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Mysterious severe right upper quadrant abdominal pain........please help

Posted in General clinical at Thu, 02 Jul 2015 07:08:18

Sofat

Posts: 10
Joined: 02 Jul 2015
I know of a 29 yo caucasian female of otherwise good health who developed acute,severe onset of right upper abdominal pain always localized to right under ribs as if gall bladder and occasional severe pain in back , most of the time nausea, vomiting occasionally.This individual has had this persistant pain for over two months now. Since her first visit to emergency dept. she has had an ultrasound,endoscopy, CAT scan, Hida Scan, MRI, blood work up with no indication that gallbladder,pancreas, stomach,intestine,kidney,liver is functioning abnormally. Finally a surgeon, is refering her to a gastro enterologist with much hesitation. He really was going to just abandon the whole problem and suggested to just manage the pain...that was his solution. To just have her continue on taking morphine....not even wanting to pursue the challenge of finding a solution.
She continues to suffer every minute of every day....
Does anyone out there know of a solution??
She desperately needs medical attention

What's your diagnosis? A teenager with a cough, fever and poor appetite

Posted in Respiratory medicine at Thu, 02 Jul 2015 08:49:20

Maxim

Posts: 447
Joined: 14 Dec 2010

The article below appeared in the Endgames section of the BMJ a few years ago. I'll post the answer in a few days.

A 14 year old girl presented to her local hospital with a three week history of progressively worsening cough, fever, and poor appetite, which had not responded to a week of oral antibiotics.

On examination she had a temperature of 38°C, was pale, not clubbed, and her oxygen saturations were 95% in air. There was a dull note on percussion, with reduced air entry on auscultation in the right upper zone of the chest, and no added sounds. The rest of the systemic examination was normal.

At admission, blood tests showed haemoglobin 109 g/L (reference range 105-135), white blood cell count 12.7×106 cells/L (6.0-18), neutrophils 7.65×106 cells/L (2.0-6.0), C reactive protein 33 mg/L (0-5), erythrocyte sedimentation rate 116 mm in the first hour (10). Chest radiography and computed tomography were performed (see below). She was started on intravenous antibiotics and transferred to a tertiary centre for further management.

What abnormality do the figures show and what is the best way to manage it. 

Any idea what placebo is?

Posted in General at Sat, 04 Jul 2015 09:21:59

sken

Posts: 999
Joined: 13 Oct 2009

Hi guys. I am a 16-year old student and one of my homework’s in science class is placebo effect. Can anyone tell me what it means please? I have been searching about it in the net and there are so many things that came out. I don’t know what it really means now. I would really appreciate your answers. Thank you so much.

It is time to break the silence on physician suicide.

Posted in News & media at Thu, 02 Jul 2015 13:05:58

sken

Posts: 999
Joined: 13 Oct 2009

There is an increasing trend of reports concerning doctors that committed suicide. (1,2)

Widespread corruption and wrongdoings involving the American Association of Addiction Medicine (ASAM) and Physician Health Programs (PHPs) have been denounced by different sources as a key factor involved in the abuse, hopelessness, and suicide of our colleagues.(3) ASAM and PHPs are coercing physicians into 12-steps recovery programs, an intervention not supported by the evidence, but "spiritual recovery" and irrational prescription of active pharmacological principles (e.g., suboxone).(4) The creation of "addiction medicine" as a medical specialty is also part of this problem and far away to be the solution.

One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come." ―Michael Lawrence Langan.(5)

I am concerned about the insufficient information about physician suicide in countries outside the United States (considering that there is also not enough information about this matter in the US). In Colombia, a statistical report by the national institute of legal medicine, reported eight cases of suicides of doctors and other healthcare professionals in 2011.(6) However, this report does not provide specific details about these eight cases of suicide. A more recent publication by the National Institute of Legal Medicine (2013) unfortunately does not report the number of suicides among doctors and other healthcare professionals in Colombia. I knew two colleagues in Colombia that committed suicide but the circumstances, motives, and predisposing factors remain hidden behind a wall of silence.      

If we continue keeping the silence involving the suicide of our colleagues, it will be very difficult for us to prevent  the suicide of our patients, as well as effectively supporting families suffering by the suicide of one of their loved ones.

References

1. Google News (search query: "physician suicide"): https://goo.gl/vp72Ub

2. Pamela Wibble. Physician suicide 101: Secrets, lies and solutions. 
http://www.kevinmd.com/blog/2014/11/physician-suicide-101-secrets-lies-solutions.html

3. Michael L. Langan. Category: Physician Suicide.
http://disruptedphysician.com/category/physician-suicide-2/

4. [(Chaos) x (Suboxone + J Addict Med + Am Soc Addict Med + Like Minded Docs + Addiction Medicine + Spiritual Interventions + 12 Step Recovery Programs + Drug Testing)]
http://disruptedphysician.com/2015/01/30/chaos-x-suboxone-j-addict-med-am-soc-addict-med-like-minded-docs-addiction-medicine-spiritual-interventions-12-step-recovery-programs-drug-testing/

5. Re: Drug policy: we need brave politicians and open minds BMJ 2014.
http://www.bmj.com/content/349/bmj.g7603/rr

6. Comportamiento del suicidio en Colombia, 2011. Instituto Nacional de Medicina Legal.
http://www.medicinalegal.gov.co/documents/10180/34616/6-F-11-Suicidio.pdf/6b2966e7-cbcb-4618-a3c3-af5cd111629e

IV Steroids May Help in Serious Community-Acquired Pneumonia

Posted in Respiratory medicine at Thu, 02 Jul 2015 18:19:02

Mukhtar Ali

Posts: 978
Joined: 14 Nov 2010

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Use of intravenous corticosteroids might lead to better outcomes among patients hospitalized with severe community-acquired pneumonia and high inflammatory responses, a JAMA study suggests.

Some 120 adults with severe pneumonia and C-reactive protein levels above 150 mg/L at admission were randomized to receive IV methylprednisolone (0.5 mg/kg every 12 hours) or placebo for 5 days, beginning within 36 hours of admission. All patients also received antibiotics.

The primary outcome — a composite of treatment failure endpoints — occurred less often with steroids versus placebo (13% vs. 31% of patients). This difference was due to a reduction in radiographic progression at 3–5 days with methylprednisolone. In-hospital mortality did not differ between the groups.

The authors write, "If replicated, these findings would support the use of corticosteroids as adjunctive treatment in this clinical population." An editorialist calls for a "definitive study ... to confirm that less radiographic progression does in fact lead to lower mortality."

Link(s):

JAMA article (Free abstract)

JAMA editorial (Subscription required)

Background: NEJM Journal Watch General Medicine summary on corticosteroids for uncomplicated pneumonia (Your NEJM Journal Watch registration required)

Victory Over Disease

Posted in News & media at Thu, 02 Jul 2015 17:53:23

Mukhtar Ali

Posts: 978
Joined: 14 Nov 2010

There were many victories achieved in 19th century. The first of these victories was won Against smallpox, a disease which at one time was so common that almost everyone was sure of getting it. In the more severe epidemics, one person out of three who contracted smallpox died of the disease. Those who recoveredwere often so severely disfigured that their faces were hardly human.Since smallpox was so common that people scarcely hoped to avoid itentirely, they hoped instead to have a mild case.Now, Neurologists are trying their best to achieve a remarkable advancement in the therapy of Type 1Diabetes, through retraining the patient`s immune system with a vaccine.

Follow the link for some details.

http://www.bbc.co.uk/news/health-23064897


Lung Ultrasound May Be Superior to Chest X-Ray for Diagnosing Pneumonia

Posted in Respiratory medicine at Thu, 02 Jul 2015 07:22:47

Sofat

Posts: 10
Joined: 02 Jul 2015

Daniel J. Pallin, MD, MPH reviewing Nazerian P et al. Am J Emerg Med 2015 May.

With CT as the gold standard, bedside ultrasound was more sensitive than x-ray for pneumonia in ED patients.

Lung ultrasound can detect pneumothorax and pulmonary edema, but limited data exist to quantify its accuracy for diagnosing pneumonia. In a prospective study, investigators compared lung ultrasound to chest computed tomography (CT) and chest x-ray among adult patients presenting with unexplained respiratory symptoms to an academic emergency department in Italy.CT served as the gold standard for diagnosis of an infiltrate consistent with pneumonia. Patients were enrolled when a CT scan was planned. Bedside lung ultrasound was performed within 3 hours of the CT scan by either emergency physicians or internists, and chest x-ray was performed at the discretion of the treating physician.During the 8-month study period, 285 patients underwent CT and ultrasound, and, of these, 190 also had a chest x-ray. Chest CT was positive for pneumonia in 87 patients. Sensitivity for diagnosing pneumonia was significantly higher with ultrasound than x-ray (81% vs. 64%), while specificities were statistically similar (94% and 90%)

 

A Vaccine for Lung Cancer?

Posted in Respiratory medicine at Thu, 02 Jul 2015 07:23:54

Sofat

Posts: 10
Joined: 02 Jul 2015

Looks like Cuba, famous for its cigars, develloped a vaccine for lung cancer. 

http://www.wired.com/2015/05/cimavax-roswell-park-cancer-institute/

The vaccine is called Cimavax, and is on its way to get FDAs approval. 
It promises to stop cancer growth with a a protein, the epidermal growth factor (EGF), which stimulates the growth of cells, naturally found in the body, but cancerous tumors stimulate the body produce too much of. This causes the tumor to multiply and grow. Once vaccinated, EGF, and other compounds encourages the immune system to produce antibodies against EGF. This prevents tumors from getting bigger, but doesn't directly attack them.

Sounds promising?

Has the legal system gone bananas?

Posted in General clinical at Sat, 04 Jul 2015 00:14:10

DuaneF

Posts: 1544
Joined: 09 Dec 2011

In the news there is a story that religious views can trump medical opinion. This decision has been looming in the sidelines for some time and has profound implications for our use of emergency medical services and ITU beds. It is somewhat contrary to a previous test case.

 The court accepted that the patient was devoutly religious - and this meant he might be "predestined" to suffer until the end of his life. In his ruling the judge strongly believed that life was sacred, given by God and could only be taken away by God. 

The judge felt that the patient had powerful wishes and feelings which were well expressed and which should not be supplanted or substituted by anyone else's view."

Note this is a patient who is an minimal conscious state and has had a cardiac arrest - some might say the almighty has already expressed a view - and a decision to discontinue after brain stem death could still be overruled on this verdict.

Med school finals sample question from OnExamination: Amiodarone for AF

Posted in Finals help! at Sat, 04 Jul 2015 10:08:51

pramila

Posts: 44
Joined: 11 Feb 2009

A 68-year-old man is started on amiodarone for atrial fibrillation.

Prior to starting the drug his GP sends him for some baseline tests including liver and renal function and a chest x ray.

A splenic lesion

Posted in Radiology at Sat, 04 Jul 2015 10:06:29

pramila

Posts: 44
Joined: 11 Feb 2009

An often seen splenic condition. What is it?

NaCl - The hidden enemy

Posted in Public health at Thu, 02 Jul 2015 07:14:30

Sofat

Posts: 10
Joined: 02 Jul 2015

A hot day and somewhat thirsty. Reached for a bottle of low alcohol cider. Idly read the label : 10% of the recommended salt intake included. Worse still the stuff tasted salty……. Must go back to my alcohol free beer (virtually NaCl free) or if all else fails try water.

world´s oldest doctoral student

Posted in Public health at Thu, 02 Jul 2015 07:16:39

Sofat

Posts: 10
Joined: 02 Jul 2015

Denied by Nazis, world´s oldest doctoral student awarded her PhD- aged 102

 

This amazing lady, who was a leading child neotatologist in the GDR, has finally been allowed to claim her title ist now – after passing exams etc !- a doctor of Hamburg university.

Her thesis, which was refused back then in the Dark Ages, was about diphtheria

Never give up!

  • My congratulations !

 

http://gu.com/p/49jfj

Where do you think morphine comes from?

Posted in Anaesthesia at Fri, 03 Jul 2015 14:36:58

DuaneF

Posts: 1544
Joined: 09 Dec 2011

I have to admit that, even as an anesthetist, I've not asked this question before.    I've wondered if we could offer to buy all the output from Afghanistan, and cut out the Bad Men, but I suppose that's fantasy.  So I was a bit surprised to see in my daily paper a picture of the opium poppy fields - in Blandford Forum, Dorset!

I can't find the pic on the Guardian website, so I must send you to another, equally reliable source - the Daily Mail:  http://www.dailymail.co.uk/news/article-2003904/No-isnt-Afghanistan-Stunning-field-opium-poppies-actually-DORSET.html

The estate of the Tory MP Richard Drax has been licenced by the Home Office to grow opium poppy.    The crop from this estate will supply half the UKs national needs!

Somehow, I feel, priorities are wrong.

John

On the estate of Tory MP

SSHHH...KEEP IT DOWN, The Patient Is Listening, Doctor!

Posted in General clinical at Thu, 02 Jul 2015 03:40:26

ahyperdoc

Posts: 24
Joined: 13 Nov 2014

Virginia, USA. — From the moment he went under, the wisecracks began.

A Virginia (USA) man was awarded $500,000 (~£318,000 or ~450,000 EUR)  in court after being mocked about his masculinity and insulted by an anesthesiologist during a colonoscopy in 2013. The Washington Post reports the Fairfax County jury ordered a 42-year-old anesthesiologist and her practice to pay the man after a three-day trial last week.

Officials say the man, who wanted to remain anonymous, recorded the incident in April 2013 while being prepped for the procedure to capture the doctor’s post-operation instructions. But when he listened to the recording on his way home, he discovered that he had recorded the entire examination and that the doctor and the rest of the surgical team had insulted and mocked him once he fell asleep.

The defendant was recorded saying to the sedated patient that “after five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit.” When a medical assistant noted the man had a rash, the anesthesiologist warned her not to touch it, saying she might get “some syphilis on your arm or something,” then added, “It’s probably tuberculosis in the penis, so you’ll be all right.”

The lawsuit states the recording captured the defendant mocking the amount of anesthetic needed to sedate the man and a  48-year-old gastroenterologist, commented that another doctor they both knew “would eat him for lunch.” The gastroenterologist, who performed the colonoscopy, was dismissed from the case. The procedure took place at a large medical suite in Virginia.

The jury awarded the man $100,000 for defamation – $50,000 each for the comments about the man having syphilis and tuberculosis – and $200,000 for medical malpractice, as well as the $200,000 in punitive damages.

[Copyright ©2015 The Washington Post and The Associated Press. All Rights Reserved. And used by permission]

FULL ARTICLE:
http://washington.cbslocal.com/2015/06/24/jury-awards-patient-500k-after-anesthesiologist-mocked-him/

Certainly there are some lessons to be learned with this case and/or reinforced. During my EM residency and while rotating through surgery we had both a chief surgeon and one of our surgical fellows get in some big trouble when they forgot that the patient was having a BKA while given an epidural w/o any general anesthesia but maybe just light sedation. So the two joked about the patient and his family and even the patient's children. Needless to say the outcome was NOT a smooth one for the two surgeons who were both suspended and eventually lost hospital privlidges.

Especially with the micro-technical devices we all have today, it pays to STOP this childish and unprofessional behavior on any patient. Ask yourself how much YOU would like it if being mocked/insulted while under the trust of other human beings.

Will you stop this practice of talking about YOUR patient(s) while under the knife? Why? Why Not?

Comments? Opinions? Complaints?

WHO Says Certain Insecticides and Herbicides Tied to Cancer

Posted in Public health at Thu, 02 Jul 2015 07:12:51

Sofat

Posts: 10
Joined: 02 Jul 2015

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

 

The World Health Organization's International Agency for Research on Cancer has determined that two insecticides and one herbicide cause cancer — or may cause cancer — in humans. After reviewing recent studies, the group announced the following:

 

  • The insecticide gamma-hexachlorocyclohexane (lindane) is carcinogenic to humans, given the 60% increased risk for non-Hodgkin lymphoma (NHL) observed in epidemiologic studies. Most countries already ban or restrict use of lindane.
  • The insecticide dichlorodiphenyltrichloroethane (DDT) is probably carcinogenic to humans. This is based on sufficient evidence of carcinogenicity in animals and limited evidence in humans. Epidemiologic studies have found increased risk for NHL and testicular and liver cancers. DDT was largely banned in the 1970s, but the insecticide still persists in the environment.
  • The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is possibly carcinogenic, given limited evidence in animals and insufficient evidence in humans. Epidemiologic studies have not found an association with cancer, but some research has shown that the herbicide could induce oxidative stress and cause immunosuppression.

 

IARC news release (Free PDF)

 

When should we be silent?

Posted in BMJ at Sun, 05 Jul 2015 09:53:46

sken

Posts: 999
Joined: 13 Oct 2009

This is not a clinical post but I had been wondering about the national minute's silence  for the dead Tunisian tourists , which I only heard about in retrospect. I then saw an article in the Guardian and realised I was not alone in this. 

Certain catastrophic events - of the type that perhaps only occur once or twice in a lifetime or in the course of a century - warrant a general public recognition of this type. But beyond that they seem inappropriate - at private functions of course they may well be in order. 

One of my objections is that we introduce a competitive element but we also belittle those very special occasions  relating to times of real national significance. Tragic as the events have been I cannot see that the death of tourists , which will happen from time to time , is a cause for this type of national expression. But then I felt the overwhelming outpouring of "grief" after the  death of Princess Diana was also singularly inappropriate. At that time one was at risk of being lynched if one commented about the event in any form of rational perspective.These events are sad but we should not mark them in the same way as those surrounding WW1 and 2.

These tourists were not war heroes so why treat them as such - politacal milage seems inappropriate. If we are to have a minute's silence for victims of the actions of deranged individuals , perhaps we should have done jut that for the victims of Harold Shipman?

 

Costs to be printed on prescriptions - Genius or disaster?

Posted in General clinical at Fri, 03 Jul 2015 14:41:48

John D

Posts: 3606
Joined: 01 Feb 2010

I've been reading & thinking about this new plan to print the cost of a medication (if above £20) on a prescription. And I wonder what people's thoughts are? The rationale seems to be to make patients aware of this when ordering unnecessary repeats or wasting scripts. http://m.bbc.co.uk/news/health-33345356

i can see a number of arguments both ways:

pros: 

  • Patients may be more thoughtful when placing repeat orders
  • People may become more aware of the cost of the NHS & realise how good a deal they are getting 
  • If it was done for all items, then for items that are cheaper over the counter (like paracetamol) those who pay prescription charges may stop doing so 
  • might make GPs more conscious of drug costs & prompt them to reconsider cheaper equivalents

Cons:

  • Potential for patients to sell on their spare medications creating a black market for prescription drugs
  • Generating a belief culture that "I'm on a cheaper drug than my friend with same condition so I'm not as valued/it can't possibly work as well as more expensive drugs"

Would love to hear people's thoughts and other pros and cons

New Scientist? Or Daily Mail?

Posted in General clinical at Fri, 03 Jul 2015 18:51:16

sken

Posts: 999
Joined: 13 Oct 2009

Chronic Fatigue Syndrome, Myalgic Encephalitis, Yuppy Flu are all names for a strange collection of symptoms including muscular fatigue, depression, tiredness and malaise.     All subjective, and the disease, if it is one, has been the subject of several 'breakthrough cures", especially in the popular press.    The latest is basd on a theory of persistent immune response to a previous infection, NOT murine leukemia virus, mediated by B-cells that have the immune role of secreting antibodies.  Rituimab wipes out B-cells and is supposed to stop the bad antibody secretion, which sounds like treatment that risks other infections in this immune deficient state.

This study: http://www.ncbi.nlm.nih.gov/pubmed/26132314  "B-Lymphocyte Depletion in Myalgic Encephalopathy/ Chronic Fatigue Syndrome. An Open-Label Phase II Study with Rituximab Maintenance Treatment."  treated 29 patients with rituximab, with no control group, and no blinding, and has been hailed in no less august a journal as the New Scientist  as "hope of a breakthrough", in an article and an Editorial that goes on to suggest that this has "implications" for conditions with no apparent cause such as "Morgellons" (things in the skin).

  They should know better - and they do.   The article concludes with the statement that a 150 patient study will follow, including a control group.  I just hope they bother to blind patients and investigators as well.

John

 

 

Happy 4th Of July to All Doc to Doc Members...

Posted in General clinical at Sat, 04 Jul 2015 15:16:31

DuaneF

Posts: 1544
Joined: 09 Dec 2011

Happy 4th of July to all Doc to Doc Members.   I post this at 8:15 the night of the 3rd, and hope everyone has a great 4th of July.   This Great day,  America became a Nation,  and cast off the Iron Mantle of English Oppression, declaring her independence.   In all the world there is no Nation like America,  we are a melting pot of the best that the world has to offer,  the many faceted skill sets,  and cultures give The United States a unique Flavor for the world to to appreciate.   There are many unique countries, but none like America,  the great experiment,  from Sea to shining sea.

DuaneF

Any reason not to retract?

Posted in Anaesthesia at Sat, 04 Jul 2015 00:29:59

Jorge Ramirez

Posts: 15
Joined: 09 Jan 2015

The effect of dabigatran plasma concentrations and patient characteristics on the frequency of ischemic stroke and major bleeding in atrial fibrillation patients: the RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy). J Am Coll Cardiol. 2014 Feb 4;63(4):321-8. doi: 10.1016/j.jacc.2013.07.104. Epub 2013 Sep 27.

This question thread is also open via:

- ResearchGate: 
https://www.researchgate.net/post/Any_reason_not_to_retract2#55971fe961432591358b45da [accessed Jul 3, 2015].

- Twitter:
https://twitter.com/Jor_H_R/status/617108041620672512

I previously requested (2014) four retractions of publications of the RE-LY trial:

- New England Journal of Medicine (n=1): No response.

- Lancet (n=2): Refused to retract the two publications of the RE-LY study (without explaining their decision).

- Heart (n=1): no answers yet.

I have also requested the retraction of a clinical practice guideline concerning acute coronary events and a pharmacoeconomic evaluation of dabigatran and rivaroxaban (Colombia).

References

1. Dabigatran Investigation. http://www.bmj.com/investigation/dabigatran. The BMJ 2014.

2.  Re: Concerns over data in key dabigatran trial. http://www.bmj.com/content/349/bmj.g4747/rr/778288

3. A message to people responsible for abandoned or misreported trials: you will be published or retracted.
http://www.bmj.com/content/346/bmj.f2865/rr

4. Should doctors use Twitter? http://bit.ly/1GV7yHj doc2doc.

--

P.S. I apologize for my mistake of posting this question on the wrong category (i.e., open anesthesiology - I cannot edit the category of the question).

More 'hope' for patients, but this time it's valid.

Posted in General clinical at Fri, 03 Jul 2015 12:44:59

John D

Posts: 3606
Joined: 01 Feb 2010

Following the recent "hope" reports on a trial of treatment for chronic fatigue http://doc2doc.bmj.com/forums/open-clinical_general-clinical_new-scientist-daily-mail today the media havevalatched onot another small study, this time of gene therapy in Cystic Fibrosis.  http://www.thelancet.com/pb/assets/raw/Lancet/pdfs/S2213260015002453.pdf   But this time the still small trial of 140 people was properly randomised,  double-blinded and controlled.   And the results are treated cautiously, even by the Imperial College investigators, who say that the improvement in FEV1 after a year is a "significant, albeit modest".   In fact as they obviously feel proud to say, this was "The data reported here provide the first proof of concept that repeated administration of non-viral CFTR gene therapy can safely change clinically relevant parameters, providing another step along the path of translational cystic fibrosis gene therapy."

So, hope!

 

John

individualized type 2 diabetes education program on clinical outcomes during Ramadan

Posted in Diabetes at Fri, 03 Jul 2015 16:56:00

diabetesMD

Posts: 741
Joined: 15 Apr 2011

Impact of an individualized type 2 diabetes education program on clinical outcomes during Ramadan

BMJ Open Diab Res Care 2015;3:e000111 doi:10.1136/bmjdrc-2015-000111

Verbatim Abstract

Objective To determine if individualized education before Ramadan results in a safer fast for people with type 2 diabetes.

Methods Patients with type 2 diabetes who received care from participating clinics in Egypt, Iran, Jordan and Saudi Arabia and intended to fast during Ramadan 2014 were prospectively studied. Twelve clinics participated. Individualized education addressed meal planning, physical activity, blood glucose monitoring and acute metabolic complications and when deemed necessary, provided an individualized diabetes treatment plan.

Results 774 people met study criteria, 515 received individualized education and 259 received usual care. Those who received individualized education were more likely to modify their diabetes treatment plan during Ramadan (97% vs 88%, p<0.0001), to perform self-monitoring of blood glucose at least twice daily during Ramadan (70% vs 51%, p<0.0001), and to have improved knowledge about hypoglycemic signs and symptoms (p=0.0007). Those who received individualized education also reduced their body mass index (−1.1±2.4 kg/m2 vs −0.2±1.7 kg/m2, p<0.0001) and glycated haemoglobin (−0.7±1.1% vs −0.1±1.3%, p<0.0001) during Ramadan compared those who received usual care. There were more mild (77% vs 67%, p=0.0031) and moderate (38% vs 19%, p<0.0001) hypoglycemic events reported by participants who received individualized education than those who received usual care, but fewer reported severe hypoglycemic events during Ramadan (23% vs 34%, p=0.0017).

Conclusions This individualized education and diabetes treatment program helped patients with type 2 diabetes lose weight, improve glycemic control and achieve a safer fast during Ramadan.

COMMENT:  While the results are unsurprising, they are nevertheless a significant contribution to our understanding of the role in individualized patient education in preventing diabetes adverse events during the religious fasting associated with observation of Ramadan.  Whereas the data were collected in clinics in Muslim countries, the results may be most useful in non-Muslim countries where physicians may be less familiar with the rituals of Ramadan and their potential risks to persons with diabetes.

 

Heartthrobs and Rosacea

Posted in Public health at Sat, 04 Jul 2015 15:54:32

Mukhtar Ali

Posts: 978
Joined: 14 Nov 2010

 

Industry 'must do more' to Improve Urinary Catheters

Posted in Public health at Sat, 04 Jul 2015 15:36:35

Mukhtar Ali

Posts: 978
Joined: 14 Nov 2010

A leading researcher says industry must "wake up and invest more" in urinary catheters.

Mandy Fader, professor of continence technology at the University of Southampton, says their design has changed "very little" in 80 years.

http://www.bbc.com/news/health-33270030