As heart disease continues to be one of the leading causes of death in the United States, practitioners and patients alike are looking for ways to cut risk factors and identify new clues to assist with early detection. New research published in the March issue of The American Journal of Medicine suggests that there is an association between a difference in interarm systolic blood pressure and a significant increased risk for future cardiovascular events, leading researchers to recommend expanded clinical use of interarm blood pressure measurement.News | Leave a comment
An apple a day really does keep the doctor away, according to a new study that found prescribing a daily apple to adults over the age of 50 could prevent about 8,500 vascular deaths each year in the UK. The effect, the researchers found, would be roughly the equivalent of assigning the drugs designed to lower cholesterol levels to everyone 50 years old and up who is not already taking them.
Published in the British Medical Journal, the study comes at a time when calls for more liberal use of statins among those in the studied age group are on the rise in the UK.News | Leave a comment
Curing insomnia in people with depression could double their chance of a full recovery, scientists are reporting. The findings, based on an insomnia treatment that uses talk therapy rather than drugs, are the first to emerge from a series of closely watched studies of sleep and depression to be released in the coming year.News | Leave a comment
Written by Dr Christine Read.
I have been a medico for almost 40 years, but an artist for far longer. In fact, we are all artists in childhood – remember how we expressed it so well back in the heady days of kindergarten with finger painting, cut outs and mud pies? Sadly many people forget that they have a creative side, but it is there in all of us, just waiting to be expressed in some way.
I started as a maker of marks with pencil, pen and charcoal and later became a painter in acrylics and oils. My major work for the Higher School Certificate was a series of figure studies and I still enjoy life drawing. Indeed, medical illustration was my first choice of a career, but there was no course in Australia at the time and London was in a distant land. An integral part of being an artist is the study of the human form and of course I learned so much about the intricacies of muscles, the skeleton, anatomical landmarks and the way the human body moves in my medical studies.
In this first column I have chosen to write about medical illustration as a vital part of the medical story, but later columns will discuss and examine other places where art is found intersecting with medicine: physicians have become painters, surgeons have become sculptors, many GPs are wonderful photographers, there is a real art in producing medical prostheses, art is increasingly being used to teach medical students the art of diagnosis, art is used as therapy and colour theory is used to calming effect in hospitals, artists even use their skill to express their own illness – (I think of Vincent van Gogh with his bandaged ear). In fact art is everywhere in medicine!
But first, a glance at history. In ancient times the Egyptians were advanced in surgical skills for their day. Although they believed that demons and devils were responsible for illness, they had a reasonable understanding of the place of diet in healthy living and we have evidence of their surgical practice (generally simple incisions and excisions and bone setting) from carvings of instruments into the stone of tombs – possibly the earliest medical illustrators. They even sculpted simple prostheses – there is in existence a wooden and leather great toe – attached to mummified remains and probably used to aid walking in an amputee during life.
Da Vinci was a brilliant depicter of the human body and carefully drew Vitruvian man in around 1490 to show the perfect human proportions as described by the ancient Roman architect, Vitruvius. It has now been suggested that this drawing actually shows an inguinal hernia in the left groin of the man. It has recently been suggested that this illustration may have been made post mortem and the hernia be the cause of death.
In more recent times the renowned surgeon, William Hunter, physician extraordinary to Queen Charlotte (who bore 15 children) commissioned magnificent illustrations of the foetus within the gravid uterus in an obstetric atlas published in 1774. He also created a small bronze model scaled down from full size for use in anatomy studies and used widely by artists creating images depicting the human body.
If you are interested in this topic, have a look at my blog where I have posted some of the images: http://creadoartstuff.blogspot.com.au/2014/02/intersection-art-and-medicine-no-1.htmlNews | Leave a comment
The consequences of androgen deficiency in males are well established, namely:
- alterations in body composition
- decreased libido
However, the idea of female androgen deficiency is controversial – does it have similar clinical consequences? Are there similar benefits of treatment?
The Princeton Consensus Statement proposes a syndrome of female androgen insufficiency, with the following clinical features:
- decreased wellbeing/dysphoric mood and/or blunted motivation
- persistent, unexplained fatigue
- sexual dysfunction, with decreased libido, receptivity, and pleasure
- possibly, decreased bone mineral density, decreased muscle strength, and changes in cognition and memory.
Studies of testosterone administration in women via implant, injection, tablet, or transdermally have shown improvements in sexual desire, fantasies, and frequency of satisfying sexual activity and arousal, compared to placebo or oestrogen alone.
Unfortunately, there are issues with these studies, as most were of surgically menopausal women who achieved supra-physiological levels of testosterone. In addition there was a strong placebo effect and short-term risks of hirsutism, acne, and virilising effects and an absence of long-term safety data. The only study of testosterone-only treatment was associated with an increased risk of breast cancer.
Additionally, there are no TGA approved products for use in women.
Nevertheless, there are treatment options:
- Ensure adequate oestrogen +/- progestogen.
- Use a testosterone implant (50–100 mg placed subdermally 6 monthly. Unfortunately, this product has been discontinued but an alternative implant is being sought).
- Use a transdermal cream (1%, daily dose, aiming to keep levels within the normal reproductive female range).
The potential adverse effects include:
- hirsutism/male pattern hair loss
- mood change (irritability, aggression)
- lowered HDL
- irreversible clitoromegaly
- irreversible deepening of the voice.
Some small studies have shown an increase in vertebral and hip BMD. Overall, there is a decrease in fat mass and an increase in lean mass with no increase in breast density or breast cancer and no increase in endometrial cancer. With the transdermal or subcutaneous routes there are no adverse effects on lipids, C-reactive protein, SHBG, insulin sensitivity, or HbA1C. Candidate women for testosterone therapy have primary or secondary ovarian failure/surgical menopause with a 50% drop in testosterone production.
Other potential indications are postmenopausal women with low libido, blunted motivation, fatigue, and poor wellbeing who are already oestrogenised, have a low total/free testosterone, and whose psychosocial issues have been addressed.
Guidelines are available:
- North American Menopause Society. Consensus statement on androgens in
- Women. Menopause 2006
- Androgen therapy in women: an Endocrine Society Clinical Practice Guideline. JCEM 2006.
Source: Dr Sonia Davison, Jean Hailes for Women’s Health, The Annual Women’s and Children’s Health Update, Perth 2013Posted in News | Leave a comment
In a first-of-its-kind study, researchers have developed a blood test for Alzheimer’s disease that predicts with astonishing accuracy whether a healthy person will develop the disease.
Though much work still needs to be done, it is hoped the test will someday be available in doctors’ offices, since the only methods for predicting Alzheimer’s right now, such as PET scans and spinal taps, are expensive, impractical, often unreliable and sometimes risky.
“This is a potential game-changer,” said Dr. Howard Federoff, senior author of the report and a neurologist at Georgetown University Medical Center. “My level of enthusiasm is very high.”Uncategorized | Leave a comment
A variety of medications are now used to treat neuropathic pain and these are summarised below in alphabetical order.
Baclofen is used only for the muscle spasm seen with spinal conditions and for trigeminal neuralgia. It is difficult to use. Tolerance develops very quickly and sedation is a common problem. Note: There is no role for diazepam in the treatment of neuropathic pain.
Calcium channel blockers: pregabalin and gabapentin
Pregabalin is a calcium channel blocker and an analgesic, anticonvulsant, anxiolytic, and sleep-modulating agent that may be useful as a component of multimodal analgesia and may decrease opiate use. It does not work for all neuropathic pain; for example, it doesn’t work for HIV. It may also reduce post-surgical chronic pain.
Gabapentin, like pregabalin, is a calcium channel blocker but it has a slower onset.
Ketamine is an NMDA antagonist and phencyclidine derivative with multiple effects. It is given IV, SC, topically, and possibly orally and intrathecally (intrathecal use is not approved, so it is only used in palliative care with the necessary consent).
Lignocaine is a sodium channel blocker that acts especially on abnormal ion channels. It acute states it is given SC or IV. For chronic allodynia, it is given as a patch.
Methadone is a naturally long acting opioid that caused a statistically significant decrease in pain in a small randomised, double-blind, placebo-controlled study (N=18).
Oxycodone is up to twice as potent as morphine and may have some benefit in neuropathic pain but the effect is dose limited.
Tramadol has a low affinity for all opiate receptors and also inhibits noradrenaline and serotonin reuptake, making it helpful in neuropathic pain.
Tapentadol has fewer potential interactions than tramadol and less potential for abuse.
Tricyclic antidepressants improve all aspects of neuropathic pain but can cause side effects of sedation, cardiac arrhythmias, orthostatic hypotension, and urinary retention that limit dosing. Contraindications include conduction defects, and they should be used with care in the elderly.
Serotonin and norepinephrine reuptake inhibitors: venlafaxine and duloxetine
These have good safety, tolerability, and effectiveness in patients with painful diabetic neuropathy: their role in other neuropathic and nociceptive states is undetermined. Possibly, they have synergistic effects with other agents. There are minimal anticholinergic effects.
There is very little in literature about valproate and it is not TGA approved for neuropathic pain. However, it is sometimes used because it is a voltage-gated sodium channel blocker and it increases brain GABA levels. It should not be used in patients with impaired liver function or in pregnancy and it interacts with warfarin. Side effects include weight gain, hair loss/curliness, and drowsiness.
Source: Dr David Gronow, The General Practice Education Day, Sydney 2013Posted in News | Leave a comment
Women with estrogen-responsive breast cancer who consume soy protein supplements containing isoflavones to alleviate the side effects of menopause may be accelerating progression of their cancer, changing it from a treatable subtype to a more aggressive, less treatable form of the disease, new research suggests.
The study, published in the journal Molecular Nutrition and Food Research, raises troubling questions about the safety and the potential health consequences associated with long-term use of dietary supplements containing soy isoflavones, such as the phytoestrogen genistein.Uncategorized | Leave a comment
“There have been several trials now, including this one, where surgeons have examined whether meniscal tear surgery accomplishes anything, basically, and the answer through all those studies is no, it doesn’t,” said Dr. David Felson, a professor of medicine and public health at Boston University. He was not involved in the new research.
For the new study, doctors recruited patients between the ages of 35 and 65 who’d had a meniscal tear and knee pain for at least three months to have an arthroscopic procedure to examine the knee joint. If a patient didn’t also have arthritis, and the surgeon viewing the knee determined they were eligible for the study, he opened an envelope in the operating room with further instructions.
At that point, 70 patients had some of their damaged meniscus removed, while 76 other patients had nothing further done. But surgeons did everything they could to make the sham procedure seem like the real thing. They asked for the same instruments, they moved and pressed on the knee as they otherwise would, and they used mechanical instruments with the blades removed to simulate the sights and sounds of a meniscal repair. They even timed the procedures to make sure one wasn’t shorter than the other. Patients weren’t told if they’d had their knee repaired or not.
“It’s a wonderfully designed study, amazing,” said Felson.
…Read more »
Children who suffer from frequent nightmares or bouts of night terrors may be at an increased risk of psychotic experiences in adolescence, according to new research from the University of Warwick.
Nightmares are considered to be commonplace in young children with incidence reducing as they grow older. They occur in the second half of sleep during REM (rapid eye movement) sleep. Those who have experienced them will be familiar with the sensation of waking suddenly with a sense of fear, worry and possible palpitations.
Night terrors, a sleep disorder, differ from nightmares and occur during deep sleep (non-REM) cycles in the first half of the night. A night terror bout is often signified by a loud scream and the individual sitting upright in a panicked state, though unaware of any of the involuntary action. The thrashing of limbs and rapid body movements are witnessed in more extreme cases. Children wake up in the morning unaware of their activity throughout the night.