News and Views
Diabetes: Shoes and socks (Dr G M Singh)
Don’t wear shoes without socks.
Don’t wear sandals or other open–toed shoes.
Avoid high–heeled shoes and shoes with pointed toes.
Wear well–padded socks or stockings that are 1/2 inch longer than your longest toe. Don’t wear stretch socks, nylon socks, socks with an elastic band or garter at the top, or socks with inside seams.
Don’t wear uncomfortable or tight shoes that rub or cut into your feet. If you’ve had problems before because of shoes that didn’t fit, you may want to be fitted for a custom–molded shoe.
Talk to your doctor before you buy special shoes or inserts.
Shop for new shoes at the end of the day when your feet are a little swollen. If shoes are comfortable when your feet are swollen, they’ll probably be comfortable all day.
Break in new shoes slowly by wearing them for no more than an hour a day for several days.
Change socks and shoes every day. Have at least 2 pairs of shoes so you can switch pairs every other day.
Look inside your shoes every day for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores.
Glaucoma drugs lowers mortality
Among glaucoma patients, the use of any class of glaucoma drug was associated with a significantly lower likelihood of dying, according to a study published in the February issue of the Archives of Ophthalmology.
Presswatch (Dr Vivek Chhabra, Sr Consultant, Max Healthcare, New Delhi)
ReNeuron approved for world first stem cell trial
ReNeuron has overcome the final regulatory barrier to treating stroke patients with stem cells. The UK Gene Therapy Advisory Committee granted its approval for the Guildford–based company to begin a clinical trial with a dozen stroke patients in Scotland. It will be the world’s first human test of stem cell therapy for strokes. Extensive animal tests have shown neural stem cells – derived from cells that originated several years ago in an aborted human fetus – could help a damaged brain to regenerate, potentially relieving some symptoms of strokes
Sepsis and pneumonia caused by hospital-acquired infections kill 48,000 patients Two common conditions caused by hospital–acquired infections (HAIs) killed 48,000 people and ramped up health care costs by $8.1 billion in 2006 alone, according to a study released in the Archives of Internal Medicine.
ECG testing of young athletes cost–effective in preventing deaths. Routine testing of the hearts of young American athletes using ECGs to screen for sudden death is reasonable in cost and effective at saving lives, according to a new study by cardiologists at the Stanford University School of Medicine.
MRI for Diagnosing Testicular Cancer
Researchers have found that non–invasive magnetic resonance imaging (MRI) is a good diagnostic tool for the evaluation and staging of testicular cancer and may improve patient care by sparing some men unnecessary surgery, according to a study in the March issue of the American Journal of Roentgenology.
Weight–loss diets may reverse atherosclerosis in obese and overweight
A low–carbohydrate diet, a low–fat diet and the Mediterranean diet were equally effective in helping obese people to reverse carotid atherosclerosis after losing moderate amounts of weight and improving their blood pressure, in a study reported in Circulation, Journal of the American Heart Association.
Women need clot–busting therapy after stroke
New research shows women who do not receive a clot–busting drug after a stroke fare worse than men who are not treated. The study is published in the March 2, 2010, issue of Neurology, the medical journal of the American Academy of Neurology.
Long–time cannabis use associated with psychosis
Young adults who have used cannabis or marijuana for a longer period of time appear more likely to have hallucinations or delusions or to meet criteria for psychosis, according to a report posted online that will appear in the May issue of Archives of General Psychiatry.
Transforming Healthcare with IT 2010 (The 1st International Conference on Transforming Heathcare with Information Technology) Date: March 8–10, 2010
Venue: Intercontinental Eros, New Delhi.
Quote of the Day
Health is inner peace. Therefore, healing is letting go of fear. To make changing the body our goal is to fail to recognize that our single goal is peace of mind. (G G Jampolsky)
More insulin is produced with oral drugs. With oral glucose, intestinal cells produces GIP and GLP–1 polypeptides which increases insulin secretion. These two are degraded by DPP
Public Forum (Press Release)
International Women Day: Focus on the heart of your beloved
All women are at risk of heart disease. Take all women older than 65 to a family doctor and ask for a prescription of 325 mg aspirin if not contraindicated.
To reduce their risk, advise Younger Women to indulge in minimum of 60––90 minutes of moderate–intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.
These are a few of the updated guidelines of prevention of heart disease in the women released by Heart Care Foundation of Indian on the occasion of International Women’s day.
Dr K K Aggarwal, President of the Foundation and Editor, eMedinewS said that a woman’s heart is different. They get less attention when there is a heart attack and when they do suffer one, the attack is more serious.
He said that women are at risk for heart disease and heart attacks, just like men. Heart disease is the leading cause of death among women over 65. Urban women are 4 to 6 times more likely to die of heart disease than of breast cancer.
Heart disease kills more women over 65 than all cancers combined.
Facts and guidelines
Women develop heart problems later in life than men –– typically 7 or 8 years later. However, by about age 65, a woman’s risk is almost the same as a man’s.
Women are less likely to survive heart attacks than men.
Recommended lifestyle changes to help manage blood pressure include weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables and low–fat dairy products.
Advice women to quit smoking by counseling, nicotine replacement or other forms of smoking cessation therapy.
Physical activity recommendations for women who need to lose weight or sustain weight loss includes minimum of 60––90 minutes of moderate–intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.
All women should reduce their saturated fats intake to less than 7 percent of calories.
Healthy women should eat oily fish at least twice a week for omega 3 fatty acids. Women with heart disease should take a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which is to be increased to 2–4 grams if associated high triglycerides.
Hormone replacement therapy and selective estrogen receptor modulators are not recommended to prevent heart disease in women.
Antioxidant supplements (such as vitamin E, C and beta–carotene) should not be used for primary or secondary prevention of heart disease.
Folic acid should not be used to prevent heart disease.
Routine low–dose aspirin therapy may be considered in women aged 65 or older regardless of heart disease risk status, if benefits are likely to outweigh other risks in other means if not contraindicated.
The upper dosage of aspirin for high–risk women is 325 mg per day rather than 162 mg.
Reduce bad LDL cholesterol to less than 70 mg/dL in very high–risk women with heart disease.
Top 10 points: Preventing heart diseases in the women
Increased emphasis on lifestyle changes
Hormone replacement therapy does not help heart disease
All women need adequate intake of omega–3 fatty acids
All women should decrease intake of saturated fats
All women need frequent exercise
Nicotine replacement therapy may be used
Antioxidants don’t prevent heart disease
Folic acid doesn’t prevent heart disease
All women older than 65 should consider daily aspirin
High risk women need more aggressive cholesterol treatment
Question of the day
Is there any role of Trichuris suis in IBD?
Inflammatory bowel disease or IBD, is a disease of industrialized countries and rare in the developing world. One reason is the relatively high rate of helminth colonization in less developed countries. Infection with helminths may reduce the risk of inflammatory bowel disease by decreasing the immune response.1,2 A potential therapeutic aspect to this association was evaluated in a study involving 54 patients with active ulcerative colitis who were randomly assigned to ingestion of Trichuris suis ova or placebo for 12 weeks.3 Improvement in disease activity was observed significantly more often in patients receiving active treatment (43 vs 17%). There were no side effects. Additional studies are needed before this approach can be recommended.
Sabin EA, Araujo MI, Carvalho EM, et al. Impairment of tetanus toxoid–specific Th1–like immune responses in humans infected with Schistosoma mansoni. J Infect Dis 1996;173:269.
Borkow G, Leng Q, Weisman Z, et al. Chronic immune activation associated with intestinal helminth infections results in impaired signal transduction and anergy. J Clin Invest 2000;106:1053.
Summers RW, Elliott DE, Urban JF Jr, et al. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Gastroenterology 2005;128:825.
eMedinewS Try this it Works
Evaluating lipid panel results
Total cholesterol and high–density lipoprotein (HDL) levels are more accurate when samples are from non fasting patients.
Triglyceride levels should be measured only in samples from fasting patients, because triglycerides increase after a fatty meal.
Dr Good Dr Bad
Situation: A diabetic patient with uncontrolled diabetes came with cognitive impairment.
Dr Bad: Its dementia and nothing can be done.
Dr Good: Get your blood sugar controlled.
Lesson: An analysis of ~3,000 individuals with established type 2 diabetes demonstrates a clear age–adjusted inverse relationship between cognitive function and the degree of chronic hyperglycemia as measured by A1C level.
(Source: Diabetes Care 2009; 32:221–226.)
Situation: A patient developed dangerous arrthymias immediate post-CABG.
Reaction: Oh my God! Why did you not correct his K+ value of 2.5 pre–operatively?
Make Sure that a pre–operative K+ value of <3.5 is corrected. Cardiac surgery patients who have serum potassium levels below 3.5 mmol.L are at high risk for peri–operative arrhythmia.
Contributions to the Central Government Health Scheme also allowed as a deduction under Section 80D.