By: Arkansas Children’s Hospital
When the weather is warm enough, my children play outside for hours.
Even though the temperature is not hot, they are getting sunburned as if it were summer. Do I need to apply sunscreen with the highest SPF this time of year, or will lighter coverage be enough?
In general, when using sunscreen, always use the higher SPF. Even though it is only spring and we are not yet experiencing the “hot” sun exposure we do in the summer time there is enough sunshine that children and adults already are experiencing sunburn and some have blisters. It is not too early to begin thinking of sun safety for your family and yourself.
Despite the many public concerns about the harmful effects of sun rays, I think many parents underestimate the harmful effects of overexposure. Anytime our children are outdoors for a period of time, regardless of the season, we should consider providing them with sun protection.
What appears to be a “healthy tan” may be the result of the skin’s reaction to overexposure to sun and is a precursor to definite skin-damaging sun burn. Our children should be told that continued tanning leads to premature aging and wrinkles. There is a definite relationship between the number of cases of sunburn in childhood and the incidence of skin cancer later in life. The thinning of the Ozone layer has more than likely made the sun’s rays more damaging than they were 50 years ago and the incidence of skin cancer is increasing. Sixty to 80 percent of our lifetime sun exposure takes place before we are 18 years of age.
With this in mind, it is important to protect your child’s skin from the sun. Here are some points to be considered:
Babies younger than 6 months of age have much more sensitive skin and are much more easily sunburned.
• Children younger than 6 months should be kept out of the direct sun. If outdoors, babies should be completely covered in clothing and should wear a hat. Any child who has sunburn that results in blisters, particularly an infant 12 months or younger, should be seen by a physician. Discuss limited use of sunscreen with your physician if your 6-month-old must be outside for any period of time. Limited use of sunscreen is probably acceptable.
Children and adults must always use sunscreen while going to be outdoors or exposed to sunshine for more than 15-20 minutes.
• Choose sunscreen that’s made for children and that is waterproof. When choosing a sunscreen, select a sun protection factor (SPF) of 15 or above. Sunscreen should be applied every two hours if your child is playing in the water. The nose, ears, cheeks and shoulders are especially vulnerable to sunburn and in these areas one can use zinc oxide for additional protection. Before using a product, always apply to a small surface and check for the rare allergic reaction. It has now been shown that wearing long-sleeved shirts can be more effective than sunscreen in preventing some skin cancers.
Children should always wear a hat outdoors.
• Hats and caps can greatly protect a child’s face and head from the sun. If using a cap, the bill should face forward to shield the child’s face. Sunglasses or goggles with UV protection can also be used to protect children’s eyes, as they also are vulnerable to sun rays.
It is important not to rely on t-shirts for sun protection while in the pool; they provide no help. The sun’s reflection on the water’s surface increases exposure and makes your child more susceptible to sun burn. Use of sunscreen is most important while swimming.
General considerations in trying to prevent excessive sun exposure include:
• Sun rays are strongest between 10 a.m. and 4 p.m., so this is a good time of day to avoid excessive exposure outdoors. The sun’s ultraviolet rays can bounce from sand, snow, concrete or water - areas that will enhance the possibility of excessive sun and sunburn.
• Even on cloudy days, ultraviolet rays penetrate through clouds so the risk of excessive exposure remains.
• Fair-skinned children burn more easily than others when they receive excessive sun exposure, and they need additional protection. Nevertheless, even those with darker skin need routine protective measures.
Recent reports have accentuated the protective effect of Vitamin D against some cancers and since Vitamin D is produced by the effect of sunlight on the skin, some researchers have suggested more exposure to sunshine could be beneficial. Most people are exposed to adequate sunlight in ordinary day-to-day activities so additional exposure to enhance Vitamin D protection is probably not necessary.
Excessive sun exposure is not good for anyone, and this is particularly true in children. Discourage excessive tanning and the use of tanning beds in teenagers. Discuss suntan lotions with your physician or pharmacist as new products are released every year and some may be more advantageous.
Common sense rules, reasonable length of exposure to outdoor activities and appropriate use of protective clothing and various sunscreens are logical approaches for protecting you and your family from the sun’s harmful effects. Don’t forget that parents should also wear protective clothing and use sunscreen appropriately. As always, children are more impressed by what their parents do as an example rather than what they say.
June 20th, 2006
By: Baylor College of Medicine
Since childhood, Baylor College of Medicine physician assistant Jessica Salmans suffered with excessive sweating in her hands and feet.
During grade school, she hid paper towels so she wouldn’t soak the work on her desk at school.
In health care, dealing with paperwork and touching patients became the challenge.
“It is something I have had for as long as I remember, and it affected everything in my life,” she said. “Meeting someone and having to shake their hand would make me self conscious, or I would ruin my homework because all the ink would smear.”
Salmans picked outfits based on how well she could wipe her hands off on the clothing during the day. A pair of shoes never lasted very long, because the intense sweating would ruin them.
Thanks to a little-known therapy being offered by a Baylor dermatologist, she has conquered the embarrassing malady and has a new lease on life.
Iontophoresis involves passing a mild electrical current through tap water to shut of the sweat glands temporarily. The hands and feet are soaked in a basin of water for 40 minutes in the comfort of the patients’ home.
“The technology has been around since the 1950s, but it never gained widespread fame, in part because most doctors don’t know it is an option,” said Dr. Ramsey Markus, an assistant professor of dermatology at Baylor. “It is a very safe and effective way to decrease sweating, especially in the hands and feet.”
Salmans started the therapy in December. After only one week of treatments she noticed a difference.
“It’s been remarkable,” she said. “I no longer have a problem with it. I can now shift my focus to where it needs to be and not worry about this. I’m really amazed by it.”
Markus said he prefers Iontophoresis for his patients with sweating in the hands and feet because it is less expensive and less painful than Botox injections, and it can be done regularly as needed in the home. Most patients only require the therapy twice a month to keep the sweat glands from producing excessive sweat.
June 20th, 2006
By: eshre.com
Prague, Czech Republic: A new and highly successful method of freezing human eggs will help to even out the current inequality between men and
women whereby, until now, men have been able to use their previously frozen sperm for IVF treatment but women have not been able to do the same with their eggs.
The research, presented today (Monday 19 June) at the 22nd annual meeting of the European Society of Human Reproduction and Embryology, gives hope to hundreds of women who want to preserve their future fertility but who, for whatever reason, only have eggs, not embryos, available for freezing.
Dr Masashige Kuwayama told a news briefing that although sperm could be frozen, thawed and used for in vitro fertilisation with high levels of success, the freeze-thawing process could damage eggs and, until now, it had been very difficult to perform successful IVF using frozen-thawed eggs. Research by Professor Stefania Nottola and Dr Sandrine Chamayou, presented at the conference, gave examples of the current problems of conventional freeze-thawing and the need for more effective techniques. It is thought that worldwide less than 150 babies have been born using eggs that have been frozen.
Dr Kuwayama, scientific director of the Kato Ladies Clinic in Tokyo, Japan, has developed a new method of freezing eggs (oocytes) called the Cryotop method, which he first used for artificial insemination in sheep and cattle.
He said: “The Cryotop method is a highly efficient freezing procedure that opens a new way to resolve the various aspects of the problem of human oocyte cryopreservation. Using this method, we achieved a more than 90% survival rate for the freeze-thawed oocytes and a high pregnancy rate of nearly 42% after the oocytes had been fertilised and implanted in the women. This pregnancy rate is practically the same as the rate we can achieve in our clinic using fresh oocytes.”
The Cryotop method involves very rapid freezing in a tiny amount (less than 0.1 microlitres) of a special vitrification solution, before storing in liquid nitrogen. This process prevents ice crystals forming, which do so much damage to the structure of the egg. Dr Kuwayama froze 111 eggs, of which 94.5% survived freeze-thawing, 90.5% were fertilised using ICSI (intra-cytoplasmic sperm injection), and 50% of the resulting zygotes were successfully developed for embryo transfer. Twelve pregnancies resulted from 29 embryo transfers (a pregnancy rate of 41.9%, compared with 42.5% using fresh eggs), with an average of 2.3 embryos transferred each time (compared with an average of 1.1 embryos formed from fresh eggs). Eleven healthy babies were born (nine singletons and one pair of twins), while two pregnancies miscarried. The women were aged between 25 and 37.
Dr Kuwayama said: “The conventional slow freeze-thawing method has been used successfully for human embryos in assisted reproduction for two decades, but has been far less successful for oocytes. The post-thaw survival rate for human embryos is about 85-90%. Now, using the Cryotop method, we can achieve post-thaw survival rates for oocytes of 90-95%, making oocyte cryopreservation a real option for women.
“This technology opens up new horizons for medically assisted reproduction in women, enabling them to have the option of having children at a later date by freezing eggs rather than embryos. Moreover, it will help to eliminate the existing time differences in fertility between men and women, whereby women’s supplies of eggs decline at a faster rate than men’s supplies of sperm.”
Dr Chamayou, scientific director of the Unita di Medicina Della Riproduzione, Fondazione HERA, Catania, Italy, told the conference that Italy had banned embryo and zygote freezing in 2004, and any embryos created for IVF, up to a maximum of three, had to be implanted in one transfer. As a consequence of this new law, interest in egg freezing had grown. “Even although oocyte freezing is still considered experimental by the scientific community, nowadays in our centre it is routinely proposed to patients as an alternative to disposing of any surplus oocytes. Surplus oocytes become available in 78.5% of IVF cycles.”
Her research into the potential of freeze-thawing eggs, using conventional methods of slow freezing and rapid thawing, revealed the consequences of freezing on fertilisation, subsequent initial cell division (cleavage) and embryo quality. Out of 337 thawed eggs, 263 survived (78%), 221 were fertilised using ICSI (67.9%), 116 underwent cleavage up to the second day (77.3%), 92 embryos were implanted in 37 embryo transfer procedures and two pregnancies resulted with two babies born (13.5%, although this figure was not significant due to the small numbers involved).
Dr Chamayou also found that the quality of embryos differed significantly depending on whether fresh or frozen eggs had been used; out of the total number of embryos, 36.7% were grade 1 embryos after IVF using fresh eggs, 19.5% were grade 1 after ICSI using fresh eggs (giving an overall percentage after IVF and ICSI of 24.7% grade 1 embryos), but only 12.1% were grade 1 using frozen-thawed eggs.
“We concluded that oocyte preservation decreased the proportion of cleavage and grade 1 embryos, but did not influence fertilisation rates,” she said. One reason for the high percentage of failure after fertilisation could be the damage done to the structure of the egg during freeze-thawing, in particular to a part called the meiotic spindle which is involved in cell division. The meiotic spindle is a bundle of microtubules, some of which become attached to chromosomes, providing the mechanism for chromosomal movement.
“Before freezing we observed meiotic spindles in 62.5% of oocytes, but in only 43.4% after thawing. This is statistically significant and I deduced that cryopreservation may induce irreversible damage to the bonding of the microtubules,” she said.
Professor Nottola, an associate professor of anatomy in the Department of Anatomy, University La Sapienza, Rome, Italy, told the conference that a variety of abnormalities became apparent when frozen-thawed eggs were inspected more closely, even in those that appeared undamaged after thawing. In addition, the type and/or concentration of agent that was used to protect the egg during freezing (cryoprotectant agent or CPA) might affect the eggs as well.
Six eggs were frozen using a multi-step procedure that involved increasing concentrations of ethylene glycol (EG) as a CPA. Twelve were frozen using propane-1,2-diol (PrOH) and two different amounts of sucrose as CPAs. After thawing, the eggs were studied using light and transmission electron microscopy (LM and TEM).
The eggs appeared normal when observed with LM, although some eggs showed the development of vacuoles (small cavities that sometimes contain water, food or metabolic waste) in their cytoplasm. When TEM was used, more differences became apparent. These included:
• changes to the linkages between mitochondria (microscopic respiratory structures in the cytoplasm) and intracellular membranes amongst the EG-treated eggs
• changes to the amount and density of cortical granules (particles that harden the exterior of the egg once it has been fertilised to prevent other sperm penetrating it)
• changes to the structure of the egg exterior (the zona pellucida).
TEM also confirmed that some eggs, particularly those treated with EG and with the PrOH agent containing more sucrose, had vacuoles developing - a process known as vacuolisation.
Professor Nottola said: “These data suggest that frozen-thawed oocytes may look similar to fresh oocytes, but when they are examined more closely it becomes apparent that there are a number of very small but important alterations to specific parts of numerous oocytes, which presumably are responsible for their reduced developmental potential. The type and/or concentration of the CPA used may play a role, at least in part, in producing these alterations. In particular, EG appears less suitable than PrOH.
“In my opinion, the most important alteration found in frozen-thawed oocytes could be the presence of vacuolisation. This is a quite non-specific feature commonly found in cells that are responding to an injury and, even in absence of other alterations, might lead to an impairment of the developmental potential of the frozen-thawed oocytes.
“As far as the other possible alterations are concerned, the reduction in amount and density of the cortical granules and the consequent hardening of the zona pellucida in frozen-thawed oocytes may be an expected phenomenon that possibly could be by-passed by the application of ICSI technique at insemination; other zona pellucida damage may greatly affect oocyte survival but it depends on the type and amount of the damage; alterations in the mitochondrial organisation can be very subtle and deserve to be further investigated by transmission electron microscopy.”
Professor Arne Sunde, former chairman of ESHRE, said: “Cryopreservation of human semen and embryos has been a routine procedure since the early 1980s, while cryopreservation of mature oocytes has proved to be very difficult. Current techniques for freezing oocytes have a very low success rates in terms of viable pregnancies per frozen oocyte. This is probably due to basic biological differences between oocytes and sperm cells and embryos.
“For decades men have had the opportunity to freeze sperm prior to treatment for malignant diseases, and thousand of babies have been born to couples where the male is an infertile survivor of cancer treatment. With the current techniques, women would need to freeze hundreds of oocytes in order to have a reasonable chance of obtaining a child, but by using the technique of Dr Kuwayama and his colleagues, it will be possible to achieve the same rates of success with 10-20 frozen-thawed oocytes as with fresh oocytes. This is a major improvement, and for the first time, cryopreservation of oocytes represent a realistic option for the preservation of fertility in women who are in need of aggressive treatment for malignant diseases.”
June 20th, 2006
By: Mayo Clinic
Impaired uterine function is not the cause of lower birth rates among overweight women using fertility technologies to become pregnant,
according to a Mayo Clinic study published in the August 2003 issue of Fertility and Sterility.
Previous studies have shown that overweight women using fertility technologies such as in vitro fertilization have significantly lower birth rates. This fact has caused some researchers to question whether body mass somehow disrupts endometrial function - the ability of the uterus to receive an embryo and carry a pregnancy to term.
The Mayo Clinic study results painted a more encouraging picture for overweight women using fertility technologies.
“Our research shows that when we control variables such as hormone levels and embryo quality, the uterus works fine, regardless of body mass. The key is good embryos,” says Ian Tummon, M.D., a Mayo Clinic reproductive endocrinologist who is the study’s principal investigator.
The study involved 96 women of childbearing age whose body mass indices ranged from below normal to obese. Each woman received hormone injections to prepare the uterus to receive embryos. Researchers made efforts to standardize the quality of embryos implanted.
Embryo implantation rates for non-obese and obese subjects were nearly equal (27 percent and 29 percent, respectively). Live birth rates also were comparable, with 44 percent of non-obese and 42 percent of obese women giving birth.
Although the Mayo Clinic study suggests that uterine function is not the cause of lower birth rates among overweight women using fertility technologies, it also raises questions.
“We still need to explore possible connections between weight and other factors such as hormone levels or embryo development, which can affect a woman’s ability to become pregnant and carry a pregnancy to term,” says Dr. Tummon.
June 20th, 2006