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Health Economics
 
03:41
Hi, my name is Dr. Sanjay Sharma. I am a Professor of Ophthalmology and Epidemiology at Queen's University. As a researcher, I am very interested in a particular area of epidemiology called health economics. Part of the goal of health economics is to work out the cost-benefit numbers for new interventions in a way that can help doctors and policy makers make the often difficult decisions on which interventions to pay for and which may be too expensive for public healthcare to fund. I want to give you a high level overview of how we do this... The key thing is being able to put a value on a new drug or procedure.  In healthcare we measure value in a unit called the QALYs or quality adjusted life years. One QALY is equal to living for one year in perfect health. So how do we work this out? Well, what we do is we look at the average person with a specific disease and then we look at all the outcomes of that disease both with and without the intervention that we are evaluating. For each possible outcome, we assign a probability and a utility score. The utility score is a measure of how much your quality of life would decrease with a certain outcome. For example, someone with wet macular degeneration might say that if they went blind, their quality of life would decreases by 55% - this would mean a utility score of 0.45. Using a mathematical model called a Markov model, we combine the utility scores and probabilities and other factors to determine the average benefit to someone with a disease who takes the drug we are evaluating. We calculate that benefit over the course of the treatment, and end up with the increase in QALYs caused by the drug. The next thing we do is look at the costs to society as a result of each outcome. Most obviously we have to look at the cost of paying for the drug treatments, but then we also have to take into account the total cost of each possible outcome associated with both receiving treatment and not receiving treatment. For example, in eye-care, we also have to consider the costs to the healthcare system if a patient went blind, including personal assistance, patient education and continuing medical care. In this case, the blindness could have been caused by adverse effect of the drug or through not taking the drug at all. Once we have determined the costs we can calculate the cost per QALY, or, how much does it cost us to gain the equivalent of a year in perfect health for a patient. This cost per QALY becomes a standardized metric to evaluate new interventions The typical scenario is that a new intervention provides an improvement in the length or quality of life, but costs money. Then health economists and doctors argue it out as to whether government should pay for the intervention. Most governments fund things that cost less than $50,000 per QALY and do not pay for others that are more costly. It is a complex analysis and we have only brushed the surface, but I hope I have been able to give you a small glimpse into how health economists work and how their analysis helps us run our healthcare system with a reasoned approach.
Просмотров: 51967 insidermedicine
The policy debate.  Lucentis vs Avastin --  The value of safety.
 
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A new study by Dr. Sanjay Sharma at Queen's University in Kingston Ontario looked at the relative safety of Lucentis (retail price $1700) and Avastin (retail price $100) - two drugs used to treat wet macular degeneration (AMD). The results could influence current health policy trends. To learn more about the use of Lucentis and Avastin for macular degeneration, click: http://youtu.be/8ioLGS8c9S4 Sanjay Sharma, Davin Johnson, Marwan Abouammoh, Simon Hollands, Ashley Brissette. Rate of serious adverse effects in a series of bevacizumab and ranibizumab injections. Canadian Journal of Ophthalmology - June 2012 (Vol. 47, Issue 3, Pages 275-279).
Просмотров: 15279 insidermedicine
The Role of Inflammation in Dry Eye
 
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Просмотров: 3761 insidermedicine
If I Had - Retinitis Pigmentosa - Dr. Gerry Chader, MD, Ph.D, USC Medical School
 
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Watch Dr. Gerry Chader, MD, Ph.D., whose research focuses on the cause, prevention, treatment, and cure of retinal disease, discuss retinitis pigmentosa. Dr. Chader is a Chief Scientist at the Doheny Retina Institute at University of Southern California Medical School
Просмотров: 20424 insidermedicine
Three O's of Eyes: How Ophthalmologists, Optometrists and Opticians work together for your eyes
 
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Not sure of the difference between ophthalmologist, optometrist and optician? In this engaging whiteboard animation, we walk you through how each of these three work together to provide the best care for your eyes.
Просмотров: 17580 insidermedicine
If I Had Wet Age-related Macular Degeneration (AMD)
 
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Dr. Sanjay Sharma, MD, MSc (Epid), FRCSC, a Retina Specialist from Hotel Dieu Hospital and professor of ophthalmology at Queen's University, discusses what he would do if he had wet Age-related Macular Degeneration.
Просмотров: 23841 insidermedicine
Le rôle d'inflammation dans l'oeil sec
 
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Просмотров: 3572 insidermedicine
Insidermedicine In Depth - July 7, 2010 - Cancer Risk With Telomere Length
 
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The shorter your telomeres, the greater your risk of cancer and death from cancer, according to research published in the Journal of the American Medical Association. Here is some information about telomeres: • They are stretches of DNA that are found at the ends of chromosomes • They protect the stretches of DNA that contain precious genetic information, much like the plastic tips of shoelaces protect laces from fraying • Every time a cell divides, its telomeres get shorter, and when they become too short, the cell dies Researchers from Innsbruck Medical University measured the telomere length in the white blood cells of nearly 700 individuals without cancer. They then followed up the participants for ten years to see who would develop and die from cancer. Overall, nearly 12% of the participants developed cancer during the ten-year follow-up period. The shorter their telomeres, the greater the risk for cancer. Compared with those who had the longest telomeres, those with middle-length telomeres had more than twice the risk of cancer, and those with the shortest telomeres had more than three times the risk. In addition, those with short telomeres were more likely to die from cancer when they developed it. Today's research demonstrates how measuring telomeres can help predict the risk for cancer and cancer outcomes.
Просмотров: 4067 insidermedicine
Women with migraines may have lesions deep in the brain
 
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Women with migraines have been found to be at increased risk of having lesions deep in the white matter of the brain, but the health implications of these findings remain uncertain. The research is published in the November 14 issue of the Journal of the American Medical Association. Here is some information about migraine headache: • It is a form of headache caused by dilation of blood vessels in the brain, which in turn triggers the release of certain chemicals from nerve fibers that coil around the large arteries of the brain • The chemicals cause inflammation, pain, and further dilation of the arteries • Symptoms if migraine include intense head pain as well as nausea, vomiting, and diarrhea Researchers from the Leiden University Medical Center followed up more than 400 individuals with and without migraines who underwent brain scans in 2000 using magnetic resonance imaging (MRI). The investigators repeated these scans in nearly 300 of the original participants to assess the progression of any brain lesions they discovered and to determine whether the changes they observed were linked with the presence of migraines. No link between brain lesions and migraines were found in men. Among women, however, those with migraines were more than twice as likely to have progression of brain lesions deep in the white matter of the brain than those without migraines, after taking into account participants' age, sex, and educational level as well as the presence of diabetes or high blood pressure. No link was seen between migraines in women and lesions in other parts of the brain. In addition, the intensity, frequency, number, and treatment of the migraines did not appear to be related to the brain lesions, nor was the volume of the brain lesions associated with changes in cognitive ability. Today's research raises questions about the relationship between migraines and neurological health in women. It remains unclear whether migraines may place women at increased risk for neurological diseases such as stroke.
Просмотров: 3991 insidermedicine
Silently Going Blind -- Glaucoma strikes when patients are not regularly screened
 
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Dr Sanjay Sharma explains the results of his study on glaucoma published in the Journal of American Medical Association (JAMA) as part of their rational clinical exam series. In this video he explains what glaucoma is and talks about the importance of receiving periodic eye assessments for glaucoma detection, especially for those in higher risk categories. Video Transcript: Hi I am Dr. Sanjay Sharma and I am an ophthalmologist and epidemiologist at Queen's University. Today I want to talk about the importance of having your patients receive periodic eye assessments for glaucoma detection. This video is based on our systematic review of the leading glaucoma literature, and was published as part of the rational clinical exam series in JAMA. Open angle glaucoma is a leading cause of visual loss, but because it begins by affecting the far periphery of vision, most patients don't know that they have it until the disease progresses and begins to destroy their central vision. Nearly half of those with glaucoma remain undetected and 50% of those diagnosed have very advanced disease on presentation. This is why it is so critical that at-risk patients be regularly screened for glaucoma. All eyes have pressure in them so that refraction can properly take place and the eye's internal structures can be bathed in nutrients. The eye's pressure is maintained because of the continuous creation and flow of aqueous humor. This fluid, which is secreted by the ciliary body, flows through the pupil and leaves the eye through its drainage system called the trabecular meshwork. There are two types of glaucoma: open angle and closed angle defined by the state of the angle at the junction between the iris and the cornea. In closed angle glaucoma the iris is pushed forward such that it obstructs the trabecular meshwork, whereas in open angle glaucoma the iris remains posterior and the trabecular meshwork remains open but degenerates over time. While glaucoma caused by a closed angle is very rare -- its presentation is dramatic and it is a true medical emergency as vision can be lost within a matter of hours. Open angle glaucoma accounts for the vast majority of cases. In these patients chronically elevated pressure can destroy the optic nerve over a period of many years. However with drops, laser treatment or surgery -- disease progression can be halted. Our analysis based on a synthesis of 50 peer reviewed articles shows that 2.6% of the overall population has glaucoma. We also found a higher risk of glaucoma in: 1. those over the age of 80 2. those who are nearsighted 3. those with a positive family history, and 4. those who are African-American The analysis also showed that certain physical findings detected through high quality periodic screening are strongly associated with open angle glaucoma. These include: 1. an increased cup to disc ratio 2. a cup disc asymmetry between the two eyes 3. the presence of a disc hemorrhage, and 4. an eye pressure that is greater than 21 mmHg. Because diagnosing glaucoma requires specialized testing including measuring visual fields and retinal nerve fibre layer thickness, it is essential that generalist physicians direct any patient over the age of 45 to be periodically screened for glaucoma typically every 2 to 4 years. As patients age, or if they have more than one risk factor as listed previously, patients should be screened more regularly, up to once every 1 or 2 years It is our sincere hope that if generalist physicians adopt this practice and regularly refer their patients for high quality periodic eye examinations, glaucoma can be detected at an early stage and proactively managed before it causes significant visual loss and blindness.
Просмотров: 6213 insidermedicine
Healthy diet may reduce, even eliminate, menopause symptoms - In Depth
 
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Losing weight by following a healthy diet can help reduce or even eliminate symptoms of menopause, according to research published online ahead of print in Menopause. Some lifestyle changes that may help ease you gently into menopause include: • Avoiding caffeine and spicy foods • Eating foods high in soy • Getting plenty of exercise Researchers from Kaiser Permanente analyzed data on more than 17,000 postmenopausal women aged 50 to 79 who participated in the Women's Health Initiative Dietary Modification trial. For this trial, the women were randomly assigned to continue with their usual eating habits or to follow a low-fat diet that was high in fruits, vegetables, and whole grains. None of the participants were taking hormone therapy to treat their menopausal symptoms. Among the women bothered by menopausal symptoms such as night sweats and hot flashes, those assigned to the low fat diet were 14% more likely to be free of these symptoms than those assigned to eat as usual. In addition, the women were 23% more likely to be symptom-free if they lost 10 lbs or more and 56% more likely to be symptom-free if they lost 10% or more of their body weight within the first year of the study, compared with those who maintained their weight. Interestingly, the weight loss had a greater effect on symptom elimination if it occurred among the women assigned to the low fat diet, rather than among those who followed their usual diet, suggesting following a healthy diet, not just losing weight, is important for symptom improvement. Today's research demonstrates the important role that diet can play in managing symptoms of menopause
Просмотров: 2821 insidermedicine
Men with erectile dysfunction at raised risk of heart disease - IN60
 
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From Hong Kong - According to research published in Journal of the American College of Cardiology, men with erectile dysfunction are at significantly higher risk for developing heart disease. Researchers followed over 2,300 patients with type 2 diabetes and noted that those with ED were twice as likely to develop coronary artery disease. Given that ED may predict future heart disease, its documentation should be included in the assessment of cardiovascular risk. From Rome - According to research published in the Lancet Oncology, testing thyroid nodules for the presence of galectin-3, a protein that is involved in inhibiting cell replication, may reduce the number of unnecessary surgeries for potential thyroid cancer. In a study of over 400 thyroid nodules that were potentially cancerous, researchers noted that if the lesion expressed the protein the likelihood of cancer was over 80%, and in its absence, it was less than 10%. And finally from Toronto - Drinking caffeinated coffee an hour before eating breakfast cereal can affect the body's blood-sugar response. In a study of 10 healthy men, those that drank caffeinated coffee before or while eating low-sugar cereal saw their blood glucose levels spike by 250% compared with decaf coffee. The researchers concluded that some people may be better off eating sweeter cereal, and drinking decaf. For Insidermedicine in 60, I'm Dr. Susan Sharma.
Просмотров: 6571 insidermedicine
Avastin Riskier than Lucentis in Eye Injections for Macular Degeneration
 
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You, or a family member may be getting eye injections for macular degeneration or diabetes. The two drugs most commonly used in eye injections are Lucentis and Avastin. Lucentis is FDA approved and is expensive. Avastin is used "off-label" in the eye and is very cheap. Recent research in the Canadian Journal of Ophthalmology show that those treated with Avastin have a 12 times higher risk of developing severe inflammation in the eye when compared to patients who received Lucentis. This complication can lead to significant visual loss. Watch now to learn more about eye injections and this increased risk. To view our animated whiteboard video that explains the heated health policy debate surrounding these two drugs, click: http://www.youtu.be/lWdN3kUlB0Q Sanjay Sharma, Davin Johnson, Marwan Abouammoh, Simon Hollands, Ashley Brissette. Rate of serious adverse effects in a series of bevacizumab and ranibizumab injections. Canadian Journal of Ophthalmology - June 2012 (Vol. 47, Issue 3, Pages 275-279).
Просмотров: 58269 insidermedicine
Stenting falls short of endarterectomy for carotid artery stenosis - IN Depth
 
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Outcomes of carotid stenting fall short of endarterectomy for the treatment of symptomatic carotid artery stenosis, according to a randomized trial published online ahead of print in The Lancet Neurology. Here are some recommendations for the use of carotid endarterectomy (CE) From the American Academy of Neurology: • CE is established as effective for recently symptomatic (within previous 6 months) patients with 70 to 99% internal carotid artery (ICA) angiographic stenosis • CE should not be considered for symptomatic patients with less than 50% stenosis • CE may be considered for patients with 50 to 69% symptomatic stenosis, but also consider additional clinical and angiographic variables Researchers out of the National Hospital for Neurology and Neurosurgery in London representing The International Carotid Stenting Study (ICSS) investigators randomly assigned 1,713 patients with recently symptomatic carotid stenosis to stenting or surgery. After a follow-up period of up to 120 days, 8.5% of patients in the stent group experienced a stroke, compared with only 5.2% in the surgery group. In total, 84 of the patients in the stent group experienced a stroke or died, compared with only 42 in the surgery group. The main factor driving this difference, however, was a higher rate of non-disabling strokes in the stent group. The incidence of disabling strokes or death was actually similar for both groups. Among 231 patients who underwent magnetic resonance imaging (MRI) after treatment, 50% of those in the stent group and only 17% of those in the surgery group developed new ischemic lesions. Today's research suggests that endarterectomy should remain the gold standard for the treatment of symptomatic carotid stenosis, at least until stent placement is demonstrated to be as good or better.
Просмотров: 9248 insidermedicine
Virus found to raise prostate cancer risk - IN60
 
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From New York - Scientists have identified a virus that may increase a mans risk of prostate cancer, according to research published in the Proceedings of the National Academy of Sciences. Researchers compared over 200 prostate cancer tumors to 101 non-cancerous prostate tissue samples. They found that 27% of the tumors contained the virus XMRV--a virus that is known to cause other types of cancer in animals--compared to only 6% of the benign samples. From The Netherlands - New research suggests that the 'hygiene hypothesis'--a theory that maintains that early exposure to infections through daycare reduces ones risk of later illness--is false, according to a report published by the American Thoracic Society. Dutch researchers studied the respiratory symptoms of 4,000 children for the first eight years of their life. Results showed no beneficial or harmful effects of daycare--children who attended early were just as likely to wheeze later in life as those who did not. And finally, from the UK - Infections outside of the brain may increase an elderly persons risk of developing Alzheimer's Disease, according to a report published in the journal Neurology. Researchers studied over 200 elderly patients for a six month period; just over 100 of the patients developed different infections in places such as the chest, stomach, intestines and urinary tract. Those who developed these infections suffered memory loss twice as fast as patients who did not get infected or injured.
Просмотров: 6449 insidermedicine
Lazy Eye in Children and Discrimination - IN Depth
 
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Children with a lazy or wandering eye may start to be discriminated against by other children starting around age 6, according to research published in the British Journal of Ophthalmology. Here is some information about a wandering or lazy eye: • An eye that turns in or out can lead it to become "lazy". In this situation, the proper nerve connections do not form properly and the vision from the eye may never improve. • Anyone child with an eye that turns inward or outward needs to be urgently assessed, because this may be due to a tumor, cataract and may result in permanent visual loss if not corrected. • An eye that turns inward or outward may require glasses or surgery. If the eye has become lazy, patching of the other eye may be necessary to force it to work and form proper nerve connections with the brain. Swiss researchers digitally altered photographs of six sets of identical twins such that it looked as though one child in each set appeared to have a lazy eye that turned either inward or outward. They then asked over 100 children aged 3 to 12 to look at these photographs and select which one of each set of twins they would invite to their birthday party. The participants had normally aligned eyes themselves, although they were either patients at an eye clinic or siblings of such patients. Children under the age of 6 did not discriminate between children with and without strabismus. Among the 48 participants aged 6 to 8, however, 18 did not select any child with strabismus, 17 selected only one, 11, selected only two, and 2 selected only three. None selected four or more out of a total six. Only about a fifth of the children aged 4 to 6 mentioned eye alignment when asked if they noticed anything different about one twin. This rose to nearly 40% when they were specifically prompted to look at the twins' eyes. Today's research suggests that strabismus may have social implications. If you have a child with an eye that wanders, you should have this urgently assessed, as the eyes need to be examined to rule out serious problems, and glasses, surgery or patching may be necessary to maximize vision
Просмотров: 19068 insidermedicine
Insidermedicine In Depth - February 19, 2010 - Benazepril and Amlodipine
 
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Combining the two blood pressure-lowering drugs benazepril and amlodipine protects the kidneys better than combining benazepil with the diuretic hydrochlorothiazide, according to research published online ahead of print in The Lancet. Here is some information about high blood pressure and kidney disease: • Having untreated high blood pressure makes the heart work harder, which can, over time, damage blood vessels all over the body • One of the places blood vessels are often damaged in those with high blood pressure is the kidneys • High blood pressure is a leading cause of kidney disease Researchers from the University of Chicago representing the ACCOMPLISH study investigators randomly assigned over 11,000 patients from five countries who were suffering from high blood pressure to treatment with the gold standard of benazepril combined with hydrochlorothiazide, a drug that helps flush excess fluid from the body, or with a novel combination of benazepril plus amlodipine, a drug that uses a different mechanism to lower blood pressure. All the participants were considered to be at high risk for cardiovascular disease. The study was stopped early, after an average follow-up period of about 3 years, because those in the benazepril/ hydrochlorothiazide were nearly twice as likely to experience progression of chronic kidney disease as those in the benazepril/amlodipine group. The rate of progression of chronic kidney disease was 2% in the benazepril/amlodipine group, versus nearly 4% in the benazepril/ hydrochlorothiazide group. Todays research suggests that health care professionals make a change from preferentially prescribing benazepril/ hydrochlorothiazide for high blood pressure to benazepril/amlodipine, because this second combination does a better job of protecting the kidneys.
Просмотров: 1788 insidermedicine
Insidermedicine in 60 - April 1, 2008
 
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From Cleveland - The weight loss drug Acomplia may alter certain risk factors for heart disease, but doesn't appear to reverse it. Researchers randomized over 800 patients who required an angiogram to receive either Acomplia or placebo. Using intravascular ultrasound, no differences were noted in those who received the two treatments. Those who received Acomplia lost more weight and had a greater reduction in triglycerides, but were also more likely to develop psychiatric symptoms. From Texas - The American Heart Association has officially recognized that "hands only" CPR, a technique in which no breaths are administered and instead 100 compressions per minute are delivered, is superior to the traditional technique. The traditional technique is still recommended for children, given that a collapse in a child is more likely due to a breathing problem. And finally, from Hamilton - A newer class of blood pressure lowering medications known as ARBs may have a better safety profile than older ones. A trial of over 25,000 patients with heart disease were randomized to receive an ARB, an ACE inhibitor or both. Those who received an ARB or an ACE inhibitor had an equal lowering effect on blood pressure, but those who received the ARB were less likely to experience side effects. For Insidermedicine in 60, I'm Dr. Susan Sharma.
Просмотров: 3865 insidermedicine
CIHR Video: Dr. Ray Rajotte, PhD & Dr. Peter Senior, MD, PhD
 
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In this video, Dr. Ray Rajotte, PhD and Dr. Peter Senior, MD, PhD discuss their research into islet cell transplantation for the treatment of diabetes. Dr. Rajotte is Professor of Surgery and Medicine at the University of Alberta, while Dr. Senior is Assistant Professor in the Division of Endocrinology at the University of Alberta.
Просмотров: 2629 insidermedicine
Link found between circadian rhythm and diabetes, obesity - IN DEPTH
 
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A compound that plays a role in the regulation of the body's day/night rhythm has also been found to be implicated in how the liver produces glucose, offering a biological link between the body's biological clock and metabolic disorders such as diabetes. The research is published online ahead of print in Science. Here is some information on diabetes: • It is a condition in which glucose levels in the blood rise • Chronically high levels of glucose in the blood can lead to health problems such as heart disease, stroke, and blindness • Laboratory studies have linked disrupted biological clocks with an increased risk for diabetes Researchers from the University of California at San Diego identified a small molecule they called KL001 while screening for compounds that affect the body's day/night internal clock, known as the circadian rhythm. They demonstrated that KL001 affects the circadian rhythm by preventing the breakdown of a protein known as cryptochrome. This protein regulates the circadian rhythm of both plants and animals, but it is also involved in the production of glucose by the liver. The investigators used a complex mathematical model to help clarify the role that KL001 plays in regulating the circadian rhythm. This model helped them zero in on its effect on the liver. They placed KL001 into the liver cells of mice. Normally, in the presence of the hormone glucagon these cells will produce glucose. Adding KL001 to the cells prevented this process. Today's research provides a biological basis for the observed link between disrupted circadian rhythms and the development of metabolic disorders such as obesity and diabetes. It may be the first step toward developing new treatments for these disorders.
Просмотров: 737 insidermedicine
Mini-strokes can cause permanent disability, need immediate treatment - In Depth
 
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Transient ischemic attacks, known as TIAs or "mini-strokes" can cause disability if not treated quickly and aggressively, according to research published in the journal Stroke. Remember F.A.S.T. to help you recognized the signs of a stroke: • F -- Face weakness • A -- Arm weakness • S --Speech problems • T - Time to contact emergency medical services Researchers from Foothills Hospital in Calgary used brain scanning and other tools to assess the level of disability of nearly 500 patients who experienced a TIA. The investigators conducted their assessment 90 days after the TIA occurred. Overall, 15% of the patients had at least minor disability, defined as a loss of some previous ability without losing the ability to manage one's personal affairs independently. Repeated strokes were far more damaging than a single event, and more than half of those who experienced repeated TIAs had some level of disability at 90 days. Other features that increased the risk of disability following a TIA were being female, having type 2 diabetes, having signs of blood vessel narrowing on brain scans, and experiencing a worsening of symptoms in the first weeks following the attack. Today's research indicates that TIAs are a medical emergency that require rapid, aggressive care in order to prevent potentially permanent disability.
Просмотров: 1408 insidermedicine
OxyContin Death Risk - IN Depth
 
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(December 7, 2009 - Insidermedicine) The alarming risk of death associated with the use of prescribed narcotic drugs, particularly OxyContin, is highlighted in a study published in the latest issue of the Canadian Medical Association Journal. Here is some information about narcotic drugs and OxyContin: • Also known as opioid drugs, narcotics are commonly prescribed pain-relieving drugs • Narcotics are dangerous because their side effects can include depression of breathing and a decrease in consciousness • OxyContin, also known as oxycodone, is a particularly potent and popular narcotic To evaluate the impact of narcotic drugs on death rates in Ontario, researchers from St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto reviewed over 7,000 files from the Coroner's office and linked these with provincial data on physician visits and medication prescribing. They also analyzed data on the sales of prescription narcotics that were collected by a private company. The researchers focused their evaluation on the period from 1991 to present. Based on their analyses, prescriptions of OxyContin have increased by more than 850% during the study period. In 2006, this drug represented one-third of the narcotic prescriptions written in 2006 in Ontario. Since this drug began to be covered by provincial drug plans in 2000, deaths associated with its use have increased fivefold. In fact, deaths from use of prescribed narcotics far outstrip those associated with heroin use. Overall, 54% of deaths associated with prescribed narcotics were considered to be accidental. Most of those whose deaths were related to use of a prescribed narcotic drug had visited a doctor and received a prescription for the drug in the previous month. We had a chance to speak with Dr. Irfan Dhalla, the principal investigator of this study, who provided some further insight. Today's research highlights the increased risk associated with prescribed narcotic drugs in general and OxyContin in particular. Both physicians and patients need to be better informed about the dangers of these drugs.
Просмотров: 8200 insidermedicine
Purine rich foods, such as asparagus and meat, linked to gout flareups
 
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Eating foods rich in purine has been linked with a nearly fivefold risk of having a gout flare up, according to research published online ahead of print in the Annals of Rheumatic Diseases. Here is some information about gout: • It is a type of arthritis that occurs when uric acid builds up in the blood and causes inflammation in one or more joints • It is most well-known as a very painful type of inflammation of the joint in the big toe, although it can affect other joints • While an acute attack of gout usually lasts only a few days, the attacks can recur and the condition can even become chronic Researchers from Boston University School of Medicine asked more than 600 gout sufferers to record the onset of every gout attack they had over a 1-year period. For every attack, the participants reported the specific symptoms and signs as well as any medication they were taking at the time. They also indicated if there were any risk factors for gout present during the 2 days before the attack. Included in these risk factors was the eating foods rich in purine, which include meat, offal, seafood, beans, peas, lentils, oatmeal, spinach, asparagus, mushrooms, yeast, and alcohol. For the purposes of comparison, the participants also recorded similar information for 4 gout-free 2-day periods during the same 1-year study period. Those who ate the most purine-rich foods were nearly 5 times more likely to experience repeated gout attacks as those who ate the least purine-rich foods. When the investigators looked only at intake of purine from animal sources, the highest consumers were more than twice as likely to have repeated gout attacks as the lowest consumers. Looking at purine from plant sources alone, however, revealed that the highest consumers had only a 39% increased risk compared with the lowest consumers. Today's research suggests that avoiding purine-rich foods, especially animal-based ones may help stave off painful attacks of gout.
Просмотров: 1561 insidermedicine
ADHD patients should be screened for heart conditions  - IN60
 
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From London - Nutrition and bacterial flora in the intestines may influence blood pressure more than our genes. A study published in Nature analyzed the urine metabolites or breakdown products of over 4,600 subjects, and found that various nutritional factors influenced the risk of developing high blood pressure, including a high salt diet, formic acid, and the presence of alanine, an amino acid found in animal meat. From Philadelphia - The American Heart Association is recommending that those diagnosed with ADHD be screened for heart conditions, because stimulants used to treat the condition may raise the risk of high blood pressure and arrhythmias. The study, published in Circulation, is recommending that an EKG be obtained prior to the initiation of treatment. If normal, screening should continue on a regular basis. And finally, from Minnesota - While men are known to have a higher risk of heart disease, new research shows that the raised risk may start in adolescence. In a study that followed over 500 adolescents for a number of years, males and females were similar in terms of blood pressure, blood fats and cholesterol at the start of the study. By the age of 19, however, boys had higher blood pressure, lower HDL levels and higher insulin resistance, all of which raise the risk of heart disease. For Insidermedicine in 60, I'm Dr. Susan Sharma.
Просмотров: 10663 insidermedicine
Pedometers increase walking, lower blood pressure - IN60
 
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From Stanford - Using pedometers results in walking more and lowering blood pressure. According to a meta-analysis of 26 studies, those who used pedometers walked an extra 2000 or more steps per day - the equivalent of a mile. They also lowered their BMI and lowered their systolic blood pressure by 4 mmHg. It is estimated that if 10% of Americans began a daily walking program over $5 billion could be shaved off the healthcare budget. From Duke - Obese men may have artificially low levels of prostate-specific antigen, a marker that is frequently monitored to detect and follow prostate cancer. In fact, a patient whose BMI was 35 had an 11-21% lower PSA level than those of regular weight. This does not mean that obese males are protected from prostate cancer, but rather that the test may not be accurate in detecting cancer or inflammation of the prostate in those who are overweight. And finally from Boston - Researchers from Harvard's Mass General have concluded that those with migraine may be wired differently. Comparing the brains of those with migraines to those without, researchers noted that the somatosensory cortex was 21% thicker in those with migraine, especially in the areas that supply sensation to the head and face. Researchers are unsure whether the changes cause migraine or if they result from the condition. For Insidermedicine in 60, I'm Dr. Susan Sharma.
Просмотров: 8833 insidermedicine
Groundbreaking treatment for C. diff?
 
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An experimental therapy involving transplantation of stool into the gut has shown remarkable safety and efficacy for the treatment of intestinal infections caused by Clostridium difficile, commonly known as C. diff. The study is being presented today in San Diego at the annual Infectious Diseases Society of America meeting. Here is some information on C. diff: • It is a type of bacterial infection that is highly resistant to most antibiotics • Many hospitals worldwide are plagued with C. diff infections that spread among patients • Treatment for C .diff requires the use of very powerful antibiotics and sometimes surgery, but even these can fail and as many as 14,000 people die annually from the infection Researchers from Henry Ford hospital in Detroit treated 49 individuals suffering from intestinal C. diff infections with a procedure known as intestinal microbiota transplant. For this procedure, stool is obtained from a healthy family member. The stool is then mixed with warm tap water and delivered into the gut of the infected person via a nasogastric tube. The patient neither tastes nor smells the slurry. The transplant helps the body fight the infection by delivering healthy bacteria into the gut, which can then compete with the illness-causing bacteria. Of the 49 treated patients, 43 recovered fully, often feeling significantly better within 24 hours. Four of the patients died from unrelated causes. One required surgery, and one failed to improve. Today's research suggests that an unconventional therapy may offer new hope for the treatment of a very serious and difficult to eradicate type of infection.
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Transcatheter aortic valve implementaiton (TAVI) a life-saving procedure - IN Depth
 
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A new minimally invasive procedure known as transcatheter aortic-valve implantation, or TAVI, is potentially life-saving for individuals with aortic stenosis who are too ill to risk surgery, according to research published in the New England Journal of Medicine. Here is some information about aortic stenosis: • It is the narrowing of an important valve in the heart • In severe cases, it can substantially restrict day-to-day activities and shorten life • The primary treatment is valve replacement, but this requires open heart surgery, which can be dangerous in very sick patients Researchers from Columbia University Medical Center/New York--Presbyterian Hospital randomly assigned over 350 individuals with severe aortic stenosis who were too ill to risk surgery to undergo TAVI or standard therapy. TAVI involved inserting a valve made from cow tissue into the body using a catheter and placing it inside the original diseased valve. Standard therapy involved the use of medications to treat symptoms and a procedure in which a balloon-tipped catheter is placed into the diseased valve, and the balloon is inflated in order to open up the narrowed area. After one year, death rates were 45% lower among those who received TAVI than those who received standard therapy. The risk of dying or being hospitalized a second time was also reduced by 54% with TAVI. Among patients who lived for an entire year after surgery, those who received TAVI were less likely to have symptoms associated with heart disease. The main disadvantage of TAVI was an increased risk for stroke or severe blood vessel complications during the first month after the procedure. Today's research suggests that using TAVI instead of standard therapy can help save lives among individuals with severe aortic stenosis, but only if they are not good candidates for surgery.
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Insidermedicine In Depth - February 12, 2010 - PCI Access
 
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About two-thirds of Canadians live within a 60 minute drive of a facility that can provide percutaneous coronary intervention (PCI), the current treatment of choice for ST-segment elevation myocardial infarction (STEMI), according to research published in the latest issue of Open Medicine. Here are some recommendations regarding prehospital destination protocols for STEMI patients from the American Heart Association and American College of Cardiology: • Patients with STEMI who have cardiogenic shock and are less than 75 years of age should be brought immediately or secondarily transferred to facilities capable of cardiac catheterization and rapid revascularization if it can be performed within 18 hours of onset of shock. • Patients with STEMI who have contraindications to fibrinolytic therapy should be brought immediately or secondarily transferred promptly (i.e., primary receiving hospital door-to-departure time less than 30 minutes) to facilities capable of cardiac catheterization and rapid revascularization • Every community should have a written protocol that guides emergency system personnel in determining where to take patients with suspected or confirmed STEMI. Researchers out of the University of Calgary used geographical information systems to estimate the amount of travel time by ground transportation to PCI facilities. They then used 2006 Canadian census data to identify adults aged 40 and older who lived within 60, 90, and 120 minutes of such a facility. Overall, 63.9% of Canadians aged 40 and older live within 60 minutes of a PCI facility, although this proportion varies widely from province to province. In New Brunswick for example, the proportion is only 15.8%. Adding of a single facility to each of 4 selected provinces would increase this proportion by 3.2 to 4.3%, depending on the province, providing ready access to PCI to about 470,000 additional individuals. Today's research provides information that can help decision-makers plan the development of regional STEMI care models.
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Insidermedicine In Depth - March 19, 2010 - Acupuncture Infection Risk
 
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With the increasing popularity of acupuncture, cases of infection spread by this treatment are also on the rise, according to an editorial published online ahead of print in the British Medical Journal. Here are some ways to minimize your risk of being infected during an acupuncture treatment: • Be sure your practitioner uses only disposable needles • Make sure your practitioner disinfects your skin before inserting needles • Be sure your practitioner uses only sterile equipment, such as cotton swabs, towels, or hot pack covers To date, more than 50 cases of bacterial infections causing pus-filled lesions have been reported to be associated with acupuncture, and experts from the University of Hong Kong believe this is just the tip of the iceberg. Usually, the infection is caused by failing to adequately disinfect the skin before inserting an acupuncture needle. These infections are usually limited to the skin and surrounding tissue, but rarely can spread, causing joint destruction, multi-organ failure, flesh eating disease, paralysis, and even death. Hepatitis B and antibiotic-resistant bacterial infections have been spread by acupuncture needles, and there is a theoretical risk that they could cause the spread of hepatitis C and even HIV. Recently, experts have discovered a new clinical entity they have called acupuncture mycobacteriosis. It is a skin infection caused by acupuncture that starts as a red lump at the site where the needle was inserted. Over weeks or months it can develop into a large pustule, abscess, or ulcer. So far, two large outbreaks of this condition are known to have affected more than 70 people. Todays research highlights the risk of the spread of infection during acupuncture. If you develop any signs of skin irritation or infection during the days, weeks, or months after undergoing acupuncture, consult your health care professional.
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Diabetes drug, Metformin, stimulates prodcution of new brain cells - IN60
 
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From Toronto - Metformin stimulates the production of new brain cells, according to a report published in Cell Stem Cell. Studying mice, researchers found that rodents taking the diabetes drug had increased new neurons in the brain, and also performed better in a maze test measuring spatial learning. From the UK - Strawberries may protect cardiovascular health, according to a report presented at the biennial meeting for the Society of Free Radical Research International. Scientists discovered that an extract taken from strawberries activates a protein which in turn increases antioxidant levels and decreases cholesterol and lipid levels in the body. From Tennessee - Obesity raises risk of kidney injury following heart surgery, according to a report published in the Journal of the American Society of Nephrology. Researchers studied over 400 cardiac surgery patients, and found that risk of acute kidney injury following the operation increased by 26.5% for every 5 point increase in a patient's body mass index.
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Insidermedicine in 60 - March 11, 2008
 
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From Geneva - In a study of over 20,000 surgical patients, screening for the superbug MRSA on admission resulted in little benefit; while 5% tested positive for being a carrier, the rate of MRSA infections was no different in the group of patients who were screened for the bug versus the group who did not receive the test. With only 8% of all hospital acquired infections being related to MRSA, the best practices to lower all infections include frequent hand washing, effective antiseptic technique, and careful monitoring of IVs. From Arizona - A new CPR initiative emphasizing chest compression over breathing appears to improve the chances of survival if a cardiac arrest happens outside of hospital. A study of over 800 patients with cardiac arrest outside of hospital showed that while only 2% survived with traditional CPR, the number rose to 5% with the new technique, which consists of 200 consecutive chest compressions without breathing into the patient. And finally from Philadelphia - A study is showing that pharmaceuticals are showing up in the drinking water of many areas in the US. Commonly prescribed medicines, including sedatives and anti-inflammatories, were found in 24 of 28 samples tested. The trace amounts are believed to be related to the fact that purification systems do not remove these compounds. For Insidermedicine in 60, I'm Allison Chow.
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Minimally invasive treatment for male infertility - IN60
 
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From Germany - According to research published in Radiology, scientists have discovered a new minimally invasive treatment for male infertility. Researchers from the University of Bonn Medical School have found that venous embolization, which involves placing a catheter through the groin, was able to improve sperm function in men with varicoceles, a common cause of infertility that affects 1 in 10 men. From Surrey - According to a study published in the Journal of Clinical Oncology, a new prostate cancer drug is showing promise for treating an aggressive form of the disease. Researchers enrolled 21 men with drug resistant prostate cancer to treatment with abiraterone and found that, in addition to being well-tolerated, the drug lead to tumor shrinkage in 70 to 80% of patients. And finally, from London - In an effort to tackle the public health issue of high blood pressure, the Food Standards Agency has stated that the average adult should eat no more than 6g of salt each day. Experts claim that the resulting drop in blood pressure could prevent as many as 20,000 heart attack and stroke deaths across the UK each year. However, some critics are warning that this advice may not benefit everyone, such as the elderly, those who sweat heavily when they exercise, or pregnant women. For Insidermedicine in 60, I'm Allison Chow from Queen's University.
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Hearing loss affects many adults in the US - IN60
 
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From Baltimore - According to research published in the Archives of Internal Medicine, hearing loss is a common condition that affects many adults in the US. In a research study of over 5700 subjects, researchers from Johns Hopkins University noted that 16% of patients suffered from speech frequency hearing loss, and nearly one third had high frequency hearing loss. Risk factors for hearing loss included smoking, noise exposure and cardiovascular risk. From Boston - According to researchers from Beth Israel Deaconess Medical Center, low or high levels of thyrotropin may be linked to Alzheimer's disease. In a study of over 1800 subjects, women with very low or very high levels of the hormone, which is secreted by the anterior pituitary gland, had nearly twice the probability of having Alzheimer's. It is unclear if the levels cause Alzheimer's or if they are a manifestation of the condition. And finally, from Chicago - According to research presented at the International Conference on Alzheimer's Disease, MRI holds significant promise in the early diagnosis of Alzheimer's. In a study, rabbits were fed a diet rich in cholesterol to induce the development of amyloid plaques. These lesions, which are usually noted in autopsy, were detectable on MRI. The results need to be replicated in humans prior to routine use as a diagnostic test. For Insidermedicine in 60, I'm Dr. Susan Sharma.
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Researchers use stem cells to reverse diabetes in a mouse model
 
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Transplanting human stem cells into diabetic mice successfully reversed the condition in research published online ahead of print in Diabetes. Here is some information about diabetes: • It is a condition in which the body cannot produce enough insulin, a hormone necessary for the body to absorb sugar in the blood and use it for energy, which results in high blood sugar levels • 346 million people worldwide suffer from the condition • In 2004, an estimated 3.4 million people died from the consequences of high blood sugar Researchers from the University of British Columbia in Vancouver implanted human stem cells into mice with diabetes. Stem cells are immature cells that can develop into any number of mature cells, depending on their environment. All the mice had weakened immune systems, which prevented their bodies from rejecting the transplant. Once the transplant was complete, the mice were slowly weaned off insulin therapy. After three to four months, the mice were able to produce their own insulin in response to their bodies' need and were even able to maintain a normal level of sugar in their blood after eating a large amount of sugar. When the investigators removed the transplanted cells and examined them, they found the cells had many of the features of normal insulin-producing cells. Today's research demonstrates the potential for stem cell transplantation to be a cure for diabetes, although a great deal more research needs to be done before the procedure can be tested in humans.
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Insidermedicine in 60 - January 22, 2008
 
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From California - Caffeine may raise the risk of miscarriage. In a study of over 1,000 pregnant women, those who consumed 200 mg or more of caffeine, the equivalent of 10 oz of coffee or 25 oz of tea, were twice as likely to have a miscarriage. While these results conflict with those from other studies, pregnant women should consider limiting their caffeine intake. From Minnesota - Genetic variations can predict who might better respond to certain blood pressure lowering medications. In an evaluation of nearly 40,000 patients, genetic variability in the NPPA gene predicted better response to some pressure lowering medications. The findings, and pharmacogenetics in general, could one day help to determine how medicines will be prescribed to maximize efficacy and lower adverse events. And finally, from Italy - A new study suggests that low levels of vitamin E are associated with declines in physical function in the elderly. In a study of nearly 700 adults 65 years of age or older, those with low levels of vitamin E at the start of the study were the most likely to experience a physical decline during the 3-year study period. Low levels of vitamin E have been linked to increased oxidative stress, atherosclerosis and neurodegenerative disorders. For Insidermedicine in 60, I'm Dr. Susan Sharma.
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Birth control pill linked to plaque buildup in arteries - IN60
 
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From Belgium - Oral contraceptives may significantly increase a woman's chances of plaque buildup in the arteries. In a study of women aged 35 to 55, the risk of arterial atherosclerosis increased between 20% and 30% for each decade of pill use. Unlike other side effects of oral contraceptives such as increased blood pressure and risk of blood clots, the risk of plaque buildup was not lowered after a woman stopped taking the pill. From California - Taking as little as two doses a week of over-the-counter painkillers like ibuprofen could drastically reduce the risk of developing Parkinson's disease. Those who took non-steroidal anti-inflammatory drugs, except aspirin, on a regular basis had a 60% lower chance of developing Parkinson's. In addition, women who took aspirin alone reduced the likelihood of contracting the disorder by 40% -- an effect which was not seen in men. From Nicaragua - Health care professionals are blaming the death of a 22-year-old Nicaraguan law student on the country's recent ban on abortions. The young woman had been diagnosed with an ectopic pregnancy, a complication which results in the loss of the fetus and can cause severe bleeding in the mother if left untreated. Citing the no-exceptions law banning abortions, it seems some doctors are unwilling to treat women prior to the fetus dying naturally. And finally, from Washington - The FDA says that it won't investigate glow-in-the-dark shrimp being sold in some Seattle supermarkets. Several consumers alerted authorities when they noticed that packages of pre-cooked shrimp from food supplier Ocean Beauty Seafood emitted a blue glow in darkened kitchens and freezers. Scientists believe that luminescent species of bacteria found in salt water, which are not harmful to humans, are responsible. For Insidermedicine in 60, I'm Dr. Susan Sharma.
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Complex carbs, sugars strongly linked to colon cancer recurrence
 
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From Boston - A diet high in sugars and and carbohydrates is strongly associated with colon cancer recurrence, according to a report published in the Journal of the National Cancer Institute. Researchers studied over 1,000 advanced colon cancer patients who had undergone surgery and were enrolled in a chemotherapy-trial for their disease. Participants reported their diet during the trial and 6 months afterwards. Results showed that patients whose diet had high levels of complex sugars and carbohydrates were at 80% increased risk of their cancer recurring and dying, when compared to patients with the lowest levels. This increased risk was even greater among patients who were overweight or obese. Lead author of the study, Jeffrey Meyerhardt, had this to say, "Eat less sugar...Our study certainly supports the idea that diet can impact the progression of colon cancer, and that patients and their doctors should consider this when making post-treatment plans."
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Oral immunotherapy reduces allergic reactions in children allergic to eggs - In Depth
 
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A new report published in the New England Journal of Medicine finds that exposing children with egg allergies to very small doses of eggs over an extended period of time may reduce or even eliminate their allergic reactions. Here are some symptoms of food allergies: - Skin symptoms including hives, angioedema, itchy red rash - Respiratory symptoms including coughing, wheezing, throat swelling - GI symptoms including severe abdominal pain with vomiting and/or diarrhea Researchers from the University of North Carolina studied 55 children who were allergic to eggs, randomizing 40 to oral immunotherapy and 15 to placebo for 10 months. The oral immunotherapy consisted of very small daily amounts of powdered egg whites, with the amount gradually increasing every two weeks. Children were followed for up to three years, periodically taking food challenges to assess their sensitivity. After 10 months, 55% of children taking oral immunotherapy were able to eat 5 grams of egg white--passing their food challenge--compared to none of those taking placebo. After 22 months, 75% of children in the oral immunotherapy group passed a food challenge of 10 grams of egg white. To test if this newfound tolerance would take, researchers then told the children who passed the second test to avoid eating eggs altogether for 4-6 weeks, afterwards allowing the children to resume eating eggs. Results showed that 28% of these children were able to eat eggs with no symptoms at all. We spike with Dr. Wesley Burks, principal investigator of the study, who offered some further insight. Today's research demonstrates that sensitizing children with food allergies to the food they are allergic to has the potential to reduce or even eliminate their allergic reactions. The authors emphasize, however, that this testing was done in a very controlled setting and with a very small amount of eggs and should not be attempted at home.
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Insidermedicine in 60 - July 3, 2008
 
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From Geneva - The World Health Organization has unveiled a new diagnostic test that can tell whether patients have drug-resistant tuberculosis within hours, instead of months, and can be used to determine from a person's saliva whether the tuberculosis can be treated with antibiotics. Tuberculosis is a contagious respiratory disease that kills 1.5 million people each year. From North Carolina - Researchers believe that a cure for the virus that causes cold sores is on the horizon. Cold sores, which typically appear as painful ulcers around the mouth, are caused by the herpes simplex virus, which usually lies dormant. Researchers have discovered how the virus becomes activated and believe a treatment can be developed which includes artificially activating the virus, and then killing it with antiviral medication. And finally, from London - Including broccoli in one's diet may help protect men from prostate cancer. Researchers asked men at risk for prostate cancer to eat 4 servings of broccoli each week. After taking tissue samples from the men's prostate glands the researchers found that eating broccoli changed how certain genes behaved, reducing the risk of developing prostate cancer, and preventing the disease from becoming more aggressive. For Insidermedicine in 60, I'm Dr. Susan Sharma.
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Insidermedicine In Depth - September 1, 2010 - Sibutramine
 
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(September 1, 2010 - Insidermedicine) Individuals with a history of heart disease may be at increased risk of having a heart attack or stroke if they take the weight loss drug sibutramine, commonly known as Meridia, according to research published in the New England Journal of Medicine. (September 1, 2010 - Insidermedicine) Individuals with a history of heart disease may be at increased risk of having a heart attack or stroke if they take the weight loss drug sibutramine, commonly known as Meridia, according to research published in the New England Journal of Medicine. Your weight and health risk can be determined by measuring three key factors: • Body mass index, or BMI, which is based on your height and weight • Your waist circumference • The presence of other risk factors and conditions associated with obesity, such as diabetes Researchers from the London School of Hygiene and Tropical Medicine randomly assigned nearly 10,000 individuals aged 55 and older to receive sibutramine or a placebo. All of the participants had a history of cardiovascular disease, type 2 diabetes with at least one other cardiovascular risk factor, or both. The trial started with a 6-week test period in which those whose blood pressures or heart rates increased while taking the drug were excluded from the trial. All participants engaged in an individualized diet and exercise program. During the initial 6-week test period, participants lost an average of 2.6 kg. During the rest of the treatment period, which lasted, on average, nearly three-and-a-half years, those taking sibutramine lost an additional 1.7kg and kept the weight off. Those taking the drug were slightly more likely to have a cardiovascular event than those on placebo, however. While nonfatal heart attacks and strokes occurred slightly more commonly among those taking sibutramine than those taking placebo, there was no difference between the two groups with respect to death rates from cardiovascular or other causes. Today's research suggests that sibutramine may not be a safe treatment option for individuals with cardiovascular disease, even though it can help them lose weight. Do not make any changes to your prescribed medications without first consulting your physician.
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Insidermedicine In Depth - August 13, 2010 - Tylenol Linked to Allergy, Asthma
 
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Evidence is mounting that using the pain and fever reliever acetaminophen, which is known under several trade names that include Tylenol and Paracetamol, may increase the risk of developing allergy and asthma symptoms. Two such studies are published online in the American Journal of Respiratory and Critical Care Medicine. If you have asthma, here are some tips to help you control your symptoms: • Be sure you are well- educated about asthma, including its triggers and treatments • Always take your asthma medications as directed, even if you are feeling fine • Know your triggers and how to avoid them Researchers from the Medical Research Institute of New Zealand representing the International Study of Asthma and Allergies in Childhood, or ISAAC, administered two written questionnaires and one video questionnaire to over 300,000 children aged 13 and 14 from 113 centers across 50 countries. The questionnaires were about their use of acetaminophen as well as their asthma and allergy symptoms. A significant relationship between use of acetaminophen and asthma and allergy symptoms was uncovered. Among "high" users of acetaminophen, which was defined as those who had used the drug at least once in the previous month, the risk for asthma was more than 2.5 times greater than for non-users of the drug. Similarly, "medium" users, or those who reported using acetaminophen at least once in the previous year, had a 43% increased risk for asthma. Also compared with non-users, high users of acetaminophen had a 2.39 times increased risk and medium users a 38% increased risk for hay fever. In addition, high users were about twice as likely and medium users 31% more likely to have eczema as non-users. It is impossible to tell from the above study whether the relationship between acetaminophen use and allergy or asthma symptoms is causal. Research out of Ethiopia, however, suggests that it is. This study demonstrated that, in general, the use of acetaminophen preceded the development of allergy and asthma symptoms.
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Interprofessional Project on Disability, Maternal and Child Health (IPODMCH)
 
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Every year in developing countries, almost 500,000 women die and 1.5 million become disabled from issues relating to childbearing. In addition, approximately 11 million children die annually, the majority of deaths arising from preventable causes. Bangladesh has among the highest infant and maternal mortality rates in the world; in children with disabilities the mortality rate is 80%. Research attributes high mortality to a lack of services, a shortage of trained health providers and referrals, low utilization of existing services, and issues around gender inequality and violence. Maternal and child health (MCH) is a priority for the healthcare system of Bangladesh. The current level of services demonstrates the need for enhanced availability, quality, and accessibility of MCH and disability (MCHD) services. This project responds to this need by increasing capacity and availability of multi-skilled community workers in interprofessional (IP) MCHD teams, and contributing to the reduction of maternal and infant mortality and disability rates. We work with men and women in communities to raise awareness of the benefits of seeking skilled health providers during pregnancy, during labour and postnatally, to ensure safe birth practices. At the policy level, by creating understanding of IP practice and inclusive MCHD services among policy makers and improving coordination, the project develops a replicable model for mainstreaming disability into MCH initiatives that will draw on experiences of IPMCHD services introduced at the regional level, and contribute to the inclusion of disability into Millennium Development Goals (MDG) globally. --- Please visit http://www.queensu.ca/icacbr/index.html for more information on the International Centre for the Advancement of Community Based Rehabilitation. --- The IPODMCH project is funded by The Canadian International Development Agency (CIDA). Our Bangladesh partner is CRP-Bangladesh (The Centre for the Rehabilitation for the Paralysed). The ICACBR is a part of the School of Rehabilitation Therapy in the Faculty of Health Sciences at Queen's University.
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Legumes can help control blood sugar in diabetics
 
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Following a diet that is high in legumes can help improve control of blood sugar and even reduce cardiovascular risk among individuals with type 2 diabetes, according to research published online ahead of print in the Archives of Internal Medicine. Examples of legumes include: • Beans • Chickpeas • Lentils Researchers from of the University of Toronto and St. Michael's Hospital randomly assigned more than 100 individuals with type 2 diabetes to follow a diet that was high in legumes or high in fiber. Those assigned the high legume diet were encouraged to increase their legume intake by at least one cup per day. Legumes are believed to be healthy for those with diabetes because they have a low glycemic index, meaning they do not cause spikes in blood sugar. The individuals assigned the high fiber diet were encouraged to eat more whole wheat products. The study period lasted 3 months. At the end of the study period, blood tests indicated that sugar levels had remained lower among those following the high legume diet than the high fiber diet. In addition, those on the high legume diet had a small reduction in their risk of coronary heart disease, which was primarily due to the fact that they experienced a greater reduction in blood pressure than those on the high fiber diet. Today's research suggests that those with type 2 diabetes could obtain health benefits from eating more legumes.
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Insidermedicine In Depth - June 16, 2010 - Tasigna vs Gleevec
 
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A new drug with a similar but more potent mechanism of action as imatinib, commonly known as Gleevec, appears to be more effective for the treatment of chronic myeloid leukemia, according to research published in the New England Journal of Medicine. Here is some information about chronic myeloid leukemia: • Also known as CML, it is a slow progressing cancer found in the blood and bone marrow • It results in the overgrowth of immature, malfunctioning white blood cells • A major cause of CML is believed to be a genetic mutation that results in the development of an abnormal chromosome called BCR-ABL Researchers from the University of Turin treated nearly 850 patients suffering from CML with either a low dose or a high dose of a new drug known as nilotinib or with Gleevec. The patients were followed up for a year. At the end of the follow-up period, more than twice as many of the patients on nilotinib as on Gleevec experienced a major molecular response to their treatment, meaning the products of BCR-ABL were nearly undetectable in the blood. Similarly, more patients taking nilotinib than Gleevec had a complete cytogenic response, meaning cells containing the BCR-ABL mutation could not be detected in the blood or bone marrow. Those taking nilotinib were also less likely to experience a progression of their disease. We spoke with Dr. Giuseppe Saglio, one of the investigators of this study, who offered some further insight. Today's research suggests that a new, more powerful drug that works in a similar manner to Gleevec, an agent that revolutionized the treatment of CML, may be even more beneficial for this condition.
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Black patients at increased risk of colon polyps - IN60
 
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From Portland - According to research in the Journal of the American Medical Association, black patients have a higher prevalence of colon polyps than white patients. In a study of over 85,000 people, researchers found that black men had a 16% increased risk for polyps larger than 9mm compared to white patients, while black women had a 62% increased risk. These findings emphasize the importance of colonoscopy screenings, particularly among black men and women. From Michigan - Researchers have validated criteria for identifying patients with out-of-hospital cardiac arrest who have little or no chance of survival after resuscitation. The criteria are relevant to responders providing basic life support or advanced life support and include rules regarding whether or not the cardiac arrest was witnessed and whether CPR was performed before EMS personnel arrived. The purpose of this study was to identify criteria to justify rapid transport to hospital, a practice which can pose hazards to EMS personnel and the public. And finally, from Pennsylvania - According to research in the Proceedings of the National Academy of Sciences, gene therapy may benefit those with an inherited form of blindness called Leber's congenital amaurosis. Researchers injected genes directly into the eyes of three young adults with the condition and noted significant improvement in both day and night vision. With further study this therapy could one day be used to treat those with macular degeneration. For Insidermedicine in 60, I'm Dr. Susan Sharma.
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Insidermedicine In Depth - March 31, 2010 - Dutasteride (Avodart)
 
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A drug used to treat symptoms associated with having an enlarged prostate also reduces the risk of developing prostate cancer among high risk men, according to research published in the New England Journal of Medicine. Risk factors for prostate cancer include: • Increasing age • Being African American • Having a first-degree relative with the condition Researchers from Washington University School of Medicine in St. Louis randomly assigned nearly 7,000 men aged 50 to 75 with elevated levels of prostate-specific antigen (PSA), an indicator of an increased risk for prostate cancer, to treatment with dutasteride, also known as Avodart, or a placebo. The men all underwent a biopsy of their prostate at the outset of the study to ensure they did not have prostate cancer. They then had repeated prostate biopsies over a 4-year period to determine who would develop the disease. As expected, men taking dutasteride were 77% less likely to suffer from acute urinary retention, a condition associated with an enlarged prostate, than those on placebo. But the men taking the medication were also nearly 23% less likely to be diagnosed with prostate cancer. Late in the study, men taking dutasteride who did develop tumors in their prostates were less likely to have highly aggressive forms of prostate cancer. Todays research highlights the benefits of dutasteride for preventing prostate cancer among men at high risk for the condition.
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Insidermedicine In Depth - July 20, 2010 - False Positive HIV Tests
 
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Individuals who have participated in clinical trials for HIV vaccines may have false positive results if they are subsequently tested for HIV, according to research published in the Journal of the American Medical Association. Here is some information about HIV and its treatment: • Currently, an estimated 7,500 people are being infected with the virus worldwide every day • The number of people gaining badly-needed access to HIV treatment is on the rise • At the end of 2009, approximately 5.2 million people in low- and middle-income countries were receiving life-saving treatment for HIV Researches from Fred Hutchinson Cancer Research Center used several standard HIV testing kits to evaluate the HIV status of over 2,000 individuals who had participated in clinical trials for HIV vaccines in the previous decade. Several different vaccine types were tested during these trials. The results of the standard HIV tests were compared against more sophisticated and accurate tests known as Western blot analysis and nucleic acid testing. Overall, nearly 42% of the participants tested positive for HIV on the standard tests when the more accurate tests showed that they were not, in fact, HIV-positive. The rates of these false positives varied widely -- from under 10% to over 85% -- depending on what type of vaccine the participants had been exposed to. Each of the different HIV test kits used also gave different rates false positive results. Today's research indicates that individuals who participate in clinical trials for HIV vaccines should be followed up using more sophisticated testing to ensure they are not falsely identified as being HIV positive using standard tests.
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Air pollution exposure in early childhood linked to reduced lung function at age 8 - In Depth
 
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Exposure to air pollution from traffic during the first year of life has been linked with reduced lung functioning at the age of 8 by research published online ahead of print in the American Journal of Respiratory and Critical Care Medicine. Here are some tips to protect yourself from unhealthy air: • Check local levels of air pollution and avoid exercising outdoors when levels are high • Don't burn wood or trash • Don' allow anyone to smoke in your home Researchers from the Karolinska Institute in Stockholm followed more than 1,900 children born and living in Sweden from the time of their birth to the age of 8. The children were regularly followed-up using questionnaires, lung function tests, and blood tests that help indicate whether the children were developing allergies. At the same time, the investigators estimated the level of air pollution from road traffic present near the children's homes, daycares, and schools. There was a significant difference in the level of lung function at age 8 between the children exposed to the greatest amount of air pollution and the children exposed to the least amount of air pollution during their first year of life. This association was strongest for children with allergies. It was also more pronounced among boys and among children with asthma. Exposure to air pollution after the first year of life was less likely to have an effect on lung function at age 8. Today's research highlights how sensitive babies' developing lungs can be to air pollution and contributes to a growing body of evidence that exposure to air pollution early in life can have long-term effect on lung functioning.
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Smoking During Pregnancy Can Slow Fetal Growth - In Depth
 
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Several physical characteristics of mothers as well as lifestyle habits such as smoking and use of supplements can affect growth of the fetus in early pregnancy, which in turn can influence the eventual outcome of pregnancy, according to research published in the Journal of the American Medical Association. Here is some information about preterm birth: • It is defined as a birth that takes place before 37 weeks' gestation. Normally, pregnancy lasts 40 weeks. • It is a leading cause of infant death • Babies born preterm are at increased risk for several health problems, including potentially life-threatening breathing difficulties, infections, and cerebral palsy Researchers from Erasmus Medical Center in Rotterdam looked at the relationship between several physical characteristics and lifestyle habits among over 1,500 mothers-to-be and the growth of their fetuses during the first trimester of their pregnancy. The investigators also looked at whether restrictions in growth during this period were associated with negative outcomes of the pregnancy. Fetal growth during the first trimester was greater among older mothers. High blood pressure and a high concentration of red blood cells in the mother's circulation were associated with poor fetal growth. Fetal growth was reduced among mothers who both smoked and failed to take supplements of folic acid in an optimal manner. Restrictions in growth during the first trimester were associated with babies being born either prematurely or being born at term but being underweight and/or small. Smaller babies tended to grow faster than usual during their first two years of life. Today's research helps identify some key factors that affect fetal growth, which in turn can affect the outcomes of pregnancy.
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Breastfeeding mothers at reduced risk of type 2 diabetes - In Depth
 
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Mothers who breastfeed are less likely to develop type 2 diabetes, according to research published in the American Journal of Medicine. Some benefits of breastfeeding an infant are: • Reduction in infectious diseases in early and later childhood • Promotion of optimal brain development • Protection against life-threatening illnesses in premature infants Researchers from the University of Pittsburgh explored the relationship between breastfeeding and type 2 diabetes among over 2,200 women aged 40 to 78 who were all members of a large integrated health care delivery organization in California. Among these women were over 1,800 mothers, and 56% had breastfed an infant for one month or more. After controlling for several factors that affect the risk of developing type 2 diabetes, including age, race, weight-for-height, physical activity level, and family history, women who had never given birth to a child and mothers who had breastfed all of their children for at least one month had about an equal risk of developing type 2 diabetes. In contrast, mothers who had never breastfed any of their children were nearly twice as likely to develop the condition as women who had never had a child. In addition, mothers who never exclusively breastfed any of their children were more than 50% more likely to develop type 2 diabetes than mothers who exclusively breastfed for 1 to 3 months. Today's research demonstrates that breastfeeding is not only important for infant health but also for the mother's health.
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