My eye doctor, Evan Wolf, MD, PhD was telling me that I had bad eys with lots of complications. I told him my sugar was better, at 5.7 and I said I was hoping that my eyes had improved and he said "We'll see". So he sits down and shines that bright light in my eye so he can look deep inside and he says, "I can't believe this, all the damage you had, is completely gone! It's like you have new eyes. I've NEVER seen that happen before. He was so excited!!
I did have to get a new prescription though, cause now I need a magnifier for up close, no glasses for the tv or computer and then something for far away if I"m driving.
And he took me off the Acetazolamide. The only med I have to take is the Synthroid.
Good news
Cindy T
Alaska
Friday, October 30, 2009
Sunday, October 25, 2009
http://ping.fm/hOojs
Lap Band Less Effective than Stomach Stapling 3
Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial
Level I Evidence: The Lap Band is inferior to the old stomach stapling
Lap Band Less Effective than Stomach Stapling 3
Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial
Level I Evidence: The Lap Band is inferior to the old stomach stapling
Saturday, October 24, 2009
http://ping.fm/qlJV6
Lap Band worse than stomach stapling.
Controlled prospective trial shows the old stomach stapling is better than the band!
;-(
Lap Band worse than stomach stapling.
Controlled prospective trial shows the old stomach stapling is better than the band!
;-(
Wednesday, October 21, 2009
Dr. Rutledge,
Like some of the people I have seen on your videos on you tube, I found your name after typing in failed lap-band. I have had my band for 3 years after I let myself be talked into it by my best friend. The vomiting is awful and has almost put a complete stop to my life for weeks on end as I try to get things under control time and time again. My question is do you ever just remove a lap band without doing the MGB surgery? I feel as though I am done with this and am slowly losing my mind as well as my health.
Thank you and thank you for this site which makes me feel not so alone.
J
Like some of the people I have seen on your videos on you tube, I found your name after typing in failed lap-band. I have had my band for 3 years after I let myself be talked into it by my best friend. The vomiting is awful and has almost put a complete stop to my life for weeks on end as I try to get things under control time and time again. My question is do you ever just remove a lap band without doing the MGB surgery? I feel as though I am done with this and am slowly losing my mind as well as my health.
Thank you and thank you for this site which makes me feel not so alone.
J
The Comparative Dose-Response Effects of Melatonin and Midazolam for Premedication of Adult Patients: A Double-Blinded, Placebo-Controlled Study
Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD*, and Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI{dagger}
Departments of Anesthesia, *University of Iowa College of Medicine, Iowa City, Iowa, and {dagger}King Saud University, Riyadh, Saudi Arabia
Address correspondence and reprint requests to Mohamed Naguib, MD, University of Iowa College of Medicine, Department of Anesthesia, 200 Hawkins Dr., 6JCP, Iowa City, Iowa 52242-1009. Address e-mail to mohamed-naguib@uiowa.edu.
We designed this prospective, randomized, double-blinded, placebo-controlled study to compare the perioperative effects of different doses of melatonin and midazolam.
Doses of 0.05, 0.1, or 0.2 mg/kg sublingual midazolam or melatonin or placebo were given to 84 women, approximately 100 min before a standard anesthetic.
Sedation, anxiety, and orientation were quantified before, 10, 30, 60, and 90 min after premedication, and 15, 30, 60, and 90 min after admission to the recovery room.
Psychomotor performance of the patient was evaluated at these times also, by using the digit-symbol substitution test and Trieger dot test.
Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation preoperatively compared with control subjects.
Patients in the three midazolam groups experienced significant psychomotor impairment in the preoperative period compared with melatonin or placebo.
After operation, patients who received 0.2 mg/kg midazolam premedication had increased levels of sedation at 90 min compared with 0.05 and 0.1 mg/kg melatonin groups. In addition, patients in the three midazolam groups had impairment of performance on the digit-symbol substitution test at all times compared with the 0.05 mg/kg melatonin group.
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
Implications:
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
Mohamed Naguib, MB, BCh, MSc, FFARCSI, MD*, and Abdulhamid H. Samarkandi, MB, BS, KSUF, FFARCSI{dagger}
Departments of Anesthesia, *University of Iowa College of Medicine, Iowa City, Iowa, and {dagger}King Saud University, Riyadh, Saudi Arabia
Address correspondence and reprint requests to Mohamed Naguib, MD, University of Iowa College of Medicine, Department of Anesthesia, 200 Hawkins Dr., 6JCP, Iowa City, Iowa 52242-1009. Address e-mail to mohamed-naguib@uiowa.edu.
We designed this prospective, randomized, double-blinded, placebo-controlled study to compare the perioperative effects of different doses of melatonin and midazolam.
Doses of 0.05, 0.1, or 0.2 mg/kg sublingual midazolam or melatonin or placebo were given to 84 women, approximately 100 min before a standard anesthetic.
Sedation, anxiety, and orientation were quantified before, 10, 30, 60, and 90 min after premedication, and 15, 30, 60, and 90 min after admission to the recovery room.
Psychomotor performance of the patient was evaluated at these times also, by using the digit-symbol substitution test and Trieger dot test.
Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation preoperatively compared with control subjects.
Patients in the three midazolam groups experienced significant psychomotor impairment in the preoperative period compared with melatonin or placebo.
After operation, patients who received 0.2 mg/kg midazolam premedication had increased levels of sedation at 90 min compared with 0.05 and 0.1 mg/kg melatonin groups. In addition, patients in the three midazolam groups had impairment of performance on the digit-symbol substitution test at all times compared with the 0.05 mg/kg melatonin group.
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
Implications:
Premedication with 0.05 mg/kg melatonin was associated with preoperative anxiolysis and sedation without impairment of cognitive and psychomotor skills or affecting the quality of recovery.
http://sites.google.com/a/clos.net/mini/melatonin
Melatonin
Anesth Analg 2007; 105:1263-1271
© 2007 International Anesthesia Research Society
ANESTHETIC PHARMACOLOGY
The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy
Wolnei Caumo, MD, PhD*{dagger}, Fernanda Torres, MSc{ddagger}, Nívio L. Moreira, Jr, MD§, Jorge A. S. Auzani, MD§, Cristiano A. Monteiro, MD§, Gustavo Londero, MD§, Diego F. M. Ribeiro||, and Maria Paz L. Hidalgo, MD, PhD||
From the *Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); {dagger}Instituto de Ciências Bsicas da Saúde, Pharmacology Department, UFRGS; {ddagger}Multidisciplinary Group of Development of Biological Rhythms of Universidade de São Paulo; §Registrar of Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); ||Psychiatric Service of Hospital Materno Infantil Presidente Vargas, Hospital de Clínicas de Porto Alegre (HCPA); and ¶Hospital de Clínicas de Porto Alegre (HCPA), Psychiatric Department of School of Medicine, UFRGS, Brazil.
Address correspondence and reprint requests to Dr. Maria Paz Loayza Hidalgo, Castro Alves 167 sala 204, CEP 90430-131 – Porto Alegre, RS, Brazil. Address e-mail to mpaz@cpovo.net.
BACKGROUND: Melatonin has sedative, analgesic, antiinflammatory, antioxidative, and chronobiotic effects. We determined the impact of oral melatonin premedication on anxiolysis, analgesia, and the potency of the rest/activity circadian rhythm.
METHODS: This randomized, double-blind, placebo-controlled study included 33 patients, ASA physical status I–II, undergoing abdominal hysterectomy.
Patients were randomly assigned to receive either oral melatonin 5 mg (n = 17) or placebo (n = 16) the night before and 1 h before surgery.
The analysis instruments were the Visual Analog Scale, the State-Trait Anxiety Inventory, and the actigraphy.
RESULTS:
The number of patients that needed to be treated to prevent one additional patient reporting high postoperative anxiety and moderate to intense pain in the first 24 postoperative hours was 2.53 (95% CI, 1.41–12.22) and 2.20 (95% CI, 1.26–8.58), respectively.
The number-needed-to-treat was 3 (95% CI, 1.35–5.0) to prevent high postoperative anxiety in patients with moderate to intense pain, when compared with 7.5 (95% CI, 1.36–{infty}) in the absence of pain or mild pain.
Also, the treated patients required less morphine by patient-controlled analgesia, as assessed by repeated measures ANOVA (F[1,31] = 6.05, P = 0.02).
The rest/activity cycle, assessed by actigraphy, showed that the rhythmicity percentual of 24 h was higher in the intervention group in the first week after discharge ([21.16 ± 8.90] versus placebo [14.00 ± 7.10]; [t = –2.41, P = 0.02]).
CONCLUSIONS: This finding suggested that
*** preoperative melatonin produced clinically relevant
*** anxiolytic and analgesic effects,
*** especially in the first 24 postoperative hours.
Also, it improved the recovery of the potency of the rest/activity circadian rhythm.
Melatonin
Anesth Analg 2007; 105:1263-1271
© 2007 International Anesthesia Research Society
ANESTHETIC PHARMACOLOGY
The Clinical Impact of Preoperative Melatonin on Postoperative Outcomes in Patients Undergoing Abdominal Hysterectomy
Wolnei Caumo, MD, PhD*{dagger}, Fernanda Torres, MSc{ddagger}, Nívio L. Moreira, Jr, MD§, Jorge A. S. Auzani, MD§, Cristiano A. Monteiro, MD§, Gustavo Londero, MD§, Diego F. M. Ribeiro||, and Maria Paz L. Hidalgo, MD, PhD||
From the *Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); {dagger}Instituto de Ciências Bsicas da Saúde, Pharmacology Department, UFRGS; {ddagger}Multidisciplinary Group of Development of Biological Rhythms of Universidade de São Paulo; §Registrar of Anesthesia Service and Perioperative Medicine at Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS); ||Psychiatric Service of Hospital Materno Infantil Presidente Vargas, Hospital de Clínicas de Porto Alegre (HCPA); and ¶Hospital de Clínicas de Porto Alegre (HCPA), Psychiatric Department of School of Medicine, UFRGS, Brazil.
Address correspondence and reprint requests to Dr. Maria Paz Loayza Hidalgo, Castro Alves 167 sala 204, CEP 90430-131 – Porto Alegre, RS, Brazil. Address e-mail to mpaz@cpovo.net.
BACKGROUND: Melatonin has sedative, analgesic, antiinflammatory, antioxidative, and chronobiotic effects. We determined the impact of oral melatonin premedication on anxiolysis, analgesia, and the potency of the rest/activity circadian rhythm.
METHODS: This randomized, double-blind, placebo-controlled study included 33 patients, ASA physical status I–II, undergoing abdominal hysterectomy.
Patients were randomly assigned to receive either oral melatonin 5 mg (n = 17) or placebo (n = 16) the night before and 1 h before surgery.
The analysis instruments were the Visual Analog Scale, the State-Trait Anxiety Inventory, and the actigraphy.
RESULTS:
The number of patients that needed to be treated to prevent one additional patient reporting high postoperative anxiety and moderate to intense pain in the first 24 postoperative hours was 2.53 (95% CI, 1.41–12.22) and 2.20 (95% CI, 1.26–8.58), respectively.
The number-needed-to-treat was 3 (95% CI, 1.35–5.0) to prevent high postoperative anxiety in patients with moderate to intense pain, when compared with 7.5 (95% CI, 1.36–{infty}) in the absence of pain or mild pain.
Also, the treated patients required less morphine by patient-controlled analgesia, as assessed by repeated measures ANOVA (F[1,31] = 6.05, P = 0.02).
The rest/activity cycle, assessed by actigraphy, showed that the rhythmicity percentual of 24 h was higher in the intervention group in the first week after discharge ([21.16 ± 8.90] versus placebo [14.00 ± 7.10]; [t = –2.41, P = 0.02]).
CONCLUSIONS: This finding suggested that
*** preoperative melatonin produced clinically relevant
*** anxiolytic and analgesic effects,
*** especially in the first 24 postoperative hours.
Also, it improved the recovery of the potency of the rest/activity circadian rhythm.
Monday, October 19, 2009
http://sites.google.com/a/clos.net/mini/lap-band-less-effective-than-stomach-stapling
Lap Band Less Effective than Stomach Stapling
The Lap Band is advertised as an attractive choice for weight loss. A recent controlled prospective randomized trial shows that the LapBand is not as good as the abandoned "Stomach Stapling!"
Obes Surg. 2009 Aug;19(8):1108-15. Epub 2009 Jun 10.Click here to read Links
Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial.
Scozzari G, Farinella E, Bonnet G, Toppino M, Morino M.
Digestive Surgery and Center for Minimal Invasive Surgery, Department of Surgery, University of Turin, C.so A.M. Dogliotti 14, 10126, Turin, Italy.
BACKGROUND: Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.
METHODS: A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years.
RESULTS: Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05).
Late complication rates were
36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05),
46.9% vs 43.1% at 5 years (NS), and
55.1% vs 47.1% at 7 years (NS).
Late reoperation rates were
28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001),
38.8% and 2.0% at 5 years (p<0.001), and
46.9% and 7.8% at 7 years (p<0.001).
Excess weight loss in LASGBs was
41.8% at 3 years,
33.2% at 5 years, and
29.9% at 7 years;
excess weight loss in LVBGs was
60.9%,
57%, and
53.1%, respectively (p<0.05).
CONCLUSIONS:
This study demonstrates that
LVBG is significantly more effective than LASGB in terms of
late complications,
late reoperations, and
long-term results on weight loss.
http://sites.google.com/a/clos.net/mini/lap-band-less-effective-than-stomach-stapling
--
Dr. Rutledge
Email: DrR@clos.net
Private Cell Phone 702-215-9550
On the Web=> www.CLOS.Net
Lap Band Less Effective than Stomach Stapling
The Lap Band is advertised as an attractive choice for weight loss. A recent controlled prospective randomized trial shows that the LapBand is not as good as the abandoned "Stomach Stapling!"
Obes Surg. 2009 Aug;19(8):1108-15. Epub 2009 Jun 10.Click here to read Links
Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial.
Scozzari G, Farinella E, Bonnet G, Toppino M, Morino M.
Digestive Surgery and Center for Minimal Invasive Surgery, Department of Surgery, University of Turin, C.so A.M. Dogliotti 14, 10126, Turin, Italy.
BACKGROUND: Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity.
METHODS: A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years.
RESULTS: Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05).
Late complication rates were
36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05),
46.9% vs 43.1% at 5 years (NS), and
55.1% vs 47.1% at 7 years (NS).
Late reoperation rates were
28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001),
38.8% and 2.0% at 5 years (p<0.001), and
46.9% and 7.8% at 7 years (p<0.001).
Excess weight loss in LASGBs was
41.8% at 3 years,
33.2% at 5 years, and
29.9% at 7 years;
excess weight loss in LVBGs was
60.9%,
57%, and
53.1%, respectively (p<0.05).
CONCLUSIONS:
This study demonstrates that
LVBG is significantly more effective than LASGB in terms of
late complications,
late reoperations, and
long-term results on weight loss.
http://sites.google.com/a/clos.net/mini/lap-band-less-effective-than-stomach-stapling
--
Dr. Rutledge
Email: DrR@clos.net
Private Cell Phone 702-215-9550
On the Web=> www.CLOS.Net
http://sites.google.com/a/clos.net/mini/increased-need-for-hospitalization-after-rny-gastric-bypass
Increased Need for Hospitalization after RNY Gastric Bypass
Unbiased Study shows RNY Gastric Bypass Increases Need for Hospitalization after gastric bypass surgery Primarily because of Complications
The rate of hospitalization in the year AFTER RNY was more than double the rate in the year preceding RNY (19% vs 8%, P<.001).
JAMA. 2005 Oct 19;294(15):1918-24.Click here to read Links
Comment in:
JAMA. 2005 Oct 19;294(15):1960-3.
JAMA. 2006 May 24;295(20):2355-6; author reply 2356.
Hospitalization before and after gastric bypass surgery.
Zingmond DS, McGory ML, Ko CY.
Division of General Internal Medicine and Health Services Research, Department of Medicine, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles 90095-1736, USA. dzingmond@mednet.ucla.edu
CONTEXT:
The use of Roux-en-Y gastric bypass (RYGB) has been reported to be effective in the treatment of obesity and its related comorbidities.
Need for Hospitalization after RYGB is less well understood.
OBJECTIVE:
To determine the rates and indications for inpatient hospital use before and after RYGB.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of Californians receiving RYGB in California hospitals from 1995 to 2004.
MAIN OUTCOME MEASURE: Hospitalization in the 1 to 3 years after RYGB.
RESULTS: In California from 1995 to 2004, 60,077 patients underwent RYGB-11,659 in 2004 alone.
The rate of hospitalization in the year following RYGB was more than double the rate in the year preceding RYGB (19.3% vs 7.9%, P<.001).
Furthermore, in the subset of patients (n = 24,678) with full 3-year follow-up,
a mean of 8.4% were admitted a year before RYGB
while 20.2% were readmitted in the year after RYGB,
18.4% in the second year after RYGB, and
14.9% in the third year after RYGB.
** The most common reasons for admission prior to RYGB were obesity-related problems (eg, osteoarthritis, lower extremity cellulitis), and elective operation (eg, hysterectomy),
** while the most common reasons for admission after RYGB were complications procedure related,
such as ventral hernia repair and gastric revision.
In multivariate logistic regression models predicting 1-year readmission after RYGB, increasing Charlson Comorbidity Index score, and hospitalization in the 3-year period prior to RYGB were significantly associated with readmission within a year.
CONCLUSIONS: Increases in hospital use after surgery appear to be related to RYGB. Payers, clinicians, and patients must consider the not-inconsequential rate of rehospitalization after this type of surgery.
Increased Need for Hospitalization after RNY Gastric Bypass
Unbiased Study shows RNY Gastric Bypass Increases Need for Hospitalization after gastric bypass surgery Primarily because of Complications
The rate of hospitalization in the year AFTER RNY was more than double the rate in the year preceding RNY (19% vs 8%, P<.001).
JAMA. 2005 Oct 19;294(15):1918-24.Click here to read Links
Comment in:
JAMA. 2005 Oct 19;294(15):1960-3.
JAMA. 2006 May 24;295(20):2355-6; author reply 2356.
Hospitalization before and after gastric bypass surgery.
Zingmond DS, McGory ML, Ko CY.
Division of General Internal Medicine and Health Services Research, Department of Medicine, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles 90095-1736, USA. dzingmond@mednet.ucla.edu
CONTEXT:
The use of Roux-en-Y gastric bypass (RYGB) has been reported to be effective in the treatment of obesity and its related comorbidities.
Need for Hospitalization after RYGB is less well understood.
OBJECTIVE:
To determine the rates and indications for inpatient hospital use before and after RYGB.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of Californians receiving RYGB in California hospitals from 1995 to 2004.
MAIN OUTCOME MEASURE: Hospitalization in the 1 to 3 years after RYGB.
RESULTS: In California from 1995 to 2004, 60,077 patients underwent RYGB-11,659 in 2004 alone.
The rate of hospitalization in the year following RYGB was more than double the rate in the year preceding RYGB (19.3% vs 7.9%, P<.001).
Furthermore, in the subset of patients (n = 24,678) with full 3-year follow-up,
a mean of 8.4% were admitted a year before RYGB
while 20.2% were readmitted in the year after RYGB,
18.4% in the second year after RYGB, and
14.9% in the third year after RYGB.
** The most common reasons for admission prior to RYGB were obesity-related problems (eg, osteoarthritis, lower extremity cellulitis), and elective operation (eg, hysterectomy),
** while the most common reasons for admission after RYGB were complications procedure related,
such as ventral hernia repair and gastric revision.
In multivariate logistic regression models predicting 1-year readmission after RYGB, increasing Charlson Comorbidity Index score, and hospitalization in the 3-year period prior to RYGB were significantly associated with readmission within a year.
CONCLUSIONS: Increases in hospital use after surgery appear to be related to RYGB. Payers, clinicians, and patients must consider the not-inconsequential rate of rehospitalization after this type of surgery.
Monday, October 05, 2009
http://sites.google.com/a/clos.net/mini/h-pylori-and-iron-deficiency-anemia
H. Pylori and Iron Deficiency Anemia
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
New studies show that treatment of H. Pylori can treat certain forms of Iron Deficiency Anemia
Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
right arrow Bruno Annibale, MD; Massimo Marignani, MD; Bruno Monarca, MD; Giorgio Antonelli, MD; Adriana Marcheggiano, MD; Gina Martino, MD; Franco Mandelli, MD; Renzo Caprilli, MD; and Gianfranco Delle Fave, MD
2 November 1999 | Volume 131 Issue 9 | Pages 668-672
Background: Iron deficiency anemia is the most common form of anemia worldwide. Recent studies have suggested an association between Helicobacter pylori infection and iron deficiency.
Objective: To investigate the effects of eradicating H. pylori with combination antibiotic therapy on iron deficiency anemia in patients with H. pylori-associated gastritis.
Design: Case series.
Setting: University hospital.
Patients: 30 patients with a long history of iron deficiency anemia in whom H. pylori-associated gastritis was the only pathologic gastrointestinal finding detected.
Intervention: Eradication therapy with two antibiotics and discontinuation of iron replacement therapy.
Measurements: Complete blood count, ferritin levels, and gastroscopy with biopsy to evaluate H. pylori status.
Results: At 6 months, 75% of patients had recovered from anemia (P < 0.001), ferritin values increased from 5.7 ± 0.7 µg/L to 24.5 ± 5.2 µg/L (95% CI, 8.85 to 29.97). After 12 months, 91.7% of patients had recovered from anemia.
Conclusions: Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
H. Pylori and Iron Deficiency Anemia
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
New studies show that treatment of H. Pylori can treat certain forms of Iron Deficiency Anemia
Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
Reversal of Iron Deficiency Anemia after Helicobacter pylori Eradication in Patients with Asymptomatic Gastritis
right arrow Bruno Annibale, MD; Massimo Marignani, MD; Bruno Monarca, MD; Giorgio Antonelli, MD; Adriana Marcheggiano, MD; Gina Martino, MD; Franco Mandelli, MD; Renzo Caprilli, MD; and Gianfranco Delle Fave, MD
2 November 1999 | Volume 131 Issue 9 | Pages 668-672
Background: Iron deficiency anemia is the most common form of anemia worldwide. Recent studies have suggested an association between Helicobacter pylori infection and iron deficiency.
Objective: To investigate the effects of eradicating H. pylori with combination antibiotic therapy on iron deficiency anemia in patients with H. pylori-associated gastritis.
Design: Case series.
Setting: University hospital.
Patients: 30 patients with a long history of iron deficiency anemia in whom H. pylori-associated gastritis was the only pathologic gastrointestinal finding detected.
Intervention: Eradication therapy with two antibiotics and discontinuation of iron replacement therapy.
Measurements: Complete blood count, ferritin levels, and gastroscopy with biopsy to evaluate H. pylori status.
Results: At 6 months, 75% of patients had recovered from anemia (P < 0.001), ferritin values increased from 5.7 ± 0.7 µg/L to 24.5 ± 5.2 µg/L (95% CI, 8.85 to 29.97). After 12 months, 91.7% of patients had recovered from anemia.
Conclusions: Cure of H. pylori infection is associated with reversal of iron dependence and recovery from iron deficiency anemia.
http://sites.google.com/a/clos.net/mini/chocalate-and-death-from-heart-attack
Chocolate and Death from Heart Attack
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold
1.
AFP: Chocolate 'cuts death rate' in heart attack survivors
Chocolate 'cuts death rate' in heart attack survivors. By Marlowe Hood (AFP) – Aug 13, 2009. PARIS — Heart attack survivors who eat chocolate two or more ...
www.google.com/.../ALeqM5gxKbyt-iymZ-PS8tgMMyi65kM4Tw - Similar
2.
Health Highlights: Aug. 13, 2009 - US News and World Report
Aug 13, 2009 ... Chocolate Helps Heart Attack Survivors Childhood Radiation Tied to ... that chocolate can help prevent death in heart attack survivors. ...
health.usnews.com/.../health-highlights-aug-13--2009.html - Cached - Similar
3.
Death by Chocolate? Not for Heart Attack Survivors
Aug 14, 2009 ... If you've survived a heart attack, you could dramatically cut your risk of dying from heart disease by eating chocolate two or more times ...
digg.com/.../Death_by_Chocolate_Not_for_Heart_Attack_Survivors - Cached - Similar
4.
Chocolate 'cuts death rate' in heart attack survivors | NowPublic ...
Aug 13, 2009 ... Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to ...
www.nowpublic.com/.../chocolate-cuts-death-rate-heart-attack-survivors - Cached - Similar
5.
Study: Eating Chocolate Reduces Risk of Death in Heart Attack ...
Aug 13, 2009 ... Study: Eating Chocolate Reduces Risk of Death in Heart Attack Survivors, Here's one more reason to eat chocolate: A study finds that eating ...
www.foxnews.com/story/0,2933,539254,00.html - Cached - Similar
6.
Raw Story » Chocolate 'cuts death rate' in heart attack survivors
Aug 13, 2009 ... PARIS (AFP) – Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold ...
rawstory.com/.../chocolate-cuts-death-rate-in-heart-attack-survivors/ - Cached - Similar
7.
Chocolate cuts death risk in heart attack survivors - Health ...
Chocolate cuts death risk in heart attack survivors. ... even indulging in chocolate once a week can nearly halve the risk of death from heart problems. ...
timesofindia.indiatimes.com/.../Chocolate...death...heart-attack.../4896143.cms - Cached - Similar
8.
Chocolate cuts death rate after heart attack - Washington Times
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to those who never ...
www.washingtontimes.com/.../chocolate-found-to-cut-death-rate-after-heart-atta/?... - Cached - Similar
9.
Dark chocolate 'cuts death risk in heart attack survivors'
London, Aug 15 (ANI): A chocolate fix twice a week could be good for heart attacker sufferers, suggests a new study. The research, published in the Journal ...
www.thaindian.com/.../dark-chocolate-cuts-death-risk-in-heart-attack-survivors_100232765.html - Cached - Similar
10.
Study: Chocolate cuts risk of death in heart attack survivors - On ...
Aug 13, 2009 ... Chocolate lovers rejoice: A new study shows a substantial cut in the risk of death from heart disease for heart attack survivors who eat ...
blogs.usatoday.com/.../study-eating-chocolate-cuts-risk-of-heart-disease-for-heart-attack-survivors.html - Cached - Similar
11.
News results for Chocolate and Death from Heart Attack
A Woman's Heart, Eating Chocolate May Reduce Risk of Cardiac Death ... - 1 hour ago
What we are just now learning is that chocolate may also be beneficial to your heart health after a heart attack as well. A joint US-Swedish study recently ...
J Intern Med. 2009 Sep;266(3):248-57.Click here to read Links
Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J.
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. imre.janszky@ki.se
OBJECTIVES: To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.
DESIGN: In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.
RESULTS: Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41-1.31), 0.56 (0.32-0.99) and 0.34 (0.17-0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality.
CONCLUSIONS: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.
Chocolate and Death from Heart Attack
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold
1.
AFP: Chocolate 'cuts death rate' in heart attack survivors
Chocolate 'cuts death rate' in heart attack survivors. By Marlowe Hood (AFP) – Aug 13, 2009. PARIS — Heart attack survivors who eat chocolate two or more ...
www.google.com/.../ALeqM5gxKbyt-iymZ-PS8tgMMyi65kM4Tw - Similar
2.
Health Highlights: Aug. 13, 2009 - US News and World Report
Aug 13, 2009 ... Chocolate Helps Heart Attack Survivors Childhood Radiation Tied to ... that chocolate can help prevent death in heart attack survivors. ...
health.usnews.com/.../health-highlights-aug-13--2009.html - Cached - Similar
3.
Death by Chocolate? Not for Heart Attack Survivors
Aug 14, 2009 ... If you've survived a heart attack, you could dramatically cut your risk of dying from heart disease by eating chocolate two or more times ...
digg.com/.../Death_by_Chocolate_Not_for_Heart_Attack_Survivors - Cached - Similar
4.
Chocolate 'cuts death rate' in heart attack survivors | NowPublic ...
Aug 13, 2009 ... Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to ...
www.nowpublic.com/.../chocolate-cuts-death-rate-heart-attack-survivors - Cached - Similar
5.
Study: Eating Chocolate Reduces Risk of Death in Heart Attack ...
Aug 13, 2009 ... Study: Eating Chocolate Reduces Risk of Death in Heart Attack Survivors, Here's one more reason to eat chocolate: A study finds that eating ...
www.foxnews.com/story/0,2933,539254,00.html - Cached - Similar
6.
Raw Story » Chocolate 'cuts death rate' in heart attack survivors
Aug 13, 2009 ... PARIS (AFP) – Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold ...
rawstory.com/.../chocolate-cuts-death-rate-in-heart-attack-survivors/ - Cached - Similar
7.
Chocolate cuts death risk in heart attack survivors - Health ...
Chocolate cuts death risk in heart attack survivors. ... even indulging in chocolate once a week can nearly halve the risk of death from heart problems. ...
timesofindia.indiatimes.com/.../Chocolate...death...heart-attack.../4896143.cms - Cached - Similar
8.
Chocolate cuts death rate after heart attack - Washington Times
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to those who never ...
www.washingtontimes.com/.../chocolate-found-to-cut-death-rate-after-heart-atta/?... - Cached - Similar
9.
Dark chocolate 'cuts death risk in heart attack survivors'
London, Aug 15 (ANI): A chocolate fix twice a week could be good for heart attacker sufferers, suggests a new study. The research, published in the Journal ...
www.thaindian.com/.../dark-chocolate-cuts-death-risk-in-heart-attack-survivors_100232765.html - Cached - Similar
10.
Study: Chocolate cuts risk of death in heart attack survivors - On ...
Aug 13, 2009 ... Chocolate lovers rejoice: A new study shows a substantial cut in the risk of death from heart disease for heart attack survivors who eat ...
blogs.usatoday.com/.../study-eating-chocolate-cuts-risk-of-heart-disease-for-heart-attack-survivors.html - Cached - Similar
11.
News results for Chocolate and Death from Heart Attack
A Woman's Heart, Eating Chocolate May Reduce Risk of Cardiac Death ... - 1 hour ago
What we are just now learning is that chocolate may also be beneficial to your heart health after a heart attack as well. A joint US-Swedish study recently ...
J Intern Med. 2009 Sep;266(3):248-57.Click here to read Links
Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
Janszky I, Mukamal KJ, Ljung R, Ahnve S, Ahlbom A, Hallqvist J.
Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. imre.janszky@ki.se
OBJECTIVES: To assess the long-term effects of chocolate consumption amongst patients with established coronary heart disease.
DESIGN: In a population-based inception cohort study, we followed 1169 non-diabetic patients hospitalized with a confirmed first acute myocardial infarction (AMI) between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants self-reported usual chocolate consumption over the preceding 12 months with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registries for 8 years.
RESULTS: Chocolate consumption had a strong inverse association with cardiac mortality. When compared with those never eating chocolate, the multivariable-adjusted hazard ratios were 0.73 (95% confidence interval, 0.41-1.31), 0.56 (0.32-0.99) and 0.34 (0.17-0.70) for those consuming chocolate less than once per month, up to once per week and twice or more per week respectively. Chocolate consumption generally had an inverse but weak association with total mortality and nonfatal outcomes. In contrast, intake of other sweets was not associated with cardiac or total mortality.
CONCLUSIONS: Chocolate consumption was associated with lower cardiac mortality in a dose dependent manner in patients free of diabetes surviving their first AMI. Although our findings support increasing evidence that chocolate is a rich source of beneficial bioactive compounds, confirmation of this strong inverse relationship from other observational studies or large-scale, long-term, controlled randomized trials is needed.
Monday, September 14, 2009
http://sites.google.com/a/clos.net/mini/female-hair-loss
Female Hair Loss
Semin Cutan Med Surg. 2009 Mar;28(1):19-32.Click here to read Links
Hair loss in women.
Camacho-Martínez FM.
Department of Dermatology, School of Medicine, Hospital Universitario Virgen
Macarena, Seville, Spain. camachodp@medynet.com
Female pattern hair loss (FPHL) is a clinical problem that is becoming more
common in women.
Female alopecia with androgen increase is called female androgenetic alopecia
(FAGA) and without androgen increase is called female pattern hair loss.
The clinical picture of typical FAGA begins with a specific "diffuse loss of
hair from the parietal or frontovertical areas with an intact frontal hairline."
Ludwig called this process "rarefaction."
In Ludwig's classification of hair loss in women, progressive type of FAGA, 3
patterns were described: grade I or minimal, grade II or moderate, and grade III
or severe. Ludwig also described female androgenetic alopecia with male pattern
(FAGA.M) that should be subclassified according to Ebling's or
Hamilton-Norwood's classification. FAGA.M may be present in 4 conditions:
persistent adrenarche syndrome, alopecia caused by an adrenal or an ovarian
tumor, posthysterectomy, and as an involutive alopecia.
A more recent classification (Olsen's classification of FPHL) proposes 2 types:
early- and late-onset with or without excess of androgens in each.
The diagnosis of FPHL is made by clinical history, clinical examination, wash
test, dermoscopy, trichoscan, trichograms and laboratory test, especially
androgenic determinations.
Topical treatment of FPHL is with minoxidil, 2-5% twice daily.
When FPHL is associated with high levels of androgens, systemic antiandrogenic
therapy is needed.
Persistent adrenarche syndrome (adrenal SAHA) and alopecia of adrenal
hyperandrogenism is treated with adrenal suppression and antiandrogens.
Adrenal suppression is achieved with glucocorticosteroids.
Antiandrogens therapy includes cyproterone acetate, drospirenone,
spironolactone, flutamide, and finasteride.
Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian
hyperandrogenism is treated with ovarian suppression and antiandrogens.
Ovarian suppression includes the use of contraceptives containing an estrogen,
ethinylestradiol, and a progestogen.
Antiandrogens such as cyproterone acetate, always accompanied by tricyclic
contraceptives, are the best choice of antiandrogens to use in patients with
FPHL.
Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress
pituitary and gonadal function through a reduction in luteinizing hormone and
follicle-stimulating hormone levels.
Subsequently, ovarian steroid levels also will be reduced, especially in
patients with polycystic ovary syndrome.
When polycystic ovary syndrome is associated with insulin resistance, metformin
must be considered as treatment.
Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be
treated with bromocriptine or cabergoline.
*** Postmenopausal alopecia, with previous high levels of androgens or with
prostatic-specific antigen greater than 0.04 ng/mL, improves with finasteride or
dutasteride.
Although we do not know the reason, postmenopausal alopecia in normoandrogenic
women also improves with finasteride or dutasteride at a dose of 2.5 mg per day.
Dermatocosmetic concealment with a hairpiece, hair prosthesis as extensions, or
partial hairpieces can be useful.
Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
Female Hair Loss
Semin Cutan Med Surg. 2009 Mar;28(1):19-32.Click here to read Links
Hair loss in women.
Camacho-Martínez FM.
Department of Dermatology, School of Medicine, Hospital Universitario Virgen
Macarena, Seville, Spain. camachodp@medynet.com
Female pattern hair loss (FPHL) is a clinical problem that is becoming more
common in women.
Female alopecia with androgen increase is called female androgenetic alopecia
(FAGA) and without androgen increase is called female pattern hair loss.
The clinical picture of typical FAGA begins with a specific "diffuse loss of
hair from the parietal or frontovertical areas with an intact frontal hairline."
Ludwig called this process "rarefaction."
In Ludwig's classification of hair loss in women, progressive type of FAGA, 3
patterns were described: grade I or minimal, grade II or moderate, and grade III
or severe. Ludwig also described female androgenetic alopecia with male pattern
(FAGA.M) that should be subclassified according to Ebling's or
Hamilton-Norwood's classification. FAGA.M may be present in 4 conditions:
persistent adrenarche syndrome, alopecia caused by an adrenal or an ovarian
tumor, posthysterectomy, and as an involutive alopecia.
A more recent classification (Olsen's classification of FPHL) proposes 2 types:
early- and late-onset with or without excess of androgens in each.
The diagnosis of FPHL is made by clinical history, clinical examination, wash
test, dermoscopy, trichoscan, trichograms and laboratory test, especially
androgenic determinations.
Topical treatment of FPHL is with minoxidil, 2-5% twice daily.
When FPHL is associated with high levels of androgens, systemic antiandrogenic
therapy is needed.
Persistent adrenarche syndrome (adrenal SAHA) and alopecia of adrenal
hyperandrogenism is treated with adrenal suppression and antiandrogens.
Adrenal suppression is achieved with glucocorticosteroids.
Antiandrogens therapy includes cyproterone acetate, drospirenone,
spironolactone, flutamide, and finasteride.
Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian
hyperandrogenism is treated with ovarian suppression and antiandrogens.
Ovarian suppression includes the use of contraceptives containing an estrogen,
ethinylestradiol, and a progestogen.
Antiandrogens such as cyproterone acetate, always accompanied by tricyclic
contraceptives, are the best choice of antiandrogens to use in patients with
FPHL.
Gonadotropin-releasing hormone agonists such as leuprolide acetate suppress
pituitary and gonadal function through a reduction in luteinizing hormone and
follicle-stimulating hormone levels.
Subsequently, ovarian steroid levels also will be reduced, especially in
patients with polycystic ovary syndrome.
When polycystic ovary syndrome is associated with insulin resistance, metformin
must be considered as treatment.
Hyperprolactinemic SAHA and alopecia of pituitary hyperandrogenism should be
treated with bromocriptine or cabergoline.
*** Postmenopausal alopecia, with previous high levels of androgens or with
prostatic-specific antigen greater than 0.04 ng/mL, improves with finasteride or
dutasteride.
Although we do not know the reason, postmenopausal alopecia in normoandrogenic
women also improves with finasteride or dutasteride at a dose of 2.5 mg per day.
Dermatocosmetic concealment with a hairpiece, hair prosthesis as extensions, or
partial hairpieces can be useful.
Lastly, weight loss undoubtedly improves hair loss in hyperandrogenic women.
http://cme.medscape.com/viewarticle/708355?src=cmemp
From Medscape Medical News CME
Large Waist Size Linked to Asthma in Women CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME Released: 09/03/2009; Valid for credit through 09/03/2010
* Print This Print This
* Email This Email this
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CME Information
Target Audience
This article is intended for primary care clinicians, pulmonologists, gynecologists, and other specialists who care for women with obesity or asthma.
Goal
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the association between asthma prevalence and body mass index in women.
2. Describe the association between asthma prevalence and severity and waist circumference in women.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MedscapeCME designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. (This/Each) (element, volume, issue, monograph, tape, web cast, etc) is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of (this/each) (issue, webcast, etc.)
Note: Total credit is subject to change based on topic selection and article length.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/03/2009; Valid for credit through 09/03/2010
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 3, 2009 — Large waist size is associated with increased asthma prevalence, even among women considered to have normal body weight, according to results from the California Teachers Study cohort reported online in the August 25 issue of Thorax.
"Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation," write J. Von Behren, MPH, from Northern California Cancer Center in Berkeley, California, and colleagues. "A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers."
Questionnaires were completed in 1995, 1997, 2000, and 2005. Allowing adjustment for age, smoking, and race/ethnicity, multivariable linear modeling was used to calculate prevalence odds ratios (ORs) for current asthma. At baseline, 11,500 (13%) of 88,304 women studied from the cohort were obese, defined as BMI of more than 30 kg/m2, and 1334 were extremely obese, defined as BMI of more than 40 kg/m2.
The adjusted OR for adult-onset asthma was 1.40 (95% confidence interval [CI], 1.31 - 1.49) for overweight women vs those of normal weight and 3.30 (95% CI, 2.85 - 3.82) for extremely obese women. Even among women with normal BMI, large waist circumference (WC; > 88 cm) was linked to increased prevalence of asthma (OR, 1.37; 95% CI, 1.18 - 1.59).
Compared with obese women whose waist was 88 cm or less, obese women who also had abdominal obesity had a greater risk for asthma (OR, 2.36 vs 1.57). The risk for severe asthma episodes, reflected in urgent medical visits and hospital admissions, was also greater in obese and overweight women.
"This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight," the study authors write. "All measures of obesity were strongly associated with increased asthma prevalence. Even being modestly overweight was associated with higher asthma prevalence in this population."
Limitations of this study include lack of data on several recognized risk factors for asthma, mostly cross-sectional data, reliance on self-report for physician diagnosis of asthma, and possible selection bias or participation bias.
"These findings are particularly troubling because a majority of American adults are now overweight or obese," the study authors conclude. "In the next phase of this study we will prospectively ascertain new asthma cases and will be able to evaluate BMI, waist size and weight change as risk factors for incident asthma in women."
The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.
Thorax. Published online August 25, 2009. Abstract
From Medscape Medical News CME
Large Waist Size Linked to Asthma in Women CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Authors and Disclosures
CME Released: 09/03/2009; Valid for credit through 09/03/2010
* Print This Print This
* Email This Email this
processing....
[ ]
[ ]
CME Information
Target Audience
This article is intended for primary care clinicians, pulmonologists, gynecologists, and other specialists who care for women with obesity or asthma.
Goal
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosures
Laurie Barclay, MD
freelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the association between asthma prevalence and body mass index in women.
2. Describe the association between asthma prevalence and severity and waist circumference in women.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MedscapeCME designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape News CME has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2009. Term of approval is for 1 year from this date. (This/Each) (element, volume, issue, monograph, tape, web cast, etc) is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of (this/each) (issue, webcast, etc.)
Note: Total credit is subject to change based on topic selection and article length.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/03/2009; Valid for credit through 09/03/2010
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 3, 2009 — Large waist size is associated with increased asthma prevalence, even among women considered to have normal body weight, according to results from the California Teachers Study cohort reported online in the August 25 issue of Thorax.
"Obesity is a risk factor for asthma, particularly in women, but few cohort studies have evaluated abdominal obesity which reflects metabolic differences in visceral fat known to influence systemic inflammation," write J. Von Behren, MPH, from Northern California Cancer Center in Berkeley, California, and colleagues. "A study was undertaken to examine the relationship between the prevalence of asthma and measures of abdominal obesity and adult weight gain in addition to body mass index (BMI) in a large cohort of female teachers."
Questionnaires were completed in 1995, 1997, 2000, and 2005. Allowing adjustment for age, smoking, and race/ethnicity, multivariable linear modeling was used to calculate prevalence odds ratios (ORs) for current asthma. At baseline, 11,500 (13%) of 88,304 women studied from the cohort were obese, defined as BMI of more than 30 kg/m2, and 1334 were extremely obese, defined as BMI of more than 40 kg/m2.
The adjusted OR for adult-onset asthma was 1.40 (95% confidence interval [CI], 1.31 - 1.49) for overweight women vs those of normal weight and 3.30 (95% CI, 2.85 - 3.82) for extremely obese women. Even among women with normal BMI, large waist circumference (WC; > 88 cm) was linked to increased prevalence of asthma (OR, 1.37; 95% CI, 1.18 - 1.59).
Compared with obese women whose waist was 88 cm or less, obese women who also had abdominal obesity had a greater risk for asthma (OR, 2.36 vs 1.57). The risk for severe asthma episodes, reflected in urgent medical visits and hospital admissions, was also greater in obese and overweight women.
"This study confirms the association between excess weight and asthma severity and prevalence, and showed that a large waist was associated with increased asthma prevalence even among women considered to have normal body weight," the study authors write. "All measures of obesity were strongly associated with increased asthma prevalence. Even being modestly overweight was associated with higher asthma prevalence in this population."
Limitations of this study include lack of data on several recognized risk factors for asthma, mostly cross-sectional data, reliance on self-report for physician diagnosis of asthma, and possible selection bias or participation bias.
"These findings are particularly troubling because a majority of American adults are now overweight or obese," the study authors conclude. "In the next phase of this study we will prospectively ascertain new asthma cases and will be able to evaluate BMI, waist size and weight change as risk factors for incident asthma in women."
The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships.
Thorax. Published online August 25, 2009. Abstract
Monday, September 07, 2009
http://sites.google.com/a/clos.net/mini/80-percent-gastric-bypass-patients-vit-d-defficient
80% of Gastric Bypass patients Vitamin D Defficient
Obes Surg. 2009 May;19(5):590-4. Epub 2008 Oct 11.
Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery.
Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M.
Saint Vincent Charity Hospital, 2351 East 22nd St., Cleveland, OH, 44115, USA.
BACKGROUND: Literature regarding the effect of Roux-en-Y gastric bypass (RYGBP) on vitamin D level shows contradictory findings.
Our goal was to determine preoperatively vitamin D levels, to evaluate the efficacy of therapeutic and prophylactic doses of vitamin D and to assess the relationship of 25-OH vitamin D level and body mass index (BMI).
METHODS: We conducted a retrospective cross-sectional study of 72 patients who underwent RYGBP from April 2007 to October 2007 in Bariatric Surgery Department at Saint Vincent Charity Hospital.
RESULTS:
Our study demonstrated that ** 80% ** of the obese patients undergoing RYGBP had serum 25-OH vitamin D levels of less than 32 ng/ml.
(many laboratories currently have listed their normal range as 32-150 ng/ml)
Postoperative data show that 45% of these patients continue being vitamin D insufficient despite the treatment.
We demonstrated that a statistically significant inverse correlation between BMI and 25-OH vitamin D levels (r = 0.464, p = 0.01) exists.
I.e. Heavier patients = Lower Vitamin D
CONCLUSION: Our finding strongly supports the need for aggressive monitoring of vitamin D levels for long-term prevention of complications of vitamin D deficiency in gastric bypass patients.
Identifying the factors that predict patient's responses to vitamin D supplementation requires larger-scale studies and further analysis of these tendencies suggested by our findings.
PMID: 18850253 [PubMed - in proces
http://www.ncbi.nlm.nih.gov/pubmed/18850253
80% of Gastric Bypass patients Vitamin D Defficient
Obes Surg. 2009 May;19(5):590-4. Epub 2008 Oct 11.
Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery.
Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M.
Saint Vincent Charity Hospital, 2351 East 22nd St., Cleveland, OH, 44115, USA.
BACKGROUND: Literature regarding the effect of Roux-en-Y gastric bypass (RYGBP) on vitamin D level shows contradictory findings.
Our goal was to determine preoperatively vitamin D levels, to evaluate the efficacy of therapeutic and prophylactic doses of vitamin D and to assess the relationship of 25-OH vitamin D level and body mass index (BMI).
METHODS: We conducted a retrospective cross-sectional study of 72 patients who underwent RYGBP from April 2007 to October 2007 in Bariatric Surgery Department at Saint Vincent Charity Hospital.
RESULTS:
Our study demonstrated that ** 80% ** of the obese patients undergoing RYGBP had serum 25-OH vitamin D levels of less than 32 ng/ml.
(many laboratories currently have listed their normal range as 32-150 ng/ml)
Postoperative data show that 45% of these patients continue being vitamin D insufficient despite the treatment.
We demonstrated that a statistically significant inverse correlation between BMI and 25-OH vitamin D levels (r = 0.464, p = 0.01) exists.
I.e. Heavier patients = Lower Vitamin D
CONCLUSION: Our finding strongly supports the need for aggressive monitoring of vitamin D levels for long-term prevention of complications of vitamin D deficiency in gastric bypass patients.
Identifying the factors that predict patient's responses to vitamin D supplementation requires larger-scale studies and further analysis of these tendencies suggested by our findings.
PMID: 18850253 [PubMed - in proces
http://www.ncbi.nlm.nih.gov/pubmed/18850253
New Study:
Revision Surgery after RNY Gastric Bypass
Only Leads to 18 lb Weight Loss!
http://ping.fm/WBzVL
One of the common long-term problems with the RNY is weight regain
Revision surgery of the RNY led to only 18 lb weight loss.
Revision Surgery after RNY Gastric Bypass
Only Leads to 18 lb Weight Loss!
http://ping.fm/WBzVL
One of the common long-term problems with the RNY is weight regain
Revision surgery of the RNY led to only 18 lb weight loss.
Higher risk for Adverse Events, especially serious type 1 reactions, with iron dextran therapy than and suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
Nephrol Dial Transplant. 2005 Jul;20(7):1443-9. Epub 2005 Apr 26.Click here to read Links
Hypersensitivity reactions and deaths associated with intravenous iron preparations.
Bailie GR, Clark JA, Lane CE, Lane PL.
Albany Nephrology Pharmacy (ANephRx) Group, Albany, NY, USA. bailieg@acp.edu
BACKGROUND:
Parenteral iron therapy is an accepted adjunctive management of anaemia in kidney disease.
Newer agents may have fewer severe hypersensitivity adverse events (AE) compared with iron dextrans (ID).
The rate of type 1 adverse events to iron sucrose (IS) and sodium ferric gluconate (SFG) relative to iron dextran is unclear.
We used the US Food and Drug Administration's Freedom of Information (FOI) surveillance database to compare the type 1 adverse events profiles for the three intravenous iron preparations available in the United States.
METHODS: We tabulated reports received by the FOI database between January 1997 and September 2002, and calculated 100 mg dose equivalents for the treated population for each agent.
We developed four clinical categories describing hypersensitivity adverse events (anaphylaxis, anaphylactoid reaction, urticaria and angioedema) and an algorithm describing anaphylaxis, for specific analyses.
RESULTS:
All-event reporting rates were
29.2, 10.5 and 4.2 reports/million 100 mg dose equivalents,
while all-fatal-event reporting rates were 1.4, 0.6 and 0.0 reports/million 100 mg dose equivalents
for Iron Dextran, sodium ferric gluconate (Ferrlecit) and Iron Sucrose (Venofer),
respectively.
Iron dextran had the highest reporting rates in all four clinical categories and the anaphylaxis algorithm.
Sodium ferric gluconate (Ferrlecit) had intermediate reporting rates for urticaria, anaphylactoid reaction and the anaphylaxis algorithm, and a zero reporting rate for the anaphylaxis clinical category.
Iron sucrose (Venofer) had either the lowest or a zero reporting rate in all clinical categories/algorithm.
CONCLUSIONS:
These findings confirm a higher risk for AE, especially serious type 1 reactions, with iron dextran therapy than with newer intravenous iron products and also suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
Nephrol Dial Transplant. 2005 Jul;20(7):1443-9. Epub 2005 Apr 26.Click here to read Links
Hypersensitivity reactions and deaths associated with intravenous iron preparations.
Bailie GR, Clark JA, Lane CE, Lane PL.
Albany Nephrology Pharmacy (ANephRx) Group, Albany, NY, USA. bailieg@acp.edu
BACKGROUND:
Parenteral iron therapy is an accepted adjunctive management of anaemia in kidney disease.
Newer agents may have fewer severe hypersensitivity adverse events (AE) compared with iron dextrans (ID).
The rate of type 1 adverse events to iron sucrose (IS) and sodium ferric gluconate (SFG) relative to iron dextran is unclear.
We used the US Food and Drug Administration's Freedom of Information (FOI) surveillance database to compare the type 1 adverse events profiles for the three intravenous iron preparations available in the United States.
METHODS: We tabulated reports received by the FOI database between January 1997 and September 2002, and calculated 100 mg dose equivalents for the treated population for each agent.
We developed four clinical categories describing hypersensitivity adverse events (anaphylaxis, anaphylactoid reaction, urticaria and angioedema) and an algorithm describing anaphylaxis, for specific analyses.
RESULTS:
All-event reporting rates were
29.2, 10.5 and 4.2 reports/million 100 mg dose equivalents,
while all-fatal-event reporting rates were 1.4, 0.6 and 0.0 reports/million 100 mg dose equivalents
for Iron Dextran, sodium ferric gluconate (Ferrlecit) and Iron Sucrose (Venofer),
respectively.
Iron dextran had the highest reporting rates in all four clinical categories and the anaphylaxis algorithm.
Sodium ferric gluconate (Ferrlecit) had intermediate reporting rates for urticaria, anaphylactoid reaction and the anaphylaxis algorithm, and a zero reporting rate for the anaphylaxis clinical category.
Iron sucrose (Venofer) had either the lowest or a zero reporting rate in all clinical categories/algorithm.
CONCLUSIONS:
These findings confirm a higher risk for AE, especially serious type 1 reactions, with iron dextran therapy than with newer intravenous iron products and also suggest that iron sucrose (Venofer) carries the lowest risk for hypersensitivity reactions.
http://sites.google.com/a/clos.net/mini/mortality-rate-sleeve-gastrectomy-over-1-per-100
Mortality Rate Sleeve Gastrectomy Over 1 per 100
National Study Mortality Rate Sleeve Gastrectomy Over 1 per 100 (1.4%)!
New Study of All Sleeve Gastrectomies in Germany
Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany.
Results
The total study contains 3,122 patients.
From January 2006 to December 2007,
144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study.
The mean body mass index (BMI) of patients undergoing SG was 54.5 kg/m2.
The complication rate after SG was 14.1%, and
the surgical complication rate was 9.4%.
The postoperative mortality rate was 1.4%.
Conclusions
`The complication rate during the first 2 years after SG in Germany is similar to that published in the literature.`
Mortality Rate Sleeve Gastrectomy Over 1 per 100
National Study Mortality Rate Sleeve Gastrectomy Over 1 per 100 (1.4%)!
New Study of All Sleeve Gastrectomies in Germany
Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany.
Results
The total study contains 3,122 patients.
From January 2006 to December 2007,
144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study.
The mean body mass index (BMI) of patients undergoing SG was 54.5 kg/m2.
The complication rate after SG was 14.1%, and
the surgical complication rate was 9.4%.
The postoperative mortality rate was 1.4%.
Conclusions
`The complication rate during the first 2 years after SG in Germany is similar to that published in the literature.`
Sunday, September 06, 2009
http://sites.google.com/a/clos.net/mini/high-fructose-corn-syrup-deadly-soup
High-Fructose Corn Syrup: Deadly Soup
Over 10% of Americans' daily calories from fructose.
Fructose accelerates the progression of chronic kidney disease
Fructose causes the Metabolic Syndrome
Beware High Fructose Corn Syrup
Green tea, Carnitine, Quercetin, Soy and other foods/supplements may help
Read on....
High-Fructose Corn Syrup: Deadly Soup
Over 10% of Americans' daily calories from fructose.
Fructose accelerates the progression of chronic kidney disease
Fructose causes the Metabolic Syndrome
Beware High Fructose Corn Syrup
Green tea, Carnitine, Quercetin, Soy and other foods/supplements may help
Read on....
Saturday, September 05, 2009
http://mgb.fm/
From a new MGB patient: "No I have had no previous weight loss surgery. My wife, Teresa, had the MGB on December 12, 2008. I watch her get healthier every day! Sign me up."
From a new MGB patient: "No I have had no previous weight loss surgery. My wife, Teresa, had the MGB on December 12, 2008. I watch her get healthier every day! Sign me up."
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