Latest Health News

HIV: MEDICAL TREATMENTS-EXPERIMENTAL DRUGS AND CLINICAL TRIALS: INFORMED CONSENT FOR THE TRIAL

admin — Sat, 30 Jul 2011 08:28:47 +0000

The most important safeguard in protecting the rights of participants in clinical trials is the informed consent process. All participants in clinical trials in the United States (and in most areas of the world) are required to sign an informed consent document. In the event that the participant is not competent to sign, this responsibility is assigned to the spouse, parent, an adult child, or a brother or sister (in that order). The informed consent document must also be signed by a witness and by the investigator. Information in the consent form usually includes the following: Purpose of the trial. The informed consent document must include an explanation of the scientific question the trial is to answer. It must also include an explanation of why the participant qualifies for the trial. Procedures. Informed consent must include an explanation of the trial’s design, that is, exactly how the trial will proceed. The explanation will include: the nature of the treatment arms; the method by which participants are assigned to a specific arm; the requirements for participation, including the number of clinic visits or the duration of hospitalization; the frequency and types of tests that will be done; the amount of blood that will be required; the duration of the trial; and the end point of the trial. Risks. Informed consent must include an explanation of the drug’s side effects, including their anticipated frequency and severity. It is unrealistic to list every possible side effect, or even all of the side effects that have occurred in previous trials. But certainly the most severe and the most frequent side effects should be noted. Benefits. Informed consent must include a statement of whether the participant has any realistic likelihood of benefiting from participation. Expenses for the drugs or for monitoring, and any payment to the participant, should also be explained. Alternatives to participation. Informed consent must include the various options people have if they choose not to participate. This generally includes the statement that a decision not to participate will not affect your care. In other words, no one at the center offering the trial will bear a grudge if you choose not to participate. Confidentiality of records. People with HIV infection are often concerned about the confidentiality of their trial records. Some trials are done without identifiers, that is without the names, addresses, hospital numbers, or social security numbers that would connect the data to a specific person. Trials done without identifiers essentially guarantee anonymity for the participant. Unfortunately, it is often impractical and undesirable for clinical trials that collect clinically useful data over a prolonged period to be done without identifiers. The next best option to guarantee confidentiality is to keep the records in a locked file with limited access. The FDA and the drug company that sponsors the trial can require access to these locked files, but we are not aware that this access has ever resulted in a participant’s name being revealed to inappropriate persons. In many instances, data obtained in the trial are also recorded in the participant’s medical record: such data can be relevant to medical treatment. Occasionally, participants object to what they view as an unnecessary dispersal of sensitive information. The best advice is to read the consent form carefully for an explanation of how data from the trial are handled and who has access to the record. If such an explanation is not included in the consent form, ask for further information. Further information. No consent form can provide all the information desired by all the participants. And consent forms often include technical information and medical terms that may be difficult to understand. It is expected that most participants will need to discuss any questions not answered or points not clarified with a member of the investigating team. If, either before or after signing the consent form, you have questions about toxicity, alternatives to drugs, possible participation in other studies, or compensation for injury as a result of participation, you should be answered to your satisfaction. You should not sign the consent form until you are satisfied and have no further questions. One option is to take the consent form home and list the questions you have after you have reviewed the form and discussed it with others. In addition, most consent forms include the name and phone number of an appropriate person to contact if the participant has any further questions after participation begins. Withdrawal of consent. Informed consent continues throughout the course of the trial, but withdrawal of consent at any time is the participant’s right. Withdrawal must not have any repercussions for the participant. Withdrawal may not interfere with the availability of care. Participation. To find the nearest clinical trial, call the hotline at the National Institute of Allergy and Infectious Diseases: 1-800-TRIALS-A.*189\191\2*

DRUG THERAPIES FOR HEALTHY BONES: CALCITONIN (MIACALCIN)

admin — Tue, 19 Jul 2011 08:23:51 +0000

The second major medication for preserving and increasing bone density is calcitonin (brand name Miacalcin). Calcitonin is a natural hormone made by the thyroid gland that limits the release of calcium from bones into the blood. Levels in the body generally decrease with age, and estrogen stimulates the secretion of it; menopause, with markedly decreased levels of estrogen, causes even lower levels. Low bodily calcitonin does not indicate low bone density, but prescription calcitonin can help protect bones. What you get in a prescription, though, is actually from salmon because it is fifty to a hundred times stronger than human calcitonin. Like estrogen and bisphosphonates, calcitonin acts to slow bone breakdown.Over three-quarters of the patients who use calcitonin will see increases in their bone density. Studies show gains of over 3 percent a year in bone density after two years of taking calcitonin, in most—but not all—patients, and a 40 percent reduction in risk of fractures in the spine. So my patient was ahead of the curve—a plug for adopting a healthy lifestyle to maximize the results of drug treatment. Even if there is no gain but there is also no loss, calcitonin is beneficial. It works best in men, and women more than five years after menopause and hence no longer in the accelerated phase of bone loss, and it may be more effective in the spine than other parts of the skeleton. (Although I’m convinced we’ll eventually find out that it is equally effective all over the body, and I use it as if it is.) Calcitonin is not yet proven to decrease the rate of fractures.Calcitonin is the best choice for those who do not take estrogen and who cannot tolerate alendronate. Calcitonin, unlike other treatment options, can help control bone pain, although we don’t know why. So it may also be the best choice for those in pain from vertebral fractures. More studies have been done on alendronate than on calcitonin, so it is most doctors’ first recommendation. But given the safety record of and lack of side effects associated with calcitonin, I usually recommend starting with that. I’m betting that as more studies are completed, calcitonin will be shown to equal or even surpass alendronate in overall effectiveness, especially in women not taking HRT. My stance Is slightly against the current, but I’m a believer in giving calcitonin a chance to work as long as there is time to play with, because it is the safest and most physiologically natural choice when a prescription is required.For years, the only way to get calcitonin was by injection several times a week, but now a nasal spray makes using it much simpler (not to mention more appealing). The usual dose is 200IU, sprayed in alternating nostrils daily. About 10 percent of patients experience nasal dryness and irritation. Calcitonin must be kept refrigerated. You should take supplements of calcium and vitamin D to maximize the effectiveness. Calcitonin is considered very safe, since it has been used (in the injectable form) for over twenty years to treat bone disease without any significant problems.*156\228\2*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: EATING FOR BETTER HEALTH – BASIC EATING GUIDELINES – INCLUDE TWO TO THREE SERVINGS OF LOW-FAT OR SKIM MILK DAIRY PRODUCTS IN YOUR DAILY DIET

admin — Fri, 08 Jul 2011 08:17:41 +0000

Dairy products do not have to be a significant source of fat in your diet. To get an idea of the differences among dairy products, consider that 8 ounces of whole milk contain about as much fat as 8 ounces of skim milk plus 2 teaspoons of butter or margarine. Skim milk has an added advantage—the calcium content is higher than that of whole milk. For women who especially need adequate calcium to help prevent osteoporotic dairy products are a main source of calcium. You can get the benefits without the fat by focusing on low-fat or no-fat varieties.For example, instead of eating a slice of regular American cheese, you can cut the calories in half and reduce the fat by three-fourths by choosing reduced-fat American cheese.Although switching to milk with less fat is a good way to reduce calories and fat in the diet for most adults, infants and children younger than age 2 may need the extra calories and fat in whole milk.*294\252\8*

CAUSES OF CANCER: DRUGS, ENVIRONMENTAL CHEMICALS AND INDUSTRIAL POLLUTANTS

admin — Wed, 22 Jun 2011 17:18:43 +0000

Drugs and Environmental Chemicals
The present era is full of chemical pollution all around. The air, water and foods, all contain thousands of man-made toxic chemicals. Most of them are potential carcinogens. According to Dr. Alfred Taylor of the biology institute of the University of Texas, even sodium fluoride in fluoridated water is linked to cancer growth. Several commonly used drugs are considered by many researches to be possible carcinogens.
Many widely-used pesticides are also definite carcinogens. Animal Studies commissioned by HEW and conducted by Bionetics Research Laboratories of Bethesda, Maryland, showed that more than half of all mice given oral doses of DDT developed tumours. In spite of mounting evidence that DDT is a proven carcinogen, it is widely used on food crops all over the world.

Industrial Pollutants
Occupational exposure to industrial pollutants such as asbestos, nickel, tar and soot can lead to skin and lung cancers and leukemia. Aromatic amines used in the manufacture of synthetic dyes cause cancer of urinary bladder. Radium and other radioactive elements produce cancer of the bone.
Workers in some branches of the dye industry develop cancer of the bladder. The compounds found to be responsible are 2-naphthylamine and benzidine. Arsenites and arsenious oxide may produce cancer of the skin, if applied over a period of time.
Many persons working with X-rays develop cancers of the skin and those exposed to radiation develop leukemia. Ultraviolet radiation may, in certain circumstances, cause cancer of the skin.
*16/355/5*

ALCOHOLISM TREATMENT TECHNIQUES AND APPROACHES: EDUCATION

admin — Sat, 18 Jun 2011 17:07:51 +0000

In addition to self-awareness, the client also needs education about alcohol, the drug, and the disease of alcoholism. Provide facts and data. A host of pamphlets are available from state alcohol agencies, insurance companies, and AA. Everyone likes to understand what is going on with them. This is becoming increasingly apparent in all areas of medicine. Some institutions have hired client educators. Client education sessions on diabetes, heart disease, cancer, and care of newborns are becoming commonplace. The importance of education has two thrusts in alcoholism. The first is to help instill new attitudes toward alcoholism: that it is a disease, has recognizable signs, and is treatable. The hope is to elicit the alcoholic’s support in helping to manage and treat his problem. The other reason for educating alcoholics is to handle feelings of guilt and low self-esteem. The chances are pretty good that the alcoholic’s behavior has been downright crazy, and not just to others. It has also been inexplicable to the alcoholic. The fact that he has been denying a problem confirms this. There is no need to deny something unless it is so painful, so out of step with values, that it cannot be tolerated. Learning facts about alcohol and alcoholism can be a big relief to the alcoholic. Suddenly, things make sense. All the crazy behavior becomes normal, at least for an active alcoholic. That / makes a significant difference. Successful recovery appears to be related to a client’s acceptance of the disease concept. Energy can be applied to figuring out how one can live around the disease, live successfully, now. The client is relieved of the need to hash around back there, in the past, to uncover causes, to figure out what went wrong. He need not dwell on his craziness; it becomes merely a symptom, one that he isn’t doomed to reexperience if he works on maintaining sobriety.
*118\331\2*

THE IRRITABLE BOWEL SYNDROME: EXERCISES SITTING ON A CHAIR

admin — Thu, 09 Jun 2011 15:11:06 +0000

I Place your feet in front of you about a foot apart. Drop your shoulders and look at the floor a few feet in front of you; this stops you shortening the muscles at the side of the neck.
2 Take one deep breath, lifting your shoulders as you do so; open your mouth as you let the breath out and drop your shoulders. Imagine you are as limp as a wet sweater.
3 Breathe normally, lift the shoulders towards the ears and let them drop towards the floor. Do this eight times if you can.
4 Keeping the arm limp, circle each shoulder in a front to back direction eight times, and then try doing them together.
5 To stretch the neck allow your head to fall to the right, bring it back to the centre, then allow it to drop to the left; four times each side. Don’t raise your shoulder to meet your ear.
6 Stretch both arms to the ceiling and let them fall loosely towards the floor.
7 Stretch out the fingers, then draw eight circles both ways with the forefingers.
8 To exercise the legs draw the same circles with each big toe in turn.
9 For the buttocks and thighs tighten these muscles and feel yourself rise in your seat.
10 Finish by standing up and shaking all over like a wet dog.
Fear of being seen to shake in public can sometimes keep people indoors; regularly doing the wet dog exercise is very helpful. It takes a lot more energy to hold shaking in than to let it out. Have a good shake whenever you feel tense and particularly before any social event you are worried about. If you are in trouble when you are out find a lavatory where you can let your jaw go loose and allow yourself to shake from the head down.
*125\326\8*

RELAXATION TRAINING FOR WAYWARD NERVES: CREATIVE VISUALIZATION – AUTOGENIC TRAINING

admin — Thu, 26 May 2011 13:18:30 +0000

This involves giving yourself positive commands when you are in a relaxed state. It differs from self-talk – which can be done anywhere at any time – and needs to be done in a disciplined manner. It can be used for relaxation, pain control, or for altering a negative and fixed mind-set (for example ‘I cannot go out in case I can’t find a lavatory in time’).
Here is an example of a relaxation exercise; you can build in your own special commands at the end. Please note: you will get much further with this if you do ten minutes abdominal breathing first, make sure you are warm, and that the telephone is disconnected.
Repeat each command three times:
1 My left arm is heavy and comfortable
2 My left leg is heavy and comfortable
3 My right arm is heavy and comfortable
4 My right leg is heavy and comfortable
5 My head is heavy and comfortable
6 My chest is heavy and comfortable
7 My abdomen is heavy and comfortable
8 My whole body is heavy and comfortable
Repeat the entire sequence, this time giving the command. My left arm is warm…
My digestion gets better every day – repeat eight times.
Every system in my body is balanced and healthy – repeat eight times.
Autogenic training is particularly useful for people who have difficulty conjuring mental images.
*114\326\8*

MEDICAL TREATMENT OF SEIZURES: TERMS YOU NEED TO KNOW – DRUG LEVELS AND TOXICITY

admin — Wed, 18 May 2011 13:10:49 +0000

Drug levels. The term “drug level” refers to the amount of a medication in the blood—to be more precise, the serum levels, since the drug is in the liquid portion of your blood (serum) rather than in the red blood cells. To be still more precise, we should refer to the amount of “free” drug in the serum, since virtually all of a drug is tightly bound to the proteins in the serum and cannot get into the brain to exert its effect; only the tiny “free” (unbound) portion can enter the brain to affect the seizures. When we measure “drug levels” or “blood levels,” we usually measure the total amount of a drug in the serum. In most cases this is sufficient, but we can, when necessary, measure the free portion as well, although it is a somewhat more expensive test. In general, when we talk about drug levels in this chapter, we are referring to serum levels.
Toxicity. The term “toxicity” covers a multitude of things. Toxicity, in general, is used here to refer to the adverse (bad) effects of a medication. There are two major forms of such toxicity: allergic and dose-related. The allergic form may be mild (such as a rash) or severe, affecting the blood cells, bone marrow, or liver, reactions that can be serious and, rarely, even fatal. The dose-related form depends on the amount of medication in the brain. Toxicity may be observed as sleepiness (sedation), unsteadiness (ataxia), tremor, or even as problems in learning. Dose-related toxicities are important to recognize, and when recognized are seldom serious, because they are reversible by a decreasing or a discontinuing of the drug.
*107\208\8*

DIABETES: INSULIN INJECTION SITES

admin — Thu, 05 May 2011 12:44:19 +0000

All diabetics know that you should inject insulin into the fatty tissue under the skin (subcutaneously) and rotate your injection sites. Antiseptics make the skin hard and the injections sore and so they are best avoided provided your skin is clean. However, people can become so intent on the details of insulin dose adjustment that they forget that one reason why their diabetes is hard to control may be the injection site.

Dents and lumps
Nowadays fewer diabetics are taking beef insulin. Most people coming to our clinic take human insulin and the others take highly purified pork insulins. Few use beef insulin. One of the problems with the old beef insulins was fat atrophy (tissue loss) or hypertrophy (tissue gain) at the injection site. These dents and lumps in the thighs or arms can be very unsightly and may also affect the absorption of insulin from that site. Fat atrophy and hypertrophy are considered to be allergic reactions to the insulin and are less common on highly purified human or pork insulins, though they do occur. You can probably lose dents and lumps by changing to human or highly purified pork insulin, if you are not already taking it, and injecting this into the edge of the abnormal area, gradually moving in towards the middle as the problem is resolved. However, it has to be said that this may not cure everyone. The best way to prevent dents and lumps occurring is to rotate your injection sites so that no area is overused.
Ten years ago I met Albert, sixty-three years old, who had been admitted to the hospital because his blood glucose was very poorly controlled. When I examined him I discovered two little black holes, one on the front of each thigh. This was where he had been injecting his insulin for the past five years! Many diabetics have a favourite area for insulin injections, easy to h and a little numb from years of injections. That is how insulin atrophy and hypertrophy develop.

Red spots and bruises
It is not unusual for new diabetics to find little d spots at the site of recent insulin injections. This normally settles down after a few months. But persistent sore red spots or lumps may mean that you are allergic to your current insulin or to the zinc in it. A single very tender lump, which may or may not be red to start with, may be an injection site abscess. This may need lancing and/or antibiotic treatment by your doctor. Bruising at the injection site should not occur very often. If it does, you may be going in too deep. Avoid piercing veins near the surface – you can see them as
blue lines.

*20/102/5*

WORK OF YOUR HEART: OBSERVATIONS AND STUDIES IN EARLY YEARS

admin — Thu, 28 Apr 2011 12:26:29 +0000

So powerful was our tradition of regarding the heart to be the spiritual as well as the physical centre of our existence that it led to a feeling that the heart was somehow sacrosanct when compared with other organs of the body: this untouchable organ was definitely not to be violated by a surgeon.
Indeed, the great physicians of antiquity believed the heart to be a delicate natural mechanism that, once interfered with, could not be repaired. Two thousand years ago Hippocrates wrote that injuries to the heart were sure to be fatal, while Aristotle too considered that ‘The heart alone of all viscera cannot withstand serious injury’. Somewhat later, Galen studied the wounds received by gladiators and concluded that a sword or spear to the heart was sure to cause death if it reached the ventricles – a belief echoed in the eighteenth century by Boerhaave, who was similarly convinced of the mortal dangers attendant to piercing wounds.
By and large this was the medical orthodoxy for around 20 centuries, although a few observant individuals had, on occasions, noticed that not everyone with a heart injury actually died from it. Moreover, from early in the seventeenth century there is a report of two autopsies in which undeniable evidence of previous cardiac injury was found, even though neither of the deceased had met their deaths as a result of this. This finding was confirmed later in another report: at the autopsy a scar had been found in the heart of a man who had been pierced by a sword some four years before. The heart, it seemed, could be touched without killing a person – indeed, it seemed to be positively robust!
It was, however, some time before surgeons began seriously to build on these early observations and to contemplate deliberately operating on people with heart disease or injury. There were exceptions, such as Napoleon’s famous surgeon Baron Dominique-Jean Larrey, who in 1829 successfully managed to drain fluid off the heart of a soldier who had suffered a stab wound. After the operation, he ventured to suggest that his fellow doctors had taken ‘too grave a view of the effects of wounds’ in this hitherto untouchable area, but his fellow surgeons were far from quick to respond. In fact, it was not until the late 1860s that the medical profession began to consider surgery as a serious option in the treatment of cardiac disease – and even then fairly reluctantly, the heart was still beyond the ‘last frontier’, which few were keen to cross. As late as 1896 Stephen Paget could affirm that ‘no new methods, no new discovery, can overcome the natural defects that attend a wound of the heart’. Around the same time, the celebrated Viennese surgeon Christian Albert Theodor Billroth warned, ‘Let no man who hopes to retain the respect of his medical brethren dare operate on the human heart’. This was, said Billroth, ‘prostitution of the surgical art, if not downright madness’.
As the twentieth century drew nearer, then, the heart was still regarded as out-of-bounds by most of the medical profession – but, significantly, not by all. One of the most fascinating stories in the whole of medical history was beginning to take shape. Bit by bit, the ‘forbidden territory’ would slowly be opened up by courageous and farsighted doctors, whose skill and intelligence would be matched only by their remarkable determination.
*1/353/5*