virus. The diseases in this group can lead to congenital abnormalities if a pregnant woman experiences a primary infection or serious reactivation during pregnancy.

It may be, however, that HCMV is responsible for something else as well. Early studies with mice (reported in the Washington Post, 14 May 2009) suggest that CMV infections, together with high cholesterol diets, may lead to chronic inflammation of blood vessels, which could ultimately result in those vessels becoming less compliant and stiffer. Additionally, CMV-infected mouse and human cells also produced more renin than normal. Either of these factors could play a role in elevated blood pressure.

Therefore, if you are HCMV positive (which, statistically speaking, you are) and have high blood pressure: rather than blaming the Big Mac you had for lunch yesterday or the day before, it might be more accurate to blame the unknown person who, years ago, gave you HCMV and, in the process, high blood pressure as well.

Perhaps science is on the verge of finding an infection-based explanation for heart disease and hypertension but, for now, the jury is still out.

Vocabulary

* blood pressure – krevní tlak

* disquieting – znepokojový, zneklidnující

* insignificant – bezvýznamný, neduležitý, zanedbatelný

* estimate – odhadovat

* seem – pravdepodobne, zdát se

* occur – objevit se,

* pregnant – gravidní

* stiffer – tužší

* blame – dávat vinu, obvinovat

* verge – okraj

Some Like it Hot!

Some Like it Hot!

By Tom Secrest

If you’re a film buff or a Marilyn Monroe fan, then the title of this article brings to mind the film, which is considered by many, or perhaps most, to be the greatest American comedy film of all time. The film is from 1959 and stars Marilyn Monroe, Tony Curtis, and Jack Lemmon.

However, as it turns out, this article has nothing to do with film and to all of Marilyn’s fans, I offer my heartfelt apologies. Instead, this article is about a bit of research (British Medical Journal, March 2009), which emanates from Iran and concerns the dangers of drinking exceedingly hot beverages.

In Iran, black tea is an extremely popular drink, just as it is in many countries around the world. Just like those countries which share Iran’s propensity for hot tea, Iran has a particularly high rate of esophageal cancer, in fact one of the highest in the world. At first blush, there appeared to be a relationship between consumption of the popular refreshment and the occurrence of esophageal cancer; so researchers at Tehran University set out to decipher the riddle of the increased incidence of esophageal cancer among tea drinkers.

As it turns out, it’s not the tea at all, it’s the temperature. The hotter the tea and the faster it is imbibed, the greater the risk of developing esophageal cancer. Those who consumed scalding hot tea (temperatures greater than 70 °C) had an eight-fold increased risk. The association between tea drinking and esophageal cancer declined with temperature and no association was noted, between tea drinking and cancer, in those who consumed lukewarm tea (56–60 °C). Of course the same would logically also apply to other hot concoctions such as coffee or soup. A good rule of thumb is to pour it, and then wait at least 4 minutes before drinking it.

The connection between cancer and temperature is not well understood and certainly warrants further study. There is speculation that regular scorching of the esophagus maintains a level of chronic inflammation, which over time could lead to increased susceptibility.

So the next time you’re in the mood for something hot, rent the movie, and enjoy it with a nice tepid cup of tea.

Vocabulary

* buff – nadšenec

* considered – považovaný

* heartfelt – srdecný, uprímný

* apologies – omluvy

* emanate – pocházet

* exceedingly – mimorádne, nadmíru, neobycejne

* propensity – náchylnost, dispozice, tendence, sklon

* esophageal cancer – karcinom jícnu

* declined – pokles

* appeared to be – zdál se být

* riddle – rébus, hádanka

* scalding – horký, pálivý

* lukewarm – vlažný, netecný, lhostejný

* concoctions – odvar, smes

* scorching – horký, palcive horký

* susceptibility – vnímavost, citlivost, schopnost, náklonnost

Apples and Aspirin

Apples and Aspirin

By Tom Secrest

There’s an old proverb which goes something like this, “An apple a day keeps the doctor away.” This little bit of wisdom, in a somewhat modified version, probably had its origin in Wales and dates back to the second half of the 19th century. It was certainly true, as we now know that apples have potential health benefits ranging from strengthening the immune system (vitamin C) and reducing cholesterol (phenols), to possibly offering protection from neurodegenerative diseases such as Alzheimer's Disease and Parkinsonism (phytonutrients).

However, we have a new maxim to consider today. “An aspirin a day keeps the doctor away.” Acetylsalicylic acid was first concocted by the French chemist Charles Gerhardt in1853 and patented under the name of aspirin in 1899. Today, an estimated 40,000 metric tons of aspirin are consumed annually. Despite its old age, this geriatric pharmaceutical friend still has value. No longer used in high doses as an anti-inflammatory agent, it has found a new lease on life in the form of small, daily doses of less than 100 mg.

New medical guidelines (The Annals of Internal Medicine, March 2009) now suggest that an aspirin a day for men over 45 and women over 55 should be considered in preventive therapy for myocardial infarctions and strokes, respectively. Data from various studies continues to trickle in, with each new study providing more and more guidance as to who should receive aspirin and what dose they should take. However, all the facts are not yet in and, for now, patients need to understand both the risks (e.g. GI bleeding, hemorrhagic stroke, etc.) and the benefits (reduced risk of MI and CVA) of daily aspirin. The responsibility falls on the shoulders of the physician, to assess the patient's risk factors, clearly explain the benefits and risks and perhaps suggest that, along with an apple a day, they should also include a low-dose aspirin tablet, as well.

Vocabulary:

* proverb – prísloví

* wisdom – moudrost

* health benefits – prínosy pro zdraví

* to offer protection – nabízet ochranu

* maxim – zásada, výrok, rcení

* to consider – zvážit, uvážit, vzít v úvahu

* to concoct – laboratorne pripravit (dosl. uvarit)

* to estimate - odhadnout

* despite – pres, nehlede na

* lease – lhuta, trvání

* guidelines – závazná doporucení, pokyny

* stroke – mozková mrtvice, cévní mozková príhoda

* trickle in – pricházejí po kapkách

* guidance – smernice, vodítko

* MI – infarkt myokartu (myocardial infarction)

* CVA – mozková mrtvice (cerebrovascular accident)

* to assess - odhadnout