Sunday, March 19, 2023

Dad jokes

“‘Dad, will you hand me my sunglasses?’. ‘As soon as you hand me my dadglasses, Son.’”

A recent study says that despite the embarrassment that "dad jokes" can cause, it might do some kids good in the future.

Humor researcher Marc Hye-Knudsen published a study in British Psychological Society‘s journal this week arguing that "dad jokes" actually have a positive effect on development.

"When considered properly, dad jokes are an intricately multi-layered and fascinating phenomenon that reveals a lot not just about how humour and joke-telling work but also about fathers’ psychology and their relationships with their children," Hye-Knudsen wrote. It’s also what makes dad jokes so susceptible to accusations of being stupid, lame, and unfunny," the study observed.

Hye-Knudsen suggests that when fathers embarrass their children with unfunny jokes, it teaches them how to overcome awkwardness.

"By continually telling their children jokes that are so bad that they’re embarrassing, fathers may push their children’s limits for how much embarrassment they can handle," the article said. "They show their children that embarrassment isn’t fatal."

The study ends by encouraging fathers to continue aiding their children's development by telling embarrassing jokes.

"You’re partaking in a long and proud tradition, and your embarrassingly awful jokes may even do them some good," the paper concludes. "Keep repeating the same old stale puns, year-in and year-out."

https://www.foxnews.com/health/dad-jokes-help-kids-develop-healthy-adults-study

See: Hye-Knudsen M. 'Dad jokes? That’s the way eye roll…’ The Psychologist. 14 March 2023  https://www.bps.org.uk/psychologist/dad-jokes-thats-way-eye-roll

Also: Hye-Knudsen M. Dad jokes and the deep roots of fatherly teasing. https://psyarxiv.com/r9mhc/

Monday, March 13, 2023

IVF issues

Worth and cost are two very different things, but once you put a price on something, it’s hard not to feel that you should get what you paid for, even if what was ordered is a baby. The complicated story of Paris Hilton’s desire not just to be a mother in general, but to be the mother of a little girl is case in point. With two daughters of my own, I appreciate the sentiment, but at the heart of this story isn’t only one desired girl, but 20 lost boys.

Today, about two percent of children born each year are conceived in a lab through In Vitro Fertilization (IVF), a "complex series of procedures" in which a woman’s eggs and a man’s sperm are brought together. Yet, Hilton and husband Carter Reum found that seven times was not a charm.

Hilton wanted a girl and the results were 20 boys, snowflake babies now in limbo. IVF has helped some very wonderful people have a family, but there is something profoundly sad about 20 little people found not good enough based on their sex and a business model that commodifies humanity.  

While the heiress plans to keep going, a specific baby order is not for the underfunded. Forbes reports that a single cycle of IVF can cost up to $30K just to get started, and in Hilton’s case, the costs will go even higher as she intends to use a surrogate. "Base pay" for carrying another’s child is $55K and up.

But there are other costs – human costs – as for those unchosen, and parents have three options: destroy them, donate them to science for research, or donate them to someone else.

Creating disposable people on purpose is central to the IVF business model, troubling to many people who remember high school biology where we learned that a new life begins when egg and sperm unite. That didn’t used to be a trick question on a test or a religious point of view.

Preborn people are exactly like us – only smaller and without social media accounts.

Because of the cost, creating far too many preborn than can safely be implanted leads to the kinds of arbitrary life and death decisions usually seen in war movies – a Sophie’s Choice. Some of those children are flushed away after "failing" genetic testing or sex screening, things that lead to accommodation or treatment among the born.

Also troubling is a business model where people are owned by others, and wombs of the young and poor are rented out.

Sophia Vergaro and her former fiancĂ©, Nick Loeb, went twenty-rounds in court before the knockout punch to two children, whose rights to life didn’t count in court because of papers drawn up on their ownership. "In California, which is where the embryos were frozen, they are referred to as products," notes the Daily Mail.

Writing in the New York Times in 2015, Loeb asked, "When we create embryos for the purpose of life, should we not define them as life, rather than as property?"

That contractual power over human property in the world of IVF is absolute, leading even to "Couples are turning extra IVF embryos into jewelry" through companies like Baby Bee Hummingbirds.

If that’s not disturbing enough, the health risks to those involved get little attention.

A Heritage Foundation report found "children born from IVF have higher rates of autism, cancer, and minor birth issues like cleft palate." In fact, about six percent of babies born through IVF have "birth anomalies" compared to four percent of all other babies, and a baby’s risk of dying near birth is "slightly higher’ along with premature birth, which can have severe implications.

The women undergoing the treatments can have an increased risk of heart and pregnancy complications. Overstimulating ovaries to produce many eggs and not just one or two in a cycle "can result in blood clots, kidney failure and death."

Under contract, those problems are endured sometimes by poor young women who provide eggs or take jobs as surrogates in financial arrangements that commodifies their fertility. A woman is born with all the eggs she will ever have, making it an ugly kind of human trafficking as for-profit enterprises advertise for egg "donation." NBC reports that the "fertility industry" is set to pull in $41 billion by 2026.  

What will Hilton’s future little girl feel about her birth story? Will she feel a need to perform up to the expectations that lead to her acquisition? Will she be troubled knowing that her twenty brothers are among one million others in cold storage? Will those boys be born?

When she welcomed her son via surrogate, Hilton told People magazine, "It's always been my dream to be a mother." 

It’s a dream many share, but the science and the contract disputes have far outpaced conversations on the ethics. A National Institutes of Health article noted the business model is riddled with moral dilemmas, and "problems may exist, in part, due to the lack of regulation in the U.S."

Harder choices about how to respect all the women and preborn impacted by this business seem long overdue. Tiny lives hang in the balance … and I don’t mean the balance sheet.

https://www.foxnews.com/opinion/what-became-20-babies-paris-hilton-left-behind

Sunday, March 12, 2023

Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer

The blogmaster has a stake in this information

Freddie C. Hamdy, F.R.C.S.(Urol.), F.Med.Sci., Jenny L. Donovan, Ph.D., F.Med.Sci., J. Athene Lane,Ph.D., Chris Metcalfe, Ph.D., Michael Davis, M.Sc., Emma L. Turner, Ph.D., Richard M. Martin, B.M.,B.S., Ph.D., Grace J. Young, M.Sc., Eleanor I. Walsh, M.Sc., Richard J. Bryant, Ph.D., F.R.C.S.(Urol.), Prasad Bollina, M.B., B.S., F.R.C.S.(Urol.), Andrew Doble, F.R.C.S.(Urol), et al. for the ProtecT Study Group. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. March 11, 2023 DOI: 10.1056/NEJMoa2214122

Abstract

BACKGROUND Between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age received a prostate-specific antigen (PSA) test. Localized prostate cancer was diagnosed in 2664 men. Of these men, 1643 were enrolled in a trial to evaluate the effectiveness of treatments, with 545 randomly assigned to receive active monitoring, 553 to undergo prostatectomy, and 545 to undergo radiotherapy.

METHODS At a median follow-up of 15 years (range, 11 to 21), we compared the results in this population with respect to death from prostate cancer (the primary outcome) and death from any cause, metastases, disease progression, and initiation of long-term androgen-deprivation therapy (secondary outcomes). 

RESULTS Follow-up was complete for 1610 patients (98%). A risk-stratification analysis showed that more than one third of the men had intermediate or high-risk disease at diagnosis. Death from prostate cancer occurred in 45 men (2.7%): 17 (3.1%) in the active-monitoring group, 12 (2.2%) in the prostatectomy group, and 16 (2.9%) in the radiotherapy group (P=0.53 for the overall comparison). Death from any cause occurred in 356 men (21.7%), with similar numbers in all three groups. Metastases developed in 51 men (9.4%) in the active-monitoring group, in 26 (4.7%) in the prostatectomy group, and in 27 (5.0%) in the radiotherapy group. Long-term androgen-deprivation therapy was initiated in 69 men (12.7%), 40 (7.2%), and 42 (7.7%), respectively; clinical progression occurred in 141 men (25.9%), 58 (10.5%), and 60 (11.0%), respectively. In the active-monitoring group, 133 men (24.4%) were alive without any prostate cancer treatment at the end of follow-up. No differential effects on cancer-specific mortality were noted in relation to the baseline PSA level, tumor stage or grade, or risk-stratification score. No treatment complications were reported after the 10-year analysis.

CONCLUSIONS After 15 years of follow-up, prostate cancer–specific mortality was low regardless of the treatment assigned. Thus, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.  (Funded by the National Institute for Health and Care Research; ProtecT Current Controlled Trials number, ISRCTN20141297. opens in new tab; ClinicalTrials.gov number, NCT02044172. opens in new tab.). opens in new tab; ClinicalTrials.gov number, NCT02044172




Sunday, March 5, 2023

Congenital cervical teratoma

 See video: https://photos.app.goo.gl/wCoGPpvc8phuES1F9

S.T. Alharbis, A.S. Alsaadi, A.U. Yosuph, F.D. Abdulhameed, M.M. Arkoubi
Diagnostic imaging and surgical management of a congenital cervical teratoma
J Taibah Med Sci, 13 (2018), pp. 83-86

Abstract

Congenital cervical teratomas are rare tumours arising from the neck and consist of three major tissue layers of an embryo: the ectoderm, endoderm, and mesoderm. A great majority of cerviteratomas are benign tumours. However, the clinical significance of these tumours arises from the complications they can cause during pregnancy due to the postnatal mass effect on the airway and oesophagus of the neonate.

Diagnosis of a congenital cervical teratoma is possible during an early prenatal ultrasound evaluation. The appearance depends on the size of the tumour, but it is typically a large neck mass with solid and cystic components that causes hyperextension of the neck and is frequently associated with polyhydramnios. In the postnatal period, ultrasound helps in differentiating cervical teratoma from other common congenital cervical masses. MRI is the modality of choice to evaluate the consistency of the tumour, surrounding soft tissue extent of the tumour, and any mass effect on other cervical structures. In our case report, we present a case of a full-term baby that was delivered with a large cervical mass. MRI was helpful in demonstrating the complex content of the mass, surrounding soft tissue extension, and mass effect on other major cervical structures. The clear demarcation of the mass facilitated complete surgical removal without complications.

Friday, March 3, 2023

Belly dancer's dyskinesia

Courtesy of a colleague

Gupta A, Kushwaha S. Belly Dancer's Dyskinesia: A Glimpse of a Rare Phenomenon. Cureus. 2017 Jul 11;9(7):e1457. doi: 10.7759/cureus.1457. PMID: 29104832; PMCID: PMC5593747.

Abstract

Belly dancer's dyskinesia (BDD) is an extremely rare manifestation consisting of involuntary and repetitive rhythmic movements of the abdominal wall. These movements cannot be voluntarily suppressed but may be influenced by respiratory maneuvers. Investigations such as spinal cord and abdominal imaging usually fail to reveal any local abnormalities to explain the movement disorder. A 23-year-old male presented with sudden onset of undulating movements of the abdominal wall for the last two months after he took domperidone. There was no associated pain or effect of respiration. The movements used to subside during sleep. His radiological and hematological evaluations were inconclusive. The movements, however, subsided after administration of promethazine and clonazepam. The cause of BDD varies, making diagnosis difficult. One of the causes being drug induced but it has never been reported earlier by domperidone. Also, our report provides a possible way to manage BDD by clonazepam and promethazine.

Thursday, March 2, 2023

Guillain-Barre

 https://www.youtube.com/watch?v=SdoWNYFIk6c

Omaveloxolone for treatment of Friedreich ataxia

Omaveloxolone (Skyclarys; Reata Pharmaceuticals, Plano, TX) has been approved by the Food and Drug Administration (FDA) as the first therapy to treat Friedreich ataxia (FA) in adults and adolescents aged 16 years and older. Those who received omaveloxolone improved by −1.63 ± 1.78 points on the Modified Friedreich's Ataxia Rating Scale (mFARS), while those who received a placebo worsened by +2.52 ± 1.18 points on mFARS at week 48. In the omaveloxolone cohort, participants noted an improvement in each component of the mFARS compared with the placebo cohort. The rates of adverse events in both cohorts were similar, with most common adverse events being mild to moderate in intensity. Patients who received omaveloxolone were more likely to experience headaches, nausea, and increased alanine and aspartate aminotransferase (ALT and AST, respectively).

MOXIe (NCT02255435) was an international, double‐blind, randomized, placebo‐controlled, parallel‐group, registrational phase 2 trial that determined the safety and efficacy of omaveloxolone over 48 weeks. The trial took place at 11 healthcare facilities in the United States, Europe, and Australia. Participants were included if they were between 16 and 40 years of age, had genetically confirmed FA, baseline mFARS scores between 20 and 80, and could use a recumbent stationary bicycle for physical testing. Patients were excluded for uncontrolled diabetes, cardiac disease, active infections, laboratory abnormalities, or medical conditions that would alter the testing. Participants (n=103) were 1:1 randomized in an intent-to-treat cohort (n=51) to receive 150 mg per day of omaveloxolone or the placebo cohort (n=52). Maximal exercise testing using the stationary bike and mFARS assessments were completed at weeks 4, 12, 18, 24, 36, and 48. The primary outcome was the change in mFARS scores from baseline and 48 weeks in the omaveloxolone cohort compared with those in the placebo cohort. A post hoc analysis was performed to account for the variety of covariates present at baseline.

According to Susan Perlman, Department of Neurology, David Geffen School of Medicine, UCLA, “The approval of Skyclarys (omaveloxolone) represents an important step forward in the treatment of Friedreich's ataxia, providing physicians with the first disease-specific treatment option approved for patients living with this ultra-rare and progressive disease.”

Friedreich ataxia is a rare, inherited neuromuscular disease that causes impaired muscle coordination, reduced sensation, and increased spasticity. An estimated 1 in 50,000 individuals is affected by this chronic, progressive condition.

https://practicalneurology.com/news/omaveloxolone-approved-by-fda-as-first-therapy-for-friedreich-ataxia