Monday, 31 December 2018
Why cheese is no longer my friend
Self-confessed cheese addict Tim Samuels discovered his favourite food needs a health warning. via BBC News - Health Read More Here..
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Should the NHS pay for transgender fertility treatment?
Some transgender people get free fertility treatment but it's not the same for everyone who's transitioned. via BBC News - Health Read More Here..
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'Dangerous orange pill' prompts Australia festival warning
Festival-goers are told that a "dangerous" drug is circulating in Australia, following a man's death. via BBC News - Health Read More Here..
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Minority take up 'life-saving' free health check
It can pick up preventable heart problems - and more people should be getting the routine check. via BBC News - Health Read More Here..
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New Year Honours 2019: Sepsis campaigner appointed MBE
Melissa Mead campaigned for greater awareness of sepsis after the death of her son, William. via BBC News - Health Read More Here..
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The breakthroughs that could save our lives
From reversing blindness and paralysis to new treatments for cancer and infertility. via BBC News - Health Read More Here..
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Friday, 28 December 2018
‘Losing 18st left me uncomfortable in my own skin’
Jack Towers is crowdfunding for surgery to remove his excess skin, but the NHS won't pay for it. via BBC News - Health Read More Here..
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The simple tips to improve your health
The list of things we should do to become healthier can seem endless, so we asked experts for their one top tip. via BBC News - Health Read More Here..
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Couple have baby after Facebook group pays for IVF
The couple, who both had cancer as teenagers, wanted to have a second baby but could not afford IVF. via BBC News - Health Read More Here..
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Thursday, 27 December 2018
Smoking v vaping: Watch lab test results
E-cigarettes are significantly less harmful than traditional cigarettes, a government advisory body says. via BBC News - Health Read More Here..
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Care home trials virtual cycling trips for dementia patients
Care home staff say a cycling scheme has improved wellbeing among residents living with dementia. via BBC News - Health Read More Here..
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Wednesday, 26 December 2018
How to resist 'drink pushers' during the festive season
Actor Stephen McGann and others call for more tolerance for non-drinkers. via BBC News - Health Read More Here..
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Tuesday, 25 December 2018
Exceptional longevity: why some people live to be more than 100-year old
Interventions that promote longevity, remembered by mnemonic: DEEP purple - “eat colorful plant foods: Dietary modification, Exercise, active Engagement, Purposeful living (click here to enlarge the image).
Based on a Mayo Clinic Proceedings article (https://www.mayoclinicproceedings.org/article/S0025-6196(18)30792-4/):
Exceptional Human Longevity: the oldest old have an extreme phenotype of delayed onset of age-related diseases and/or resistance to lethal illnesses occurring earlier in life.
Centenarians have delayed onset of chronic diseases
During the span of human history the likelihood of living from birth to age 100 rose from 1 in 20 million to 1 in 50 as of year 1995 (for females in low-mortality nations such as Japan and Sweden). By 2009, this probability increased to 1 in 2. About 1 in 5,000 persons in the United States is a centenarian or older. Human longevity now exceeds 115 years. However, maximum life span has remained largely unchanged. There is a limit to human longevity, and it may be around 120 years.
In centenarians, the age at onset of common age-associated diseases is delayed: 43% of both male and female centenarians reach the age of 80 years before experiencing age-associated illness.
There is an absence of any disease diagnosis in some 15% and 30% of female and male centenarians, respectively, at the age of 100 years!
As many as 25% of centenarians are cognitively intact.
Geographic Clusters
Geographic Clustering of Exceptionally Long-Lived Individuals: Countries with the world's oldest populations in 2015: Japan, followed by Germany, Italy, Greece, Finland, and Sweden.
Long-lived Okinawans subscribe to the nutritional behavior of “hara haci bu” or “eat until you are only 80% full.” Their “rainbow diet” is based on diverse fruits and vegetables, with soy providing the bulk of protein intake. Their daily caloric intake is reduced, accounting for their low BMI of 20.
Life span is increased in regular churchgoers, whatever their faith. Seventh Day Adventists exhibit significantly lower levels of measured stress hormones.
Behavioral and environmental influences that may contribute to longevity in the so called “blue zones”:
- Eating in moderation, mostly plant-based diet. Small-portioned “regular” meals. Lighter meals at the end of the day.
- Purposeful living: life philosophy, volunteerism, “hard work” or “work ethic”
- Social support systems: interactions with family/friends, laughter/humor
- Exercise, especially walking, gardening
- Other nutritional factors: goat's milk, red wine, herbal teas
- Spirituality
- Maintenance of a healthy body mass index (BMI)
- Other possible factors: sunshine, adequate hydration, naps
Compression of Morbidity: diseases occur later in life. Fries' “compression of morbidity” hypothesis: chronic morbidity begins at a later age.
Why Are Some People Long-Lived?
Genes: Centenarians' offspring have an increased likelihood of surviving to 100 years and exhibit a diminished prevalence of age-associated diseases.
Environmental factors exert even greater effect than genes.
Sex Differences: Universally, women live longer than men. Despite the greater longevity of women, functional status is better in older men compared with older women.
Resiliency is the capacity to adequately respond to stressors. It helps resist age-related physiologic changes. Resiliency protects against insults that shorten life and health span. Resiliency can explain why some centenarians, despite onset of chronic disease before the age of 80 years, live exceptionally long.
How Is Exceptional Longevity Achieved?
Caloric restriction delays the aging phenotype in mammals. This is shown by abundant studies. Caloric restriction delayed the onset of diabetes, cancer, cardiovascular disease, and brain atrophy.
Reduced calorie intake by 20% to 60% retards aging. It only works if such reduction is quite substantial.
What about exercise? Regular physical activity promotes healthy human life span. However, it is unclear if exercise increases maximum longevity.
Normal body weight confers the most protection from mortality.
Active engagement and development of social networks and support systems confer longevity benefits. Lack of strong social relations is associated with a mortality risk roughly equivalent to smoking.
Interventions that promote longevity can be remembered by the mnemonic: DEEP purple - “eat colorful plant foods”:
- Dietary modification
- Exercise
- active Engagement
- Purposeful living
How to Measure Successful Aging?
Several algorithms have been proposed to estimate biological age. They are based on functional as well as biochemical measurements.
Biomarkers of Aging Processes and Longevity:
Disease-free survival or disability-free survival at 6-month intervals
Time to impairment in the next activity of daily living
Length of stay after hospitalization
Height, especially in men
Facial features
Gait speed, grip strength, muscle mass, mobility stress test
Daily and instrumental activities of daily living
Cognitive tests such as the Digit Symbol Substitution Test or Montreal Cognitive Test
Blood glucose or hemoglobin A1c, hypertension and elevated lipids, interleukin 6, insulin-like growth factor 1, and insulin-like growth factor binding proteins
CD4+, CD28− and CD8+, CD28− T cells; percentage of T cells that are naive vs memory (CD4 cells, CD8 cells)
Antibody response to annual influenza vaccination; delayed hypersensitivity skin test
Cataracts
Threshold for hearing high-pitched tones; tests of taste and smell
Tests of proprioception and balance
Forced expiratory volume in 1 second
Number of remaining teeth
One or two parents reaching 90 years of age
Educational attainment
More speculative: DNA methylation indices; senescent cell burden
References:
https://www.mayoclinicproceedings.org/article/S0025-6196(18)30792-4/
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Monday, 24 December 2018
Why are more boys than girls born every single year?
Is it just down to evolution or male sperm swimming that little bit faster? via BBC News - Health Read More Here..
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Reality Check: Do you sleep worse at Christmas?
Sleep disruption has a big effect in the short-term - but what about longer term? via BBC News - Health Read More Here..
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The buddies who send recovery parcels for support
Strangers with long-term mental and physical illnesses are being paired up and encouraged to send gifts to one another to stop them feeling isolated. via BBC News - Health Read More Here..
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Spinal surgery for unborn babies to be available on NHS
The procedure can reduce the likelihood of illnesses later in life and improve walking ability. via BBC News - Health Read More Here..
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'Drunk tanks' to ease NHS pressure
It is hoped that providing supervised units for revellers who have over-indulged will free up A&E staff. via BBC News - Health Read More Here..
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Saturday, 22 December 2018
Clare knitted and raised thousands, now she's in love
When she started knitting after her bereavement, Clare didn’t realise it would raise thousands for charity – and help her find love again. via BBC News - Health Read More Here..
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Christmas 2018: 'It's hard being young and sober'
Three people who all drank in their teens tell how they have turned their back on alcohol. via BBC News - Health Read More Here..
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Friday, 21 December 2018
Tax unhealthy food, says top UK doctor
The food industry is "failing the public" and must do more, England's chief medical officer says. via BBC News - Health Read More Here..
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Thursday, 20 December 2018
Obama plays Santa at children's hospital in Washington
Former US President Barack Obama plays Santa - delivering gifts, singing and greeting patients. via BBC News - Health Read More Here..
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Jazz guitarist Musa Manzini plays through brain surgery
Surgeons removing Musa Manzini's tumour say an "awake" operation helps reduce damage to the brain. via BBC News - Health Read More Here..
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For type 2 diabetes patients who require an injectable drug, GLP-1-based drugs are preferred over insulin
That's a pretty big change:
Diabetes Guidelines Updated: For patients with type 2 diabetes who require an injectable drug, a glucagon-like peptide 1 receptor agonist is preferred over insulin. https://buff.ly/2T0Kowc
Glucagon-like peptide-1 (GLP-1)-based therapies (eg, GLP-1 receptor agonists, dipeptidyl peptidase-4 [DPP-4] inhibitors) affect glucose control through several mechanisms, including:
- enhancement of glucose-dependent insulin secretion
- slowed gastric emptying
- reduction of postprandial glucagon and food intake
These agents do not usually cause hypoglycemia.
Short-acting GLP-1 receptor agonists have an effect on postprandial hyperglycemia and gastric emptying:
- Exenatide twice daily. Exendin-4 is a naturally occurring component of the Gila monster lizard saliva and shares 53 percent sequence identity with GLP-1. Exenatide (half-life 2.4 hours) is synthetic exendin-4. Brand Names: Bydureon; Byetta Pen.
- Lixisenatide is a GLP-1 receptor agonist that shares some structural elements with exendin-4. Compared with native GLP-1, it has a prolonged half-life (2.7 to 4.3 hours). Brand Names: Adlyxin.
Long-acting GLP-1 receptor agonists have a greater resistance to dipeptidyl peptidase-4 (DPP-4) degradation. They activate the GLP-1 receptor continuously and have a prolonged half-life, thus allowing for once-daily and even once-weekly subcutaneous injection. They have a marked effect on fasting glucose.
- Exenatide once weekly is a sustained-release formulation of the short-acting subcutaneous exenatide.
- Liraglutide is GLP-1 receptor agonist which binds to serum albumin, resulting in slower degradation (half-life 11 to 15 hours) and allowing for once-daily, subcutaneous dosing. Brand Names: Saxenda; Victoza.
- Dulaglutide is a long-acting GLP-1 receptor agonist with structural modifications to prevent degradation by DPP-4 and to prolong its half-life. The half-life of dulaglutide is approximately five days, which allows for once-weekly administration. Brand Names: Trulicity/
- Semaglutide is a long-acting GLP-1 receptor agonist (94% homology with native human GLP-1) with structural modifications to reduce renal clearance and decrease degradation by DPP-4, resulting in half-life 155 to 184 hours, thus allowing for once-weekly, subcutaneous (or potentially once-daily, oral) dosing. Semaglutide is the only GLP-1 receptor agonist that has shown to be effective when given orally. Brand Names: Ozempic.
Based on studies, liraglutide or semaglutide are the preferred options.
The medications have a US Boxed Warning for Thyroid C-cell tumor risk.
References:
https://www.jwatch.org/fw114893/2018/12/19/diabetes-guidelines-updated
http://care.diabetesjournals.org/content/42/Supplement_1
https://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus
Diabetes Guidelines Updated: For patients with type 2 diabetes who require an injectable drug, a glucagon-like peptide 1 receptor agonist is preferred over insulin. https://buff.ly/2T0Kowc
Glucagon-like peptide-1 (GLP-1)-based therapies (eg, GLP-1 receptor agonists, dipeptidyl peptidase-4 [DPP-4] inhibitors) affect glucose control through several mechanisms, including:
- enhancement of glucose-dependent insulin secretion
- slowed gastric emptying
- reduction of postprandial glucagon and food intake
These agents do not usually cause hypoglycemia.
Short-acting GLP-1 receptor agonists have an effect on postprandial hyperglycemia and gastric emptying:
- Exenatide twice daily. Exendin-4 is a naturally occurring component of the Gila monster lizard saliva and shares 53 percent sequence identity with GLP-1. Exenatide (half-life 2.4 hours) is synthetic exendin-4. Brand Names: Bydureon; Byetta Pen.
- Lixisenatide is a GLP-1 receptor agonist that shares some structural elements with exendin-4. Compared with native GLP-1, it has a prolonged half-life (2.7 to 4.3 hours). Brand Names: Adlyxin.
Long-acting GLP-1 receptor agonists have a greater resistance to dipeptidyl peptidase-4 (DPP-4) degradation. They activate the GLP-1 receptor continuously and have a prolonged half-life, thus allowing for once-daily and even once-weekly subcutaneous injection. They have a marked effect on fasting glucose.
- Exenatide once weekly is a sustained-release formulation of the short-acting subcutaneous exenatide.
- Liraglutide is GLP-1 receptor agonist which binds to serum albumin, resulting in slower degradation (half-life 11 to 15 hours) and allowing for once-daily, subcutaneous dosing. Brand Names: Saxenda; Victoza.
- Dulaglutide is a long-acting GLP-1 receptor agonist with structural modifications to prevent degradation by DPP-4 and to prolong its half-life. The half-life of dulaglutide is approximately five days, which allows for once-weekly administration. Brand Names: Trulicity/
- Semaglutide is a long-acting GLP-1 receptor agonist (94% homology with native human GLP-1) with structural modifications to reduce renal clearance and decrease degradation by DPP-4, resulting in half-life 155 to 184 hours, thus allowing for once-weekly, subcutaneous (or potentially once-daily, oral) dosing. Semaglutide is the only GLP-1 receptor agonist that has shown to be effective when given orally. Brand Names: Ozempic.
Based on studies, liraglutide or semaglutide are the preferred options.
The medications have a US Boxed Warning for Thyroid C-cell tumor risk.
References:
https://www.jwatch.org/fw114893/2018/12/19/diabetes-guidelines-updated
http://care.diabetesjournals.org/content/42/Supplement_1
https://www.uptodate.com/contents/glucagon-like-peptide-1-receptor-agonists-for-the-treatment-of-type-2-diabetes-mellitus
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Wednesday, 19 December 2018
Five tips if you've found out your child has an allergy
If you've recently found out that your child has an allergy, here's some charity-endorsed tips to help. via BBC News - Health Read More Here..
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Derby pub's 'sign-a-long' for boy with Down's syndrome
Regulars have learned Makaton sign language to perform five-year-old Oliver Callis's favourite song. via BBC News - Health Read More Here..
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Tuesday, 18 December 2018
Vanuatu uses drones to deliver vaccines to remote island
Vital medicines are flown to a remote Vanuatu village in what will now become a regular service. via BBC News - Health Read More Here..
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My filler was botched but now I love my natural lips
After 18 months of pain and embarrassment over botched lip filler, we follow Paige, 22, from Doncaster, as she gets hers dissolved. via BBC News - Health Read More Here..
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Chronic fatigue: Overactive immune system 'may trigger ME-like symptoms'
Researchers say the study is a "light in the fog" in the search for the causes of chronic fatigue syndrome. via BBC News - Health Read More Here..
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Doctor turns author after having strokes
A rare condition robbed Dr Louise Lightfoot of her dream job but has given her a new purpose. via BBC News - Health Read More Here..
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'Why I tried to cut off my breast'
Peter explains how his breast cancer treatment affected him. via BBC News - Health Read More Here..
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'Why I chose to have my leg amputated'
Victoria Snell, who has a prosthetic limb, has just run a 5k race. She explains why she chose to have her leg amputated. via BBC News - Health Read More Here..
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The secret I'm hiding under my oversized fashion style
Blogger Arooj Aftab explains why wearing oversized clothes is more than just a fashion statement for her. via BBC News - Health Read More Here..
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Skin creams can lead to fire deaths
Products for conditions such as eczema can leave people at risk of setting themselves ablaze, experts warn. via BBC News - Health Read More Here..
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Monday, 17 December 2018
Gently stroking babies 'provides pain relief'
A study monitored the brain activity of babies when they had a blood test while being stroked. via BBC News - Health Read More Here..
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E-cigarette use among US teens rises
Discreet versions of e-cigarettes and different flavours may be some of the reasons behind the surge. via BBC News - Health Read More Here..
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Royal Marines' Christmas gift for arthritis boy
Malachi Neat, 14, is given the chance to take on their assault course at their training base in Devon. via BBC News - Health Read More Here..
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Piriformis muscle syndrome remains controversial and diagnosis is difficult
Piriformis syndrome is a controversial entrapment neuropathy
What is piriformis muscle?
The piriformis muscle is a small but important external rotator of the hip that crosses the sciatic nerve and is believed by some to cause sciatica-type pain when it compresses the nerve. However, the existence of this so-called "piriformis syndrome" remains controversial and diagnosis is difficult.
Controversy is due to the limited research about the condition and the difficulty of making the diagnosis, particularly as symptoms mimic many other more common diagnoses.
How common is it?
Piriformis syndrome may account for 0.3-6% of sciatic-like syndromes.
What causes it?
The sciatic nerve normally passes inferior to the piriformis muscle. Entrapment of the sciatic nerve may develop following trauma to the buttocks or piriformis muscle strain causing scarring and fibrosis around the nerve, or due to the structure of the piriformis, such as when branches of the nerve pass through a bifid piriformis muscle.
During downhill running or sprinting, the piriformis muscle undergoes eccentric contraction and some runners may develop the syndrome via this mechanism.
The activities involved may include running, where the gluteus medius and tensor fascia lata are activated in the stance phase, but more often sports requiring cutting and turning, which involve the external rotators of the hip (eg, piriformis, gluteus medius). The onset of pain is less acute but usually within 24 hours.
Piriformis syndrome in the runner may be associated with foot overpronation, weakness of the gluteal muscles and other hip abductors, and tightness of the hip adductors.
Clinically, the diagnosis of piriformis syndrome is considered when the classic signs of a lumbar radiculopathy elicited by provocative testing are absent, neurologic examination is normal, and other causes of gluteal and sacroiliac pain are ruled out.
Can you test for it during physical examination?
A provocative test (Freiburgs test) suggesting piriformis syndrome is performed by placing the hip in extension and internal rotation, and then resisting external rotation. Pain or sciatic symptoms denotes a positive test . Another test (Pace sign) involves having the seated patient resist abduction and external rotation. Pain and reproduction of symptoms marks a positive test.
Are there any imaging tests?
When necessary, plain radiographs and MRI of the hip and pelvis are obtained to rule out other causes of symptoms. EMG and nerve conduction studies are rarely positive in piriformis syndrome but can be useful for eliminating other diagnostic possibilities.
What is the treatment?
Treatment begins with physical therapy involving strengthening of the pelvic and hip region and stretching of the piriformis. Physical therapy is effective in the majority of cases.
YouTube search shows same of the exercises: https://www.youtube.com/results?search_query=piriformis+syndrome+exercises Always consider consulting a professional before any treatment is started.
The mainstay of treatment for both gluteus medius tendinopathy and piriformis syndrome is physical therapy and correction of biomechanical abnormalities. Orthotics and massage therapy may be useful; acetaminophen and nonsteroidal antiinflammatory drugs may be used for analgesia.
Ultrasound-guided glucocorticoid injections have been beneficial in some cases, and botulinum toxin injections have also been used. Surgery (typically a piriformis tenotomy) may be considered if symptoms are debilitating and persist despite conservative therapy.
Gluteus medius weakness and tendinopathy
The gluteus medius muscle originates along the external surface of the ilium and runs distally and laterally to its attachment on the greater trochanter of the femur. The gluteus medius abducts the hip and assists with pelvic stability during running. Weakness of the muscle causes pain with hip abduction and rotation. Pain generally increases when the muscle is stretched and there may be focal tenderness at the muscle's insertion, just medial and superior to the greater trochanter. Difficulty maintaining a level pelvis while standing on one leg is called positive Trendelenburg sign.
References:
https://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity
https://www.uptodate.com/contents/approach-to-hip-and-groin-pain-in-the-athlete-and-active-adult
What is piriformis muscle?
The piriformis muscle is a small but important external rotator of the hip that crosses the sciatic nerve and is believed by some to cause sciatica-type pain when it compresses the nerve. However, the existence of this so-called "piriformis syndrome" remains controversial and diagnosis is difficult.
Controversy is due to the limited research about the condition and the difficulty of making the diagnosis, particularly as symptoms mimic many other more common diagnoses.
How common is it?
Piriformis syndrome may account for 0.3-6% of sciatic-like syndromes.
What causes it?
The sciatic nerve normally passes inferior to the piriformis muscle. Entrapment of the sciatic nerve may develop following trauma to the buttocks or piriformis muscle strain causing scarring and fibrosis around the nerve, or due to the structure of the piriformis, such as when branches of the nerve pass through a bifid piriformis muscle.
During downhill running or sprinting, the piriformis muscle undergoes eccentric contraction and some runners may develop the syndrome via this mechanism.
The activities involved may include running, where the gluteus medius and tensor fascia lata are activated in the stance phase, but more often sports requiring cutting and turning, which involve the external rotators of the hip (eg, piriformis, gluteus medius). The onset of pain is less acute but usually within 24 hours.
What are the symptoms?
The most common presenting symptom is buttock pain of gradual onset that increases with sitting. The "wallet sign" associated with the syndrome is when a male patient finds he can no longer sit on his wallet without causing symptoms. Paresthesias may develop, but the classic radicular symptoms of sciatica are not common.
Clinically, the diagnosis of piriformis syndrome is considered when the classic signs of a lumbar radiculopathy elicited by provocative testing are absent, neurologic examination is normal, and other causes of gluteal and sacroiliac pain are ruled out.
Can you test for it during physical examination?
A provocative test (Freiburgs test) suggesting piriformis syndrome is performed by placing the hip in extension and internal rotation, and then resisting external rotation. Pain or sciatic symptoms denotes a positive test . Another test (Pace sign) involves having the seated patient resist abduction and external rotation. Pain and reproduction of symptoms marks a positive test.
Are there any imaging tests?
When necessary, plain radiographs and MRI of the hip and pelvis are obtained to rule out other causes of symptoms. EMG and nerve conduction studies are rarely positive in piriformis syndrome but can be useful for eliminating other diagnostic possibilities.
What is the treatment?
Treatment begins with physical therapy involving strengthening of the pelvic and hip region and stretching of the piriformis. Physical therapy is effective in the majority of cases.
YouTube search shows same of the exercises: https://www.youtube.com/results?search_query=piriformis+syndrome+exercises Always consider consulting a professional before any treatment is started.
Ultrasound-guided glucocorticoid injections have been beneficial in some cases, and botulinum toxin injections have also been used. Surgery (typically a piriformis tenotomy) may be considered if symptoms are debilitating and persist despite conservative therapy.
Gluteus medius weakness and tendinopathy
The gluteus medius muscle originates along the external surface of the ilium and runs distally and laterally to its attachment on the greater trochanter of the femur. The gluteus medius abducts the hip and assists with pelvic stability during running. Weakness of the muscle causes pain with hip abduction and rotation. Pain generally increases when the muscle is stretched and there may be focal tenderness at the muscle's insertion, just medial and superior to the greater trochanter. Difficulty maintaining a level pelvis while standing on one leg is called positive Trendelenburg sign.
References:
https://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity
https://www.uptodate.com/contents/approach-to-hip-and-groin-pain-in-the-athlete-and-active-adult
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