VITAMIN B12 DEFICIENCY DUE TO METFORMIN

Vitamin B12 deficiency due to metformin is a less common, but potentially severe complication that is often overlooked. Patients at risk for vitamin B12 deficiency include those taking more than 1,000 mg daily of metformin for three years or longer. Patients receiving metformin therapy should be monitored for signs and symptoms of vitamin B12 deficiency such as megaloblastic anemia or peripheral neuropathies.

Also, advise patients on metformin to take a multivitamin with B12 and encourage them to get their recommended daily amount of calcium, although there's no proof this will prevent B12 deficiency.
While neuropathy can be related to hyperglycemia, vitamin B12 deficiency should be ruled out as a cause, especially in those patients with diabetes who are taking metformin.

In patients with vitamin B12 deficiency, supplemental oral vitamin B12 should be administered. Calcium supplementation to assure that the recommended daily allowance is being met can also be considered

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.

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

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

Clinically Significant Statin Drug Interactions

Perhaps the most serious consequence of statin interactions is rhabdomyolysis. The risk of myopathy is increased when statins are coadministered with medications that inhibit their metabolism. Atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor) are CYP3A4 substrates and when coadministered with potent CYP3A4 inhibitors the incidence of myopathy is increased by about five fold.
The extent of interaction between atorvastatin and CYP3A4 inhibitors is less than that with lovastatin and simvastatin. Lovastatin and simvastatin are termed "sensitive substrates" because their levels may be increased five-fold or higher by CYP3A4 inhibitors.

Fluvastatin (Lescol) is primarily metabolized by CYP2C9 and to a lesser extent by CYP3A4 and CYP2D6. Pravastatin (Pravachol) is not significantly metabolized by the cytochrome P450 system and does not interact with other CYP substrates. Rosuvastatin (Crestor) is also not extensively metabolized by the cytochrome P450 system. Statins are substrates for P-glycoprotein; therefore, drugs that inhibit p-glycoprotein (e.g., cyclosporine, diltiazem, etc) may increase statin levels.
The increased risk of myopathy is well recognized when statins and fibric acid derivatives are coadministered since both classes of drugs have the potential for inducing myopathy. However, the risk is less with fenofibrate than gemfibrozil. This may be because gemfibrozil inhibits hepatic glucuronidation of statins, thereby interfering with statin elimination.

In managing statin interactions, choosing a non-interacting medication or switching to a non-interacting statin (i.e., for chronic therapy) may be the safest or easiest option. For certain statin interactions, reducing the statin dose may be an acceptable management technique.

Interactions between lovastatin or simvastatin and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole) are managed by stopping the statin as soon as the interacting drug is started. Recommendations vary, but some experts suggest restarting the statin three days or so after the interacting drug has been discontinued. The cardiovascular risk of stopping a statin must be considered when managing drug interactions. Stopping a statin for up to six weeks in a stable patient appears safe. The cardiovascular risk of stopping a statin is higher in unstable patients. Morbidity and mortality is increased in acute myocardial infarction (MI) patients whose statins are discontinued.The results of statin discontinuation in high risk patients may be seen quickly. In one study there was increased risk of in-hospital death in patients with non-ST segment elevation MI whose statin was discontinued. In addition, stopping statin therapy in acute ischemic stroke patients resulted in early neurologic deterioration and poorer outcomes in an unpublished study. Therefore, statins should only be discontinued in acute MI or stroke when indicated (e.g., rhabdomyolysis).

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.

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

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

10 Tips on Hemorrhoids

1.Hemorrhoids are masses of swollen veins in the lower rectum (internal hemorrhoids) or at the anus (external hemorrhoids).

2.Symptoms of internal hemorrhoids include:
Bright red rectal bleeding
Staining of undergarments with mucus

3.Symptoms of external hemorrhoids include:
Pain and itching when irritated by constipation or diarrhea
Difficulty with hygiene

4.Hemorrhoids are caused by:
Straining
Work strain (lifting, etc.)
Straining while defecating
Chronic constipation
Passing hard, dry, small stools
Laxative abuse

5.Do not assume rectal bleeding is from hemorrhoids. See your doctor to rule out cancer or other disease.

6.To prevent or manage hemorrhoids, increase your fiber and fluid intake. Consider adding a fiber supplement.

7.Avoid straining at stool or sitting on the toilet for a long time.

8.Clean the external rectal area gently with soap and water following stool evacuation.

9.Try a topical cream or sitz baths to reduce inflammation.

10.See your doctor if you don't improve.

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.

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

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

Safe Biopsy: Validated Method for Staging Liver Fibrosis in Hep C

Study results in Hepatology indicate that safe biopsy is a rational and validated method for staging liver fibrosis in hepatitis C with a marked reduction in the need for liver biopsy. It is an attractive tool for large-scale screening of hepatitis C virus carriers.

The staging of liver fibrosis is pivotal for defining the prognosis and indications for therapy in hepatitis C. Although liver biopsy remains the gold standard, several noninvasive methods are under evaluation for clinical use. Researchers validated the recently described sequential algorithm for fibrosis evaluation biopsy. The safe biopsy detects significant fibrosis and cirrhosis by combining the AST-to-platelet ratio index and Fibrotest-Fibrosure, thereby limiting liver biopsy to cases not adequately classifiable by noninvasive markers.

The researchers enrolled hepatitis C virus patients in nine locations in Europe and the U.S. The diagnostic accuracy of safe biopsy versus histology, which is the gold standard, was investigated. The reduction in the need for liver biopsies achieved with safe biopsy was also assessed. Safe biopsy identified significant fibrosis with 90 percent accuracy, and reduced the number of liver biopsies needed by 47 percent. Safe biopsy had 93 percent accuracy for the detection of cirrhosis, obviating 82 percent of liver biopsies. A third algorithm identified significant fibrosis and cirrhosis simultaneously with high accuracy and a 36 percent reduction in the need for liver biopsy. The patient's age and body mass index influenced the performance of safe biopsy, which was improved with adjusted Fibrotest-Fibrosure cutoffs.
The team found that 10 percent of cases had discordant results for significant fibrosis with safe biopsy versus histology, whereas 8 percent of cases were discordant for cirrhosis detection. The research team also found that 71 of the former cases and 56 of the latter cases had a Fibroscan measurement within two months of histological evaluation. Fibroscan confirmed safe biopsy findings in 83 percent and 75 percent, respectively.

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.

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

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

Gastric distress-related ED visits may increase during the holidays.

At hospitals, gastric distress is a part of the holiday tradition." Indeed, "in the early hours of Thanksgiving...emergency rooms are typically empty," but certain turkey-cooking practices "can easily strike a blow" to diners. Typically, a frozen turkey is left on a countertop for 12 hours, while a roasted bird may sit "for two or three hours before" reaching the table. "During that time, a virus or bacterium can land on the food and start growing," causing gastroenteritis. "Although bacteria will die" once the bird is reheated, "the toxins made by the bacteria that cause illness can survive even in a hot oven." Bones have also been known to trigger "trips to the hospital," and those "with heart conditions should avoid too much salt, which can trigger an accumulation of fluid in the lungs."

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.

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

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

Safe Biopsy: Validated Method for Staging Liver Fibrosis in Hep C

Study results in Hepatology indicate that safe biopsy is a rational and validated method for staging liver fibrosis in hepatitis C with a marked reduction in the need for liver biopsy. It is an attractive tool for large-scale screening of hepatitis C virus carriers.

The staging of liver fibrosis is pivotal for defining the prognosis and indications for therapy in hepatitis C. Although liver biopsy remains the gold standard, several noninvasive methods are under evaluation for clinical use. Researchers validated the recently described sequential algorithm for fibrosis evaluation biopsy. The safe biopsy detects significant fibrosis and cirrhosis by combining the AST-to-platelet ratio index and Fibrotest-Fibrosure, thereby limiting liver biopsy to cases not adequately classifiable by noninvasive markers.

The researchers enrolled hepatitis C virus patients in nine locations in Europe and the U.S. The diagnostic accuracy of safe biopsy versus histology, which is the gold standard, was investigated. The reduction in the need for liver biopsies achieved with safe biopsy was also assessed. Safe biopsy identified significant fibrosis with 90 percent accuracy, and reduced the number of liver biopsies needed by 47 percent. Safe biopsy had 93 percent accuracy for the detection of cirrhosis, obviating 82 percent of liver biopsies. A third algorithm identified significant fibrosis and cirrhosis simultaneously with high accuracy and a 36 percent reduction in the need for liver biopsy. The patient's age and body mass index influenced the performance of safe biopsy, which was improved with adjusted Fibrotest-Fibrosure cutoffs.

The team found that 10 percent of cases had discordant results for significant fibrosis with safe biopsy versus histology, whereas 8 percent of cases were discordant for cirrhosis detection. The research team also found that 71 of the former cases and 56 of the latter cases had a Fibroscan measurement within two months of histological evaluation. Fibroscan confirmed safe biopsy findings in 83 percent and 75 percent, respectively.

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.

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

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

10 Tips on Belching, Bloating, and Flatulence

1.Belching is caused by swallowed air from:
Eating or drinking too fast
Poorly fitting dentures; not chewing food completely
Carbonated beverages
Chewing gum or sucking on hard candies
Excessive swallowing due to nervous tension or postnasal drip
Forced belching to relieve abdominal discomfort

2.To prevent excessive belching, avoid:
Carbonated beverages
Chewing gum
Hard candies
Simethicone may be helpful

3.Abdominal bloating and discomfort may be due to intestinal sensitivity or symptoms of irritable bowel syndrome. To relieve symptoms, avoid:
Broccoli
Baked beans
Cabbage
Carbonated drinks
Cauliflower
Chewing gum
Hard candy

4.Abdominal distention resulting from weak abdominal muscles:
Is better in the morning
Gets worse as the day progresses
Is relieved by lying down

5.To prevent Abdominal distention:
Tighten abdominal muscles by pulling in your stomach several times during the day
So sit-up exercises if possible
Wear an abdominal support garment if exercise is too difficult

6.Flatulence is gas created through bacterial action in the bowel and passed rectally. Keep in mind that:
10-18 passages per day are normal
Primary gases are harmless and odorless
Noticeable smells are trace gases related to food intake

7.Foods that are likely to form gas include:
Milk, dairy products, and medications that contain lactose--If your body doesn't produce the enzyme (lactase) to break it down.
Certain vegetables--baked beans, cauliflower, broccoli, cabbage
Certain starches--wheat, oats, corn, potatoes. Rice is a good substitute.

8.If flatulence is a concern, see your doctor to determine if you are lactose intolerant.

9.Identify offending foods. Reduce or eliminate these gas-forming foods from your diet.

10.Activated Charcoal may provide some benefit.

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.

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

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