Tobacco Addiction can be A Death Trap

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Tobacco addiction is a death trap. More Indians are becoming slave of its addictive potential. Tobacco contains nicotine, germacrene, anabasine and other piperidine alkaloids (varying between species). There are several laws to ban smoking, but having no effective way of implementing it. Strict implementation of it has decreased the lungs cancer in US in the recent past. In India tobacco is consumed in many ways. Those are;

• Smoking, 
• snuff,
• paste,
• beetle and 
• processed packets.

The ill effects can be;

• Quid cancer in mouth following chewing of beetle and keeping it in the mouth for long time,
• Cancer tongue,
• cancer of oral cavity,
• cancer of stomach,
• Lungs cancer,
• Bronchitis,
• Tuberculosis,
• Atherosclerosis,
• Tobacco related loss of vision     and
• corneal opacity.

 


Smoking, both active and passive is equally harmful. Baby of smoker mother is known to start suffering while in womb itself, and may have malformations and low intelligence.
Several attempts and alternatives are being thought to help tobacco users; starting from low nicotine tobacco cigarettes, tobacco patch to drugs, viz. varenicline and bupropion support to wean it off. But, strong will power is the most important one to leave tobacco use in any form..

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Bad Effects of Gastric Acid Lowering Drugs in Long Term Use

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Gastric acid lowering drugs dramatically improved the treatment options of acid peptic diseases. Once the primary treatment, surgery has become perhaps the second or third option in acid peptic disease management. There are two main groups of these drugs;

• Histamine II blockers;
1. Cimetidine,
2. Ranitidine,
and
3. Famotidine
etc.and
• Proton pump inhibitors (PPI);
1. Omeprazole,
2. esomeprazole,
3. Lansoprazole,
4. Rabeprazole,
and
5. Pantoprazole

etc. Now FDA has certain reservations to make the PPI drugs available over the counter (OTC).
Main adverse effect of cimetidine was gynaecimastia and it not much in use.
PPIs were first blamed for development of benign stomach tumors, but subsequently cleared from it. Now, researchers indicate these for;

1. Osteopenia; related to the decreased calcium absorption due to gastric acid lowering, hampered calcium ionization and absorption from the gut.
2. Decreasing the full potential of tamoxifen action on breast cancer by sharing its the metabolic pathway in the liver; resulting in more recurrence rate of breast cancer.
3. Decreasing the blood thinning effect of clopidogrel when used along with aspirin as a gastro-protector and thereby increasing the return of heart patients to emergency department with increased cardiovascular events.
4. Continuous use of it is also linked to increased colonization of harmful bacteria in the gut, and specially C. difficile, known to cause colitis and loose motion.
5. These drugs by  virtue of strong acid lowering property often suppress the symptoms of gastric cancer resulting in loss of golden hours and time in subjecting a patient to endoscopy for diagnosis of cancer. These patients, especially in India come very late when PPIs no more improve the symptoms or secondary effects of cancer appear
These are good drugs having very good utility, but patients by virtue of dependency and ignorance are overusing PPIs and further, over the counter (OTC) availability will definitely increase their misuse, ultimately landing to more problems. Always, judicious use of a good armor in the hands of physicians will yield very good results.  

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Molecular Breast Imaging

Molecular Breast Imaging

I quote the summary from Mayo Clinic;

"Recent recommendations against routine mammograms for women in their 40s have prompted heated debate about the cost-effectiveness of annual breast screenings for that group. The thousands of breast cancer diagnoses each year in women aged 40 to 49 would seem to justify annual mammograms. But mammography’s ability to detect tumors in younger, dense breast tissue is limited. Mayo Clinic researchers have developed a new tool that can solve this dilemma. Molecular breast imaging (MBI) is three times more effective than mammograms, but far less costly than other nuclear-medicine imaging. Available to patients soon, MBI has the potential to revolutionize breast imaging."





Molecular breast imaging (MBI), when available will be able to detect more number of small breast cancers, resulting more assured removal of cancer tissue.

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Metformin Associated Vitamin B Defficiency

The researchers have found out that metformin a medication for obesity and diabetes may cause vitamin B 12 deficiency.

clipped from www.medpagetoday.com Keeping Tabs on Vitamin B Advised with Metformin The association of metformin treatment with vitamin B12 deficiency was confirmed in a long-term trial, suggesting that diabetic patients receiving the popular drug would benefit from vitamin monitoring and perhaps B12 supplementation. With 4.3 years of treatment in a randomized, placebo-controlled trial, the hazard ratio for developing vitamin B12 deficiency while on metformin was 5.5 relative to placebo (95% CI 1.6 to 19.1), reported Coen Stehouwer, MD, of Maastricht University in the Netherlands, and colleagues online in BMJ. "Our study shows that this decrease is not a transitory phenomenon, but persists and grows over time," the researchers wrote. From a mean of about 355 pmol/L at the end of the run-in phase, B12 levels dropped to about 305 pmol/L after four months, and from there to 280 pmol/L over the next four years.

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Tests to Diagnose Heart Attack

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Angiogram

Heart attack is a grave situation requiring urgent attention. Diabetic and hypertensive patients are prone to it. It may present as an acute condition with destruction of musculature of heart called Myocardial Infarcation or in a more insidious way as angina. In myocardial infarction there may be ;

• sudden fainting attack,
• sudden fall of blood pressure in hypertensive patients,
• Severe cold sweating,
• Pulselessness,
• Pain in the chest, especially in the left side,
• Breathlessness,
• Sudden death.

These clinical features, almost suggest a classical case of heart attack or myocardial infarction. Some quick blood tests are ;

1. Troponin test; a small amount of blood is taken from the vein of the patient for the test. It does not take much time to get the result. Troponin I level more than 10 micrograms/liter and Troponin T level more than 0.1micrograms/liter are taken as positive for myocardial damage. In heart attack it becomes positive within 6 hours and there is definite rise after 12 hours. It remains elevated for 1 to 2 weeks following it. Though this test is more specific in comparison to other blood tests, still can be false positive in certain diseases like
   
   
   
   
   • Blood clots in the lungs,
   • Spasm of arteries to heart,
   • Severe gastrointestinal bleeding,
   • Weakening of the heart muscle (cardiomyopathy),
   • Angioplasy/stenting of heart,
   • Viral infection of heart muscle,
   • Strenuous exercise,
   and
   • Open heart surgery
   etc.
2. CPK stands for creatine phosphokinase; a blood test frequently done for the support to the diagnosis. This test has been superseded by the troponin test.
3. CRP stands fro C-reactive protein, has less supportive value than the above two. 
4. Copeptin, a new biomarker for heart attack is having promising results, but at present not widely available.

Simultaneously an Electrocardiogram recording can be done. Changes in the electrical activity of heart can be recorded by this machine, which will support the diagnosis. More tests like an echo-cardiogram, functional MRI and angiogram can be planned for future for definitive treatment, in case to case basis.

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Cautions to be Taken in Prescribing Blood Thinning Agent

Warfarin, a blood thinning agent used in medicine for various diseases, may interact with other herbal products, either to loose or enhance its action in the body. Consequently, it may be dangerous; say the researchers.

clipped from www.nlm.nih.gov Herbal Supplements, Warfarin Can Be Hazardous Mix The authors note that almost 20 percent of Americans currently take some type of herbal or non-herbal supplement. More than half of the herbal and non-herbal supplements were found to have either an indirect or direct impact on warfarin. Nearly two-thirds of all the supplements were found to raise the risk for bleeding among patients taking the blood thinner, while more than one-third hampered the effectiveness of the medication. An increase in bleeding risk was specifically linked to the use of cranberry, garlic, ginkgo and saw palmetto supplements, the team said. Glucosamine/chondroitin, essential fatty acids, multi-herb products, evening primrose oil, co-enzyme Q10, soy, melatonin, ginseng and St. John's wort all affected warfarin's effectiveness so much so that they prompted a need for adjustments in the drug's prescribed dosage.

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Tonsillitis may Keep Head Turned to One Side, Torticillis

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Learned father of a five years old girl came to the out patients department complaining that his daughter was keeping her head turned to one side since two days, suggesting that she was suffering from a sprain in her neck. The girl was obviously in pain when asked to keep her face straight from a deviated position to right side, disagreeable to be touched at the neck. On inquiry, she said that there was pain during swallowing of food. When asked to open her mouth, she reluctantly did so. The tonsils of both sides are swollen and angry looking; but the left side was more so. The examination finished there only. It was thought, not to put the girl to further discomfort. She was suffering from tonsillitis.
Many think that once one painfully keeps the head turned to one side, must be suffering from a sprain, called torticollis.
The commonest cause of torticollis in children is tonsillitis, many times misdiagnosed as sprain in neck. Tonsillitis, most often is due to viral infection to be followed by a bacterial, streptococcal infection. It has to be found out from a swab culture of throat. Antibacterial treatment, a full course is recommended in case of bacterial infection. Oral hygiene is to be taken care of.
Before advent of good antibiotics, tonsillitis was becoming chronic leading to rheumatic disease of joints and thereafter affecting heart with serious illness. Now-a-days, that has decreased. 

    
 

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Ways to Prevent Cancer

Ways to Prevent Cancer

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Why Urinary Tract Infections in Females are Difficult to Treat

Why Urinary Tract Infections in Females are Difficult to Treat

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Why Urinary Tract Infections in Females are Difficult to Treat

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Urinary tract infection is very common in females due to various reasons. Most of the women suffer from urinary infection at least once in their life time. It is also difficult to eradicate.
The urinary tract extends right from the kidneys to the end of urethra. The urethra in female is only 4 cms in length in comparison to male where it is 20 cms. It is also situated in close proximity to vaginal and anal opening. Vagina and anus are the potentially infected places; harboring different microbes, those can have easy access to urethra. This anatomical disadvantage in female may make them susceptible to frequent urinary tract infections.
Ladies get infection from their sexual partners during active sex life. Masturbation also contributes to the entry of infection by way of inflicting minor injuries. Those help bacteria to colonize and spread infection.
Sometimes catheterization of urethra may be necessary for different medical conditions. Pelvis surgeries in the female viz. hysterectomy and caesarian section may require catheterization of urinary bladder. An unclean catheterization may introduce bacteria to the urinary tract; and urinary bladder in particular gets infected in this way. That is termed as iatrogenic urinary tract infection.
Apart from these, in hormonal insufficiency state, particularly the estrogen in post-menopausal setting; may lead to colonization pathogenic bacteria, as natural acidity in vagina is lost or becomes low. This is one of the commonest causes of urinary tract infection in post-menopausal women, which run a protracted course. Apart from these ascending infections; urinary tract may get infected from blood borne infections from other adjacent infected structures e.g. a pelvic inflammatory disease.
Features of urinary tract infection include;
•    Burning urination,
•    Frequency of urination,
•    Pus discharge in urine making it opaque,
•    Blood in urine,
•    Pain in the lower abdomen,
•    Weakness, loss of appetite and vomiting and
•    Fever with chills and rigors.
Common tests include; routine and microscopic urine analysis, culture and sensitivity test of urine and ultrasonogram to exclude other facilitating causes of urinary infection viz. a calculus disease of urinary tract or anomalous urinary tract. Diabetic state of the patient has to be evaluated as they are prone for infection in any form.
Empirically, an antibiotic targeting E.Coli is usually started pending urine analysis and result of sensitivity test. Paracetamol for fever and a urinary soothing agent for burning sensation in urethra may be needed. Later on recommended antibiotic as available from the culture and sensitivity report may be substituted. In ladies, a little prolonged antibiotic therapy may be necessary, may be in full doses for 15 days and another 15 days in a relatively low dose. Plenty of water drinking is advised. Urinary alkalinisation may sometimes be required, of course depending on the type of antibiotics selected because some antibiotics work better in acidic environment and aklalinisation may hamper the effectiveness. Cleanliness, particularly in using tampons and catheterization will minimize contact of infection. Local application of low dose estrogen hormone gel in the vagina in menopausal ladies or low dose hormone replacement therapy (HRT) wherever needed may aid to prevent this resistant infection.
Untreated or under treated patients may land up in more problems including recurrent infections of urinary tract, stone formation and infection of kidneys.

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Laser in Surgery

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Laser is already in surgery. Carbon dioxide laser is used to incise tissue (skin). Argon laser used in treatment of piles. Now, it is thought be be used in deep cancer surgery. It will be perhaps the most fascinating to watch these developments.

clipped from news.bbc.co.uk Lasers scan future possibilities There had been a race to demonstrate "light amplification by stimulated emission of radiation" (Laser), and Maiman beat everyone to it on 16 May, 1960. "Lasers can accelerate particles to high energy and we can use that to treat cancer," she adds. "At the moment, with the way we treat cancer with radiation, photons travel into the body and they deposit energy in healthy tissue as well as at the cancer site. "Whereas when protons and ions travel into the body, they will deposit most of their energy only at the very end of their range. So we can use lasers to tune protons to deposit their energy just within the tumour site." As lasers have got ever more powerful, their pulse rate has also pushed new boundaries.

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How Vitamin D and Sun Can Protect Us

How Vitamin D and Sun Can Protect Us

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To All The Mothers In Mother's Day

There is picture in a local daily; one mother deer licking saliva and polishing the skin of her baby; with a caption mother’s love. I saw a video footage yesterday in a local news channel; a cobra was found from the depth, while a person was digging to lay foundation of his house. The cobra was guarding her eggs by encircling those with her body; and was unmoved by the sight of the human gathering. There was no fear. That was the concern for her future siblings.
There is a folk tale in our locality; one cow had gone to the forest for grazing. While returning, en route, she encountered a tiger. The tiger was hungry and wanted to eat her. The cow asked the tiger to give her some time, so that she can go home and feed her baby; and come back as a prey to the tiger. The tiger disbelieved, but let her go. After some time the cow returned with her calf and they offered themselves to be food for the tiger. This happened because the calf while getting fed by her mother, knew about the incidence; when the cow started to depart with tears in her eyes, thinking to be unable to see her baby henceforth; the calf accompanied her mother. Seeing all these, the tiger also started crying and left both mother and her calf free.
In my life, when my mother was alive, I never know a mother’s day. Probably it was not in vogue. Now she is no more available physically, but sometimes, I figure out a village lady in very simple minimal attire, always busy in taking care of everything without any complain, comes to my mind.
A few drops of tear are wetting my eyes in her memory while I write this story; the only thing I can do to-day. It is said in Odia(Orissa, India); the person who loses mother, becomes unsupported and orphan, and a baby in mother’s lap does not fear the world.
In Sanskrit It is said; “Janani Janma Bhumischa, Swargadapi Gariyasi”; which means mother and motherland are more precious than the heaven.
Lastly, I would like to say that, God had created a wonderful creation very leisurely; with all devotion, hard work, affection and sincerity; what is called a woman. The great is the adoptability and versatility in all the situations. I salute the race.

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Optimal Duration of Sleep

Most of the people require five to seven hours of sleep at night.

clipped from news.bbc.co.uk Lack of sleep 'linked to early death' Getting less than six hours sleep a night can lead to an early grave, UK and Italian researchers have warned. They said people regularly having such little sleep were 12% more likely to die over a 25-year period than those who got an "ideal" six to eight hours. They also found an association between sleeping for more than nine hours and early death, although that much sleep may merely be a marker of ill health. "Sleep is just a litmus paper to physical and mental health. Sleep is affected by many diseases and conditions, including depression," he said. And getting improved sleep may not make someone better or live longer, he said. "But having less than five hours a night suggests something is probably not right. "Five hours is insufficient for most people and being drowsy in the day increases your risk of having an accident if driving or operating dangerous machinery."

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What is New in Asthma Treatment?

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There has been some addition of facts and precautions in treatment of asthma in the recent times. It will be appropriate to go straight to newer news on treatment of asthma.
Researchers say that vitamin D may actually be beneficial to the asthma patients. It has long been proved to be related to calcium metabolism and bone health. Now it has been learnt that Vitamin D regulates nearly 200 genes. Vitamin D deficiency has been shown to increase the risk of upper respiratory tract infections, tuberculosis; and decrease the forced expiratory volume in 1 second (FEV1) in asthma and wheezing diseases.
Vitamin D metabolism primarily takes place in the kidney and liver. Respiratory epithelial cells in addition to immune cells are also able to metabolize vitamin D and raising its local concentration to influence the associated genes. Its role in stabilizing the cells and keeping integrity of cells intact may be the mechanism of action in preventing the attacks of wheeze. It may also be helpful in preventing infection in the respiratory tract.
Airway remodeling and increase in smooth muscle cell number are associated with severe narrowing of respiratory tract in asthma. MMP-9, a disintegrin and a metalloproteinase-33’ (ADAM33) are the most relevant enzymes in airway remodeling. The levels of expression of these enzymes are associated with asthma development and severity. Researchers have seen that 1,25(OH)2D3 has a direct anti-proliferative effect on human airway smooth muscle cells and can inhibit the expression of both MMP-9 and ADAM33 suggesting a further beneficial role for vitamin D in the prevention and treatment of asthma.
Glucocorticoids are the most effective anti-inflammatory drugs in management of acute attack of asthma. Resistance to this therapy may also develop. It has been seen that Vitamin D enhances the action of steroids in resistant cases.
Recently it has been seen that long acting B2 stimulants may actually increase the cardiovascular events. FDA has cautioned its use in acute attack of asthma.More can be read here.
Also, recently USFDA has issued warning to the pharma companies to withdraw CFC (Chlorofluorocarbon) propelled inhalers like;

• Nedocromil(Tilade Inhaler),
• Metaproterenol (Alupent Inhalation Aerosol),
• Triamcinolone (Azmacort Inhalation Aerosol),
• Cromolyn (Intal Inhaler),
• Flunisolide (Aerobid Inhaler System),
• Albuterol and ipratropium combination (Combivent Inhalation Aerosol)
and
• Pirbuterol (Maxair Autohaler).

This is in response to fulfill the obligation to help in protecting Ozone.
Hope in this “World Asthma Day”; the information will be helpful in planning the treatment of asthma patients.

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