Prostate Cancer - 19-05-2008
Prostate Cancer (Adenocarcinoma of the Prostate)
What is Prostate Cancer
Who gets it?
Predisposing Factors
Progression
Probable Outcomes
How is it diagnosed?
How is it treated?
Drugs Associated with Prostate Cancer
Prostate cancer is a malignant cancerous tumour, which arises within the prostate gland. Compared with other types of cancer, prostate cancer is relatively slow growing, however, if left untreated, prostate cancer may grow outwards and spread to organs and tissue close to the prostate. The prostate is one of the male sex glands, though function of the prostate gland is uncertain. The other major sex glands in men are the testes and the seminal vesicles. Together, these sex glands secrete the fluids that make up semen. The prostate gland is about the size of a walnut. The prostate location is just below the urinary bladder and surrounds the upper part of the urethra. The urethra is the tube that carries urine from the bladder and semen from the sex glands out through the penis. Prostate cancer is usually located in the peripheral or outer zones of the prostate. For more cancer information on prostate cancer visit your local doctor.
Who gets it?
Prostate cancer occurs in 1 out of 6 men. Prostate cancer the second most common cause of death for Australian males over the age of 70 and becomes increasingly common after middle age. The period between 1921 up to the early 1990's saw a slow increase in deaths due to prostate cancer. Alarmingly, a marked increase occurred in the early 1990's, but since then an annual decrease in prostate cancer deaths has been observed between 1993 and 2000. This may be due to increased screening of prostate cancer.
Predisposing Factors
A positive family history of prostate cancer increases risk. Other probable risk factors include:
Age: 55 years old and older.
Diet: High saturated fat content.
Exposure to heavy metals (e.g. cadmium).
Ethnicity (African American have a high rate of prostate cancer compared to Asian men in Asian countries. However this may be also due to environmental factors duch as diet).
Sedentary lifestyle.
Smoking.
Hormonal: High levels of testosterone are probably involved in the development of prostate cancer.
Progression
This type of prostate cancer tumour spreads by direct invasion of the surrounding structures such as the bladder and seminal vesicles. Blood borne spread is most common to bone and causes thickened lesions of the bone at the site. Lymphatic spread can lead to disease within lymph nodes. Organ involvement such as lung and liver metastases are less common.
Probable Outcomes
The prognosis of this prostate cancer varies widely with tumour stage and grade. Prostate cancers are graded with the Gleason scoring method. Essentially the higher the score the worse the outlook. Staging refers to how far the prostate cancer has spread. If the prostate cancer is contained within the prostate gland at diagnosis and treated, the 10 year survival is generally good. Prostate cancer which has metastasised to distant parts of the body carries a very poor prognosis. Caution should be exercised with prognosis as prostate cancer can be quite slow growing. Prostate cancer is common with increasing age and a large number of patients who have prostate cancer will die WITH it, rather than FROM it.
Treatment of prostate cancer is dependent on many factors, such as the stage of prostate disease (whether only the prostate is affected or if the cancer has spread to other parts of the body), age, general health, preference of the individual and the Gleason score. Prostate cancer treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery (e.g. a Radical prostatectomy), Radiotherapy for prostate cancer, hormonal therapy, cryotherapy, combinations of some of these prostate cancer treatments, and watchful waiting. A cure for metastatic prostate cancer is, unavailable. Treatments for metastatic prostate cancer, which include hormonal therapy and chemotherapy, therefore, are considered palliative. The aims of palliative prostate cancer treatments are, at best, to slow the growth of prostate tumors and relieve the symptoms of the patient, so that males with prostate cancer can have a reasonable quality of life for as long as possible.
Treatments used in this disease:
Radical Prostatectomy
Radiotherapy for Prostate cancer
Rehabilitation after Prostate Cancer Treatment
Rehabilitation after Prostate Cancer Treatment
Robotic Prostate Surgery
Cryotherapy for Prostate Cancer
Cryotherapy for Prostate Cancer
Drugs used in the treatment of this disease:
Cyproterone acetate
(Androcur)
Bicalutamide
(Cosudex)
Leuprorelin acetate
(Eligard)
Flutamide
(Eulexin)
Leuprorelin acetate
(Lucrin)
Docetaxel
(Taxotere)
Goserelin acetate
(Zoladex 3.6mg and 10.8 mg Implant)
Zoledronic acid
(Zometa)
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Herniated Lumbar Disc - 19-05-2008
Herniated nucleus pulposus (slipped disc; Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disc; Prolapsed intervertebral disc; Ruptured disc)
What is Herniated nucleus pulposus
Who gets it?
Predisposing Factors
Progression
Probable Outcomes
How is it diagnosed?
How is it treated?
Drugs Associated with Herniated nucleus pulposus
What is Herniated nucleus pulposus
3D Animation on
Ruptured Disc
--------------------------------------------------------------------------------
This animation brought to you by Blausen Medical Communications.
Contact Andrew Walbank.A slipped disc, or herniated nucleus pulposus, is a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk (the nucleus pulposus) is forced through a weakened portion of the disk, resulting in back and leg pain caused by nerve root irritation.
Please click here for a diagram of a Herniated nucleus pulposus.
Who gets it?
Disk herniation occurs more frequently in middle aged and older men, especially those involved in strenuous physical activity. Other risk factors include any congenital conditions that affect the size of the lumbar spinal canal.
Predisposing Factors
Being of middle age and male are predisposing factors to the condition and, as stated, strenuos physical activity can also bring about the disorder.
Other risk factors include any congenital conditions that affect the size of the lumbar spinal canal. Smoking, increased coughing, prolonged sitting and excessive driving have been associated with increased rates of herniation related to different pressures on the disk.
Progression
Much has been written concerning the process of spinal deterioration or spondylosis, which occurs over a lifetime. Disc deterioration leads to lack of stiffness and diminished stability resulting in episodic pain. The episodic pain is common and may be temporarily severe.
Optimism remains in the long run, as continued deterioration leads to a restabilisation of the spine. Patients in their 50s and 60s customarily are stiffer but have less pain than younger patients in their 30s and 40s who are undergoing initiation of the degenerative cascade. Patients who ask if they have to live with this pain for the rest of their lives can be reassured from this natural history. Furthermore, spontaneous recovery of an acute episode routinely occurs, so any treatment must be demonstrated effective by positively altering the expectation without treatment.
Probable Outcomes
Most people will improve with conservative treatment. A small percentage may continue to have chronic back pain even after treatment. People who injure themselves on the job tend not to do as well as those without such injuries.
It may take several months to a year or more to resume all activities without pain or strain to the back. Certain occupations that involve heavy lifting or back strain may need modification to avoid recurrent back injury.
How is it diagnosed?
A neurological examination will be performed to evaluate muscle reflexes, sensation, and muscle strength. Often, an examination of the spine will reveal a decrease in the spinal curvature in the affected area. Straight-leg-raising test that reveals leg pain is diagnostic of a herniated lumbar disk.
How is it treated?
The mainstay of treatment for herniated disks is an initial period of rest with pain and anti-inflammatory medications, followed by physical therapy. Under this regime, over 95% of people will recover and return to their normal activities. A small percentage of people do need to go on and have further treatment which may include steroid injections or surgery.
Medications:
For people with an acute herniated disk caused by some sort of trauma (like a car accident or lifting a very heavy object) and immediately followed by severe pain in the back and leg, narcotic pain relievers and non-steroidal anti-inflammatory medications (NSAIDs) will be prescribed.
Lifestyle Modifications:
Any extra weight being carried by an individual, especially weight up front in the abdomen, will worsen any back pain syndrome. A program of diet and exercise is crucial to improving back pain in overweight patients. Physical therapy is another crucial treatment for nearly everyone with lumbar disk disease. Therapists will instruct you how to properly lift, dress, walk, and perform other activities.
Surgery:
For the few patients whose symptoms persist despite the above interventions, surgery may be a good option to control pain. A Diskectomy is performed to remove a protruding disk under general anesthesia. The hospital stay is short, about 2-3 days. You will be encouraged to walk the first day after surgery to reduce the risk of blood clots.
Complete recovery takes several weeks. If more than one disk needs to be taken out or if there are other problems in the back besides a herniated disk, more extensive surgery may be needed. This may require a much longer recovery period.
Other surgical options include micro diskectomy, a procedure removing fragments of nucleated disk through a very small incision with x-ray guidance and chemo nucleosis (injection of an enzyme into the herniated disk to dissolve the protruding gelatinous substance). This procedure may be an alternative to diskectomy in certain situations.
Drugs used in the treatment of this disease:
Ibuprofen
(Actiprofen)
Ibuprofen
(Brufen)
Ibuprofen
(Bugesic)
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Heart Failure - 19-05-2008
What is Heart Failure
Heart failure, in simple terms, is when the heart fails to maintain an adequate circulation of blood around the body owing to a defect in the heart's pumping action. Heart disease can lead to heart failure.
Who gets it?
It is estimated at least 300,000 Australians currently suffer heart failure and around 30,000 new cases of heart failure are diagnosed each year:
Heart failure is generally a disease affecting the older generation - 13 per cent of people aged 65 and over presenting to a GP suffer heart failure;
In 1996 and 1997, 41,000 hospitalisations reported heart failure as a principal diagnosis;
During 1996 and 1997 heart failure contributed to 2 per cent of all deaths;
Heart failure has been estimated to account for $411 million of the total direct health costs attributed to cardiovascular disease (estimated in 1993-94 as being $3719 million). This figure for Heart Failure includes $140 million per year on hospitalisation and $135 million per year on nursing home costs;
Heart failure is the only major cardiovascular disease that still has an increasing incidence and prevalence, and the number of cases of heart failure in regions worldwide reflect this:
The prevalence of heart failure is estimated to be as many as 20 individuals per 1,000, rising to as many as 130 individuals per 1,000 for those aged over 65 years;
In Western Europe there are over five million heart failure patients, whilst in the USA there are around five million heart failure sufferers, with 400,000 new cases diagnosed each year;
The number of new cases of heart failure reported in Europe every year is approximately two to three per 1,000;
Worldwide among the 70-80 age group, one hundred people per 1,000 have heart failure.
The incidence and prevalence of heart failure is still rising and it is predicted that this will continue.
There are two main reasons for this increase:
1) Advances of modern medicine:
The improved management of cardiovascular disease means that patients now survive longer. Many patients who have heart attacks are now surviving them because of modern medical treatment and more rapid response times from medical services. However, the heart muscle of these patients is often damaged and can no longer compensate, leading to the development of heart failure. This has been described as an "ironic failure of success".
2) Ageing of the population:
Older people have a much higher prevalence of heart failure than younger individuals, which may be due to the greater frequency of common risk factors for heart failure, such as hypertension, myocardial infarction (heart attack) and diabetes mellitus. Among those aged over 80 years, the prevalence of heart failure reaches one in ten. In Europe, the average age of the population in 1950 was 29.2 years however by 1998 this had risen to 37.1 years. By 2050, the average age of the population is predicted to reach 47.7 years, leading to a higher incidence of heart failure.
Predisposing Factors
Infection.
Anaemia.
Thyrotoxicosis.
Pregnancy: Women with rheumatic valvular disease can first experience symptoms during pregnancy and following delivery of the baby these symptoms may be resolved.
Abnormal heart rhythms.
Rheumatic fever.
Infective endocarditis and myocarditis.
Hypertension (high blood pressure).
Heart attack.
Pulmonary embolism.
Overexercise.
Sudden increase in salt in the diet.
Excessive environmental heat or humidity.
Emotional crises.
Progression
Heart failure can occur when the heart has been overworked or damaged in some way. High blood pressure over many years, heart valve disease, defects in the heart at birth and infection are some of the causes.
The most common cause is a heart attack - also known as myocardial infarction or "coronary". Heart failurecan result from one large heart attack or several smaller ones.
Another common cause is a disease of the heart muscle known as cardiomyopathy. This can be caused a viral infection or excess alcohol consumption on a regular basis.
The cost and burden of heart failure is expected to increase markedly due to a number of factors:
The ageing population;
The projected increase in the number of older people with coronary heart disease and hypertension;
The decrease in fatality rates associated with acute coronary disease;
Improved diagnosis of CHF because of the increased use of sensitive techniques such as echocardiography.
Probable Outcomes
Heart failure is usually a chronic illness, and it may worsen with infection or other physical stressors. But with medication and correction of underlying disorders, it can be controlled.
How is it diagnosed?
Full blood count.
Urea and electrolytes.
Thyroid function tests.
Electrocardiography.
Chest x-ray.
Pulse oximetry.
How is it treated?
A variety of medications are used to treat heart failure in order to reduce the work the heart has to do, relieve symptoms and reduce the build-up of fluid:
Diuretics or fluid tablets work on the kidney to remove excess fluid from the body.
ACE inhibitors relax blood vessels making it easier for the heart to pump blood to all tissues of the body.
Digoxin helps the heart beat more strongly, slowly and regularly.
Spironolactone is used in moderate and severe heart failure to reduce the impact of hormones on the heart and prevent scarring.
Symptoms of this disease:
Chest Pain
Breathlessness
Treatments used in this disease:
Heart Transplant
Angiotensin II Receptor Blockers (ARB)
Angiotensin-converting Enzyme Inhibitors (ACE inhibitors, ACEi)
Drugs used in the treatment of this disease:
Amiodarone hydrochloride
(Amiodarone (Terry White Chemists))
Candesartan cilexetil
(Atacand)
Bisoprolol fumarate
(Bicor)
Captopril
(Captopril)
Perindopril erbumine
(Coversyl)
Losartan potassium
(Cozaar)
Frusemide
(Frusemide-BC)
Metoprolol tartrate
(GenRx Metoprolol)
Ibesartan
(Karvea)
Digoxin
(Lanoxin)
Wafarin sodium
(Marevan)
Fosinopril sodium
(Monopril)
Ramipril
(Ramace)
Spironolactone
(Spiractin)
Eprosartan mesylate
(Teveten)
Article Dates:
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Weight Loss Drugs - 19-05-2008
Weight Loss Drugs
An Introduction to Weight Loss Drugs
Centrally Acting Weight Loss Drugs
Drugs Acting on Noradrenergic Pathways (Sympathomimetic Anoretics)
Drugs Acting on Serotonergic and Adrenergic Pathways
Peripherally Acting Weight Loss Drugs
Inhibitor of Pancreatic and Gastric Lipases
An Introduction to Weight Loss Drugs
Weight-loss drugs are designed to help people who are classified as obese loss weight.
Weight loss drugs should only be used in those who are:
Morbidly obese
Have a BMI above 30 who have failed to lose weight with a lifestyle program or
Have a BMI above 27 in whom risk factors are already present.
The treatment of weight loss drugs should only be short term (for up to 3 months) and should always be used in conjunction with appropriate eating habits and physical activity. Weight loss drugs are not suitable to be used as a substitute for lifestyle modifications.
The weight loss drugs can be classified into the following classes:
Centrally acting drugs
Peripherally acting drugs
Centrally Acting Weight Loss Drugs
Drugs Acting on Noradrenergic Pathways (Sympathomimetic Anoretics)
How They Work
Drugs acting on noradrenergic pathways (sympathomimetic anoretics) are appetite suppressants and act on receptors in the brain causing stimulatory effects and increasing energy expenditure.
What Are The Benefits and Side Effects
As these agents are only for short term use, they have a limited role in the long term management of obesity. If used, intermittent treatment is preferable; a maximum of 12 weeks should be followed by a drug-free period of 4-12 weeks. This class of drugs may have a role in short term use to aid behaviour modification.
Sympathomimetic anoretics for weight loss have been withdrawn from the UK and other European countries as these drugs have been related to primary pulmonary hypertension and heart valve disorders. In Australia sympathomimetic anoretics are still available, however they are only used for short-term treatment and when other medications and treatments have not been effective.
Diethylpropion and Phentermine are sympathomimetic anoretics. Adverse effects include hypertension, sleeplessness, nervousness and tachycardia (fast heart beat). These medications are used when other treatments have not been effective or extra weight loss is required for medical reasons. Phentermine should only be used for 3 months.
Drugs Acting on Serotonergic and Adrenergic Pathways
How They Work
Obesity is associated with reduced concentrations of serotonin and noradrenaline in the brain. Serotonin and Noradrenaline reuptake inhibitors (SSRIs) increase these levels and may produce weight loss. Serotonin suppresses the appetite and noradrenaline increases the body"?Ts metabolism of fat.
What Are The Benefits and Side Effects
Serotonin and noradrenaline reuptake inhibitors (SNRIs) or Selective Serotonin Reuptake Inhibitors (SSRIs) are used as an adjunct to diet and lifestyle modifications. They have been shown to be effective in improving other co-morbid factors and may take a month for weight loss to occur.
Fluoxetine, one of the serotonin reuptake inhibitor group antidepressants, can produce weight loss in those who are depressed. It is also effective for non-depressed individuals, however, the dose required to attain weight loss is considerably high and hence there is a higher risk of adverse effects associated with the medication. Fluoxetine can be helpful for emotional or stress eaters to control their binges. Other SSRIs are not commonly used as there is lack of trial evidence and the adverse effects associated are relatively high.
Sibutramine is an SSRI which has both an appetite suppressant and a small thermogenic (increase the metabolism of the body's fat) action. It results in increased satiety, with an earlier sensation of fullness during a meal and less snacking. It produces a similar weight loss to all other drugs used for obesity. Sibutramine has been shown to improve co-morbid factors such as central obesity, lipid profile and blood glucose in people with diabetes. The drug may take a month for the weight loss to occur and increases in heart rate and blood pressure are common. Extended use may help to maintain weight loss, but the safety of prolonged (more than 2 years) use has not been demonstrated.
Peripherally Acting Weight Loss Drugs
Inhibitor of Pancreatic and Gastric Lipases
How They Work
Agents which inhibit pancreatic and gastric lipases are enzymes that help the body absorb fat. They prevent the dietary absorption of fat and can hence be used for weight loss in people with a high fat diet.
What Are The Benefits and Side Effects
This medication should be used in conjunction with a low calorie diet high in fruit and vegetables with <30% of the calories as fat. When the diet is too high in fat, it can cause fatty or oily stools. These drugs may reduce absorption of fat-soluble vitamins (A, D, E, K), rarely causing vitamin deficiency. If vitamin deficiency is pre-existing or if dietary intake is limited, then vitamin supplementation should be taken at least 2 hours apart from the medication.
Orlistat is an inhibitor of pancreatic and gastric lipases. It prevents absorption of approximately 30% of the dietary fat. Orlistat must be used with together with a low-fat eating program and taken before meals. The weight loss with this medication is modest. The treatment with Orlistat can help improve other co-existing conditions such as high blood pressure and cholesterol. The medication is only effective if the patient consumes a high fat diet. It is taken with (or up to 1 hour after) the main meals. The drug should not be taken if a meal is missed or if it does not contain fat.
Article Dates:
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Confusion over lactose intolerance - 07-03-2008
There appears to be a trend for parents to diagnose their children as lactose intolerant without seeking medical advice. This has serious consequences for children, who may miss out on vital nutrients.
Lactose intolerance is the inability to digest foods containing lactose, such as dairy products. People who have this condition may experience abdominal pain, bloating, nausea or diarrhoea after consuming foods rich in lactose. Lactose intolerance is common amongst people of African or Asian descent.
Lactose intolerance can be easily confused with other conditions. For example, its symptoms can closely mimic those of irritable bowel syndrome (IBS). This is why it is important to discuss the issue with your doctor. Recent growth in awareness of the condition has led to more parents diagnosing their children as lactose intolerant. However, an incorrect diagnosis of lactose intolerance can be very damaging to children's health.
Children who are wrongly diagnosed as lactose intolerant may miss out on an entire food group. Dairy products are rich in lactose and provide nutrients such as calcium, protein and vitamin A. These nutrients are especially important during childhood because they are needed for growth and development. For this reason, parents who suspect that their child may be lactose intolerant should seek the advice of a medical practitioner.
An individual who has been diagnosed as lactose intolerant by their doctor may still be able to enjoy dairy in moderation. Yoghurt contains bacteria that may help with the digestion of lactose. Hard cheeses should not pose any difficulties because they have low levels of lactose. Even half a glass of milk should not aggravate symptoms if it is taken with a meal and spaced throughout the day.
Avoiding dairy can have serious health consequences, especially for children. Dairy products are a food group on their own because they are rich in essential nutrients. The misdiagnosis of lactose intolerance may cause children to miss out on the essential nutrients provided by dairy.
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Does your kid just have growing pains - or arthritis? - 07-03-2008
It might not surprise you to know that arthritis is the most debilitating disease in this country, affecting some 46 million adults in the U.S. alone. You probably don't know that arthritis also affects children - sending nearly a million of them to the doctor's office for treatment each year. Here's how you can tell whether your child has growing pains, or something more.
Jay McKirnan has been dreaming of swimming in the state finals for years. His chances were nearly sunk when he was accidentally kicked by an opponent while playing soccer.
"I felt like a little, it was either a tear or a popping sensation. I fell on the ground and I just couldn't get up," says McKirnan.
It turns out the injury damaged the cartilage in Jay's hip, leaving him at risk of arthritis at the age of 17. While that may sound surprising to some, it's an area of medicine that's growing. Tom Ellis, M.D. at Ohio State University Medical Center has built a practice treating hip pain and arthritis in people under 50 - many of them teenagers.
"Some of these kids ultimately have arthritic-like conditions, very similar to adults. The only option in these kids is a hip replacement," says Ellis.
Doctors can avoid that if the arthritis is caught early. The problem is there have been very few national studies on juvenile arthritis* and many parents simply write off joint pain as growing pains. So how do you know if your child is at risk? Doctors say, in children, arthritis is almost always caused by either an infection or by an injury, like Jay's. If they are hurt, Ellis says to watch them. Kids are resilient but they will give clues when the pain is too much.
"They continue to sort of complain about the same thing over and over again, and also you'll notice that they stop doing certain activities because they're saying the activity hurts them," says Ellis.
Jay had surgery on his hip to repair the cartilage. Without it, doctors say instead of battling for a state title, he would have been battling arthritis for years to come.
Experts say growing pains never occur during the daytime. So if your child complains consistently about joint pain during the day, you may want to get them checked out. The Centers for Disease Control and Prevention began looking seriously at arthritis in kids in 2004 to see just how many of them are at risk.
(Source: Ohio State University Medical Center: March 2008)
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An Introduction to Weight Loss Drugs - 07-03-2008
Centrally Acting Weight Loss Drugs
Drugs Acting on Noradrenergic Pathways (Sympathomimetic Anoretics)
Drugs Acting on Serotonergic and Adrenergic Pathways
Peripherally Acting Weight Loss Drugs
Inhibitor of Pancreatic and Gastric Lipases
An Introduction to Weight Loss Drugs
Weight-loss drugs are designed to help people who are classified as obese loss weight.
Weight loss drugs should only be used in those who are:
Morbidly obese
Have a BMI above 30 who have failed to lose weight with a lifestyle program or
Have a BMI above 27 in whom risk factors are already present.
The treatment of weight loss drugs should only be short term (for up to 3 months) and should always be used in conjunction with appropriate eating habits and physical activity. Weight loss drugs are not suitable to be used as a substitute for lifestyle modifications.
The weight loss drugs can be classified into the following classes:
Centrally acting drugs
Peripherally acting drugs
Centrally Acting Weight Loss Drugs
Drugs Acting on Noradrenergic Pathways (Sympathomimetic Anoretics)
How They Work
Drugs acting on noradrenergic pathways (sympathomimetic anoretics) are appetite suppressants and act on receptors in the brain causing stimulatory effects and increasing energy expenditure.
What Are The Benefits and Side Effects
As these agents are only for short term use, they have a limited role in the long term management of obesity. If used, intermittent treatment is preferable; a maximum of 12 weeks should be followed by a drug-free period of 4-12 weeks. This class of drugs may have a role in short term use to aid behaviour modification.
Sympathomimetic anoretics for weight loss have been withdrawn from the UK and other European countries as these drugs have been related to primary pulmonary hypertension and heart valve disorders. In Australia sympathomimetic anoretics are still available, however they are only used for short-term treatment and when other medications and treatments have not been effective.
Diethylpropion and Phentermine are sympathomimetic anoretics. Adverse effects include hypertension, sleeplessness, nervousness and tachycardia (fast heart beat). These medications are used when other treatments have not been effective or extra weight loss is required for medical reasons. Phentermine should only be used for 3 months.
Drugs Acting on Serotonergic and Adrenergic Pathways
How They Work
Obesity is associated with reduced concentrations of serotonin and noradrenaline in the brain. Serotonin and Noradrenaline reuptake inhibitors (SSRIs) increase these levels and may produce weight loss. Serotonin suppresses the appetite and noradrenaline increases the body"?Ts metabolism of fat.
What Are The Benefits and Side Effects
Serotonin and noradrenaline reuptake inhibitors (SNRIs) or Selective Serotonin Reuptake Inhibitors (SSRIs) are used as an adjunct to diet and lifestyle modifications. They have been shown to be effective in improving other co-morbid factors and may take a month for weight loss to occur.
Fluoxetine, one of the serotonin reuptake inhibitor group antidepressants, can produce weight loss in those who are depressed. It is also effective for non-depressed individuals, however, the dose required to attain weight loss is considerably high and hence there is a higher risk of adverse effects associated with the medication. Fluoxetine can be helpful for emotional or stress eaters to control their binges. Other SSRIs are not commonly used as there is lack of trial evidence and the adverse effects associated are relatively high.
Sibutramine is an SSRI which has both an appetite suppressant and a small thermogenic (increase the metabolism of the body's fat) action. It results in increased satiety, with an earlier sensation of fullness during a meal and less snacking. It produces a similar weight loss to all other drugs used for obesity. Sibutramine has been shown to improve co-morbid factors such as central obesity, lipid profile and blood glucose in people with diabetes. The drug may take a month for the weight loss to occur and increases in heart rate and blood pressure are common. Extended use may help to maintain weight loss, but the safety of prolonged (more than 2 years) use has not been demonstrated.
Peripherally Acting Weight Loss Drugs
Inhibitor of Pancreatic and Gastric Lipases
How They Work
Agents which inhibit pancreatic and gastric lipases are enzymes that help the body absorb fat. They prevent the dietary absorption of fat and can hence be used for weight loss in people with a high fat diet.
What Are The Benefits and Side Effects
This medication should be used in conjunction with a low calorie diet high in fruit and vegetables with <30% of the calories as fat. When the diet is too high in fat, it can cause fatty or oily stools. These drugs may reduce absorption of fat-soluble vitamins (A, D, E, K), rarely causing vitamin deficiency. If vitamin deficiency is pre-existing or if dietary intake is limited, then vitamin supplementation should be taken at least 2 hours apart from the medication.
Orlistat is an inhibitor of pancreatic and gastric lipases. It prevents absorption of approximately 30% of the dietary fat. Orlistat must be used with together with a low-fat eating program and taken before meals. The weight loss with this medication is modest. The treatment with Orlistat can help improve other co-existing conditions such as high blood pressure and cholesterol. The medication is only effective if the patient consumes a high fat diet. It is taken with (or up to 1 hour after) the main meals. The drug should not be taken if a meal is missed or if it does not contain fat.
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Heart attack rates fall following national smoking bans in France - 07-03-2008
1 Mar 2008
French health authorities announced a striking 15% decrease in admissions of patients with myocardial infarction to emergency wards since the public ban on smoking came into effect in restaurants, hotels and casinos in France last January.
The announcement was made on 23 February by the Institut National de Veille Sanitaire. Similar results were published in Italy on 12 February by the Environmental Health Authority: researchers in Rome found an 11.2 percent reduction of acute coronary events since the January 2005 smoking ban took effect in Italy.
The European Society of Cardiology (ESC) wishes to stress the positive impact of smoking bans in all European countries that have adopted laws banning tobacco use in public places.
“There is a wealth of data linking smoking and cardiovascular disease (CVD),” stated Prof Daniel Thomas, of the European Society of Cardiology and a Senior Cardiologist in the Centre Hospitalier Pitié- Salpêtrière in Paris. “Although further studies are needed all over France to confirm the strong decrease in smoking related deaths over time, these statistics show the same tendency professionals have already observed in Italy, Ireland and Scotland when these countries introduced their own bans on tobacco. To me, the most striking aspect in this study is the reduction of pollution inside cafés and restaurants by over 75% between December 2007 and January 2008. Passive smoking has been shown to increase the risk of coronary heart disease and the recent smoking ban is obviously having a beneficial effect on both smokers and non-smokers.”
The European Society of Cardiology together with other health institutions has continuously informed the public of the overwhelming evidence of the adverse effect of smoking on cardiovascular health. The European Guidelines on CVD prevention warn that smoking is responsible for 50% of all avoidable deaths and that smoking causes heart attacks at any age. Data produced by Prof Pekka Jousilahti from Finland at the ESC’s EuroPrevent Congress in 2006 showed that smoking releases over 4000 chemicals into the body affecting every organ.
“The swift reduction of heart attacks and strokes in France is very good news indeed!”states Prof Jean Pierre Bassand, Past President of the ESC and Head of the Cardiology Department at the University Hospital of Besançon . “Cardiologists do not need to be convinced that smoking and passive smoking have an important impact on the rate of heart attacks; they are also convinced that giving up cigarettes and eliminating passive smoking has a very favourable effect on the rate of heart attacks. Unfortunately the ban on smoking in public places has not led to a reduction in the number of smokers in France, confirming data observed elsewhere.”
Prof Daniel Thomas agrees: “Governments must learn from these findings and not give in to pressure from the tobacco lobby. In France people are actually still buying tobacco but just the fact that working and living environments are free from smoke pollution has made an enormous difference to public health, not only regarding cardiovascular disease, but also respiratory disease and other complaints such as headaches, as the INVS findings show. It is very important to stress the immediate results observed on cardiovascular disease when people live in smoke free environments.”
“Although cardiovascular diseases are very complex in nature and due to many causes, smoking is one of the major contributors and smoking bans have certainly caused a reduction in coronary events in Italy. This has recently been documented in an article published in Circulation where the rate of reduction of coronary events was consistent with the pollution reduction observed in indoor public places. I believe that this is clearly confirming that prevention is not only a task for doctors, but also for society and politicians," explains Roberto Ferrari, President Elect of the ESC.
The European Society of Cardiology would like to encourage smoke cessation across the continent through smoking bans and taxes on cigarettes. There is a consensus on the benefits of smoking cessation which are usually almost immediate and contribute to diminish the burden of cardiovascular disease.
The positive figures communicated last week in Italy and France should encourage other European countries to enforce similar measures to protect their citizens.
Smoking bans can save lives.
(Source: European Society of Cardiology: February 2008)
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Toxins in cigarette smoke prevent stem cells from becoming cartilage - 07-03-2008
6 Mar 2008
A toxic pollutant spread by oil spills, forest fires and car exhaust is also present in cigarette smoke, and may represent a second way in which smoking delays bone healing, according to research presented at the annual meeting of the Orthopedic Research Society in San Francisco.
In 2005, researchers from the University of Rochester Medical Center identified one ingredient in smoke, nicotine, that delays bone growth by influencing gene expression in the two-step bone healing process: stem cells become cartilage; cartilage matures into bone. In the current study, some of the same researchers found that a second smoke ingredient, the polyaromatic hydrocarbon benzo(a)pyrene (BaP), also slows bone healing, but in a different way.
Smoking has been shown to delay skeletal healing by as much as 60 percent following fractures. Slower healing means a greater chance of re-injury and can lead to chronic pain and disability. The obvious solution is for smokers to quit when they get hurt, but studies show that just 15 percent can.
"Our results provide the first evidence that BaP prevents stem cells from becoming cartilage cells as part of healing," said Regis J. O'Keefe, M.D., Ph.D., chair of the Department of Orthopaedics and Rehabilitation at the Medical Center and a study investigator. "These findings extend our understanding of the impact of cigarette smoke on a process that is critical to fracture repair. Perhaps down the road we will be able to speed bone healing among smokers in more than one way."
Study Details
Gene expression is the process by which instructions encoded in genes are followed for the building of proteins, the workhorses that make up the body's organs and carry its signals. In the current study, polymerase chain reaction (PCR), a technique that measures gene expression levels, revealed the genetic changes caused by exposure to BaP in mouse stem cells.
Among the many factors that influence gene expression are transcription factors, proteins designed to direct genes to create more or less of a protein. One such factor is Sex Determining Region Y-box 9 (SOX-9), required for the transition of stem cells into cartilage cells. The PCR results show that BaP in cigarette spoke interferes with SOX-9 expression in mesenchymal stem cells, blocking their conversion into cartilage cells. When this group of stem cells is free to differentiate, the newly formed cartilage cells immediately begin manufacturing collagen 2, the tough, fibrous protein framework for cartilage. Along with interfering with SOX-9, BaP was also found to reduce levels of type II collagen gene expression.
Past studies had shown that stem cells involved in cartilage formation contain proteins known to react with BaP called aryl hydrocarbon receptors. The current results suggest that BaP binding with these receptors may suppress SOX-9 activity, reducing the number of stem cells that turn into cartilage cells and the amount of collage produced. No one knows what such receptors are doing in these cells in the first place, but one theory has it that they signal cellular machinery to metabolize toxins.
The study compared the effect of BaP versus that of cigarette smoke extract, a substance representing all the ingredients in cigarette smoke. The hope was to confirm BaP as the specific cause of the observed effect on SOX-9. Results indeed suggest BaP alone may responsible for this specific mechanism of healing delay, since its effect was equal to the extract.
In addition measuring gene expression levels, researchers also conducted tests to show the effect of BaP visually. When newly differentiated cartilage cells begin to produce collagen in a culture dish, little mounds or nodules of collagen can be visualized using a stain. Staining experiments captured images showing BaP to "completely inhibit" collagen nodule deposition.
Along with O'Keefe, the Medical Center effort was led by Ming Kung, Donna Hoak, HsinChiu Ho, Edward Puzas and Michael Zuscik, all within the Department of Orthopaedics at the Medical Center.
"Smoking reduces the rate at which the two sides of a fracture come together," said Michael Zuscik, Ph.D., associate professor in the Department of Orthopaedics and Rehabilitation at the Medical Center. "We believe this new research will establish for the first time the mechanisms by which polyaromatic hydrocarbons interfere with the healing process."
(Source: Annual Meeting of the Orthopedic Research Society: Greg Williams: University of Rochester: March 2008)
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