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    Sunday, August 30, 2009

    GETTING YOUR MEDICAL TEST RESULTS IS ALWAYS YOUR RESPONSIBILITY

    DON’T ASSUME THAT ‘NO NEWS IS GOOD NEWS’ WHEN YOU HAVE TESTS DONE.
    Bottom line:
    “Don’t assume that ‘no news is good news’ when you have tests done. That’s a very dangerous assumption. If you’ve had a test done and you don’t hear about it after a week or two goes by, call the doctor’s office.”

    Dr. Lawrence P. Casalino, an associate professor at Weill Cornell Medical College, and his colleagues reviewed the records of 5,434 patients at 19 independent primary care practices and four based in academic medical centers in a study , published in The Archives of Internal Medicine.

    After extracting the records that contained abnormal results for blood tests or X-rays and other imaging studies, they then searched for documentation that the patient had been properly informed of the problem in a timely way.

    After accounting for these and other ambiguous cases, the researchers found that of 1,889 abnormal results, there were 135 failures to inform.
    In two of the largest academic medical centers, with a combined 80 primary care specialists, 23 percent of abnormal results were never mentioned to the patients.

    The truth of the matter is that a lot of things can fall through the cracks. Information is handed down from one person to another to another before the doctor actually sees it.

    Using information from a study of the literature and an earlier pilot study, the authors concluded that following 5 relatively simple procedures could eliminate most errors:
    • results are routed to the responsible doctor,
    • the doctor signs off on them,
    • the office informs patients of all results,
    • the practice documents that patients have been informed,
    • and finally patients are told to call after a certain time interval if they have not learned the results of their tests.

    COMMENT
    The only thing for sure is #5. Every patient should be responsible to call the doctor’s office after 2 weeks of a test to find out the results. And call back over and over again till you learn the results.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for INVESTING HEAVILY IN PREVENTION MEASURES MAY NOT REDUCE HEALTHCARE COSTS, RESEARCH SUGGESTS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, August 28, 2009

    FALSE BAYER ADVERTISING

    Bayer is running "advertisements...that claim the product reduces men's risk of prostate cancer." Bayer's radio and TV ads falsely claim that selenium, an ingredient of One-A-Day Men's Health Formula and 50+ Advantage, helps prevent prostate cancer."

    The National Institutes of Health" "found no evidence the ingredient selenium prevents prostate cancer in men." "The largest prostate cancer prevention trial has found that selenium is no more effective than a placebo," and Bayer therefore "is ripping people off when it suggests otherwise in these dishonest ads." The study was "halted...last October after it became clear that selenium did not prevent prostate cancer."

    A complaint has already been filed with the Federal Trade Commission."

    Back in 2007, the FTC "ordered Bayer to stop making unproven health claims for a One-A-Day weight loss product and told the company not to make any unsubstantiated claims for any vitamins in the One-A-Day product line." The recent complaint to the FTC urges the commission to "take swift and strong action to get these deceptive Bayer ads off television, radio, and Internet and out of newspapers and magazines or wherever else they may be displayed."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for GETTING YOUR MEDICAL TEST RESULTS IS ALWAYS YOUR RESPONSIBILITY

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Wednesday, August 26, 2009

    BONE FRACTURES INCREASING FOLLOWING OBESITY SURGERY

    The findings came from long-term follow-up of about 97 patients -- mean age 44, 86 women -- who had bariatric surgery from 1985 to 2004. Gastric bypass accounted for 90% of the surgical procedures, and the rest of the patients had either vertical banded gastroplasty or biliopancreatic diversion. Follow-up averaged seven years.

    Compared with the fracture rate in Olmsted County, Minn., which includes Rochester, investigators found that the bariatric surgery patients had a standard incidence ratio (SIR) of 1.8 for first fracture at any site (95% CI 1.1 to 2.8).

    The SIR for fracture of the hip, wrist, spine, and humerus was 1.4 (95% CI 0.5 to 3.1). The ratio for first fracture at all other sites was 2.1 (95% CI 1.2 to 3.3) and was driven by a SIR of 3.3 for hand fractures and 3.9 for foot fractures, both of which were statistically significant.

    "A majority of the fractures occurred more than two years after the surgery, suggesting this is a late complication of bariatric surgery. The extent of the findings came as a surprise, to investigators despite the fact that they hypothesized that bariatric surgery would increase fracture risk. The prevailing scientific opinion is that obesity affords protection against osteoporosis and, by extension, fractures.

    The 97 patients are among almost 300 who had the obesity surgery. Investigators have now reviewed data on about half of the patients, and the overall fracture risk remains about twice the expected rate, although the difference is no longer statistically significant.

    The risk of foot fracture, however, remains about threefold higher than would be predicted and is statistically significant.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for FALSE BAYER ADVERTISING

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, August 25, 2009

    CONCERN WITH LONG-TERM EFFECTS OF BENZODIAZEPINES

    The use of "benzodiazepines, often prescribed to manage anxiety, panic, and sleep disorders," has increased "rapidly in the past 30 years. But critics say their long-term effects have gone largely unaddressed." Some "critics say benzodiazepines are broadly over-prescribed, can have serious side effects with estimates that 10 to 20 percent of those taking the drugs for extended periods will have problems with dose escalation and physical dependence. Benzodiazepines, often prescribed to manage anxiety, panic and sleep disorders, include Xanax, Ativan, Valium and Klonopin. Originally pushed as an alternative to barbiturates, their use has grown rapidly in the past 30 years.
    But critics say their long-term effects have gone largely unaddressed. Health professionals and consumers are increasingly recognizing that taking the drugs for more than a few weeks can lead to physical dependence, often ending with a grueling withdrawal.

    Some physicians are now prescribing "selective serotonin reuptake inhibitors...to replace benzodiazepines." SSRIs are thought to be a safer alternative for panic and anxiety disorders, with less risk for dependence and a less dangerous withdrawal.

    In 2008, 85 million prescriptions were filled for the top 20 benzodiazepines, an increase of 10 million over 2004. The drugs bind to receptors in the brain and spinal cord, intensifying the effects of the neurotransmitter gamma-aminobutyric acid, or GABA. "So pretty much it kind of tells your brain to slow down," creating a calming effect. But in some people, that can lead to memory loss and impaired motor skills.

    Critics say benzodiazepines are broadly over-prescribed and can have serious side effects. Some patients find themselves on high dosages after a few years because their bodies need more of the drug to get the same effect, according to health experts.

    The ordeal of withdrawing from benzodiazepines can rival that of kicking a heroin habit, according to some who have had success. Abrupt withdrawal can result in hallucinations, seizures and even death, experts say.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in tomorrow for BONE FRACTURES INCREASING FOLLOWING OBESITY SURGERY

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, August 24, 2009

    WHAT ARE PROBIOTICS?

    These are the so-called friendly bacteria with health benefits.
    These bacteria, occur naturally in fermented foods such as yogurt, kefir and miso, and are thought to aid digestion and support the immune system by balancing the intestinal ecosystem.

    But a word of caution. Caveat Emptor!
    A pending class-action lawsuit alleges that Dannon misled consumers about the benefits of Activia and DanActive, both marketed as probiotics. Dannon denies using deceptive advertising and is standing by the claims and the studies that supported them. But a spokesman agreed it's buyer beware at the market. For the consumer, finding the right probiotic can be vexing. Labels can't legally declare that the probiotic can cure, treat or prevent disease. So health claims, which don't require FDA approval, are often vague.

    First the word "probiotic" is misunderstood by consumers.

    1. While there are thousands of bacterial strains, only a few dozen have been tested for health benefits. Studies suggest some products may offer relief for digestive issues, but it's not proven whether healthy people benefit from snacking on live "bugs." Of the hundreds of new products launched in recent years, very few have been shown to be probiotic," Scientists cannot yet explain exactly how probiotics work, but it's thought they can help restore beneficial bacteria in the intestinal tract. "Some [bacteria] can produce enzymes that help digest food, while others can synthesize vitamin K in the gut or even help stimulate the immune system.
    These bacteria may produce antibodies for certain viruses, produce substances that prevent infection or prevent harmful bacteria from attaching to the gut wall and growing there, according to the American Gastroenterological Association. And if those bacteria are wiped out by disease or medication, potentially harmful microbes may flourish.(See my radio interview listed below for more facts on what happens when “good” bacteria are killed off y well meaning antibiotics)

    2. There is also no standard definition of probiotics, according to the Food and Drug Administration. Scientists generally say the term refers to foods, beverages or supplements containing live microorganisms that studies show promote health when people take enough of them. Without studies, products shouldn't be called probiotic, scientists say. For example, Kashi's Vive is called a "probiotic digestive wellness cereal," one that "may restore your digestive balance."
    And it may -- each serving contains a whopping 12 grams of fiber. But the probiotic used -- Lactobacillus paracasei ssp paracasei F19 -- has not been tested in humans eating Kashi Vive. And there's no guarantee that the microbes in the dry cereal are alive.

    The strongest studies have found that a few probiotics (Lactobacillus GG and the yeast Saccharomyces boulardii) can help with common gastrointestinal disorders that may involve an imbalance of gut bacteria."They've been also shown to reduce the incidence of postantibiotic diarrhea -- which occurs in up to 40 percent of children taking antibiotics."

    3. There's also growing evidence that children with ulcerative colitis can benefit from a proprietary mixture of eight strains called "VSL #3. And certain probiotics have been shown to reduce symptoms of irritable bowel syndrome.
    But more research is needed for probiotic effects on almost all other conditions, including cancer, oral health, allergies, skin conditions and obesity.

    4. Bazzoli F et al. Journal of Clinical Gastroenterology, 06/19/09 documented that Probiotic supplementation showed beneficial effect in the prevention and treatment of radiation-induced diarrhea in experimental animal studies. Encouraging results have been observed in humans; however, the few available clinical studies do not allow firm conclusions. More well-performed, randomized placebo-controlled studies are needed.

    Just because a food product says “probiotic” doesn’t mean it’s a probiotic. Even more aggravating, manufacturers often leave important information off the label, such as whether the product contains live organisms or the full name of the bacterial strain.
    Some advice:

    RECOMMENDATIONS TO THE CONSUMER [according to J.Deardorff ]

    Watch the dates: The organisms can die off while the product is sitting on the shelf. The best way to ensure it has an effective number of live bacteria is to look at the “best by” or expiration date.

    Get enough microbes. Easier said than done. There is no single dosage for probiotics; studies have documented health benefits for products ranging from 50 million to more than 1 trillion colony-forming units (the measure of live microbes) per day. The amount you need is the amount that the study on your product showed was effective. There is a clinical study, right--

    Scour yogurt labels. Look for yogurt products with “live and active cultures” and avoid the ones that say “made with active cultures.” Those may have been heat-treated after fermentation, which kills the bacteria. Also, Acidophilus and Bifidobacteria are less sensitive to stomach acid and more likely to make it into the colon alive than other names you might see on the label, such as Lactobacillus bulgaricus and Streptococcus thermophilis.Remember that even “live, active cultures” aren’t necessarily probiotics, meaning they may not have been tested for health benefits.

    Speak the lingo. A probiotic is defined by its genus (e.g. Lactobacillus), species (e.g. rhamnosus) and strain (a series of letters or numbers). “Products that list the genus and species and also the strain tend to have inherently better quality control and products,” said probiotics expert Gary Huffnagle.

    Watch for too-perfect names. Dannon calls its bacterial strains Bifidus Regularis (in Activia) and L. casei Defensis (in DanActive)—for marketing purposes. These are made-up, consumer-friendly, trademarked names.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for CONCERN WITH LONG-TERM EFFECTS OF BENZODIAZEPINES

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Sunday, August 23, 2009

    WHY DOCS SHOULD HANG UP THEIR WHITE COATS

    According to the CDC, nearly 100,000 U.S. patients died in 2002 from infections contracted in hospitals. There has been no conclusive evidence linking infected cuffs to any of these deaths — studies have been done showing that bacteria like MRSA and C. difficile exist on sleeves, but there’s no proof that those germs actually get passed around that way. But backers of the change in dress code argue that as long as there’s the slightest potential of transmission, everything possible should be done to avoid it. One of the policy questions that AMA delegates considered at their annual conference is whether doctors should forgo their iconic white coats for something a little more casual — and a little less dangerous for patients. The measure would urge hospitals to adopt dress codes of “bare below the elbows,” to avoid carrying bacteria between patients via coat sleeves.

    The British National Health System has already adopted a policy, banning ties, long sleeves, jewelry and white coats. Scotland went so far as to establish a uniform dress code that includes a short-sleeve requirement.

    While many U.S. docs already follow these rules, especially those in intensive-care units, some still prefer the professionalism the white coat implies. One irony, is that the spanking white coat was borrowed from lab scientists and introduced in hospitals in the 19th century in part to help prevent the spread of contamination.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for WHAT ARE PROBIOTICS?

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Saturday, August 22, 2009

    PART IV OF IV SODIUM AND HIGH BLOOD PRESSURE.

    Reducing Sodium Intake

    Avoiding the salt shaker isn't the magic bullet for sodium reduction. This is because around 80% of dietary sodium comes from processed, prepared, and restaurant foods. Steering clear of these types of foods is likely to have the most impact on sodium intake. The amount of salt in some restaurant meals can be shocking, at more than four times the recommended daily intake of sodium. Plus, another downside of most processed foods is that they are very low in potassium.

    For people who are trying to reduce dietary sodium, understanding how to read food labels is also important. Foods that contain 5% or less of the Daily Value (DV) of sodium are considered to be "low-salt." However, the percentage of the DV of sodium in the nutrition information portion of the labeling of packaged foods is based on a DV of 2,400 mg. It's not based on the 1,500 mg recommendation that applies to almost 70% of the adult population.

    In addition to food labels, checking medication labels for sodium is a good idea. Some common culprits with a relatively large amount of sodium include antacids, and drugs that are available as effervescent formulations, like Zantac 150 EFFERdose and Alka-Seltzer effervescent products.

    Note that even a small reduction in the amount of sodium your patients consume each day can make a difference.3 It's best to always encourage patients to try to meet these types of goals. Suggest reducing sodium intake gradually. It might be easier for patients to get accustomed to the taste of foods with less salt this way.

    To help combat the problem of excess sodium consumption, groups including the American Heart Association and some federal agencies have been pushing for the food industry to reduce the amount of sodium in the food supply by 50% over a ten-year period. This could help reduce blood pressure in the population as a whole.9 In the U.K., a combination of government regulations, changes in labeling requirements, and consumer awareness has helped achieve a 10% reduction in consumption of salt.3
    Conclusion

    Limiting sodium intake can help reduce blood pressure [Evidence level A; high-quality RCT]. Let your patients know that following a healthy diet (like DASH) and minimizing processed and prepared foods is likely to make the biggest difference.

    Tell most patients to make sure they're getting plenty of dietary potassium as well. Fruits and vegetables are good sources. But watch out for patients with kidney disease, or those taking medicines that can increase potassium levels (e.g., ACE inhibitors, ARBs, eplerenone [Inspra], and potassium-sparing diuretics).

    Also take the opportunity to encourage patients who are able to get at least 30 minutes of physical activity each day. Remind them that smoking cessation and moderating alcohol consumption can also reduce cardiovascular risk.

    Blood pressure-lowering benefits of reduced salt intake. Pharmacist's Letter/Prescriber's Letter 2009;25(6):250605.June 2009



    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for WHY DOCS SHOULD HANG UP THEIR WHITE COATS

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, August 21, 2009

    PART III OF IV SODIUM AND HIGH BLOOD PRESSURE.

    How to Eat Less Salt

    What makes salt harmful?
    Salt is made up of 40% sodium and 60% chloride. Eating too much sodium can increase your blood pressure. High blood pressure is related to all sorts of problems, like heart attacks, strokes, kidney problems, etc.

    How much salt can I eat?

    Most people eat about twice as much salt as they should. Generally, you should eat no more than 2300 milligrams (100 mmol) of sodium a day, which equals about 1 teaspoon of table salt a day. Keep in mind that this includes all salt consumed, including that used in cooking and at the table.

    If you have high blood pressure, are 40 or older, or are African American, your healthcare provider might advise eating no more than 1500 milligrams (65 mmol) of sodium a day.

    What are some ways that I can reduce the amount of salt I eat?
    Salt is found naturally in many foods. But processed foods account for most of the salt that people eat. Processed foods that are high in salt include regular canned vegetables and soups, frozen dinners, lunchmeats, instant and ready-to-eat cereals, and salty chips and other snacks.

    Read food labels to choose products low in salt. You might be surprised at some foods that contain a lot of sodium, such as those containing baking soda, soy sauce, and monosodium glutamate (MSG). Some medicines, especially antacids and effervescent formulas (e.g., Alka-Seltzer), have sodium. Check labels or ask your pharmacist.

    Restaurant meals can have a lot of salt as well. If there's no information about salt content available, ask your server to help you make a low-sodium choice. Learn which meals are lower in sodium at all your favorite places, and stick with those.

    Before trying salt substitutes, check with a healthcare provider, especially if you have high blood pressure. Salt substitutes usually contain potassium chloride. Too much potassium chloride can be harmful for people with certain medical conditions, or for those taking certain medicines.

    Note that there can be differing amounts of sodium in the same amount of different types of salt.
    One teaspoon table salt = 6 grams = 2400 milligrams sodium
    One teaspoon sea salt = 5 grams = 2000 milligrams sodium
    One teaspoon Diamond Crystal kosher salt = 2.8 grams = 1120 milligrams sodium

    Tips for reducing your salt intake:
    Buy fresh, plain frozen, or canned "with no salt added" vegetables.
    Use fresh poultry, fish, and lean meat, rather than canned or processed types.
    Use herbs, spices, and salt-free seasoning blends in cooking and at the table.
    Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.
    Choose "convenience" foods that are low in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings. These often have a lot of sodium.
    Rinse canned foods, such as tuna and vegetables, to remove some sodium.
    When available, buy low- or reduced-sodium or no-salt-added versions of foods.
    Choose ready-to-eat breakfast cereals that are low in sodium.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for PART IV OF IV SODIUM AND HIGH BLOOD PRESSURE

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Thursday, August 20, 2009

    PART II OF IV SODIUM AND HIGH BLOOD PRESSURE.

    THE RELATIONSHIP BETWEEN SODIUM INTAKE AND BLOOD PRESSURE HAS BEEN RECOGNIZED FOR MANY YEARS.

    It was documented as early as 1904.There's a lot of data from epidemiologic, animal, and genetic studies to support the relationship between sodium intake and hypertension. The best evidence to date for this relationship comes from the Dietary Approaches to Stop Hypertension (DASH-sodium) study.

    Subjects eating the DASH diet had a slightly better improvement in blood pressure at all levels of sodium intake. In fact, in subjects with hypertension, the blood pressure-lowering effect of the DASH diet plus low sodium intake was equal to or greater than what would be expected from a single antihypertensive drug. Systolic blood pressure was lowered by 11.5 mm Hg with the DASH diet plus low sodium compared to the typical diet plus high sodium (p<0.001) in the hypertensive group. But the DASH-sodium results did show that even without dietary changes, reduced sodium intake can lead to a reduction in blood pressure.

    Besides actually lowering blood pressure, reducing sodium intake can be beneficial for patients whose hypertension is being treated. Excessive dietary sodium can blunt the blood pressure-lowering effect of most antihypertensive drugs. This is particularly true for individuals who are considered to be "salt-sensitive." This term refers to those whose blood pressure is especially responsive to their sodium intake. Factors predisposing individuals to salt sensitivity are chronic kidney disease, obesity, old or middle-aged, African American ethnicity, and metabolic syndrome or diabetes.

    It's important to note that in most patients, potassium intake goes hand-in-hand with sodium intake. A diet low in potassium can cause sodium retention and a subsequent elevation of blood pressure.An increase in dietary potassium can actually reduce sodium sensitivity in people with normal or high blood pressure.

    Benefits of Limiting Sodium Intake

    Current guidelines for treating hypertension state that reducing sodium intake to less than 2400 mg daily can lower systolic blood pressure, on average, by 2 to 8 mm Hg.The DASH-sodium study backs this up. Without dietary changes other than sodium reduction, systolic blood pressure can be reduced by up to 7 mm Hg when sodium intake is limited to 1500 mg or 65 mmol/day.

    Limiting sodium intake as a society could have a major impact on public health. Researchers say that reducing salt intake by 3 grams daily (1200 mg or 50 mmol of sodium) would have an impact on morbidity and mortality similar to the total elimination of cigarette smoking. New cases of heart disease would drop by 6%. There would be 8% fewer heart attacks, and 3% fewer deaths. These benefits would be even more profound for specific groups like African-Americans, whose blood pressure can be more sensitive to salt.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for PART III OF IV SODIUM AND HIGH BLOOD PRESSURE

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Wednesday, August 19, 2009

    PART I OF IV SODIUM AND HIGH BLOOD PRESSURE

    Hypertension affects about one-quarter of the world's adult population. An even greater proportion of people in North America, about one-third, have hypertension. High sodium intake can increase the risk for high blood pressure. As such, sodium restriction is a first-line intervention for people with prehypertension and hypertension.
    However, many people are still consuming more than twice the recommended amount of sodium. This demonstrates the need for healthcare professionals to educate individuals about the importance of reducing sodium intake.

    How Much is Too Much?
    Overall, most people are getting too much sodium. The average adult consumes around 3500 mg (150 mmol) of sodium per day. The American Heart Association, the
    USDA, and the U.S. Department of Health and Human Services recommend that adults should not consume more than 2300 mg (100 mmol) of sodium per day. This is equal to about one teaspoon of salt daily Health Canada and the Canadian Hypertension Education Program (CHEP) make the same recommendation.

    A more limited recommendation applies for individuals with hypertension, the middle-aged, older adults, and blacks. This group, which includes about two-thirds of adults, should get no more than 1500 mg (65 mmol) of sodium per day. CHEP recommends between 65 mmol and 100 mmol for hypertensive individuals.

    The generally accepted max is 2300 mg sodium/day...about one teaspoon table salt. But even that's too much for some people.

    Recommend staying under 1500 mg/day for people with hypertension, over age 40, or African Americans. Most people get DOUBLE this much.

    Many folks THINK they don't eat much salt because they don't use the salt shaker...but most comes from prepared foods.

    Explain that a can of Campbell's chicken noodle soup has about 2000 mg of sodium...and some restaurant meals contain over 5000 mg.

    Suggest cutting back and following the 1500 mg sodium DASH diet...especially for patients with prehypertension or hypertension.

    Explain that this DASH (Dietary Approaches to Stop Hypertension) diet can lower BP about the same as a thiazide diuretic or ACE inhibitor.

    Also caution patients that too much salt can make diuretics less effective and lead to increased blood pressure or edema.

    Keep in mind that some meds have a lot of sodium...especially antacids and effervescent formulations. Zegerid (omeprazole) has 304 mg sodium per cap...Alka-Seltzer

    Original has over 500 mg per tab.

    But explain that most oral meds that come as a sodium salt, such as levothyroxine sodium or pravastatin sodium, won't increase BP.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for PART II OF IV SODIUM AND HIGH BLOOD PRESSURE

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, August 18, 2009

    The Mysterious Case Of the Missing Fingerprints

    A Singapore cancer patient arrived in the U.S. missing something very important -- his fingerprints. The man, identified only as Mr. S., was detained at airport customs for four hours until puzzled Homeland Security officials were able to verify his identity by other means, according to a letter posted online in ANNALS OF ONCOLOGY.

    The loss of fingerprints is part of a condition known as hand-foot syndrome -- formally palmar-plantar erythrodysesthesia -- that arises in patients taking capecitabine (Xeloda), according to the man's doctor, of the Singapore National Cancer Centre. The syndrome causes chronic inflammation of the palms or soles of the feet and the skin can peel, bleed and develop ulcers or blisters. "This can give rise to eradication of finger prints with time.

    The syndrome appears to be relatively common among capecitabine patients. One study, published in the JOURNAL OF CLINICAL PHARMACOLOGY in 2004, found that 65% of patients in clinical trials of the drug developed hand-foot syndrome, although only about5% had a grade 3 condition. Of those who develop the syndrome, only a few will lose their fingerprints, Dr. Tan told the Associated Press. Mr. S., who can't be identified for reasons of patient confidentiality, is a 62-year-old who was diagnosed with metastatic nasopharyngeal carcinoma and treated with a combination of cisplatin and 5-fluorouracil. After a near-complete response, he was started in July 2005 on maintenance capecitabine at 1,750 milligrams twice daily, two weeks on, one week off. Subsequently, his other doctors noticed that he had grade 2 hand-foot syndrome, "but as this did not affect his daily activities and function, he was kept on the same maintenance dose," they said. Then, last December, Mr. S. decided to visit relatives in the U.S.

    When he reached U.S. immigration he was asked to provide images of the prints on his two index fingers and could not, triggering the "inconvenience."

    Primary source: Annals of Oncology
    Source reference:
    Wong M, et al "Travel warning with capecitabine" ANN ONCOL 2009; DOI: 10.1093/annonc/mdp278.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for PART I OF IV SODIUM AND HIGH BLOOD PRESSURE

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, August 17, 2009

    MIRACLE CURES IN MEDICINE

    An Annapolis Maryland patient with terminal cancer with malignant tumors in her lungs, liver, stomach and chest was reported on June 28, 2009 as cured as a result she says of praying to Francis X. Seelos, the 19th-century Maryland priest . Her doctor did not expect it, nor could he explain it.In a few weeks, a committee appointed by the Archdiocese of Baltimore will begin exploring that question and ultimately on a campaign to have Francis X. Seelos, the 19th-century Maryland priest to whom the patient had turned in prayer for help, canonized as a saint. For the fifth time in its 200-year history, the Baltimore archdiocese has launched a test of faith and science to help the Vatican determine whether one of its own was not only exemplary in virtue during life but now has the power in death to intercede with God. “Did what happened come about by the intercession of Blessed Seelos? That’s what we have to discover,” said the judicial vicar who heads the committee to determine what took place and whether it can be attributed to natural causes. The method used today reflects a process developed since the 13th century, reformed in the 1600s, enshrined in canon law in the early 20th century and reformed again under Pope John Paul II in 1983.

    Seelos, the Redemptorist priest in several ways remains present at the church where he served two brief stints in the mid-1800s. The German native beams from stained glass in the nave, watches from a photograph on a wall near the church office, sits in a statue on a bench in the garden. A chip of his breastbone the shape and size of a pinkie fingernail is preserved in a reliquary kept in the rectory. In a brass necklace reliquary about the size of a silver dollar, the patient wears a fragment of his bone no longer than the “L” in relic.She has carried Seelos with her this way since early 2003, when she was diagnosed with and first underwent surgery for cancer.

    Seelos’ following had been building for decades. In New Orleans especially, where he died at the age of 48 in 1867 of yellow fever while tending to victims of the disease, his reputation was enhanced in the early 1970s. That’s when a local woman who had been diagnosed with terminal liver cancer was found free of the disease after prayers calling on Seelos. An investigation similar to the one in this case affirmed this as a miracle, and Seelos was beatified in a ceremony in Rome in 2000.

    The priest known as the “cheerful ascetic” would thereafter be officially known as “Blessed Seelos,” standing one difficult step away from sainthood.The difference would be one more miracle, one more case confirmed by a process that has been developing for centuries, as saint-making transformed from a spontaneous phenomenon to a formal procedure giving ultimate canonization authority to the pope.

    While elements of the process have been simplified and made more speedy, that is only in relative terms; declaring saints remains a painstaking affair. The rare candidate on the fast track might move from start to sainthood in just under 30 years, Seitz said. The longer causes go on and on. Hundreds stall at the midpoint of beatification, either for lack of a verifiable miracle or the support necessary to bring such information to the Vatican’s attention.

    Specialists at Memorial Sloan-Kettering Cancer Center in New York and M.D. Anderson Cancer Center in Houston who were consulted all have a few stories like this. Is this woman really any different from these, what I would call ’statistically improbable’ cases? The outcome is very unusual, but it’s not the only one.” Other patients with such cures that defy statistics come from a wide variety of religions and non-religions.

    There are many such other reports similar to this one.

    P. Del Poggio et al. describe the case of a 77-year-old woman with chronic hepatitis C and well compensated cirrhosis in whom a single encapsulated 5.5 cm hepatocellular carcinoma was found in the right liver lobe. The patient was symptomatic with left upper quadrant pain and had elevated alfa-fetoprotein levels (3133 ng/ml). While she was waiting for liver resection and 2 months after the initial diagnosis the pain improved and alfa-fetoprotein levels normalized. A computerized tomography scan showed reduction in size of the lesion to 2.5 cm, with no central arterial enhancement, but with the demonstration of a peripheral rim enhancing in all dynamic phases. Follow up computerized tomography and magnetic resonance imaging examinations showed further reduction in size of the lesion to 1.3 cm with persistence of the enhancing rim 20 months after the initial diagnosis. The spontaneous and durable regression of the HCC and the persistent peripheral enhancing rim could be explained by a strong and persistent activation of the immune system directed against the neoplastic cells.

    COMMENT
    Yes. Miracles do occur in medicine. Each of us as practicing clinicians has seen at least one. Who can really explain this phenomenon. Religious orders claim spiritual causes. Others try to find explanations in science. That’s why I believe a doctor should never take away hope from a patient who needs it. We do not know enough to do so.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for The Mysterious Case Of the Missing Fingerprints

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Sunday, August 16, 2009

    Cellphone Shields and Brain Cancer

    Cellphones release microwave radiation when they're in use, a fact that inevitably leads to fears of brain cancer.

    Chris Woolston writes, "cell phones release microwave radiation when they're in use, a fact that" has "inevitably led to fears of brain cancer." but, "worries about brain cancer spawned a market for products that supposedly protect cell phone users," such as "a thin polyester patch that contains a microchip that allegedly renders cell phones harmless." in an "unpublished scientific paper," investigators stated that the device "supposedly...can convert harmful delta brain waves to helpful alpha waves." A professor of physics , claims that "it's a scam," noting that "the claims they're making aren't very clear." he added that "claims of 'natural resonant frequencies' may seem impressive," but that "people have been talking about natural resonant frequencies for years." Furthermore, "the cheap devices are extremely unlikely to possess the type of technology it would take to really absorb, deflect, or modify radiation in a meaningful way."

    One site selling the biopro cell chip site says its patented technology "has been proven in numerous scientific studies to neutralize the dangers of electromagnetic radiation from cellphones and other devices." the site goes on to explain that the device "superimposes a low-frequency 'noise field' on emr [electromagnetic radiation] that resembles the natural resonant frequencies of the body's living cells. This effectively renders emr harmless."

    The site for the waveshield 2000 gold claims that the device can reduce radiation from the earpiece by "50-97%." the company used to claim that similar devices blocked up to 99% of radiation coming from the antenna -- the major source of cellphone radiation -- until the ftc filed suit for false advertising in 2002.

    The bottom line: most [experts] think these devices are worthless.


    Even Dr. Ronald Herberman, of the University of Pittsburgh Cancer institute and one of the leading voices calling for caution with cellphones, says he is "not aware of any evidence supporting the claims of cellphone guards" and doesn't recommend their use.

    He and colleagues recently offered 10 tips for reducing radiation exposure from cellphones, including holding them as far away from the head as possible, using them for only a few minutes at a time and keeping them away from children. Cellphone shields didn't warrant a mention.

    Shield or no shield, the hazards of cellphones are far from certain. Some believe that the microwaves released by cellphones don't have enough energy to break apart strands of dna, the type of damage that could possibly set the stage for cancer. Others agrees that cellphone radiation "cannot directly damage dna," but think that cellphone radiation could still indirectly scramble genetic material in ways that have yet to be explained.

    Findings on safety so far have been mixed. Researchers at the University of Utah recently pooled together the results of nine studies that looked for a link between cellphone use and brain cancer. As reported in the journal of neuro-oncology in 2008, they found no sign that frequent cellphone users were more likely than anyone else to get brain cancer. A danish study of more than 420,000 people also found no connection between cellphones and cancer, even in people who had used the phones for more than 10 years.

    However, Australian researchers who examined 11 previous studies comparing people with and without brain tumors concluded that using a cellphone for more than 10 years more than doubled the risk of developing a brain tumor on the side of the head where a person usually used the phone. (it's worth noting that some of the individual studies that they looked at concluded that cellphones didn't raise cancer risk.)

    In the face of that uncertainty, Herberman urges caution. That's caution -- not cellphone shields.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for MIRACLE CURES IN MEDICINE

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Saturday, August 15, 2009

    WHAT IS CELL PHONE ELBOW?

    You’ve heard of tennis elbow? Now Neurologists and orthopedists have encountered Cell Phone Elbow under its more common medical name, Cubital Tunnel Syndrome. Patients often present with a tingling in the pinky finger, along with pain, numbness or loss of strength in the hand.

    It has the same abbreviation (CTS) as its better-known cousin, Carpal Tunnel Syndrome, which also arises from similar overuse of an extremity This particular variant of CTS occurs when people spend too much time holding their cell phones to their ears, which requires bending the elbow for extended periods. With an estimated 200 million cell phones in the U.S., many with unlimited rollover minutes – not to mention billions of phones around the world – this could turn into a serious problem.
    Technically Cubital tunnel syndrome is caused by compression of the ulnar nerve as it traverses the posterior elbow, wrapping around the medial condyle of the humerus. When people hold their elbow flexed for a prolonged period, such as when speaking on the phone or sleeping at night, the ulnar nerve is placed in tension.Additionally, flexion of the elbow narrows the space available for the nerve and can cause a sevenfold to 20-fold increase in the pressure within the cubital tunnel, depending on muscle contraction. This can be compounded by compression on the nerve, either from various fascial bands surrounding the nerve or from extrinsic sources of compression, such as leaning on one’s elbow while driving or talking.
    "This increased pressure on the nerve leads to decreased blood flow and nerve ischemia; this in turn causes increased permeability of the epineurial vessels and nerve edema, enlarging the nerve and continuing the cycle."

    The most serious cases of Cell Phone Elbow may require surgery, typically an ulnar nerve transposition or medial epicondylectomy. A brace that immobilizes or restricts the elbow may also help those who exacerbate the problem by sleeping with their arms bent at night.
    The best solution is prevention--- a headset -- almost every phone has a jack for a wired model, but if the patient is a techno-junkie, he or she will probably insist on a wireless version. Use of a headset will also forestall a traffic ticket in a state that requires hands-free cell phone operation in a car.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for Cellphone Shields and Brain Cancer?

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, August 14, 2009

    DR. SIEGAL’S SECRET RECIPE REVEALED

    I discovered Dr. Siegal's COOKIE DIET(R) three years ago in a mall in Boca Raton, Florida, when my friend tried Dr. Siegal's cookies. She lost weight. I assumed there were illegal weight reducing compounds in the cookies, but when I tried to look up the ingredients I could not find them.

    Dr. Sanford Siegal, known to generations as the Cookie Doctor(R) is the man behind the Dr. Siegal's COOKIE DIET(R) weight-loss system. He has author of books including Dr. Siegal's Cookie Diet Book: How a Doctor and His Cookie Helped 500,000 People Lose Weight Fast.

    Dr. Siegal introduced his diet in his South Florida medical practice in 1975 and it was an immediate success.
    Eating to decrease appetite was not a new idea. Ayds (pronounced as "aids") was an appetite-suppressant candy which enjoyed strong sales in the 1970s and early 1980s. It was available in chocolate, chocolate mint, butterscotch or caramel flavors, and later a peanut butter flavor was introduced. The original packaging used the phrase "Ayds Reducing Plan vitamin and mineral Candy"; a later version used the phrase "appetite suppressant candy".

    In 1944 the US Federal Trade Commission objected to the claim that the product could cause the user to “lose up to 10 pounds in 5 days, without dieting or exercising.” However, public awareness of the disease AIDS beginning around mid-1981 caused problems for the brand due to the phonetic similarity of names. By 1988 the product's name was changed to Diet Ayds (Aydslim in Britain), but eventually it was withdrawn from the market. It was about this time that Dr. Siegal came up with his cookie idea.

    Eating six cookies a day he maintained enabled most of his patients to stick to the diet without significant hunger, and the fast weight loss they experienced kept them motivated until they reached their goal. At age 80, Dr. Siegal still personally mixes every batch of his proprietary protein formula in his private bakery near his Miami medical clinic. The cookie ingredients are, or at least have been a secret for 30 years. Siegal, however, still maintains his dark-of-night mixing routine and hints that there are subtleties in the recipe not apparent from the ingredient list.

    Once a week Sanford Siegal makes a late-night visit to a bakery in Miami. There, he mixes cookie batter. When he's finished, 22 bakery workers pick up where he leaves off, stirring, baking and packaging 10 million cookies a year that Siegal, who keeps his exact recipe under wraps, sells for up to $1.50 each Siegal,

    He maintains that there’s good reason for keeping his recipe a secret. He’s afraid of imitators. For most of the time, therefore, the osteopathic physician sold the cookies, without listing their ingredients.

    Last year Siegal's son Matthew, 45, decided to help with his operation. Matthew launched a Web site called www.cookiedietonline. It now has 60,000 registered users and brings in slightly less than half of Siegal's cookie sales, which totaled $7.2 million for the year ended in May. Pretax profit, according to the Siegals: $2 million. Siegal senior owns 60% of the Web-based company. His son owns the rest. Matthew has overseen a massive public relations offensive for his dad, getting him on 15 TV and radio shows this year. When Madonna mentioned on a radio show in April that an unnamed cookie diet had depressed her husband's libido, instead of denying ownership- of the cookies the Siegals quickly claimed she was talking about Dr. Siegal's--and debunked her suggestion. So it doesn’t matter what they say about you—as long as your name is in the headlines.

    Expanding the operation beyond his own medical practice, however, put Siegal within the realm of federal food guidelines. That took some of the mystery out of the magical diet food: He had to list ingredients.

    The ingredients are
    • wheat bran,
    • egg white solids and
    • to top it all of the real secret ingredient--microcrystalline cellulose.

    This is a filler that isn't completely digestible except by termites. You might as well be eating sawdust or wood chips. It goes in whole in one end and goes out the other unchanged. But on the way hold on to a lot of water, which is the stomach acts to keep you full.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for WHAT IS CELL PHONE ELBOW?

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Thursday, August 13, 2009

    Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus

    Swine flu (H1N1) virus will be making a comeback in just a few weeks.
    Here is a recent update on Influenza Testing from the CDC.

    IN SUMMARY

    1. These results showed that, although the Rapid Influenza Diagnostic Tests ( RIDT) were capable of detecting novel A (H1N1) virus from respiratory specimens containing high levels of virus (as indicated by low cycle threshold [Ct] values), the overall sensitivity was low (40%--69%) among all specimens tested and declined substantially as virus levels decreased (and Ct values increased). These findings indicate that, although a positive RIDT result can be used in making treatment decisions, a negative result does not rule out infection with novel influenza A (H1N1) virus

    2. Please place patients on isolation- Droplet and Contact Precautions with eye protection (surgical mask with eye shield, gown and gloves) when H1N1 is suspected with negative rapid test results.

    Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus --- United States, 2009
    The recent appearance and worldwide spread of novel influenza A (H1N1) virus (1,2) has highlighted the need to evaluate commercially available, widely used, rapid influenza diagnostic tests (RIDTs) for their ability to detect these viral antigens in respiratory clinical specimens. As an initial assessment, CDC conducted an evaluation of multiple RIDTs. Sixty-five clinical respiratory specimens collected during April--May 2009* that had previously tested positive either for novel influenza A (H1N1) or for seasonal influenza A (H1N1) or A (H3N2) viruses by real-time reverse transcription--polymerase chain reaction (rRT-PCR) assay were used in the evaluation. The results showed that, although the RIDTs were capable of detecting novel A (H1N1) virus from respiratory specimens containing high levels of virus (as indicated by low cycle threshold [Ct] values), the overall sensitivity was low (40%--69%) among all specimens tested and declined substantially as virus levels decreased (and Ct values increased). These findings indicate that, although a positive RIDT result can be used in making treatment decisions, a negative result does not rule out infection with novel influenza A (H1N1) virus. Patients with illnesses compatible with novel influenza A (H1N1) virus infection but with negative RIDT results should be treated empirically based on the level of clinical suspicion, underlying medical conditions, severity of illness, and risk for complications. If a more definitive determination of infection with influenza virus is required, testing with rRT-PCR or virus isolation should be performed. Additional evaluations of the accuracy of RIDTs in detecting novel influenza A (H1N1) virus should be conducted.

    Overall, for the 45 specimens that had tested positive for novel influenza A (H1N1) by rRT-PCR, the sensitivity of the three RIDT tests was 40% for BinaxNOW Influenza A&B, 49% for Directigen EZ Flu A+B,** and 69% for QuickVue Influenza A+B.

    Sensitivity of the RIDTs was generally greater for seasonal influenza A (H1N1) and (H3N2) than for novel influenza A (H1N1), although the number of specimens tested was small, especially for seasonal influenza A (H1N1). None of the specimens had a Ct value <20. Compared with rRT-PCR, the three tests demonstrated sensitivity ranging from 60% to 80% for seasonal A (H1N1) and from 80% to 83% for seasonal A (H3N2)

    Reported by: A Balish, et al. Influenza Div, National Center for Immunization and Respiratory Diseases, CDC.

    Editorial Note:
    The sensitivity of RIDTs to detect seasonal influenza viruses compared with virus isolation or rRT-PCR varies among commercial kits and has been shown to be low in some reports (3--5). In this evaluation, the sensitivity of three RIDTs to detect novel influenza A (H1N1) viral antigen in clinical specimens ranged from 40% to 69% and declined substantially with lower viral titers (as determined by Ct values). These findings are compatible with other recent studies, which reported that the sensitivity of some RIDTs to detect novel influenza A (H1N1) in clinical specimens ranged from 10% to 51% (6,7). Overall, the findings in this report demonstrate that these RIDTs are capable of detecting novel influenza A (H1N1) in respiratory specimens, but that many infections will be missed, especially in specimens with low viral titers.

    RIDTs do not distinguish among influenza A virus subtypes, and RIDT sensitivity might vary by subtype of influenza A (4,6,8). Therefore, when using a positive RIDT result to help determine the appropriate course of clinical treatment or other action, the result should always be interpreted in the context of currently circulating strains. Conversely, as indicated by the results of this and other studies, a negative RIDT result should not be interpreted as indicating the absence of infection. In this analysis, the sensitivity of all three assays evaluated declined as the viral titer in the specimen decreased. The amount of virus found in respiratory specimens can be affected by timing of the specimen collection; viral titers are highest in the first 3 days of illness. Other factors that can affect the amount of virus in the specimen include age (e.g., children generally shed more virus and for longer periods than adults), type of specimen collected, and transportation and storage of the specimen before testing. Testing with rRT-PCR or virus isolation should be performed if a more definitive determination of the presence of influenza virus is required. In the titered cultured virus results presented in this report, all three RIDTs detected the cultured novel H1N1 influenza A/California/4/2009 virus with a lower limit of detection between 104.5 and 105.5 TCID50, slightly higher TCID50 levels than for detection of seasonal influenza viruses. These findings are consistent with the analytical sensitivities of RIDTs to detect novel influenza A (H1N1) virus described in one report (9), but higher than those described in another report (10).

    The results described in this report should be viewed as preliminary. More data are needed on the clinical performance of all RIDTs to detect novel influenza A (H1N1) virus in different respiratory specimens. Because of the limitations of RIDTs and until additional data are available, all results from RIDTs, both positive and negative, when used for clinical decision-making in a patient with suspected novel influenza A (H1N1) virus infection, should be interpreted in the context of circulating influenza virus strains in the patient's community, level of clinical suspicion, severity of illness, and risk for complications. Additional CDC guidance on interpretation of RIDTs for testing of patients with suspected novel influenza A (H1N1) virus infection is available at http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm.

    References
    1. Dawood FS, Jain S, Finelli L, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605--15.
    2. CDC. Update: novel influenza A (H1N1) virus infections---worldwide May 6, 2009. MMWR 2009;58:453--8.
    3. Uyeki TM. Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza. Pediatr Infect Dis J 2003;22:164--77.
    4. Hurt AC, Alexander R, Hibbert J, Deed N, Barr IG. Performance of six influenza rapid tests in detecting human influenza in clinical specimens. J Clin Virol 2007;39:132--5.
    5. Uyeki TM, Prasad R, Vukotich C, et al. Low sensitivity of rapid diagnostic test for influenza. Clin Infect Dis 2009;48:e89.
    6. Faix DJ, Sherman SS, Waterman SH. Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 2009; e-published ahead of print.
    7. Ginocchio CC, Zhang F, Manji R, et al. Evaluation of multiple test methods for the detection of the novel 2009 influenza A (H1N1) during the New York City outbreak. J Clin Virol 2009;45:191--5.
    8. Carrat F, Vergu E, Ferguson NM, et al. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 2008;167:775--85.
    9. Hurt AC, Baas C, Deng YM, Roberts S, Kelso A, Barr IG. Performance of influenza rapid point-of-care tests in the detection of swine lineage A (H1N1) influenza viruses. Influenza Other Respi Viruses 2009;3:171--6.
    10. Chan KH, Lai ST, Poon LL, Guan Y, Yuen KY, Peiris JS. Analytical sensitivity of rapid influenza antigen detection tests for swine-origin influenza virus (H1N1). J Clin Virol 2009;45:205--7.



    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in tomorrow for DR. SIEGAL’S SECRET RECIPE REVEALED

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Wednesday, August 12, 2009

    WHY IS THE MEDITERRANEAN DIET AN ADVANTAGE IN LONGEVITY?

    What is the Mediterranean diet?

    The Mediterranean diet is the traditional cooking style of countries bordering the Mediterranean Sea. It is characterized by high amounts of omega-3 fatty acids, high fiber foods, low intakes of saturated fats and a high intake of mono-saturated fats, such as olive oil and nuts. Fish is favored more often than meat because of its high source of omega-3s.

    High protein options like lentils, beans and other legumes are also an important part of this diet. The Mediterranean diet incorporates the basics of healthy eating -- plus a splash of flavorful olive oil and perhaps a glass of red wine -- among other components.

    Most healthy diets include fruits, vegetables, fish and whole grains and limit unhealthy fats. While these parts of a healthy diet remain tried-and-true, subtle variations or differences in proportions of certain foods may make a difference in your risk of heart disease. Always consult your health physician before embarking on any new venture, as medicines can interact with certain food groups.

    Key components of the Mediterranean diet include:
    • Eating generous amount of fruits and vegetables daily
    • Consuming healthy fats such as olive oil and canola oil avocadoes in moderation
    • Eating small portions of nuts
    • Drinking red wine, in moderation
    • Consuming very little red meat if at all
    • Eating fish on a regular basis
    • Goat cheese is preferred choice over other cheeses
    • Whole grain bread is eaten without butter or margarines, which contain saturated or Trans fats, because these contribute to heart disease.



    This pyramid suggests amounts of serving of various food groups. Notice that the first component of this pyramid is exercise. All the doctors concurred that we should not underestimate the importance of daily activity, as it is a tremendous deterrent for any of above mentioned conditions.

    Vegetables, nuts, olives, fruit and fish — and a pleasant, sunny climate! Mediterranean’s live long and eat well, there's no question. Their diet has scored praise from nutrition experts and culinary enthusiasts. But what is it about the diet exactly that makes it so healthy?

    A new study by the Harvard School of Public Health in Boston and the University of Athens Medical School in Greece breaks down the diet staples of the Mediterranean diet. Results were released in the online edition of the British Medical Journal.

    Researchers looked at more than 23,000 Greek men and women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) over eight and a half years. They found that certain foods in the diet may offer the bulk of the nutritional benefits.

    As a surprise to us all the high consumption of fish and cereals that most of us associate with the diet, and the avoidance of dairy, did not impact the benefits of the overall diet. But the omission of prepackaged and processed foods with sugars and additives — commonly found in North American diets, probably also works in the Mediterranean diet’s advantage.

    Other components of the diet driving the mortality benefit included:
    • Low intake of mean and meat products (16.6% of the effect)
    • High vegetable intake (16.2% of the effect)
    • High fruit and nut consumption (11.2% of the effect)
    • High monounsaturated-to-saturated fat intake (10.6% of the effect)
    • High intake of legumes (9.7% of the effect)
    • High cereal intake and low dairy consumption were the lowest contributors to the mortality effect, accounting for 6.1% and 4.5%, respectively

    Moderate alcohol intake may be the single biggest contributor to the Mediterranean diet's longevity benefit, accounting for 23.5% of the effect in a prospective cohort study. The researchers defined moderate intake as 10 to <50 grams of alcohol per day. But subtracting alcohol as a component, the Mediterranean diet still appeared to contribute significantly to a long life.

    But before running to your nearest bar for your daily allotment--you must pay attention to this.
    Although moderate drinking may help protect against some chronic diseases, alcohol's net effect on health is profoundly negative around the world, researchers reported in the June 27, 2009 issue of The Lancet. Rehm J, et al "Global burden of alcohol diseases.” According to this study, the harms associated with alcohol vastly outweigh the benefits both globally and in the U.S.

    In 2004, alcohol cost the world nearly 71 million disability-adjusted life-years (DALYs) -- years of life lost to premature death or lived with disability, "Overall, their analysis shows that alcohol consumption is a major risk factor for burden of disease."

    Alcohol is linked to many disease categories. Alcohol-use disorders, cancer, cardiovascular disease, liver cirrhosis, and injury are the most important disease categories causally affected by alcohol. Although light to moderate drinking may have a beneficial effect on cardiovascular disease, this benefit is restricted to older people only," they say. Moreover, such benefits are swamped by the negative effects of heavy drinking, which often affect younger people who have more DALYs to lose The analysis also showed that for much of the world, the beneficial effects of alcohol are essentially irrelevant because of drinking habits, demographics, and lower prevalence of diabetes and cardiovascular disease


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for SPECIAL UPDATE BULLETIN FOR MEDICAL PROVIDERS ON SWINE FLU

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Tuesday, August 11, 2009

    PART III OF III -FDA ALERT ON DANGERS OF WEIGHT LOSS PRODUCTS

    The agency advises consumers to discontinue use of these supplements and then to consult their healthcare provider.

    Bumex carries a Boxed Warning because the drug may lead to serious and significant fluid and electrolyte loss. Another potential risk associated with the use of bumetanide is elevation in uric acid concentrations. Consumers should not take bumetanide if they are allergic to sulfonamides. Significant drug interactions, such as taking bumetanide with digoxin and lithium, may lead to an increased risk of toxicity. Consumers may also be at an increased risk of hypotension (low blood pressure), fainting, and resultant injury if they have normal blood pressure or are already taking an antihypertensive medication. The risk of toxic reactions to the drug may be greater in elderly consumers or consumers with impaired kidney function.

    Cetilistat is an experimental obesity drug and is currently the subject of clinical trials in the U.S., Japan, and Europe. Because cetilistat is in clinical trials, there is no safety or efficacy profile for this drug. Consumers in certain populations, however, could face serious health risks if taking cetilistat. For example, transplant patients taking anti-rejection drugs could suffer organ rejection. Cetilistat is also contraindicated with warfarin and levothyroxine as this could cause increased risk of bleeding and hypothyroidism. The majority of adverse events associated with ingestion of cetilistat are gastrointestinal in nature; e.g., fecal incontinence, rectal discharge, and defecation urgency. Because cetilistat decreases the absorption of fat, this may result in fatty or oily stool which could lead to malabsorption of nutrients and vitamin deficiency. Other adverse events include skin and subcutaneous tissue disorders. Cetilstat may reduce serum concentrations of vitamin E, vitamin D, and beta-carotene. Other safety concerns include the development of gallstones and kidney stones.

    Fenproporex is a stimulant not approved for marketing in the United States. Fenproporex, an amphetamine derivative, is a schedule IV controlled substance and could show up positive for amphetamines in a urinalysis. Serious adverse effects of stimulants include headache, tachycardia, increased breathing rate, increased blood pressure, fever, sweating, diarrhea, constipation, blurred vision, impaired speech, dizziness, uncontrollable movements or shaking, insomnia, numbness, palpitations, arrhythmia and possible sudden death.

    Fluoxetine is the active pharmaceutical ingredient in Prozac, a prescription antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Prozac carries a Boxed Warning because it and other antidepressants increase the risk of suicidal thinking and suicide in children, adolescents, and young adults. Additional potential risks from exposure to this drug include rashes, hives, and the potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome, which is characterized by changes in mental status, pulse, blood pressure, body temperature, and muscle control. Fluoxetine is also associated with nausea, diarrhea, headache, insomnia and anxiety.

    Furosemide is the active pharmaceutical ingredient in Lasix, a potent diuretic which is available only through prescription for use in the treatment of congestive heart failure, high blood pressure, and edema. It can cause profound dehydration and electrolyte imbalance, with loss of potassium, calcium, sodium, and magnesium. Patients allergic to sulfonamides may also be allergic to furosemide. Serious adverse effects from overdose may lead to dehydration, seizures, GI problems, kidney damage, lethargy, collapse, and coma.

    Phenolphthalein was an ingredient in some Over-the-Counter laxative products until 1999 when the FDA reclassified the drug as “not generally recognized as safe and effective” after studies indicated that phenolphthalein presented a potential carcinogenic risk. Phenolphthalein has also been found to be genotoxic in that it can damage or cause mutations to DNA.

    Phenytoin is the active pharmaceutical ingredient in Dilantin, an approved anti-seizure medication. Because there were trace amounts of this drug in some of these products, the risk was not assessed. However, these products could pose a risk to consumers who are allergic or hypersensitive to phenytoin.

    Rimonabant is the active pharmaceutical ingredient in Zimulti which has not been approved in the United States. In Europe the drug is known as Acomplia. In June 2007, the FDA Endocrinologic and Metabolic Drugs Advisory Committee unanimously voted not to recommend approval of the drug because of increased risk of neurological and psychiatric side effects—seizures, depression, anxiety, insomnia, aggressiveness, and suicidal thoughts among patients. In June of 2008, the Medicines and Healthcare Products Regulatory Agency of the United Kingdom linked rimonabant to 5 deaths and 720 adverse reactions over the past two years.

    In October, the European Medicines Agency recommended Sibutramine is a Schedule IV controlled substance and the active pharmaceutical ingredient in Meridia, an approved prescription drug to treat obesity.Some of the identified products recommend taking more than 3 times the recommended daily dosage of sibutramine. Because of this, even consumers without a history of health problems that take these high doses of sibutramine may suffer serious adverse effects if they take these products, such as increased blood pressure, tachycardia, palpitations, and seizure.

    Populations who would be at increased risk of serious adverse health effects from consuming a standard dose of sibutramine include:
    • Patients with a history of hypertension, especially those with uncontrolled or poorly controlled hypertension.
    • Patients with a history of coronary artery disease, congestive heart failure, arrhythmias, or stroke.
    • Patients with narrow angle glaucoma.
    • Patients with a history of seizure.
    • Patients predisposed to bleeding events and those taking concomitant medications known to affect hemostasis or platelet function.
    • Patients with severe hepatic dysfunction.
    • Patients concurrently taking the following medications:
    o Sumatriptan
    o Dihydroergotamine
    o Dextromethorphan
    o Meperidine,
    o Pentazocine
    o Fentanyl
    o Lithium
    o Tryptophan
    o MAO inhibitors




    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for WHY IS THE MEDITERRANEAN DIET AN ADVANTAGE IN LONGEVITY?

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, August 10, 2009

    PART II OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS

    FDA laboratory tests have revealed the presence of sibutramine, fenproporex, fluoxetine, bumetanide, furosemide, phenytoin, rimonabant, cetilistat, and phenolphthalein in weight loss products being sold over-the-counter. The tainted products are listed below in alphabetical order along with the undeclared drug and/or chemical ingredient

    1. 2 Day Diet - sibutramine
    2. 2 Day Diet Slim Advance - sibutramine
    3. 2x Powerful Slimming - sibutramine
    4. 3 Day Diet - sibutramine
    5. 3 Days Fit - sibutramine
    6. 3x Slimming Power – sibutramine, phenytoin
    7. 5x Imelda Perfect Slimming - sibutramine
    8. 7 Day Herbal Slim - sibutramine
    9. 7 Days Diet - sibutramine
    10. 7 Diet - sibutramine
    11. 7 Diet Day/Night Formula - sibutramine
    12. 8 Factor Diet – sibutramine, phenolphthalein
    13. Eight Factor Diet - sibutramine
    14. 21 Double Slim - sibutramine
    15. 24 Hours Diet – sibutramine, phenolphthalein
    16. 999 Fitness Essence - sibutramine
    17. BioEmagrecim, sample 1 – fenproporex
    BioEmagrecim, sample 2 – fluoxetine, furosemide
    18. Body Creator – sibutramine
    19. Body Shaping - sibutramine
    20. Body Slimming - sibutramine
    21. Cosmo Slim - sibutramine
    22. Extrim Plus – sibutramine, phenytoin
    23. Extrim Plus 24 Hour Reburn - sibutramine
    24. Fasting Diet - sibutramine
    25. Fatloss Slimming – sibutramine, phenolphthalein
    26. GMP – sibutramine
    27. Herbal Xenicol - cetilistat
    28. Imelda Fat Reducer - sibutramine
    29. Imelda Perfect Slim – sibutramine, phenolphthalein
    30. JM Fat Reducer - sibutramine
    31. Lida DaiDaihua - sibutramine
    32. Meili - sibutramine
    33. Meizitang - sibutramine
    34. Miaozi MeiMiaoQianZiJiaoNang - sibutramine
    35. Miaozi Slim Capsules - sibutramine
    36. Natural Model - sibutramine
    37. Perfect Slim - sibutramine
    38. Perfect Slim 5x – sibutramine, phenolphthalein
    39. Perfect Slim Up – sibutramine
    40. Phyto Shape - rimonabant
    41. Powerful Slim - sibutramine
    42. ProSlim Plus - sibutramine
    43. Reduce Weihgt - sibutramine
    44. Royal Slimming Formula – sibutramine, phenolphthalein
    45. Sana Plus - sibutramine
    46. Slim 3 in 1 - sibutramine
    47. Slim 3 in 1 Extra Slim Formula - sibutramine
    48. Slim 3 in 1 Extra Slim Waist Bumetanide is the active pharmaceutical ingredient in Bumex, a prescription diuretic.



    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for PART III OF III -FDA ALERT ON DANGERS OF WEIGHT LOSS PRODUCTS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Sunday, August 9, 2009

    PART I OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS

    Nearly 30 weight loss products sold over the internet and in retail stores are tainted with undeclared, active pharmaceuticals or chemicals, the FDA warned. All consumers should be familiar with the following signs of health fraud:
    • Promises of an "easy" fix for problems like excess weight, hair loss, or impotency.
    • Claims such as "scientific breakthrough," "miraculous cure," "secret ingredient," and "ancient remedy."
    • Impressive-sounding terms, such as "hunger stimulation point" and "thermogenesis" for a weight loss product.
    • Claims that the product is safe because it is "natural."
    • Undocumented case histories or personal testimonials by consumers or doctors claiming amazing results.
    • Promises of no-risk, money-back guarantees.
    An FDA analysis found the following undeclared ingredients:
    • phenytoin;
    • sibutramine, an antiobesity drug that can cause hypertension, seizures, tachycardia, palpitations, heart attack, or stroke;
    • rimonabant, an antiobesity drug not approved for use in the U.S.;
    • phenolphthalein, a possible cancer-causing agent used in chemical experiments.

    HOW IS THIS FRAUD BEING PEPERTRATED?
    Regulatory requirements for dietary supplements differ from those covering "conventional" foods and drug products (prescription and Over-the-Counter). Under the Dietary Supplement Health and Education Act of 1994 (DSHEA), the dietary supplement manufacturer is responsible for ensuring that its products are safe before they are marketed. Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements. Manufacturers must make sure that product label information is truthful and not misleading.

    The FDA has expanded its list of tainted weight loss products containing undeclared pharmaceutical ingredients. Herbal Xenicol (found to contain cetilistat, an obesity drug not approved in the U.S.) along with Slimbionic and Xsvelten (both containing sibutramine, a prescription-only weight loss drug) have been added to the list of tainted dietary supplements. There are now 72 products on the list.The FDA also identified the following undeclared pharmaceutical ingredients as appearing in some other products on the list:
    • fenproporex, an amphetamine derivative that can cause arrhythmia;
    • fluoxetine, an antidepressant;
    • furosemide, a prescription-only diuretic.

    The agency advises consumers to discontinue use of these supplements and then to consult their healthcare provider.
    In part II we will discuss the FDA laboratory tests which have revealed the presence of sibutramine, fenproporex, fluoxetine, bumetanide, furosemide, phenytoin, rimonabant, cetilistat, and phenolphthalein in weight loss products being sold over-the-counter. We will list the tainted products in alphabetical order along with the undeclared drug and/or chemical ingredient Nd how they can make you sicker.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for PART II OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Saturday, August 8, 2009

    CDC DATA IMPLICATE POULTRY AS MOST COMMON SOURCE OF FOOD POISONING.

    CDC DATA IMPLICATE POULTRY AS MOST COMMON SOURCE OF FOOD POISONING.
    Newly released CDC data indicate that "poultry was the most commonly identified source of food poisoning in the United States in 2006." During processing, chickens are at risk of being exposed to Clostridium perfringens, and the bacterium's spores can survive cooking processes, according the agency's Morbidity and Mortality Weekly Report. "Salmonella, the bacteria found in nationwide outbreaks of contaminated peanut butter, spinach, and tomatoes, was the second-leading cause of sole-source food illnesses," while, "dairy products accounted for just three percent of traceable food-related outbreaks," with 71 percent of the cases being "traced to unpasteurized milk."
    But "while poultry is the most common source of illnesses among the 17 different foods tracked by federal officials...two-thirds of all food-related illnesses traced to a lone ingredient were caused by viruses, which are often added to food by restaurant workers who fail to wash their hands."

    OTHER FOODBORNE INFECTIONS
    Foodborne infections are mostly manifested as intestinal illnesses and are largely preventable. The World Health Organization estimates that in 2005, 1.5 million people died, worldwide, from diarrheal diseases. A separate study estimated that 70% of diarrheal diseases are foodborne. The widely cited US estimate is that there are 76 million foodborne illnesses annually, resulting in 325,000 hospitalizations and 5200 deaths. The annual cost in the USA of all foodborne diseases is estimated to be $1.4 trillion.
    , humanity has become vulnerable to cross-species illnesses, thanks to modern advances such as the rapid transportation of both goods and people, increasing population density around the globe, and a growing dependence on intensified livestock production for food. The global transport of animals and animal products, which includes hundreds of species of wildlife, also provides safe passage for the harmful bacteria, viruses, and fungi they carry, not to mention the prion proteins that cause insidious illnesses such as mad cow disease and chronic wasting disease in deer and elk. Comment:

    Not only is local and national health care often a problem; internationally, no agency is responsible for, or capable of, monitoring and preventing the myriad diseases that can now cross the borders between countries and species.

    More specifically, no organization has the mandate to pursue policies based on a simple but critically important concept: that the health of people, animals, and the environment in which we all live are inextricably linked. Money must be found to help protect us more from foodborne infections, because these diseases are preventable. If the food production and marketing chain supplied food to consumers that were virtually free of pathogens there would be very little foodborne disease.

    To produce food virtually free of pathogens the government would have to take additional actions to prevent contamination-- more than the actions taken so far which documents that even the minimal food safety regulations taken 10 years ago have been effective in reducing contamination.


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for PART I OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Friday, August 7, 2009

    CONTAMINATION FORCES RECALL OF HAND SANITIZERS

    WASHINGTON, June 10 -- A line of skin care products -- including some hand sanitizers -- was voluntarily recalled after FDA inspectors discovered high levels of disease-causing bacteria in them, according to the agency.

    Clarcon Biological Chemistry Laboratory, based in Roy, Utah, said the recall covers all Clarcon products.
    The FDA said its analyses of several samples of over-the-counter topical antimicrobial skin sanitizer and skin protectant products revealed high levels of various bacteria, including some associated with unsanitary conditions.

    According to the FDA warning, some of the bacteria identified in the products can "cause opportunistic infections of the skin and underlying tissues. Such infections may need medical or surgical attention, and may result in permanent damage."

    The inspection findings, the FDA said, were "particularly concerning because the products are promoted as antimicrobial agents that claim to treat open wounds, damaged skin, and protect against various infectious diseases."

    The agency said the inspection also uncovered serious deviations from current Good Manufacturing Practice requirements.
    The FDA released this list of products covered by the recall:
    • Citrushield Lotion
    • Dermassentials DermaBarrier
    • Dermassentials by Clarcon Antimicrobial Hand Sanitizer
    • Iron Fist Barrier Hand Treatment
    • Skin Shield Restaurant
    • Skin Shield Industrial
    • Skin Shield Beauty Salon Lotion
    • Total Skin Care Beauty
    • Total Skin Care Work
    From MedPage Today


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for CDC DATA IMPLICATE POULTRY AS MOST COMMON SOURCE OF FOOD POISONING.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Thursday, August 6, 2009

    Esophageal Adenocarcinoma-the White Man’s Disease

    Development of Barrett's esophagus and esophageal adenocarcinoma appears to be strongly affected by ethnic factors, with populations resident at the west end of the Eurasian continent, such as Anglo-Celtics, being more prone to both conditions. On the other hand, ethnic groups from the eastern and southern ends of Eurasia, such as Chinese, Koreans and Japanese, and Africans might be more prone to developing esophageal squamous cell carcinoma.

    Esophageal adenocarcinoma (EAC) is the most rapidly increasing cancer in the Western world and Barrett’s esophagus (BE) is the only known precursor lesion for this lethal cancer. Long-term survival may be improved if EAC is diagnosed early, providing an opportunity for early intervention. Surveillance of all patients with known BE is probably not cost effective and factors predictive of BE progression to dysplasia/EAC are poorly understood. Screening and surveillance examinations are also faced with challenges in the endoscopic detection of intestinal metaplasia and dysplasia. Future application of molecular biomarkers may help identify the patients with BE most likely to progress, and the use of novel imaging methods may improve outcomes of BE screening and surveillance

    Esophageal squamous cell carcinoma (ESCC) used to be the dominant type of esophageal malignancy both in Western and Asian countries. The rapid increase of EAC in Western countries has occurred in parallel with an increased prevalence of gastroesophageal reflux disease (GERD) and its major determinant, obesity.
    Such an increase in EAC has not yet been observed in Asia, despite a recent increase in prevalence of GERD.

    Hongo, Michio et al.Journal of Gastroenterology and Hepatology, Volume 24, Number 5, May 2009 , pp. 729-735(7)
    Jeff Michalak et al. Current Gastroenterology ReportsVolume 11, Number 3 / June, 2009

    COMMENT: The incidence of esophageal cancer is greatest in those people with chronic heartburn. Yet the screening of these patients for cancer is not deemed “cost effective.”

    Read about the controversy and how it affects medical malpractice cases in-

    Book I - “Medical Malpractice Expert Witnessing: Introductory Guide for Physicians and Medical Professionals” (Hardcover) by Perry Hookman, MD (Author) : 592 pages.27 chapters. Publisher: CRC; Potomac Press; Language: English ISBN-10: 1420058959 ISBN-13: 978-1420058956; Dimensions: 10.1 x 7.1 x 1.4 inches; Shipping Weight: 2.6 pounds; price $239.95.
    For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for CONTAMINATION FORCES RECALL OF HAND SANITIZERS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Wednesday, August 5, 2009

    Surveillance of Barrett's Columnar-Lined Esophagus

    The benefits of endoscopic surveillance in patients with Barretts esophagus, a precursor of cancer in the esophagus, are unproven. There is little evidence yet to support recommendations for precise endoscopic intervals.

    Researchers in the U.K. examined surveillance practice for columnar-lined esophagus in the U.K. and the impact of endoscopic intervals on detection of dysplastic disease.
    The team studied 817 patients with columnar-lined esophagus, registered with the U.K. National Barrett's Esophagus registry and undergoing surveillance.

    A large proportion of dysplastic disease, it should be noted is detected on specific surveillance endoscopies.

    Shorter endoscopic intervals for surveillance of low-grade dysplasia are associated with an increased detection of high-grade dysplasia/adenocarcinoma. Regular Endoscopic surveillance of patients with columnar-lined esophagus may identify those with early adenocarcinoma.

    This particular study calculated the frequency of Endoscopic intervals in the detection of dysplastic disease which was analyzed using a test of association. Factors affecting surveillance intervals were analyzed using multiple linear regression.

    Using these techniques, the researchers diagnosed 95 percent of patients with low-grade dysplasia, 95 percent with high-grade dysplasia and 71 percent with adenocarcinoma on surveillance endoscopies.

    Mean endoscopic surveillance intervals varied between the centers from one to two years for non-dysplastic columnar-lined esophagus, and up to one year for low- and high-grade dysplasia. When low-grade dysplasia was surveyed, however, significantly higher proportions of high-grade dysplasia/adenocarcinoma were detected at intervals of three months or less.

    Shorter endoscopic intervals were significantly associated with more detection of the presence of esophageal strictures, ulcers, increasing patient age and higher grade of dysplasia surveyed.

    European Journal of Gastroenterology & Hepatology; 2009: 21(6): 636-41

    COMMENT:
    So draw your own conclusions.The evidence is not yet in to make official recommendations regarding surveillance in GERD and in Barretts. But if you had this, which would you choose for yourself? Would you choose shorter or longer surveillance times—or none at all as advocated by some?


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for Esophageal Adenocarcinoma-the White Man’s Disease.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    Tuesday, August 4, 2009

    A NEW NON INVASIVE TEST FOR ALZHEIMER'S

    Dementia and other cognitive problems are common. An estimated 24 million individuals in the world have dementia and the number affected will double every 20 years.1 Milder forms of cognitive dysfunction, including mild cognitive impairment, affect many more people.2 Alzheimer’s disease is the commonest form of dementia. Cognitive problems are a feature of many neurological and medical diseases including stroke, Parkinson’s disease, head injury, and epilepsy.

    Assessment of a patient’s cognition is a crucial part of many medical consultations. Cognitive tests aid the diagnosis of dementia and are important in the medical and social management of patients and in the assessment of capacity. Once there are effective treatments for Alzheimer’s disease there will be an even greater need for a quick sensitive test that is suitable for use in primary care and by non-specialists. Dr.Jeremy Brown, British consultant neurologist,et al devised a cognitive test, the TYM ("test your memory"), in the detection of Alzheimer’s disease in his article named Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study and wich appeared in the recent BMJ 2009;338:b2030

    The TYM test
    The TYM is a series of 10 tasks on a double sided sheet of card with spaces for the patient to fill in (see appendix 1 on bmj.com). The patient’s ability to complete the test is an 11th task. The tasks are orientation (10 points), ability to copy a sentence (2 points), semantic knowledge (3 points), calculation (4 points), verbal fluency (4 points), similarities (4 points), naming (5 points), visuospatial abilities ( 2 tasks, total 7 points), and recall of a copied sentence (6 points). The ability to do the test is also scored (5 points), giving a possible total of 50 points. The scores for the subsets are printed on the card and the total score calculated by adding the subset scores. To ensure consistent scoring a single sheet of scoring instructions is availableControl participants completed the TYM with an average score of 47/50. Patients with Alzheimer’s disease scored an lower average of 33/50. The TYM score shows excellent correlation with the two standard tests. A score of 42/50 had a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer’s disease. The TYM was more sensitive in detection of Alzheimer’s disease than the mini-mental examination, detecting 93% of patients compared with 52% for the mini-mental state examination. The negative and positive predictive values of the TYM with the cut off of 42 were 99% and 42% with a prevalence of Alzheimer’s disease of 10%. Thirty one patients with non-Alzheimer dementias scored an average of 39/50.

    The authors concluded that the TYM can be completed quickly and accurately by normal controls. It is a powerful and valid screening test for the detection of Alzheimer’s disease.



    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    * Tune in tomorrow for Surveillance of Barrett's Columnar-Lined Esophagus.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com