Brain-Injury Recovery Varies Widely Among Children

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- Although survival rates for children who sustain brain injuries have improved significantly, it remains difficult to predict how well these children will do in the long term, according to a new evidence review.

The recovery of children with brain injuries is complex, and outcomes may vary widely, the British researchers noted. Protecting these brain-injured children from infections and accidents should be a priority, they said.

The research, published online June 18 in CMAJ: Canadian Medical Association Journal, also found the age at which children sustain a brain injury will have an effect on their recovery. The authors suggested that the common belief that children's developing brains are more resilient may be naive.

"There is no single best approach to describing outcome after acquired brain injury during childhood, and the one chosen must be appropriate to the purpose at hand," Dr. Rob Forsyth, of the Institute of Neuroscience at Newcastle University and Great North Children's Hospital in Newcastle-Upon-Tyne, and colleagues wrote in a journal news release.

The researchers looked at pertinent English-language medical literature from 1966 to the present.

Not enough information is available to help doctors and families decide how to proceed with the children's treatment or, in some cases, withdraw care, the researchers said. Challenges to providing care for children with brain injuries should be considered, as should the cause of the injury.

Outcomes often are better following traumatic brain injuries than injuries sustained from oxygen deprivation, such as drowning or suffocation, the analysis found. The researchers said psychological issues these children may face later on could be masked by the initial recovery of their motor skills.

"Early injury alters the entire developmental trajectory, and effects can compound through childhood," the researchers wrote. "This is particularly clear in the literature surrounding pediatric brain injury, where sometimes impressive early motor recoveries obscure the characteristic emergence of cognitive and psychological

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Long-Term Salty Diets Tied Again to High Blood Pressure

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- Indulging in a bag of chips or munching a handful of nuts now and then isn't likely to hurt you in the short run, but regularly chowing down on salty foods over several years may damage your blood vessels and lead to high blood pressure, a new study finds.

Researchers reporting in the June 18 online edition of Circulation said that eating too much salt over time may affect the lining of blood vessels, increasing the likelihood of developing high blood pressure.

"This study reinforces guidelines backed by the American Heart Association and other professional organizations that recommend reducing salt consumption to reduce your risk of developing high blood pressure," said Dr. John Forman, lead author of the study and assistant professor of medicine at Harvard Medical School in Boston.

High blood pressure, also called hypertension, can contribute to heart failure, stroke and kidney failure.

Researchers tracked the salt intake of 5,556 white men and women from the Netherlands over about six years. None of the participants had high blood pressure at the study's start.

By analyzing 24-hour urine samples collected periodically over several years, the researchers noted the amount of uric acid and albumin in the urine, markers of blood vessel damage. They also tracked the amount of salt, or sodium, the participants ate by measuring how much sodium ended up in their urine.

The researchers found that, over time, people who ingested more sodium had more uric acid and albumin in their urine.

The higher the levels of uric acid and albumin, the more likely those people were to develop high blood pressure if they continued on high-sodium diets, the investigators found. Over the approximately six-year period of the study, 878 new cases of hypertension (high blood pressure) were discovered.

Compared with the participants eating the least amount of sodium (about 2,200 milligrams a day), those eating the most (6,200 mg a day) were 21 percent more likely to develop high blood pressure. Those who had high uric acid and albumin levels and ate the most salt were 86 percent more likely to develop high blood pressure.

How much salt is 2,200 milligrams of salt? About a teaspoon.

Much of the sodium the average American consumes comes from processed foods. Forman cautions that people who don't use salt shakers at the table shouldn't assume they're not getting too much sodium. One cup of soup or a single-serving frozen dinner can have 1,000 milligrams of sodium.

The study showed an association between the markers of blood vessel damage and high blood pressure, but not a cause-and-effect relationship.

Dr. Gregg Fonarow, professor of cardiovascular medicine at the University of California, Los Angeles, said, "the research shows that in some individuals, there is an association between these markers -- uric acid and albumin -- and the subsequent diagnosis of hypertension."

Why salt causes blood vessel damage -- called "endothelial dysfunction" -- is not fully understood, said Fonarow. "Sodium exposure may lead to progressive changes in the lining of the blood vessels, eventually becoming irreversible," he said.

"And once you've developed hypertension, lowering your salt intake most likely won't be enough to normalize your blood pressure," he said.

The study also suggests that those with markers of blood vessel damage may be more negatively affected by a high-salt diet than others.

The idea that salt influences the development of high blood pressure is considered controversial by some experts. A study published last year in the Journal of the American Medical Association suggested that lower amounts of sodium in urine were associated with more cardiovascular disease deaths.

In order to link high salt intake more closely to blood vessel damage and subsequent high blood pressure, Forman said it would be necessary to follow many people over about 20 years, ideally using ultrasound to directly assess blood vessel health.

Fonarow said the key to high blood pressure prevention is moderation and watchful management of other cardiovascular risks. "Avoid a high-salt diet, but also don't smoke, watch your weight, keep your cholesterol down and manage your blood pressure," he said. "Those factors are probably even more important."

Heart experts advise limiting sodium intake to less than 2,300 mg a day, or 1,500 mg if you're black, over 50 years old or have certain chronic diseases. By reading Nutrition Facts labels closely, you can limit your sodium intake.

More information

The U.S. National Library of Medicine has more about high blood pressure.

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Smoking Might Raise Your Odds for Skin Cancer

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- Smoking has long been tied to a number of cancers, and now another tumor type, skin cancer, may join that list.

A new review of data finds that lighting up may boost the risk of a common type of nonmelanoma skin cancer.

Researchers sifted through the results of 25 studies conducted in 11 countries worldwide. Most of the studies included middle-aged to elderly people.

This "meta-analysis" revealed that smoking was associated with a 52 percent increased risk of cutaneous squamous cell carcinoma skin cancer, according to Jo Leonardi-Bee, of the U.K. Center for Tobacco Control Studies at the University of Nottingham in England, and colleagues.

Squamous cell and basal cell carcinomas -- collectively known as nonmelanoma skin cancer -- account for about 97 percent of all skin cancers. The incidence of nonmelanoma skin cancer is rising worldwide, with about two million to three million new cases each year.

The authors said they found no clear association between smoking and basal cell carcinomas. The findings were published online June 18 in the journal Archives of Dermatology,

"This study highlights the importance for clinicians to actively survey high-risk patients, including current smokers, to identify early skin cancers, since early diagnosis can improve prognosis because early lesions are simpler to treat compared with larger or neglected lesions," the researchers concluded.

This isn't the first time smoking has been link to skin cancer. In December, researchers reporting in the journal Cancer Causes Control said that women diagnosed with squamous cell carcinoma were twice as likely to have been smokers than those who were free of the disease.

The study, led by Dana Rollison, an associate member in the Moffitt Cancer Center department of cancer epidemiology, in Tampa, Fla., also found that men who were long-term smokers were at slightly higher risk for basal cell carcinomas.

Speaking at the time, Dr. Jeffrey Dover, associate clinical professor of dermatology at Yale University Medical School, said the findings weren't surprising because "we know cigarette smoke contains carcinogens" and smokers are "blowing the smoke and ash around their faces all day."

Squamous cell cancer occurs in the epidermis, the top layer of skin, and can spread to other organs. Basal cell skin cancer occurs in the dermis, the skin layer beneath the epidermis. While it does not spread to other organs, it is far more common than squamous cell cancer.

More information

The American Academy of Family Physicians has more about skin cancer.

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Some May Drink More After Weight-Loss Surgery: Study

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- The risk of alcohol problems goes up somewhat in patients who have undergone weight-loss surgery, but not until more than a year after undergoing the procedure, new research finds.

The study doesn't prove that the procedures directly boost the risk of alcohol problems, and it's not clear why the likelihood goes up in the second year after surgery instead of the first. However, previous research suggests that weight-loss surgery may disrupt how the bodies of patients absorb alcohol, giving more of a punch to individual drinks.

One weight-loss surgery specialist questioned the value of the study. But lead author Wendy King, a University of Pittsburgh assistant professor of epidemiology, said the findings "really point to the need for discussions of the benefits and risks to include this."

Weight-loss surgery, also known as bariatric surgery, aims to treat severe obesity by physically limiting the amount of food that the body can process. Several types of bariatric procedures allow physicians to accomplish this by shrinking the size of the stomach.

King said there have been reports in the media about patients who became alcoholics after the surgery, but research is lacking. So King and colleagues followed 2,458 patients -- with an average age of 47 years, 79 percent were female and 87 percent were white -- before and after they underwent weight-loss surgeries. The patients had the procedures between 2006 and 2011.

A year after surgery, the percentage of patients who showed signs of alcohol problems stayed steady at about 7 percent. But two years after the surgery, almost 10 percent showed signs of alcohol problems.

Still, "it's certainly not a surgery that going to make everyone become an alcoholic," King said. "That's not the case."

Alcohol problems were more common in younger patients, males and those who smoked, drank at least a couple of drinks a week or used drugs. Those who underwent a procedure known as Roux-en-Y gastric bypass were also more likely to develop alcohol problems, confirming the results of a Swedish study presented at the Digestive Disease Week conference in 2011.

That procedure, which restricts food intake by creating a small pouch out of the stomach, allows alcohol to be absorbed more quickly by the body, King explained.

Why might weight-loss surgery lead to higher rates of alcohol problems? King said there are several theories. Perhaps, she said, patients become tired of strict rules about what they eat and drink. Or maybe they develop new social lives that include drinking after losing large amounts of weight.

Dr. Edward Phillips, chief of general surgery at Cedars-Sinai Medical Center in Los Angeles, pointed to another potential factor: Extremely obese people -- for example, a 450-pound man -- will lose some of their tolerance for alcohol consumption when they lose weight. "Some just don't realize that less alcohol produces as much or more of an effect," he said.

Despite the findings, weight-loss operations remain the best surgery for severely obese people, King said.

Dr. T. Karl Byrne, a professor of surgery and director of bariatric surgery at the Medical University of South Carolina, was unimpressed by the study, saying it's "not particularly useful."

"The rise in alcoholism after bariatric surgery doesn't seem that significant," he said. "Patients who are morbidly obese are addicted to food. If this addiction is altered or improved with bariatric surgery, there may be transfer of the addiction to alcohol, gambling, hypersexuality, spending and shopping, etc. It's not the surgery. It's the addictive personality."

Phillips, however, found the study useful and said it shows the importance of following up with patients over time, even years after a procedure. "Most patients don't come back if they are OK, or are embarrassed that they are regaining weight, or are using drugs or alcohol," he said.

The study was published online June 18 in the Journal of the American Medical Association.

While the study found an association between weight-loss surgery and increased drinking, it did not prove a cause-and-effect relationship.

More information

For more about weight-loss surgery, try the U.S. National Library of Medicine.

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Loneliness, Living Alone Might Shorten Life

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- They say that one is the loneliest number, but it might also be the deadliest.

Two new studies suggest that living alone or being lonely can raise a person's risk of dying from heart disease or any cause.

In one study, people with heart disease who lived alone were more likely to die than their counterparts who did not. A second report showed that people aged 60 or older were at an increased risk of functional decline and/or death if they felt left out, isolated or reported a lack of companionship. Both studies were released online June 18 in the Archives of Internal Medicine.

"Living alone may be a risk factor for a bad outcome," said study author Dr. Deepak Bhatt, director of the integrated cardiovascular intervention program at Brigham and Women's Hospital in Boston. The study only looked at whether the individual lived alone. Researchers did not ask whether this was a choice or if they had lost a partner or had a pet.

But, he said, a person can be lonely and not live alone, and live alone and not be lonely. Still, living alone, regardless of the reason, should be a red flag for doctors to ask more questions.

There are many reasons that living alone or feeling lonely could increase risk for health problems and death. "If you had a heart attack and run out of medication and don't fill your prescription, you will run into trouble," he said. "Spouses and children can run out and get medications for you, and then you are less likely to get into trouble."

What's more, someone who is lonely may be more likely to be depressed, he said. This would make them less likely to take care of themselves, which could increase their risk of dying from any cause. Bottom line is that "doctors should get a good social history," Bhatt said.

In the second report, Dr. Carla Perissinotto, of the University of California, San Francisco, found that loneliness was associated with an increased risk of death during the study's six-year follow-up period. What's more, loneliness was also associated with functional decline.

Taken together, "the studies show that social isolation is associated with cardiovascular mortality in people with heart disease," said Dr. Nieca Goldberg, a clinical associate professor in the department of medicine at the Leon H. Carney Division of Cardiology at NYU Langone Medical Center and medical director at the Joan H. Tisch Center for Women's Health in New York City.

It's all about a patient's support system, she said. Health care providers need to try to identify a support system -- or lack thereof -- before a person with heart disease is released from the hospital. "A support system doesn't have to be an individual, it can be a place of worship or senior's group," Goldberg noted.

While the study uncovered an association between being lonely and an increased risk for health problems and death, it did not prove a cause-and-effect relationship.

More Information

Learn about other risks for heart disease at the American Heart Association.

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Could Psoriasis Increase Odds for Type 2 Diabetes?

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- People suffering from the autoimmune skin disorder known as psoriasis may face an increased risk of developing type 2 diabetes, a new study suggests.

"People with psoriasis are at increased risk of developing diabetes that is independent of traditional risk factors like being obese," said lead researcher Dr. Joel Gelfand, associate professor of dermatology at the University of Pennsylvania in Philadelphia.

The risk is highest in those with the most severe psoriasis, and these patients should be screened for diabetes, he said. The reasons for this risk may be genetic, or psoriasis may cause increased insulin resistance, Gelfand said.

He also noted that obesity is a risk factor for psoriasis as well as diabetes. People who develop psoriasis should try to maintain a healthy weight to help prevent diabetes, he said.

The report was published in the June 18 online edition of the journal Archives of Dermatology.

For the study, Gelfand's team collected data on more than 108,000 people with psoriasis listed in the British Health Improvement Network, and compared it with data on more than 430,000 people without the skin disorder.

The researchers found that the risk of developing type 2 diabetes was 11 percent higher for those with mild psoriasis and 46 percent higher for those with severe psoriasis, compared to those who did not have the disorder.

In addition, the researchers found that people with severe psoriasis were more likely to be taking medications for diabetes.

Psoriasis is a chronic inflammatory disease of the skin characterized by scaling; it affects 2 percent to 4 percent of adults, the researchers said.

Since both psoriasis and diabetes are partially caused by inflammation in the body, this research may explain the link between them, the researchers speculated. Inflammation can increase insulin resistance, which is a cause of type 2 diabetes, they noted.

Dr. Michele Green, a dermatologist at Lenox Hill Hospital in New York City, said many of her obese psoriasis patients also suffer from diabetes.

"I can tell you that I have seen patients who are obese and their psoriasis is worse and their diabetes is worse -- they go hand-in-hand," she said.

Green said it is not psoriasis that causes diabetes but obesity, which is the root cause of both conditions. Moreover, psoriasis is harder to treat in obese patients, she said. The only way to improve both conditions is to lose weight.

Although this research showed an association between psoriasis and type 2 diabetes, it did not prove a cause-and-effect relationship.

More information

For more on diabetes, visit the American Diabetes Association.

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Diabetes May Hasten Mental Decline

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- Older adults with diabetes and poor blood sugar control are at increased risk for greater declines in their memory and thinking abilities, a new study finds.

Researchers followed more than 3,000 people without dementia, average age 74, for more than 10 years.

At the start of the study, 23 percent of the participants had diabetes. Of the more than 2,300 participants without diabetes, 159 developed the condition during the follow-up period.

People with diabetes at the start of the study scored lower on initial tests of their thinking skills than those without diabetes. During the follow-up, participants with diabetes showed much greater declines in mental function than those without diabetes.

The study was published online June 18 in the journal Archives of Neurology.

The findings support the theory that older adults with diabetes have reduced thinking and memory skills and that poor blood sugar control may be a contributing factor, said Dr. Kristine Yaffe, of the University of California, San Francisco, and the San Francisco VA Medical Center, and colleagues in a journal news release.

The investigators said further research is needed to determine if early diagnosis and treatment of diabetes reduces the risk of mental decline and if good blood sugar control helps reduce the effect of diabetes on thinking and memory function.

While the study found an association between diabetes and mental decline, it did not show a cause-and-effect relationship.

More information

The U.S. National Institute on Aging has more about diabetes in older people.

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Dramatic Rise in Kids Hospitalized With High Blood Pressure: Study

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Arthritis Treatment Linked to Liver Problems in Study

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- A "medical food" called Limbrel, which doctors prescribe to treat osteoarthritis of the knee, was linked to several cases of liver disease in a small study, but the effects so far seem to be rare and easily reversible.

Still, patients who take Limbrel, also known as flavocoxid, should be aware of the potential for liver problems, said study lead author Dr. Naga Chalasani, director of the division of gastroenterology and hepatology at Indiana University School of Medicine, in Indianapolis.

Patients should not assume that "medical foods," such as Limbrel, are 100 percent safe, he added.

In the United States, medical foods are not subjected to the clinical trials required of prescription drugs before coming to market.

According to Primus Pharmaceuticals, Inc., maker of Limbrel, the main ingredients of the pills are plant elements known as bioflavonoids, specifically baicalin and catechins. The company says Limbrel helps improve mobility and relieve joint discomfort and stiffness related to arthritis.

For the new study, Chalasani and colleagues analyzed 877 cases of liver injury and found four linked with Limbrel. The researchers said it's "highly likely" that the product caused the liver problems in three of the patients and possible in the other one.

Symptoms included nausea, fatigue and yellow skin, Chalasani said. The four patients were women between 57 and 68 years old who showed signs of liver illness between one and three months after taking Limbrel.

They recovered within weeks of discontinuing the drug.

"Our report provides convincing evidence that flavocoxid is capable of causing clinically apparent, acute liver injury," the study authors wrote. They also noted that the pharmaceutical company has discovered 31 possible cases of liver problems among more than 284,000 users since the drug was brought to market in 2004.

It's not clear why Limbrel might cause liver problems, although the researchers suspect one of its chemicals may be at fault, Chalasani said.

According to Dr. Robert Levy, director of clinical development for Primus Pharmaceuticals, "Limbrel is, by far, the safest anti-inflammatory on the market."

Limbrel has an "extraordinary safety profile," he added. He said medical foods must be prescribed and used under the direction of a physician, adding that physicians should monitor the livers of patients who take the drugs.

"Because the liver is the site of metabolism of most drugs and foreign chemicals, a great many drugs, including all anti-inflammatory agents, are known to have some liver toxicity," Levy said.

Painkillers, another common treatment for osteoarthritis, only provide limited relief and are also associated with adverse events, the study authors said.

About 20 million Americans suffer from osteoarthritis, which is the leading cause of disability in the United States, according to the U.S. National Institutes of Health.

Study lead author Chalasani said patients and physicians should be aware that medical food products haven't gone through the same kind of review as regular prescription drugs.

"I'll bet most people who prescribe Limbrel think it's gone through the typical review process," he said. "If a physician chooses to prescribe Limbrel, he or she should be aware that it can cause this toxicity." If patients develop symptoms of liver damage, they should stop taking Limbrel, he added.

The study appears in the June 19 issue of the Annals of Internal Medicine.

The authors of an accompanying journal editorial said that the current policy of allowing medical foods to come to market without rigorous testing may need to be reconsidered, given their popularity and potential for damage.

More information

The U.S. Food and Drug Administration has more about medical foods.

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Many Homeless May Harbor Hepatitis C

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- Nearly 27 percent of homeless adults in Los Angeles may have hepatitis C, and nearly half don't know they have the potentially deadly infection, researchers say.

Hepatitis C virus can destroy the liver and lead to a liver transplant. Recent research shows that it kills more American adults than AIDS.

For the study, researchers surveyed 534 homeless adults, most of them black men, between June 2003 and February 2004.

Tests revealed that 26.7 percent of the study participants were infected with the hepatitis C virus -- a rate more than 10 times higher than the 2 percent rate in the general U.S. population. Of the infected people in the study, 46 percent did not know they had hepatitis C.

Less than 3 percent of those who knew they were infected had ever been treated, according to the researchers from the University of California, Los Angeles.

Infection rates were much higher among those who had injected drugs or been in prison; those aged 40 or older; people with less education; U.S.-born adults; those with three or more tattoos; and users of serious non-injection drugs (excluding marijuana).

Sexual behaviors were not significantly related to hepatitis C infection, according to the study published in the July-August issue of the journal Public Health Reports.

"This and previous studies demonstrate that urban homeless adults in the U.S. are at high risk for hepatitis C virus infection," concluded study co-leader Dr. Lillian Gelberg, a professor of family medicine, and colleagues.

"Homeless adults need interventions that include hepatitis C virus education, counseling, voluntary testing and treatment services," the researchers wrote. "Hepatitis C virus prevention and treatment programs could be modeled after relevant successful interventions developed for U.S. homeless persons with HIV/AIDS."

The authors acknowledged some study limitations. While hepatitis C infection rates were based on blood tests, some of the other study measures relied on self-reporting, which is subject to recall bias.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about hepatitis C.

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Sleep Apnea May Be Linked to Nerve Damage in Diabetics

HealthDay – 4 hrs ago MONDAY, June 18 (HealthDay News) -- Obstructive sleep apnea is associated with nerve damage in people with type 2 diabetes, according to a new study.

The severity of this type of nerve damage -- called diabetic peripheral neuropathy -- is linked with the extent of sleep apnea and the degree of low blood oxygen levels that occur while patients sleep, the researchers found.

People with obstructive sleep apnea subconsciously awaken many times a night -- even dozens of times an hour -- because their airways close, disrupting their breathing. Those with diabetic peripheral neuropathy may have numbness or tingling in their extremities, or damage to their major organs.

The study of 234 adults with type 2 diabetes found that sleep apnea was independently associated with diabetic peripheral neuropathy even after the researchers accounted for a number of other possible factors, including obesity, ethnicity, gender, age at diabetes diagnosis, and the length of time a person had diabetes.

The findings were published online ahead of print in the American Journal of Respiratory and Critical Care Medicine.

"Obstructive sleep apnea is known to be associated with inflammation and oxidative stress, so we hypothesized that it would be associated with peripheral neuropathy in patients with type 2 diabetes," lead author Dr. Abd Tahrani, a clinical lecturer in endocrinology and diabetes at the University of Birmingham in England, said in a news release from the American Thoracic Society.

However, while the study uncovered an association between obstructive sleep apnea and peripheral neuropathy in diabetic patients, it did not prove a cause-and-effect relationship.

Further research is needed to determine the role of sleep apnea and low blood oxygen levels in the development and progression of nerve damage in patients with type 2 diabetes, and to assess the potential impact of continuous positive airway pressure treatment on diabetic peripheral neuropathy, the study authors said.

Continuous positive airway pressure treatment, or CPAP, keeps obstructive sleep apnea patients' airways open while they sleep.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about diabetic neuropathy.

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'Why Now?' New Dad Jack Osbourne Faces MS

Jack Osbourne arrives at the "Call of Duty: Modern Warfare 3" release party in Los Angeles, in this Sept. 3, 2011 photo. (Jesse Grant/WireImage/Getty Images)

At only 26 and a new father, Jack Osbourne was diagnosed with multiple sclerosis earlier this spring.

The son of Ozzy and Sharon Osbourne told People Magazine he was diagnosed only two weeks after his daughter, Pearl Clementine, was born.

"I was just angry and frustrated and kept thinking, 'Why now?'" Osbourne told the magazine. "I've got a family and that's what's supposed to be the most important thing."

While Osbourne is younger than the average patient who is newly diagnosed with MS, it is not by much. The average age at which a patient is diagnosed is 37.

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord. The disease attacks the myelin sheath, a protective covering that surrounds nerve cells, and approximately 400,000 Americans have MS, according to the National MS Society. About 200 people are newly diagnosed each week.

While the disease is degenerative, symptoms, which affect the muscles, bowel function, vision, nerve and sexual function and personality, can vary and range greatly in severity.

Because of the typical early onset of the disease, Osbourne, and many other newly diagnosed MS patients, are at the threshold of many life decisions, including career, marriage and children.

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