MEDICAL COURSE

نوشته هاي يك اينترن

 

Diabetes is an independent risk factor for hearing loss, according to an Annals of Internal Medicine report posted online.

Researchers analyzed data from the National Health and Nutrition Examination Survey collected from 1999 to 2004. They limited their analysis to some 5100 adults who underwent audiometric testing and answered a questionnaire on diabetes. The researchers found age-adjusted hearing loss at all frequency ranges to be more prevalent among subjects who reported having diabetes.

The authors estimate a 21% prevalence of low- or mid-frequency hearing loss among diabetics (vs. 9% in nondiabetics), and they speculate that changes to the microvasculature commonly found in diabetes may be to blame.

An editorialist suggests that performing audiometry and arranging for hearing aids "can improve an individual's productivity and quality of life."

A vaccine against angiotensin II lowers blood pressure, reports Lancet. In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12. By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic). Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."

درمان اولیه بیمارات مبتلا به فلج بل (فلج عصب زوج ۷ مغزی ) با پردنیزولون نتایج بهتری دارد درحالی که به نظر میرسد آسیکلوویر اثرات مثبتی ندارد.در مطالعه انجام شده در ژورنال    New England Journal of Medicine

۵۵۰ بیمار مبتلا به فلج بل(ملایم تا شدید) به شکل رندومی انتخاب شدند و ۷۲ ساعت بعد از شروع علایم بیماری از داروی پردنیزولون- آسیکلوویر -هر دو دارو  و یا  پلاسبو استفاده کردند.بیماران دریافت کننده  پردنیزولون نسبت به دریافت کنندگانآسیکلوویر   بعد از ۳ ماه و ۹ ماه از دریافت به شکل قابل توجه ای بهبودی کامل پیدا کردند ولی آسیکلوویر هیچ اثری نداشت.اگرچه محققان به این نتیجه رسیدند که  آسیکلوویر اثری بر فلج بل ندارد ولی داروی ضد ویروسی دیگر والسیکلوویر همراه با استروئید ها نتایج بهتری در موارد با  بیماری شدید را در مطالعات اخیر داشته است.

 

Urgent treatment after a TIA or minor stroke can reduce the 90-day risk for stroke by 80%, Lancet reports.

A study examining stroke outcomes was divided into two phases. In the first, 310 patients presenting to primary care with a TIA or minor stroke were referred to a neurovascular clinic, where patients were assessed and treatment recommendations were faxed to the primary care clinician. In phase 2, about 280 patients were sent directly to the neurovascular clinic, where they received appropriate treatment.

The median delay to clinic assessment dropped from 3 days in phase 1 to less than a day in phase 2. Likewise, the median delay to treatment fell from 20 days to 1 day. The incidence of stroke within 90 days also fell significantly — from 10% to 2%.

Editorialists conclude that patients with TIA or minor stroke "should receive the same urgent attention as is provided for those with acute coronary syndromes

Common food additives may cause hyperactivity in children in the general population, according to a study published online in Lancet.

In a randomized crossover trial, 137 three-year-olds and 130 eight- or nine-year-olds consumed daily drinks of placebo, mix A (sodium benzoate and artificial food coloring), or mix B (similar to mix A, but with additional food coloring) for 6 weeks. Hyperactivity was evaluated using teacher and parent ratings, direct observation, and a computerized test.

Compared with placebo in adjusted analyses, mix A was associated with elevated hyperactivity scores among three-year-olds, while mix B was associated with elevated scores among eight- or nine-year-olds.

The authors write, "These findings show that adverse effects are not just seen in children with extreme hyperactivity (ie, ADHD), but can also be seen in the general population and across the range of severities of hyperactivity."

As maternal blood glucose level during pregnancy increases, so does the child's risk for obesity at age 5 to 7 years, reports a study in Diabetes Care.

U.S. researchers examined the medical records of nearly 9500 mother-child pairs. During pregnancy, the women were screened for gestational diabetes. In addition, obesity in the offspring was determined when the child was 5 to 7 years old.

Overall, the risk for childhood obesity increased significantly as maternal blood glucose level increased; the association was particularly striking for fasting blood glucose. However, after multivariate adjustment, the obesity risk was not increased among children whose mothers had met criteria for gestational diabetes and were likely treated.

The authors say their findings "suggest that [gestational diabetes mellitus] treatment may decrease the risk of childhood obesity and provide an additional reason for screening for GDM in pregnancy."

A commentary in Cancer suggests that oropharyngeal cancers associated with human papillomavirus type 16 could be prevented by vaccinating adolescent boys, in addition to girls, against HPV.

The authors point to a "stagnation" in the rate of decline in the incidence of oropharyngeal cancer despite lower tobacco usage. They also cite the younger age at presentation of these cancers and the increasing prevalence of HPV-16 in tumor tissue samples.

It's likely, they say, that the mode of viral transmission to oropharyngeal sites is through oral sex. They are concerned "that vaccination programs limited to females will only delay the potential benefit in prevention of [these] cancers, which typically occur in men."

 

Strict blood pressure and glycemic control are effective in reducing vision loss from diabetic retinopathy and remain "the cornerstone in the primary prevention" of the disorder, according to a review published in JAMA.

Researchers examined 41 studies with a minimum follow-up of 12 months and 3 meta-analyses.

The 10-year Diabetes Control and Complications Trial found that, over 6.5 years of follow-up, intensive glycemic control in patients with type 1 diabetes reduced the incidence of diabetic retinopathy by 76% and progression by 54%, compared with conventional treatment. Tight blood pressure control had a similar effect, with one U.K. study reporting a 34% reduction in progression after 9 years' follow-up.

Rising incidence and many unanswered questions demonstrate the need for research on these community-acquired infections now.

 

A renin inhibitor and an angiotensin receptor blocker are more effective at lowering blood pressure when used in combination than alone, reports a Lancet study, but editorialists question the clinical value of this approach.

Industry-funded researchers randomized some 1800 patients with mean resting diastolic BP between 95 and 110 mm HG to receive aliskiren, valsartan, both drugs, or placebo. After 4 weeks, doses were titrated to the maximum.

After 8 weeks of treatment, patients receiving either drug had lower resting BP than those on placebo, and patients receiving both drugs had lower BP than those on monotherapy. Ambulatory diastolic BP, measured in some 350 patients, fell to a greater extent with combination therapy (mean reduction, 10.3) than with monotherapy (mean reduction, 7.1).

The editorialists discuss the risk for hyperkalemia with these agents and argue that the observed BP reductions are less than what one might expect from combining a renin inhibitor with a diuretic or a calcium-channel blocker, as guidelines recommend. They conclude that "because of the potential life-threatening side-effects ... this concept of treatment is unlikely to make it to general practice or even to primary prevention in specialist care."

 

Middle-aged people who drink just one soft drink a day have a substantially increased risk for metabolic syndrome, a Circulation study finds.

The results, from the offspring cohort of the Framingham Heart Study, were released early online. The study found that adults drinking one or more soft drinks a day had a 48% higher prevalence of metabolic syndrome than those who drank them infrequently. The incidence of the metabolic syndrome was similarly increased among the cohort over 4 years of follow-up.

The study found that both regular and diet soda appear to carry similar metabolic hazards. The authors suggested several possible explanations for the association, including the idea that consuming sweet drinks increases preferences for other sweetened items. They say that lowering the consumption of soft drinks "may be associated with a lowering of the burden of metabolic risk factors in adults."

 

Adopting a healthy lifestyle after age 45 may confer cardiovascular and mortality benefits even just 4 years later, according to a study in the July edition of the American Journal of Medicine.

To study the origin and progression of atherosclerosis, researchers prospectively followed roughly 16,000 adults aged 45 to 64 at baseline. After 6 years, about 1000 had newly adopted an overall healthy lifestyle, defined as four behaviors: eating at least five fruits and vegetables daily, exercising at least 2.5 hours weekly, maintaining a BMI between 18.5 and 30, and not smoking. Some 11,000 were following three or fewer of these behaviors.

During the next 4 years, those who had newly adopted all four behaviors had a 40% reduction in all-cause mortality and a 35% reduction in cardiovascular events, compared with those who were following three or fewer healthy behaviors.

The authors conclude that adhering to a healthy lifestyle is "extremely worthwhile, and that middle-age is not too late to act."

 

Epilepsy doubles the risk for suicide, according to a large case-control study published early online in Lancet Neurology.

Danish researchers identified some 450,000 people with data in five national health and socioeconomic registries. Even after differences in psychiatric history and socioeconomic status were taken into account, the risk for suicide among patients with epilepsy was twice that of people without epilepsy.

Overall, suicide risk was highest among those with both epilepsy and a history of psychiatric disease, particularly affective disorders. In addition, suicide risk was highest in the first 6 months after epilepsy diagnosis and decreased with increasing age, both among those with and those without psychiatric comorbidities.

 patients with newly diagnosed epilepsy "require special attention" to identify and treat those at risk for suicide.

 

 

A family-based program for weight management in pediatric obesity promotes sustained improvements in BMI and insulin resistance, according to a JAMA report.

Researchers compared the Bright Bodies weight management program with usual care in some 175 overweight children aged 8 through 16 who were attending a pediatric obesity clinic. Children in the intervention group, along with their adult caregiver, attended exercise classes twice a week for the first 6 months, and then biweekly for another 6 months. (They also attended behavior modification sessions, although less frequently.) Children in the usual-care group, also accompanied by a caregiver, received diet and exercise counseling at 6-month intervals.

At 6 and 12 months, changes in body weight, BMI, percentage of body fat, total cholesterol, and insulin resistance all significantly favored the intervention group.

The authors attribute the program's success, in part, to the frequency of contact between families and staff, but they caution that "the expense incurred in operating such a program is substantial."

 

The risk for stroke is twice as high in patients with newly diagnosed diabetes as in the general population, according to a study in Stroke.

Using health databases of a Canadian province, researchers identified some 12,200 adults aged 30 and older with recent diagnoses of type 2 diabetes. During a mean follow-up of about 5 years, 9.1% of the patients had hospital admissions with a stroke-related diagnosis. The rate ratio for stroke was 2.1 for diabetes patients, compared with the general population.

The authors write that their results "will help to dispel the notion that macrovascular consequences of diabetes occur only in the long term" and may motivate "both patients and providers to aggressively control cardiovascular risk factors soon after diagnosis.”

 

The FDA has approved the endothelin-receptor antagonist Letairis (ambrisentan) for the treatment of pulmonary arterial hypertension.

In clinical trials, the once-daily pill effectively delayed worsening of the condition.

The FDA notes that Letairis may cause birth defects and should not be used during pregnancy.

Reductions in blood pressure lead to improved diastolic function — regardless of the antihypertensive drugs used — reports a study in Lancet.

Researchers sought to determine whether the angiotensin-receptor blocker valsartan would be more effective than other antihypertensives at improving diastolic function. They randomized nearly 400 patients with hypertension and evidence of diastolic dysfunction to receive either the ARB or placebo. The patients also received other classes of antihypertensive agents to lower blood pressure to below 135/80 mm Hg.

After 38 weeks, tissue Doppler imaging showed improved diastolic function in both valsartan and placebo recipients, but there was no significant difference between the groups.

Authors of an accompanying commentary note that valsartan might have an advantage in patients with more advanced left ventricular remodeling. Nevertheless, they add, "the good news is that lowering blood pressure improves diastolic function, irrespective of the antihypertensive regimen used

http://jwatch.org

Despite extensive exposure to a variety of antiretrovirals, including indinavir and tenofovir, fewer than 5% of patients in a large cohort study had chronic renal insufficiency.

ادامه مطلب

 

Estrogen therapy in younger postmenopausal women is associated with less coronary-artery calcification, reports a study in the New England Journal of Medicine.

Researchers studied some 1000 women from the Women's Health Initiative who were aged 50 to 59 at randomization, had previously undergone hysterectomy, and received conjugated equine estrogens or placebo for a mean of 7.4 years. Some 1.3 years after the trial was stopped (because of alarm over the number of cardiovascular events across all age ranges) and thus 8.7 years after randomization, the women underwent CT of the heart.

The mean calcium score was 83.1 for women on estrogens and 123.1 for those on placebo — a statistically significant difference.

The authors write that their results provide support "for the hypothesis that estrogen therapy may have cardioprotective effects in younger women." However, editorialists emphasize — as the authors do — that estrogens should not be used to prevent CVD.

 

Risks for all-cause and cardiovascular-related deaths increase not only with diabetes, but also with milder elevations in glucose, a study released early by Circulation reports.

Researchers evaluated the mortality risks associated with diabetes and prediabetic states in an Australian cohort. Among some 10,000 adults examined at baseline and followed for a median of about 5 years, all-cause mortality was higher among those with known diabetes, impaired fasting glucose, or impaired glucose tolerance than among those with normal glucose tolerance. (The mortality risk was doubled in diabetics — and 50% to 60% higher in those with "prediabetes" — compared with those with normal glucose tolerance.)

Cardiovascular mortality was increased among those with diabetes or impaired fasting glucose, but not among those with impaired glucose tolerance.

According to the authors, these findings suggest that preventive strategies should also target "people with milder forms of abnormal glucose metabolism."

 

Antiplatelet therapy was associated with a small but consistent reduction in the rates of preeclampsia and preterm birth among high-risk women, according to a meta-analysis published early online by the Lancet.

Researchers analyzed data from 31 studies that randomized some 32,000 women at risk for preeclampsia to receive antiplatelet therapy (mostly aspirin). The risks for preeclampsia and for preterm birth before 34 weeks' gestation were both reduced by 10% with antiplatelet use. The number needed to treat to prevent one case of preeclampsia was 114 women. Overall, the association was not significantly stronger or weaker in particular subgroups.

Editorialists conclude that aspirin is justified in "... settings in which pre-eclampsia is almost a certainty, including women with pre-eclampsia in more than one pregnancy or women with chronic hypertension and pre-eclampsia in a previous pregnancy."

ادامه مطلب

A previously healthy 59-year-old man was admitted to the hospital with fever, weight loss, and painful swelling of both eyes and the right ear. Six weeks earlier, headache and fever had developed, followed by pain in the neck, pain and swelling of the eyes, and pain in the right ear; symptoms did not respond to antibiotic therapy. What is the differential diagnosis?

Figure 1. Appearance of the Patient on the Fourth Hospital Day, Demonstrating Periorbital Edema and Erythema of Both Eyes.
 

 

   CAN YOU DIAGNOSE WHAT HAPPEND FOR THIS MAN??? IF YES LEAVE  COMMENT AND SAY YOUR IDEA.

AFTER 6-7 COMMENTS I WIIL WRITE THE CORRECT DIAGNOSIS.

 

Individuals with high insulin secretion may lose more weight on low-glycemic-load than on low-fat diets, according to a study published today in JAMA.

Researchers tested the glucose tolerance of 73 obese 18- to 35-year-olds, randomized them to either a low-fat (55% carbohydrate, 20% fat) or low-glycemic-load diet (40% carbohydrate, 35% fat), and provided 6 months of intensive nutritional education and dietary counseling to both groups.

After 18 months, they found no significant differences in body-fat or body-weight percentage change between groups overall, or between groups among people with normal insulin secretion. In individuals with high insulin secretion, however, the low-glycemic-load diet resulted in a greater decrease in weight (–5.8 kg vs. –1.2 kg) and body-fat percentage (–2.6% vs. –0.9%). Additionally, regardless of insulin status, the low-glycemic-load diet improved triglyceride and HDL profiles; conversely, the low-fat diet improved LDL but not HDL or triglyceride levels.

 

ادامه مطلب

ادامه مطلب

 

Daily aspirin use "seems to be effective in the primary prevention of colorectal cancer," concludes a study in Lancet.

Researchers pooled the results of two large randomized trials comprising over 7500 participants, two-thirds of whom were assigned to take aspirin. Using cancer registry data, researchers ascertained the incidence of colorectal cancers after a median of 23 years since randomization.

Patients who took at least 300 mg of aspirin daily for at least 5 years showed a hazard ratio of 0.63 for colorectal cancer relative to control patients not taking aspirin. The effect was not apparent until 10 years after randomization.

A commentator notes that, although the analysis provides "convincing evidence" of an effect, "these findings are not sufficient to warrant a recommendation for the general population to use aspirin for cancer prevention."

refrence

 

Reduction in dietary sodium may lower the risk for cardiovascular disease among British Medical Journal.ُprehypertensive patients, according to a study published early online in

Researchers evaluated long-term follow-up data on some 2400 prehypertensive adults who had been randomized to reduced sodium intake or usual care in the two Trials of Hypertension Prevention (TOHP). Ten to fifteen years after the trials ended, the risk for cardiovascular disease was significantly lower in the intervention group than in the control group (adjusted relative risk, 0.70). Results of a final follow-up questionnaire suggested that intervention patients had maintained lower sodium intake than controls.

The authors conclude that "sodium reduction, previously shown to lower blood pressure and prevent hypertension, also seems to prevent cardiovascular disease." They add that their findings provide "strong support for population-wide reduction in dietary sodium intake to prevent cardiovascular disease."

منبع

ويتامين ب-6 يك ويتامين محلول در آب است. بدن شما از 3 شكل ويتامين ب-6 استفاده مي كند. پيريدوكسين (pn)، پيرويدوكسال (pl) و پيريدوكسامين (pm). بيشتر مواقع منظور از ويتامين ب-6 پيريدوكسين است.ويتامين ب-6 عملكرد هاي متفاوتي در بدن دارد كه عبارت است از: شكستن كربوهيدراتها براي ايجاد انرژي، تشكيل هموگلوبين و ديگر موادي كه بدن به آن نياز دارد.

موارد استفاده

بهبود علايم ناشي از كمبود ويتامين ب-6: اين علايم شامل التهاب (قرمزي، ورم، درد)، دهان، ترك و خشك شدن لبها، تحريك پذيري، افسردگي و گيجي است.
درمان كم خوني و اختلالات سيستم عصبي ناشي از داروهاي ضد سل.
درمان بيماراني كه ميزان زيادي ايزونيازيد (داروي ضد سل) مصرف كرده اند.
كاهش علايم سندرم پيش از قاعدگي (pms).
جلوگيري از بيماريهاي قلبي. مطالعات اخير نشان مي دهد كه ويتامين ب-6، ويتامين ب-12 و فولات مي تواند باعث كاهش سطح هوموسيستين خون (ماده اي كه خطر بيماريهاي قلبي را افزايش مي دهد) شود.

منابع غذايي

مرغ، ماهي، كليه، كبد، تخم مرغ و گوشت خوك غني ترين منابع غذايي ويتامين ب-6 هستند. موارد زير نيز منابع خوبي براي اين ويتامين هستند:مخمر، سبوس گندم، غلات، سيب زميني، موز و جو دوسر. ويتامين ب-6 در غذاهاي فريزشده يا فرآورده هاي غذايي (مانند گوشت) از بين ميرود.

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