- Advances in Secondary Prevention of Stroke - Although there is great interest in neuro-protective therapy, none of the drugs currently in trials have been shown to be of benefit and none are licensed.
Thrombolysis has now been tried in several multi-centre trials, usually within six hours of the onset of symptoms. IV therpy has been with either alteplase, streprokinase or urokinase.
Overall, the risk of symptomatic intracranial haemorrhage was increased from about 2% to 9%. There wa some reduction in the proportion of patients who died or remained dependent at the end of the trial, particularly if therapy was given within three hours (approximately 55% compared with 70% without thrombolysis).
In the USA this has lead to routine use of IV alteplase within three hours of the o Continue reading →
The technical success ofBMV (defined as successful transseptal access and completion of balloon dilatation of the mitral valve) is uniformly high (>95%) in experienced centres, and the incidence of cardiac tamponade from inadvertent cardiac perforation is <1 %. (Table 1) With successful balloon valve enlargement, there is generally a two-fold increase in the mitral valve area and as associated dramatic fall in transmitral valve gradient and left atrial pressure. Routine trabsoesophageal echocardiography immediately prior to BMV to exclude the presence of left atrial thrombus has eliminated the risk of cardioembolism. All skilled operators now consider this investigation routine and mandatory not only in patients with atrial fibrillation, previous cardioembolism or left atrial thrombus where the probability of left atrial cavity thrombus (often missed bytransthoracic echocardiography) is heightened, but also in patients with sinus rhythm. Continue reading →
Viral Invasion and Replication - Intranasal interferon-1 ± has been shown to be effective in the prevention of rhinovirus colds, provided it is given shortly before or after exposure to viruses. However, long-term use is not recommended because of local bleeding and discharge. Intranasal interferon-1± is also effective in the prevention of rhinovirus colds when given prophylactically to exposed family members. Its mechanism of action is unknown, but it may reduce virus receptor expression resulting in resistance to infection in the epithelium.
Prevention and Treatment of Viral Invasion and Replication
Anti-viral agents potentially attack viruses before they can cause a deleterious effect on the airway. Ribavirin has been shown to reduce the severity of respiratory illness when administered as an aerosol to infants with RSV-induced bronchiolitis. It appears that ribarvirin has both a direct antivirial effect and immunomodulatory functions, including the inhibition of the development of antibody responses. However a recent study involving a large group of critical care centres failed to show that ribavirin was effective treatment for RSV associated respiratory failure.
Intercellular adhesion molecule-1 (ICAM-1) is an important rhinovirus receptor and another approach would be to block the receptor ligand on the virus capsid using soluble ICAM-1 and its monoclonal antibodies. These approaches have been shown to be effective in in vitro infection, but need further evaluation. Continue reading →
Osteoporosis medications - The first published data on the incidence of the hip fractures in Singapore showed that the incidence of hip fractures in all three major ethnic groups (i.e. Chinese, Malays and Indians) was lower in both sexes compared with the Caucasian population in the West.
Osteoporosis Medications in Asia
Indians were also found to have a higher rate of hip fractures compared with the other two major ethnic groups. However, a recent survey of hospital admissions for hip fractures for the five-year period from 1987-1991 showed changing pattern of hip fracture incidence. There was a rise in incidence among Chinese women and reduced incidence among Malays and Indians of both sexes. Overall, there was a 500% increase in the number of hip fractures in this period compared to the number reported between Continue reading →
Result from clinical pharmacology studies of more than 500 subjects and from 4 non-comparative and 11 comparative clinical trials involving around 6,200 patients have been reviewed. Of 3,021 patients who received oral gatifloxacin 400 mg, more than 90% of adverse events were considered to be mild or moderate in severity. The most common drug-related adverse events were nausea (8%), diarrhea (4%), headache (4%), and vaginitis (6% of women). There were serious adverse events in 85/3021 patients. The discontinuation rate due to adverse events for oral gatifloxacin therapy was 2.9%. The incidence of drug related adverse events was higher in patients treated with intravenous gatifloxacin (n=165), probably due to greater severity of illness. Drug related adverse events were seen in 45% of gatifloxacin patients compared with 52% in those receiving comparator agents. Injection site reactions were seen in 21% of patients receiving gatifloxacin and in 20% receiving comparators. Continue reading →
Aggravation of Airway Hyperresponsiveness - The most common characteristic of asthma is airway hyperresponsiveness. It is wel known that airway hyperresponsiveness is aggravated by viral infections, resulting in virus-induced exacerbation of airway hyperresponsivenessare as follows.
Alteration of Autonomic Nerveous System Function
Increase of Vagally Mediated Bronchoconstriction
During viral infections, the activity of the cholinergic nerve sytem which cause bronchoconstriction is preventable by premedication with atropine. This suggests that viral infection induces and increases vagally mediated bronchoconstriction. This is mainly due to the dysfunction of M2 muscarinic receptors, caused by various mediators, especially the major basic protein from eosinophils which Continue reading →
oesophageal cancer - Five-year survival after surgery or radiotherapy for cancer of the oesophagus is only 5-10%. In 1992, US workers reported significant benefit from combined chemotherapy and radiotherapy compared with radiotherapy alone in a randomised trial a which included 123 patients. Now they have reported long-term results from this trial and for a further 69 patients treated with combined therapy. Chemotherapy was with cisplatin and fluorouracil
Eggs cholesterol myth - The Health Professionals Follow-up Study (1986-94) and the Nurse’s Health Study (1980-94) included almost 38.000 men and over 80.000 women. After adjustment for confounding factors such as age and smoking there was no overall association between egg consumption and the incidence of coronary disease or stroke in either men or women with egg intakes of up to six per week.
Eggs Cholesterol Myth
In patients with diabetes, consumption of more than one egg per day was associated with a doubling of coronary risk in men and a 50% increase in women.
Egg consumption of up to one egg a day does not increase the risk of coronary disease or stroke except in patients with diabetes.
Diagnosis For Diabetes – Diabetes has been be a nightmare for over decade. But what the actual method to diagnosis for diabetes ?. There is debate about the level of fasting blood glucose (FBG) which establishes a diagnosis for diabetes. In 1995 the American Diabetes Association reduced its recommended level from 7.8 to 7 mmol/L. Now workers in California, USA have questioned this recommendation.
Diagnosis For Diabetes
Diagnosis For Diabetes
They re-examined data from two large published data sets relating FBGto HbA1c levels were found in the following proportions in the four groups: 97%, 3%, and 0,1%; 87%, 13%%, and 0.2%; 61%, 36%, and 3%; and 19%, 32%, and 49%. Thus about 60% of patients diagnosed by the new criterion for FBG have normal HbA1c levels. Since glycosylated haemoglobin is thought to be related to the risk of diabetic complications, these workers argue that the new criterion includes too many patients at low risk.
They suggest that at FBG levels of between 7 and 7.7 mmol/L diabetes should be diagnosed only if HbA1c is raised. Those with FBG of 6.1-7.7 mmol/L and normal HbA1c should be diagnosed as having impaired fasting glucose and divided about diet and exercise. Despite this, an editorials stands by the new criterion.
Conclusion of Diagnosis For Diabetes
Many patients with diabetes diagnosed haemoglobin levels. Debate continues about diagnostic criteria.
Reye’s syndrome is characterized by acute encephalopathy with fatty degeneration of the liver in children and it has a high case-fatality of 30% or more. In 1980 reports began to appear associating the syndrome with aspirin medication during the prodromal illnesses of chickenpox and influenza and since then the condition has almost disappeared from the United States.
Reye’s Syndrome Decline In USA
A voluntary reporting surveillance system was re-established in 1976 and data from 1980 to 1997 have been reprted. The peak year for Reye’s syndromein the USA was 1980 when 555 cases were reported. That year the Centers for Disease Control and Prevention Continue reading →