mudphudder

an academic medicine weblog

mudphudder RSS Feed
 

health

to my regular readers

Sorry–it’s been a slow week for new content on mudphudder’s blog.  This has been a really busy week and I’m halfway home now.  I’ll write put some new material up this weekend and ask that you bare with me for the next two days.  It should be smooth sailing from there on out.

For now, if you haven’t already done so, please check out Praxis #6 Blog Carnival (my previous entry).

Share/Save/Bookmark

Check Out the Grand Rounds Blog Carnival

Just a quickie post to let everyone know that Grand Rounds is up this week at In Sickness and In Health.  In case you are unfamiliar with Grand Rounds, it’s a blog carnival that’s hosted on a different site every week. The host chooses a theme (this week the theme is “connections”) and links to blog posts (from medically-oriented blogs) that tie in with the theme.  It’s always a great & informative read.  Here’s a link to the edition from this week:

http://insicknessinhealth.blogspot.com/2008/12/grand-rounds-vol-5-no-17.html

Share/Save/Bookmark

how notch heals a broken heart

From the December 22nd issue of the Journal of Experimental Medicine:

The Notch pathway helps a developing heart get into shape but also helps a damaged heart reshape itself and keep pumping. Weakened by a heart attack or the protracted stress of hypertension, the heart rebuilds itself as it struggles to maintain blood flow.  Some studies suggest that heart stem cells begin proliferating to replace lost cardiomyocytes. Because the Notch pathway helps control self-renewal by other organs, it was hypothesized that it might also have a hand in heart remodeling.

In this study by Croquelois et al, when Notch1 was absent, mice with stressed hearts showed signs of over-exuberant repair including thicker ventricular walls and increased fibrosis–all signs of heart failure that are seen in humans after heart damage, for example after a heart attack.  These mice and their heart muscle cells also had a higher-than-normal death rate. Loss of Notch also spurred more heart stem cells to differentiate. Notch might allow the heart to conserve these cells.

The Notch pathway triggers stem cell proliferation in skeletal muscle, and the pathway short-circuits as we age. The researchers say that it’s possible the same deterioration occurs in the older heart, explaining why elderly people are more vulnerable to heart failure.

Share/Save/Bookmark

milk: the newest sports drink?

got milk?

Evidence has suggested that cow’s milk can be more effective than commercially available sports drinks for recovery after both resistance and endurance exercises. Based on so far limited research, milk appears to be an effective post-resistance exercise beverage that results in favourable acute alterations in protein metabolism: acutely increasing muscle protein synthesis, leading to an improved net muscle protein balance.  Studies have now reported that when postexercise milk consumption is combined with resistance training for at least 12 weeks, greater increases in muscle hypertrophy and lean mass are experienced. Holy smokes! I’m gonna try this out in combination with my weightlifting routine.

There is also some evidence to suggest that milk may be an effective post-exercise beverage for endurance activities. Low-fat milk has been shown to be as effective, if not more effective, than commercially available sports drinks as a rehydration beverage.  Moreover, milk is more nutrient dense for individuals who do both strength and endurance training, compared to traditional sports drinks.

Therefore, bovine low-fat fluid milk is a safe and effective post exercise beverage for most individuals–except for those who are lactose intolerant!

For a recent review article on the evidence supporting the benefits of cow’s milk as an energy drink:

http://www.jissn.com/content/pdf/1550-2783-5-15.pdf

Share/Save/Bookmark

obesity pandemic

And I wonder how it can be that there is a worldwide obesity problem amongst children of all cultures, including those that have traditionally embraced exercise and healthier foods.

 


Share/Save/Bookmark

the healing powers of… radon?!?!

Weird, huh?  I heard about this and couldn’t believe it, but maybe there is something to it.  I mean, what the mudphudder doesn’t know could fill an f’n… well, you get the point.

Radon is a colorless, odorless, radioactive gas that is a breakdown product of natural radium decay (science lesson for the day…check).  From physiology and biology to healthcare, we are all aware of the association between radon exposure and lung cancer.  Just try selling your house if there is detectable radon in the basement and you’ll see how much the general public enjoys radon exposure.  You’ll be spending thousands of dollars for ventilation systems to pump the radon out.

Merry Widow Health Mine

Merry Widow Health Mine


But apparently there are people out there who are benefiting from exposure to radon.  In the 1950′s, a woman with arthritis found pain relief and resolution of her symptoms from visiting a uranium mine in California.  Since then, word has spread–even leading to a 1952 article on the healing powers of radon in Life Magazine. These days, old uranium mines have become the place to go for your healing dose of radon.  Existing around the U.S., there is a concentration of them in Montana between the towns of Basin and Boulder, with the most well-known called the “Merry Widow Health Mine.”  Even the name of the place has “scam” written all over it–but apparently not.  According to one article in the Missoulian, a western Montana newspaper, people have been experiencing the healing powers of radon mines in eastern Europe and Russia for some time and hundreds visit the Merry Widow every year.  In the Merry Widow, there is even an area called the “Doggie Den” where people take their ailing dogs for therapy.  There are testimonials from people whose dogs could not walk when entering and then are running around after a couple of weeks at the mine. 

So I decided to look into this and was surprised to find a clinical trial that found a benefit for radon in pain relief as well as decreased use of pain medications and corticosteroids in patients with rheumatoid arthritis.  I looked up some of the other ailments for which people are using the radon mines including cataracts, multiple sclerosis, muscular dystropy, asthma and emphysema but found no evidence for a benefit from radon. 

Who knows?  Perhaps this is another example of what we have come to find with all medical treatments and what Theophrastus Phillipus Auroleus Bombastus von Hohenheim, the “father of toxicology”, described as “Alle Dinge sind Gift und nichts ist ohne Gift; allein die Dosis macht, dass ein Ding kein Gift ist,” which translates as, “All things are poison and nothing is without poison; only the dose makes a thing not a poison.”

Share/Save/Bookmark

clinical HIV resources – for patient care, physician training and self-study

Today is the 20th World AIDS Day and it is astounding how much and how quickly our clinical knowledge of HIV management has increased since 20 years ago.  Treatment guidelines and recommendations are continuously updated as we learn more–this impacts clinical patient care from both the physicians’ side as well as the patients’.  Below, I have listed some useful, clinically related links to online HIV resources for patient care, physician training or anyone who wants to learn more about the clinical aspects of HIV infection.  Please let me know if you find any of these particularly useful! 

 

Resource url Resource description
AIDS Education and Training Center (AETC) on HIV www.aids-ed.org Training resources, slide sets, self-study and more on HIV
AETC www.aids-ed.org/aidsetc?page=cm-00-00 Clinical manual for management of the HIV-infected adult
International Training and Education Center on HIV www.go2itech.org International AETC with training material
HIV Insite www.hivinsite.org Knowledge base, drug interactions, global country profiles and more
Medscape HIV/AIDS www.medscape.com/hiv News, conference coverage, reviews, CME and more
VA National HIV/AIDS Program www.hiv.va.gov Information for providers and patients
Clinical Care Options www.clinicaloptions.com Reviews, CME, and conference summaries
The National HIV/AIDS Clinicians’ Consultation Center www.ucsf.edu/hivcntr AETC clinical resource, contact information for national warm line (a National HIV Telephone Consultation Service), PEPline (National Clinicians’ Post-Exposure Prophylaxis Hotline) and the National Perinatal HIV Consultation and Referral Service

Share/Save/Bookmark

what obesity epidemic?

I saw this sign driving through North Carolina:

Share/Save/Bookmark

a picture of sickle cell disease

Sickle cell disease is an autosomal recessive genetic disorder, predominantly affecting African-American individuals, that causes deformity of the red blood cells.  These deformed red blood cells get stuck in and block off the capillaries (the smallest blood vessels), thus preventing adequate blood flow (and therefore oxygen) from reaching the tissues of the body.  This blockage of small blood vessels is what causes the characteristic pain associated with sickle cell disease.  

We’ve all heard of sickle cell disease, but what is really going on?  What does it look like?  Here are some electron microscope pictures demonstrating the actual difference between normal red blood cells and sickle red blood cells:

 

The difference in the shape of the cells is clear and quite stunning!

Share/Save/Bookmark

vitamins E and C and your cardiovascular health!

You would think that the exclamation point in the title reflects the great benefits of vitamins E and C in decreasing peoples’ risk of cardiovascular events, including heart attack and stroke as well as dying from these events. But sure of enough no, that doesn’t appear to be the case.

The results of a randomized clinical trial (HD Sesso et al) first reported online on November 9 at the Journal of the American Medical Association show that in almost 15,000 men (all of whom were physicians), those taking vitamin E or vitamin C had no advantage in prevention of heart disease or strokes. Even more surprisingly, those taking vitamin E had an increased risk of hemorragic stroke.

It is important to point out that the subjects in this study were all either middle-aged or older men so no statement can be made in regards to women. Moreover, the doses of vitamin E (400 IU) and C (500 mg) aren’t terribly high and many individuals take higher daily doses of these vitamins, and often in combination.

Finally, I also think this highlights an important issue with regard to vitamins and dietary supplements. Many people (myself included) take vitamins and dietary supplements on a daily basis without any real evidence of benefit from ingesting these substances. And in fact, are we more likely exposing ourselves to side effects than any benefit? Something to think about…

keywords: vitamin E, vitamin C, heart disease, stroke, cardiovascular health, supplements

Share/Save/Bookmark

racial health disparities

It is sadly understood that there exists in this country health care disparities for individuals of different race. This translates to disparities in health and disease outcomes.

The extent of this problem is astounding:

1) African Americans and Native Americans have higher overall mortality rates than any other group.

2) The death rate from all cancers in blacks is almost one third higher than whites

3) Eight time as many blacks have AIDS compared to whites

4) Blacks are twice as likely to die from complications of diabetes than whites

5) Hispanics and Native Americans are twice as likely as whites to develop diabetes 

More information is free available at:

The Quality of Health Care Delivered to Adults in the United States by McGlynn et al in NEJM 2003      

U.S. Department of Health and Human Services, “Progress Review: Cancer,” Healthy People 2010

U.S. Department of Health and Human Services, “Progress Review: HIV,” Healthy People 2010

 U.S. Department of Health and Human Services, “Progress Review: Diabetes,” Healthy People 2010

 U.S. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, “Diabetes: Disabling, Deadly, and on the Rise”

 
keywords: health care disparities, race, mortality, cancer, diabetes, hiv

Share/Save/Bookmark

statins, your cholesterol and your heart

According to a study in the Nov. 6 issue of the New England Journal of Medicine (PM Ridker et al), healthy men and women with normal cholesterol levels may significantly reduce their risk of developing or dying from heart disease (including chest pain, coronary bypass grafting or stenting), heart attacks and stroke by taking a crestor, a member of the cholesterol-lowering drug family of “statins”.  This study by Ridker et al was also described on CNN.com.

While statins are used currently to treat only people with high levels of cholesterol, the people in this study all had healthy cholesterol levels but had an elevated level of high sensitivity C-reactive protein (hs-CRP), which is a non-specific marker of inflammation.  Over the last few years, CRP has become an increasingly important adjunct clinical parameter used to decide whether a person with borderline cholesterol should start statin therapy.  This study further adds significance to the role of CRP in reflecting a person’s risk for cardiovascular disease. 

Moreover, the exact mechanism through which statins exert their beneficial effects remains unclear.  Certainly statins lower cholesterol but they have other ancillary effects as well.  In the laboratory setting, statins have been shown to have pleiotrophic effects–even inhibiting HIV replication!  However, there is now a lot of evidence to suggest statins have a significant anti-inflammatory effect.  And because inflammation is thought to play an important role in atherosclerotic cardiovascular disease, an anti-inflammatory effect by statins may synergize with their cholesterol lowering effects.  This is also consistent with recent controversy over the effectiveness of other cholesterol lowering drug familes (such as fibrates–e.g. TriCor or Lopid, bile acid seqeuestrants–e.g. cholestyramine, and niacin).   

keywords: cholesterol, statins, crestor, heart disease, heart attack, stroke

Share/Save/Bookmark

myostatin gene and muscle size

This is one of my favorite knockout animal models!

The myostatin gene in mice (and other animals) inhibits muscle growth and instead promotes deposition of fat.  This gene is thought to have been evolutionarily conserved in order to promote formation of energy stores (fat) and restrict calorie consumption (by muscle) in animals who don’t have a guaranteed source of food.  This makes sense because what animal knows for a fact that it will find something to eat every day?  But, if this gene is knocked out in the laboratory setting or as a naturally occurring mutation (myostatin “knockout” mice), check out what happens: there is tremendous muscle hypertrophy and a significant reduction of body fat.  There’s a reason why this animal model is called “Mighty Mouse”!

A view of the chest muscles of these mice:

 

 

A view of the muscles in the front and rear limbs (i.e. arms and legs): 

 

 

 
For a more real-life example, the Belgian Blue Bull is naturally missing the myostatin gene:

 

 

I think I speak for everyone when I say, “Awesome!”

All of these images are taken from the original scientific article, which first described the function of the myostatin gene:

McPherron AC, Lawler AM, Lee S-J. 1997. Regulation of skeletal muscle mass in mice by a new TGF-β superfamily member. Nature 387: 83–90.

Share/Save/Bookmark

artificial sweeteners: low in calories but high… in weight gain?

Low calorie artificial sweeteners–such as saccharin (e.g. Sweet N’ Low), Aspartame (e.g. Nutrasweet and Equal), or Sucralose (e.g. Splenda)–are used in countless food items including diet sodas and essentially anything labeled as “sugar-free” targeted to consumers as a strategy for reducing calorie intake and thus losing weight.

This is despite the fact that studies have shown numerous side effects to these sugar substitutes.  Most disconcerting: in regards to weight loss, studies have reported essentially no beneficial effects for artificial sweeteners.  And in fact, more recent studies have reported a link between use of these low calorie artificial sweeteners and weight gain.

Low-calorie artificial sweeteners have been linked to both increased appetite as well as metabolic changes in response to calories, both of which promote weight gain rather than weight loss. 

When people eat sweet foods, the sweet taste signals an impending high-calorie bolus to the body, which registers caloric fulfillment of energy needs and also induces metabolic changes for use of the incoming energy.  With use of these low-calorie sweeteners, these natural responses are disrupted because the body can no longer trust a sweet taste to indicate a high-calorie intake.  After a while, the body can no longer accurately gauge daily caloric intake, causing a rise in appetite while burning fewer calories. 

Check out the links below for more info:

http://www.mayoclinic.com/health/artificial-sweeteners/MY00073/UPDATEAPP=false&FLUSHCACHE=0

http://jama.ama-assn.org/cgi/content/full/299/18/2137

These findings emphasize two interesting points:

1) There is an extensive but as of yet mostly uncharacterized connection between the nervous system and the gastrointestinal system.  The effect of artificial sweeteners is just one example of the significance of this neuroendocrine axis.  I actually find this to be one of the more interesting areas for future research with obvious clinical significance and almost immediate impact on the lives of people.  Here is a link to a review paper for those of you who are interested in learning more about this physiology:

http://www.nature.com/nrd/journal/v7/n3/full/nrd2444.html

2) Not only do low-calorie artificial sweeteners not achieve their designed purpose, but apparently do the opposite!  Moreover, these sweeteners have numerous other reported side effects and have been linked to other health problems.  To be fair, the jury is still out on a definitive answer to how sweeteners affect the neuroendocrine axis.  But I think it is fair to say that it doesn’t look promising.  In the medical scientific community at least, there appears to be a growing belief that these substances should be more closely monitored and regulated by the FDA.  However, this is highly unlikely to occur due to the size (i.e. dollar worth) of the sweetener industry…yet another example of the conflicting interests of public health and the dollar…

 
keywords: artificial sweetener, sugar substitute, dieting, weight loss, splenda, equal, sweet n’ low

Share/Save/Bookmark

allergies, winter dry nose and sinus hygiene


Many people have sinus and allergy problems–almost 10% of the US population!  These problems are often treated with medication, medication and more medication.  However, one of the most useful interventions is avoided… I’m talking about nasal rinses or irrigation.  Usually normal saline, nasal irrigation is extremely effective at cleaning out the allergens and your own stuck-on secretions that cause nasal inflammation, sneezing, itching and runny nose.  And because drying out of the nasal mucosa (e.g. as happens more often in the winter) can also lead to irritation and breakdown of the protective barriers in your nose, normal saline rinses can be quite helpful in keeping your nose and sinuses moist.  This may also reduce the chances of catching viral upper respiratory infections.  If you don’t believe it, there are studies on this stuff.  Here is a review of several clinical trials that have shown the efficacy of nasal irrigation:
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006394/frame.html

I know, I know, no one like to squirt or snort fluid into their nose.  It takes a little getting used to, but once you get over that part of it, you may actually find a decreased reliance on your allergy medications as well as just greater comfort.  In my opinion, using medication for allergies or sinus problems without using a nasal rinse is a lot like taking cholesterol medication but not watching your diet. 

There are also many different formulations that you can find at your local pharmacy.  They are all for the most part made up of normal saline.  Some may have other ingredients.  For example, I use a nasal rinse called “Alkalol”, pictured here:

bottle of alkalol, a nasal rinse for allergies

that also contains a small amount menthol, which causes you to have a sensation of decreased congestion because the menthol activates chemical receptors on your nasal mucosa which simulates the sensation of increased airflow through your nose.  (Note: I have no financial interest in alkalol, nor do I necessarily endorse it–this is just an example)

Nasal rinses come in several forms.  Some are just solution in a bottle that you could simply pour into the palm of your hand (wash your hands first!) and snort (give it good snort so that you can feel it getting to the back of your throat).  For these, you can also use a number of delivery mechanisms like a simple rubber bulb to squirt the rinse up your nose.  Some rinses are in a nasal spray, which may be more convenient.  However, here is a link to at least one study which suggests that sprays aren’t as effective:

http://archotol.ama-assn.org/cgi/content/abstract/133/11/1115

One trendy delivery mechanism (if nasal rinses can even be considered trendy) is the neti pot, which has been a part of East Asian medicine for centuries.  It basically boils down to some kind of receptacle, which looks much like a tea pot, from which you pour out your nasal rinse into one nostril of your nose while tilting your head to the side so that the rinse actually comes out the other nostril, thus rinsing out both sides of your nose.  Here is a photo of a woman demonstrating how to use the neti pot.

woman rinsing nasal passages with neti pot for allergies

I’ve never used a neti pot (and I’m not sure how motivated I am to do so after looking at this picture!) so I can’t really comment.  But, it’s been around for hundreds of years, how bad could it be?

Regardless of what ultimately appeals to you or is the lesser of all the evils, as the case may be, you should definitely use nasal rinses–all the time, not just when you are feeling stuffy.  It is really not possible to overdo it with normal saline nasal rinses or normal saline nasal sprays.  For the sake of convenience, try it once or twice (morning and before bed) per day for a couple of weeks and see what you think.  You may find yourself taking less medication in the long-run.

keywords: nasal rinse, nasal irrigation, sinus problems, allergies, treatment

Share/Save/Bookmark