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New Drug Protects Against the Deadly Effects of Nuclear Radiation 24 Hours After Exposure

Source: University of Texas Medical Branch at Galveston via Medical Xpress

An interdisciplinary research team led by The University of Texas Medical Branch at Galveston reports a new breakthrough in countering the deadly effects of radiation exposure. A single injection of a regenerative peptide was shown to significantly increase survival in mice when given 24 hours after nuclear radiation exposure. The study currently appears in Laboratory Investigation, a journal in the Nature Publishing group.

UTMB lead author Carla Kantara, postdoctoral fellow in biochemistry and molecular biology, said that a single injection of the investigative peptide drug TP508 given 24 hours after a potentially-lethal exposure to radiation appears to significantly increase survival and delay mortality in mice by counteracting damage to the gastrointestinal system.

The threat of a nuclear incident, with the potential to kill or injure thousands of people, has raised global awareness about the need for medical countermeasures that can prevent radiation-induced bodily damage and keep people alive, even if given a day or more after contact with nuclear radiation.

Exposure to high doses of radiation triggers a number of potentially lethal effects. Among the most severe of these effects is the gastrointestinal, or GI, toxicity syndrome that is caused by radiation-induced destruction of the intestinal lining. This type of GI damage decreases the ability of the body to absorb water and causes electrolyte imbalances, bacterial infection, intestinal leakage, sepsis and death… Read More>>

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Birth Control Pills May Offer Lasting Endometrial Cancer Protection

Source: Lisa Rapaport via Reuters

Women who use oral contraceptives during their reproductive years may gain long-term protection against endometrial cancer, a review of previous research suggests.

Researchers analyzed 36 studies including more than 140,000 women from around the world. They found that every five years of taking birth control pills was linked to a 24 percent reduction in the risk for endometrial cancer, even more than three decades after women stopped using the contraceptives.

“Our results show clearly, for the first time, that the protective effect of the pill on endometrial cancer lasts for over 30 years,” senior study author Valerie Beral of Oxford University in the U.K. said by email.

The most commonly prescribed oral contraceptives contain man-made versions of the natural female hormones estrogen and progesterone. Past research has already linked these pills to a reduced risk of endometrial and ovarian tumors, but also an elevated risk for breast, cervical and liver malignancies, according to the U.S. National Cancer Institute (NCI)… Read More>>

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Seizing Opportunities to Discuss Healthy Lifestyle Practices

By Dr Vivienne Miller, GP and Fellow, The Royal Australian College of General Practitioners

Jake was five years old and obese for his age and presented with a sore ear. His parents were both with him and were also overweight. The GP did not know the family well, but felt that discussing Jake’s weight in a constructive way was an opportunity that might not present again to her, if ever. As the consult was over quickly, she felt it was her duty as a doctor to try help the family.

The GP told the parents that this particular day she was reminding all patients who saw her about the health benefits of regular exercise and appropriate diet (low in saturated fat, moderate in low glycemic index carbohydrates, low in salt) and the high risk of hypertension, diabetes and prediabetes in the community. She did not directly mention weight directly, yet she sensed the parents immediately felt defensive.

The GP mentioned the necessity of the whole family changing their habits, as it was very difficult for anyone to become healthy without this support. She reminded the parents that only good quality food should be purchased, as if junk food is not in the house it is harder to obtain. At this point the parents were more relaxed and were listening. They declined a referral to a dietitian, so the GP gave them some websites for healthy eating ( , to access the newsletter, and ). She suggested that the parents come back at another time to discuss their individual cardiovascular risk factors, have some routine preventative health checks and obtain more advice. Although they never saw this GP again, she felt better for having tried to help them. Brief, positive interventions such as this, although not universally considered to be successful in changing adverse health behaviour in their own right,1 increase the likelihood of the patient seeking further advice.

1. Harris, M. The role of primary health care in preventing the onset of chronic disease, with a particular focus on the lifestyle risk factors of obesity, tobacco and alcohol. Centre for Primary Health Care and Equity, UNSW Jan 2008 p13$File/commpaper-primary-hlth-care-harris.pdf


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Syringing the Ear

By Dr Vivienne Miller, GP and Fellow, The Royal Australian College of General Practitioners

Syringing the ear is not always a simple and safe procedure.  Most importantly, the patient should be warned beforehand that their balance may be affected by ear syringing. They should be warned not to climb ladders, ride a horse, change light bulbs, get up on chairs to remove things from high places, and be careful with turning their head quickly when driving, as there is a risk of sudden vertigo, or falling from a height.

The patient should be warned about the remote risk of eardrum rupture (more likely if the drum has been ruptured in the past, grommets have been used, and if there is pain or marked inflammation of the drum before syringing). The eardrum and hearing must be assessed after syringing and the findings documented. It is very wise not to syringe a painful ear, but to refer the patient. The patient should be reminded that there is a small risk of infection after syringing.

Finally, prior to syringing the patient should be warned that there is a small chance they will need to see an ENT specialist if the ear canal is not able to be completely cleared. The combination of wax, warm water, obstruction and a possibly already infected drum mandates clearing of the canal within 48 hours by ear toilet. In this situation, antibiotic/antifungal ear drops will not reach their target due to the blockage and water.

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Syringing Stubborn Ear Wax

By Dr Vivienne Miller, GP and Fellow, The Royal Australian College of General Practitioners

Sometimes a patient will require ear syringing but has not used a wax softener beforehand. If the wax is very impacted, a wax softener might not reach the wax deeper inside the canal anyway. Neither of these situations are of immediate cause of concern, as comfortably hot water syringing often succeeds anyway. In the event that it is hard to move wax plugs adjacent to the drum, it is useful to consider the following:

1. Can a gap in the wax be seen in the upper or lower part of the ear canal that the stream of water can be directed towards? This will make use of the water pressure behind the wax to weaken the plug and move it forwards.

2. Can the ear canal be straightened out? Especially in older people, the ear canal may be kinked and the stream of water is hitting, instead of streaming along, the upper or lower canal wall.

3. If the syringing is still difficult, the patient should be asked if they could return in thirty minutes, as often the wax is softened by the hot water in the canal during this time and is surprisingly easily removed when the patient returns.

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Surgery and the Hippocratic Oath

By Peter Paisley, PhD, History of Medicine, UNSW

One hears from time to time, that the Hippocratic Oath forbids surgery. At best, this is only a half truth.

So let’s indulge in a little thought experiment. Suppose one has increasingly worrying symptoms, and a GP is consulted. The diagnosis, after a few tests and so on, is not firmly made, so there is a referral to a consultant physician.  Quite soon, the physician establishes that the condition warrants surgery.  At this point the physician offers to have a go himself at the required operative procedure.  Would you agree?  I think not.

What one expects now is further appraisal, not by a physician, but by a surgeon. If action is indicated, the surgeon and not the physician should be the one to undertake it.  And this is precisely what the Hippocratic Oath recommends.  Around halfway through the Oath, those who swear it say that they will not use the knife (even on those who suffer from the stone), but will leave such action to those with surgical expertise.  Pretty sensible, wouldn’t you say?

The Oath is thus a physician’s document, which clearly does not condemn or forbid surgery, but acknowledges it as a separate specialty. So, next time you hear somebody asserting that the Oath forbids surgery, invite them to read it.

Read Peter Paisley’s other articles on the Hippocratic Oath:

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Alcoholism in Middle-Aged Women

By Dr Vivienne Miller, GP and Fellow, The Royal Australian College of General Practitioners

There has been a very significant increase in the number of woman aged 35 to 59 years of age who drink at dangerous levels. Over half a million Australian women in this age group are affected1 and many will go unrecognised by GPs unless their alcohol consumption is specifically asked about.

It seems that many do so to allay anxiety, cope with chronic life stress and to reduce past emotional trauma. The pattern of drinking may start out as irregular binging, by having several standard drinks on occasional evenings to relax. The woman then finds she needs this amount more frequently to cope with increasing pressure and after a short time this becomes the way of coping and unwinding. That is the point where dependency occurs and she then is drinking daily, needing more alcohol to feel calmer. The other pattern of drinking is regular intake of a glass or two of alcohol most days to unwind. However, this amount creeps up over a period of time, often in relationship to personal or work stress, until the person is drinking large amounts most nights.

Often, much is lost before the woman confronts the problem seriously. It appears more socially unacceptable for women to drink to the point of incapacity, when compared to men or young adults. Females may not attract the same tolerance and understanding from those around them (even from some health care professionals) if their problem is known. The shame and guilt is massive, especially when children are involved, marriages break up, jobs and livelihoods are lost and the family finances are destroyed.

The GP should be such a woman’s most important point of contact, and often she will be more open with a GP she does not know well. We are available more frequently for support and review than most psychologists, drug and alcohol counsellors and psychiatrists. We can co-ordinate detoxification in the hospital system, longer term admissions, allied mental health care and psychiatry reviews. We can help the rest of the family with counselling, write appropriate letters to school headmasters if necessary, allow time off work for spouses as carer’s leave and keep the confidence of the family in the process. GPs need to be prepared to deal with the intensity of emotional support required by partners and the children of a chronically sick mother. The chronicity of the alcoholism causes hopes to be raised and dashed repeatedly.

How is the best way to help as a GP? The evidence shows that by itself, detoxification is not the answer and that people with alcoholism rapidly relapse.1 It is not appropriate to lecture these patients. They cannot control the illness and many alcoholics will lie and steal to obtain alcohol. They frequently deny drinking, and say and do uncharacteristic things that they cannot recall when sober. Until a person with alcohol addiction admits the absolute loss of control over their life, help is impossible to enforce with any success. It is frequently said by sufferers that they had to hit rock bottom before they could decide they had to abstain completely. Abstinence has been proven to work, but it is not safe for heavy regular drinkers to stop suddenly without medical supervision in hospital. Few have the discipline to scale back their intake gradually to cessation.

Success is more likely with a supportive family environment (where others do not drink in front of the affected person), with peer support (especially Alcoholics Anonymous), with drug and alcohol counselling, changing routines that may trigger drinking and with recognition of the triggers and consequent avoidance of these to avoid drinking.1 Common triggers of relapse include anger, anxiety, loneliness and socialising with drinkers.1

Most importantly of all, GPs need to understand that the person is changed by the alcohol, but that this change is largely reversible. Above all, remember that but for luck and our own circumstances, any of us could have fallen into this trap ourselves, and could yet still do.

1. Dr Janice Withnall et al. “Women to take control on binge drinking.”
Western Sydney University

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The Microbiome of a Woman’s Reproductive Tract May Predict Preterm Birth

Source: Medical Xpress

The microbiomes in the reproductive tracts of pregnant women who later had a baby born too soon are significantly different from those of women who delivered full term.

The microbiome, a community of microorganisms on and in the body, is an emerging area of research that may help explain health issues as different as preterm birth, asthma and inflammatory bowel disease.

Researchers at the March of Dimes Prematurity Research Center at Stanford University took weekly samples of the microorganisms from the teeth and gums, saliva, reproductive tract, and stool from 49 pregnant women. They found little change in the bacterial communities in each woman, week to week at each location. But they did find that microbial communities in the reproductive tracts of women who delivered their babies too soon were different from those of women who delivered full term. Those differences were found early in the pregnancies and tended to persist throughout the pregnancies.

“These findings may help us screen women and identify and predict those who are more likely to have a baby born too soon,” said David Relman, MD, a professor of microbiology, immunology, and of medicine at the Stanford University School of Medicine and the lead investigator for the research center on this project.

Preterm birth is the number one killer of newborns and serious gaps exist between racial and ethnic groups. More than 450,000 babies are born too soon in the U.S. and the national preterm birth rate is worse than that of most other high-resource countries, the March of Dimes says. Worldwide, 15 million babies are born preterm, and more than one million die due to complications of an early birth. Babies who survive an early birth face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays… Read More>>

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Student’s Perspective of the Teaching of Empathy in Medical School

Source: Shaurya Taran via The Vancouver Sun

My medical school’s curriculum includes several lectures on compassion and empathy in the clinical setting.

These sessions occur intermittently throughout the school year, crammed into the few free spaces in our calendar, as if added in afterthought. The lectures are a welcome break from the rigours of our respective rotations, an opportunity to catch up on neglected aspects of our lives without fear of missing something important or testable.

I remember one lecture occurring on the morning after an end-of-block party: many of us were sound asleep at our desks, while the rest of us sat with our computer screens open to Facebook, scrolling through pictures from the night before. We weren’t trying to be disrespectful, but our behaviour confirmed a shared sentiment: this kind of education was wasted on us.

There is no doubt the teaching of empathy across medical schools — especially during the clinical years — is ineffective. It is difficult to conceive of any knowledge less suitable for didactic transmission, yet most schools continue to address this core competency in lecture format… Read More>>

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Lack of Education as Deadly as Smoking

Source: New York University via Medical Xpress

A new study by researchers at the University of Colorado, New York University, and the University of North Carolina at Chapel Hill estimates the number of deaths that can be linked to differences in education, and finds that variation in the risk of death across education levels has widened considerably.

The findings, published July 8 in the journal PLOS ONE, suggest that lacking education may be as deadly as being a current rather than former smoker.

“In public health policy, we often focus on changing health behaviors such as diet, smoking, and drinking,” said Virginia Chang, associate professor of public health at NYU’s Steinhardt School of Culture, Education, and Human Development and College of Global Public Health, and associate professor of population health at NYU School of Medicine. “Education – which is a more fundamental, upstream driver of health behaviors and disparities – should also be a key element of U.S. health policy.”

Low levels of education are common. More than 10 percent of U.S. adults ages 25 to 34 do not have a high school degree, while more than a quarter have some college but no bachelor’s degree. Yet studies show that a higher level of education is a strong predictor of longevity due to many factors, including higher income and social status, healthier behaviors, and improved social and psychological well being. Evidence from studies including natural experiments consistently show a strong association between education level and mortality and suggest that a substantial part of the association between education and mortality is causal… Read More>>

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