Archive for March, 2010
They were among the first to arrive on the scene of the World Trade Center attacks on 9/11, and many of them continued to work selflessly for months on the site, exposing themselves to airborne debris and other dangers. Now experts from Mount Sinai School of Medicine have reported that these first responders on 9/11 have heart problems, specifically impaired diastolic function of both the left and right ventricle.
Results of the new study come on the heels of a tentative settlement that would award as much as $657 million to the Ground Zero rescue and cleanup workers who were sickened by their exposure to the toxic debris at the site. In 2007, the first clinical study that connected exposure to the World Trade Center dust and serious disease released its findings.
In that study, published in Chest, it showed that the number of 9/11 responders who had a rare type of lung condition called sarcoidosis rose dramatically in the year after the attack. Other studies have shown that a high percentage of the rescue workers developed persistent coughs and other respiratory conditions, as well as psychological problems, including post-traumatic stress disorder.
Now, in a study entitled “First Documentation of Cardiac Dysfunction Following Exposure to the World Trade Center Disaster,” researchers provide evidence that the 9/11 responders have a condition in which their hearts are not able to relax normally, which increases their risk for heart failure and shortness of breath.
The study, conducted by Lori Croft, MD, assistant professor of medicine, evaluated 1,236 workers who had been part of the 9/11 rescue efforts. It found that more than 50 percent of them had impaired relaxation of the left ventricle. Among their same-age peers in the general population, this condition appears in only 7 percent of people. More than 60 percent of the participants had abnormal diastolic function in the right ventricle, which pumps blood to the lungs.
Although these study results do not definitively link exposure to debris by 9/11 responders and their heart problems, Dr. Croft and her team note that previous research indicates that inhaled debris may be associated with lung and heart disease. Additional studies are needed before the heart problems experienced by these and potentially other 9/11 responders can be connected with the disaster, but Croft points out that “these data are an exciting first step.”
AROUND ten per cent, or between 60,000 and 70,000 Cypriots suffer from diabetes and one third of those people will not even be aware they have it until four to seven years after the onset of the disease.
A study carried out between 2005 and 2010 on 485 patients - 280 men and 205 women – found that 52 were suffering from Type 1 diabetes or insulin dependent, and 433 from Type II diabetes or non-insulin dependent.
The research also found that good cholesterol, also known as HDL, may prevent the onset and retard the progression of Type I and Type II diabetes.
Researchers from throughout Cyprus as well as Hungary presented their findings yesterday at the University of Nicosia under the auspices of the Pancyprian Diabetes Association, the Foundation for the Promotion of Research, and the Cyprus Centre for European and International Affairs.
The link between diabetes and HDL cholesterol has never been mentioned in medical literature, the researchers claimed.
The research, which mainly examined the onset of kidney failure in the Cypriot population due to Type II diabetes, studied samples from a bank of genetic material in order to determine the relationship between kidney failure and Type II diabetes in Cypriot patients.
Half of diabetes patients develop end-stage renal failure and go on dialysis to survive, according to Dr. Theofanis Theofanous, a nephrology specialist and director of the dialysis department at Famagusta’s general hospital. Dr. Michalis Koptides, a biology professor at the University of Nicosia, did say, however, that “individual biological mechanisms are not fully understood” and that “genetic factors may be involved in the development of diabetic nephropathy.”
The study also confirmed well-established facts about how to treat diabetes so that it does not result in kidney failure, such as taking anti-hypertensive medication to control blood pressure, controlling blood sugar levels, and not smoking.
“Early diagnosis and therapeutic intervention is important and crucial for the prevention of diabetic nephropathy,” said Theofanous. “It is clear that improved prevention and therapeutic intervention in diabetic renal disease could save lives,” he said.
According to Theofanous, reigning in high blood pressure and controlling glucose levels early can reduce the incidence of diabetes-induced renal failure in the population by 14 per cent each, and quitting smoking by 7 per cent. But Theofanous does warn that the figures “may be slightly overestimated because the sample was insufficient for complete isolation and independence of each factor such as smoking in women and the impact of smoking on hypertension.”
Obesity, diet, physical inactivity, insulin resistance, a family history of diabetes, ethnicity, and age can all contribute to developing the disease, the researchers reported. The incidence of obesity among children in developed countries has increased from 4 per cent in 1963 to approximately 17 per cent in 2004, in turn increasing their chances of developing Type II diabetes, according to George Reusz, a professor from Summelweis University in Budapest.
The researchers emphasised the fact that diabetes and its complications, which also include coronoary heart disease, cerebrovascular disease, and neuropathy, among others, are on the rise in developed nations and will impact their ability to adequately treat their diabetic populations unless people alter their lifestyles to avoid developing the disease.
“Diabetes is now a global epidemiological problem,” said Theofanous. “As a chronic disease…it is plaguing all countries of the world and national budgets at great cost,” he said.
Reusz concurred, saying that “the majority of type 2 diabetes cases can be prevented – prevention costs governments far less than treating diabetes and its complications. Diagnosis, treatment, management and prevention of diabetes and other non-communicable diseases require integrated health systems, delivery of care down to primary care level, and supportive policies outside the health sector,” he said.
The study run by the National Institutes of Health, dubbed Accord, aimed to see if the dual-drug therapy could reduce heart disease and stroke-related events in diabetes patients at particularly high risk of serious heart problems due to additional risk factors, such as obesity and high blood pressure.
All subjects in the 5,518-patient trial took Zocor, which is available generically as simvastatin. One group also received TriCor, which is designed to lower the blood fats known as triglycerides and raise "good" HDL cholesterol. TriCor belongs to a class of drugs called fibrates.
There was an 8 percent risk reduction from the combination therapy compared with the statin plus dummy pill, but researchers said the result could have been a statistical fluke.
"Although our analysis suggests that certain patients may benefit from combination therapy, this study provides important information that should spare many people with diabetes unneeded therapy with fibrates," said Dr. Henry Ginsberg, the study's lead investigator, who presented the data at the American College of Cardiology scientific meeting in Atlanta.
Based on the results, Dr. Steven Nissen, a prominent cardiologist with the Cleveland Clinic, predicted that "the use of fenofibrates will decline precipitously. It's another troubling example of a drug that was approved that didn't work."
The U.S. Food and Drug Administration on Sunday said the data will undergo close scrutiny.
"The FDA will conduct a thorough review of the primary Accord data as soon as they become available," said agency spokeswoman Karen Riley.
"The results of Accord were widely expected and not surprising given that two-thirds of patients in the trial would not be treated with fibrates under current guidelines," Eugene Sun, Abbott's vice president for global pharmaceutical development, said in a statement.
"The results support how fibrates are used in treatment today."
LOWERING BLOOD PRESSURE NO HELP, EITHER
A second prong of the NIH Accord program tested 4,733 patients with Type 2 diabetes and elevated blood pressure.
It found that more intensive blood pressure lowering failed to cut the risk of heart attacks, strokes and cardiovascular death significantly more than the current standard of care.
There were 208 heart disease or stroke-related events in patients whose systolic blood pressure was reduced to below 120, compared with 237 among patients whose target goal was less than 140 - results researchers deemed a potential statistical fluke.
Current guidelines recommend that adults with Type 2 diabetes maintain systolic blood pressure - the top number of a blood pressure reading - at less than 130.
The risk of stroke alone was significantly cut by about 40 percent in the intensive treatment group, although the total numbers were low - 36 versus 62 in the standard care group.
Researchers also noted higher incidence of complications in the intensive group, including abnormally high levels of blood potassium, and some measures of kidney function were worse.
"Both of these studies provide evidence that going beyond the standard of care provides no substantive additional benefit in this population of adults with diabetes at especially high risk of cardiovascular events," said Denise Simons-Morton, the NIH's Accord project officer.
Did you know that one in every one hundred people is affected by what is known as carpal tunnel syndrome at some point in their life? While commonly found in women in the thirty to fifty-year age range, carpal tunnel syndrome can affect nearly anyone, from assembly line workers, to surgeons and dentists, to secretaries and computer data entry personnel, to even those who play musical instruments or video games.
Carpal tunnel syndrome is a very painful and progressive condition that occurs in the wrist, caused by compression to the median nerve. The median nerve runs into the hand starting from the forearm, and when it is squeezed or pressed at the wrist, the message carrying and receiving from the brain is inhibited.
The name carpal tunnel syndrome, however, comes from the eight bones in our wrists that are known as carpals. They form a tunnel-like structure, hence the term “carpal tunnel syndrome.”
Compression of the tunnel walls is the most basic of causes of carpal tunnel syndrome.
Other factors, such as congential predispostion and even trauma based injury can also be to blame. Carpal tunnel syndrome can develop quickly, especially if the wrist has been fractured or injured or rheumatoid arthritis has set in. In many cases, repetitve stress induced carpal tunnel strain can cause the syndrome, especially in those who spend a great deal of time typing.
Symptoms of carpal tunnel can include tingling, numbness, and burning in the fingers, as well as the inability to make a fist or grip things. A person eventually loses the ability to squeeze things and may even find it hard to tie their shoes. In the most extreme cases of carpal tunnel syndrome, the patients are unable to determine hot or cold by touch.
Treatment for carpal tunnel syndrome is available. Most physicians will advise against repetitive and exhaustive activities related to hand movement. Stretching exercises and medicines like corticosteroids can help in relieving the syndrome. However, if the condition worsens, surgery may be the only available course of treatment.
If you feel as though you may be suffering from carpal tunnel syndrome, you should consult your physician immediately to discuss symptoms and treatment options.
We diabetics have to pay even more attention to our teeth and gums than other people.
We are at greater risk of cavities, gum disease and tooth infections. Not only that, but those infections can cause our blood sugar to rise, so it becomes a vicious cycle.
Here are some mouth problems common in diabetics.
Plaque is, of course, a problem for many people, not just diabetics. But it’s caused by starches and sugars, and of course we have more than our share of those! So diabetics are highly prone to plaque.
Sometimes my mouth is so dry in the morning I can hardly speak—I’m sure you know how that feels. But it’s more than just inconvenient, it’s dangerous to the health of our mouths. You see, saliva washes away many of the bacteria that cause cavities and gum disease. Dry mouth cuts the amount of saliva available for this job, so the result is more cavities and gum disease. Dry mouth sometimes also creates inflammation of the soft tissue in the mouth, making eating difficult and unpleasant.
While there are artificial saliva substitutes, which your dentist can tell you about, you can usually stimulate your own saliva by sucking on a sugar-free hard candy. I like no-sugar-added Ricola for this purpose. And of course, drinking water helps.
Not only do we diabetics have less saliva than we need, but the saliva we do have is high in sugar content, so it’s double trouble for us. This can cause a fungal infection called candiasis, commonly known as thrush. It produces sore red or white spots in the mouth. Medication can help though, so ask your dentist.
As a diabetic, you must pay great attention to oral hygiene. Brush your teeth twice a day, and floss daily. Examine your gums for signs of problems—and always visit your dentist at least twice a year.