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Sunday, March 23, 2014

Chickenpox may sometimes become Life Threatening

Suffering from chickenpox is not taken that seriously as most of the patients recover. Sometime back, one of my staff’s child was suffering from chickenpox and was admitted to the hospital. On enquiry of immunization status, the treating doctor, my colleague stated that the immunity is short lasting and each year vaccine is to be administered. This shook the concept that an infection from chickenpox or vaccination gives long lasting immunity.
English: The back of a 30-year old male suffer...
English: The back of a 30-year old male suffering from chickenpox. This is on the 5th day since the rash's development. Pocks are starting to crust over. Afrikaans: Die rug van 'n 30-jarige man wat waterpokkies het. Hierdie foto is op die 5de dag sedert die uitslag begin het. Die sere begin uit te droog. (Photo credit: Wikipedia)


Yesterday, I came across an article in the Mail Online that narrates the story of death of a 7 years old girl child from chickenpox on December 27 last year. That can be accessed here.
This prompted me to remove the wrong concept that vaccination is required every year and chickenpox is not that dangerous. Of course, most of the sufferers recover well.
Chickenpox, though rarely, may cause encephalitis and ischemic arterial stroke that may result in death. The most irritating long term complication of it is shingles. That is why, it is better to get protected that to suffer from it.
Chickenpox is caused by Varicella Zoster, a virus and vaccination is started during 12-15 month of age with a second dose at 4-6 years. Those above 13 years of age and are neither suffered from it nor vaccinated, may take two shots at an interval of 28 days. Adults in a similar situation can be vaccinated.
Immunity lasts long, but as with all other vaccines, it may not translate to protection in 100% of cases.
Better to get vaccinated and protected than to suffer from it with a likely risk of death.
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Monday, January 27, 2014

You Realise it, when You Suffer from it.



“Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGH and Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices.”
Massachusetts General Hospital
Massachusetts General Hospital (Photo credit: Wikipedia)

This is the expression of a faculty member of Harvard Medical School, Arnold Relman, who got admitted to the Massachusetts General Hospital after breaking his neck bone and was carried to the hospital in a bad shape. He spent 10 excruciating weeks in the hospital to get discharged live. His views published in the Foxnews that can be accessed here.
The essence of the article is that though there is expertise, there is no personalized care, both from doctors and nurses. More attention is paid to investigations, which includes unnecessary ones also.
Those were the days, when we as medical students running after teachers to learn some clinical findings. Teachers also were taking us to patients, “listen one by one, this is called crepitation.” Now, if a patient of respiratory infection comes, at least X-Rays chest will be ordered immediately, even without going for clinical examination; thereafter a battery of investigations, like CT, MRI, Sputum examination etc..
Nobody denies to order these investigations, but what matters is that, there should be investigations just sufficient to support clinical findings reliably and pin-point the diagnosis.
Another thing he noticed is poor record keeping and doctor patient relationship. When a doctor holds hand of a patient and calls by his name to know how he is, that infuses a lot of confidence in the patient; contrary to the non-touch technique of examination and ward round.
I was taken aback, when I was told by some of my doctors that they never write findings of the clinical examination in the case-sheet and do not know, how to write. What can be more ridiculous than this?
There is definitely a lack of concern for the patients on behalf of the doctors and nurses. Can you do same thing or behave in the same way, if the patient would happen to be your own relatives? Hearts are to change, no amount of force can change it. 
However, things are taking shape in the right direction slowly.
Let us hope for the best to come. You realize it, when you suffer from it.
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Saturday, January 11, 2014

What is Metabolic Syndrome?

According to AHA (American Heart Association)/NHLBI (National Heart, Lung, and Blood Institute) diagnostic criteria, individuals with three of the following five conditions are characterized as having Metabolic Syndrome: 

1. abdominal obesity  [waist circumference ≥102 cm (≥ 40 inches) in men, ≥ 88 cm (≥ 35 inches) in women]; typically the apple shape.

Picture of an Obese Teenager (146kg/322lb) wit...
Picture of an Obese Teenager (146kg/322lb) with Central Obesity, side view.Self Made Picture of an Obese Teenager (Myself) (146kg/322lb) with Central Obesity, Front View. Feel Free to use. (Photo credit: Wikipedia)


2. Hypertriglyceridemia [TG≥150 mg/dL (≥1.7 mmol/L) or drug treatment for elevated TG].

3. low HDL-C [< 40 mg/dL (< 1.03 mmol/L) in men, <50 mg/dL (< 1.3 mmol/L) in women, or drug treatment of reduced HDL-C].

4. Elevated BP [≥130 mm Hg systolic BP, or ≥85 mm Hg diastolic BP, or drug treatment of hypertension].

5. Hyperglycemia [fasting plasma glucose ≥100 mg/dL or drug treatment for elevated glucose]. 

The risk of heart disease, diabetes, and stroke increases with the number of metabolic risk factors. In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn't have metabolic syndrome.
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Monday, December 16, 2013

Can Chelation Therapy with EDTA Reduce Cardiovascular Events in Diabetics?

In a study, funded by National Institutes of Health, "Trial to Assess Chelation Therapy (TACT)", it has been seen that chelation treatments reduced cardiovascular events, such as heart attacks, and death in patients with diabetes, but not in those, who did not have it. However, researchers are of opinion that more studies are needed before it’s known whether this promising finding leads to a treatment option.
Chelation is being used for treatment of heavy metal (like lead) poisoning. This is a chemical process in which a substance is delivered intravenously (through the veins) to bind atoms of metals or minerals, and hold them tightly so that they can be eliminated from the body.
Chelation therapy is not approved by the U.S. Food and Drug Administration  (USFDA) to treat heart disease. However, use of chelation therapy to treat heart disease and other health problems grew in the United States between 2002 and 2007 by nearly 68 percent to 111,000 people, according to the 2008 National Health Statistics Report.
The diabetes subgroup analysis of TACT was published in the Circulation: Cardiovascular Quality and Outcomes and presented at the American Heart Association’s Scientific Sessions 2013. TACT is a study supported by NIH’s National Center for Complementary and Alternative Medicine (NCCAM) and National Heart, Lung, and Blood Institute (NHLBI).

Cr(edta)-2
Cr(edta)-2 (Photo credit: Wikipedia)

TACT’s initial report was published in the March 27, 2013, issue of The Journal of the American Medical Association. The report showed that infusions of a form of chelation therapy using disodium ethylene diamine tetra-acetic acid (EDTA) produced a modest but statistically significant reduction in cardiovascular events in all EDTA-treated participants suffering from Diabetes Mellitus.


I have seen this form of treatment in many medical centers in Kochi, and they also claim very good outcome.
TACT was not designed to discover how or why chelation might benefit patients with diabetes. Further research may throw some light in that aspect.
The original article may be accessed here.
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Wednesday, November 20, 2013

USFDA Recommends Cutting Down of Trans-Fats to Prevent Many Heart Attacks



More than decade ago, American consumers started avoiding foods with trans fat and companies responded by reducing the amount of trans fat in their products.

Trans fats (Fatty Acids, as building blocks) are those, where carbon atoms are linked with double bonds, positioned in the same side of other atoms and the chain is straight. In contrast, Cis isomers contain double bonds in the opposite side and the chain is bent.
Humans are capable of digesting Cis fats that is found in nature, where as trans fats cannot be and are manufactured. The later is implicated for causing coronary artery disease (CAD), probably by increasing LDL (Low density lipoproteins) and decreasing HDL (High density lipoproteins). HDL is the carrier of lipoprotein for metabolism.

English: diagram of absorption of fats
English: diagram of absorption of fats (Photo credit: Wikipedia)

This evolution began when FDA first proposed in 1999 that manufacturers be required to declare the amount of trans fat on Nutrition Facts labels because of public health concerns. That requirement became effective in 2006.
However, there are still many processed foods made with partially hydrogenated oils (PHOs), the major dietary source of trans fat in processed food.
The Centers for Disease Control and Prevention estimates that a further reduction of trans fat in the food supply can prevent an additional 7,000 deaths from heart disease each year and up to 20,000 heart attacks each year.
Part of the FDA's responsibility to the public is to ensure that food in the American food supply is safe. Therefore, due to the risks associated with consuming PHOs, FDA has issued a Federal Register notice with its preliminary determination that PHOs are no longer "generally recognized as safe," or GRAS, for short. If this preliminary determination is finalized, then PHOs would become food additives subject to premarket approval by FDA. Foods containing unapproved food additives are considered adulterated under U.S. law, meaning they cannot legally be sold.
If FDA determines that PHOs are not GRAS, it could, in effect, mean the end of artificial, industrially-produced trans fat in foods, says Dennis M. Keefe, Ph.D., director of FDA's Office of Food Additive Safety. FDA is soliciting comments on how such an action would impact small businesses and how to ensure a smooth transition if a final determination is issued.
Trans fat wouldn't be completely gone, Keefe notes, because it also occurs naturally in small amounts in meat and dairy products. It is also present at very low levels in other edible oils, such as fully hydrogenated oils, where it is unavoidably produced during the manufacturing process.
PHOs are found in many popular processed foods, like baked goods and frozen foods that time-crunched Americans use to feed their families. They have been widely used as ingredients since the 1950s to increase the shelf-life and flavor stability of foods.
However, Mical E. Honigfort, a consumer safety officer at FDA, says that trans fat can still be found in such processed foods as:
  • crackers, cookies, cakes, frozen pies and other baked goods
  • snack foods (such as microwave popcorn)
  • frozen pizza
  • vegetable shortenings and stick margarines
  • coffee creamers
  • refrigerated dough products (such as biscuits and cinnamon rolls)
  • ready-to-use frostings
In the meantime, what should the average consumer do if he or she picks up a favorite food and sees that it has trans fat on the Nutrition Facts label? The best thing to do is to consider the amounts of saturated fat, cholesterol and trans fat. Choose the product that has the lowest combined amount of these nutrients, Keefe says.
Even if a food claims on its packaging to have "0 grams trans fat," it's a good idea to look at the ingredients, says Honigfort. Under current regulations, companies can make that claim if the food contains less than 0.5 grams of trans fat per serving. But if there is partially hydrogenated oil listed with the ingredients, there might be a small amount of trans fat. Selecting foods with even small amounts of trans fat can add up to a significant intake.
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

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Sunday, November 10, 2013

Food and Gut Microbes Acting together in Enhancing Production of TMAO (Trimethylamine N-Oxide) may Increase Risk of Heart Attack

Food and gut microbes acting together in increasing production of TMAO (Trimethylamine N-Oxide) may increase the risk of Heart Attack from atherosclerosis.

Structure of Trimethylamine oxide (TMAO)
Structure of Trimethylamine oxide (TMAO) (Photo credit: Wikipedia)

A study published online in the Cleveland Clinic on April, 2013 establishes the link between carnivorous/omnivorous food habit with predisposition to atherosclerosis and heart attack, to be TMAO (Trimethylamine Nitric-Oxide), a by-product of gut microbial action on certain foods containing lecithin and carnitine.
The researchers have proved that cholesterol cannot only be indicted to be the culprit in atherosclerosis, TMAO is the new found main facilitator for the plaque formation in the arterial walls.
Diets such as red meat and egg (Yolk) etc. when acted upon by the certain gut microbiota, produce TMAO, which is absorbed to the system and adversely affecting the reverse cholesterol transport; interferes with the metabolism of cholesterol in liver, only to facilitate its' deposition in the arterial walls, altering the macrophage foam cell function.
It is not precisely known which microbes from about a trillion of gut microbiota are responsible for increased TMAO production. In the study, when the gut flora was suppressed by antibiotics, production of this by-product was decreased. However, the Bacteroid type enterotype are associated with meat fat and protein eaters.
However, antibiotics are not recommended for prevention on heart attack because the gut flora recoups soon after the initial suppression by developing resistance.
The TMAO production was less in vegetarians and people on Mediterranean diet, in comparison to meat eaters. It is also interesting to observe that two different people can experience the same food differently because they have different gut flora. One person may generate a little more of a compound like TMAO than the other.
This concept is a new way of thinking about complex diseases like atherosclerosis and other cardiometabolic diseases. It can also apply to obesity and insulin resistance. Data links intestinal flora involvement in those phenotypes in both mice and humans.
There have been very exciting data from a gut flora transplant in persons with metabolic syndrome who received either their own fecal samples or those from a lean donor. Persistent changes in insulin sensitivity occurred just by transplanting the intestinal flora from one individual to another.
With the present level of knowledge, there has not been any recommendation on stopping meat eating for the purpose. But, promoting vegetarian diet is not a bad idea.
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