Tag: Lancet

  • “I Am Not In Pain’ Coma Patient!

    A patient who is in a vegetative state conveyed that he is not in pain.!

    The Doctors seem to have interpreted the brain waves to arrive at this conclusion.

    If this is correct, then the concept of Euthanasia  in the case of Coma Patients need to have a re-look into, as these cases are recommended on the assumption that the Coma patients are in pain.

    MRI Scan_jpg.
    A patient is prepared for an MRI in a file photo. The medical advancement is being touted as the first of its kind in the world. It happened last June when doctors in London, Ont., used a functional magnetic resonance imaging machine (fMRI) to analyze brain activity patterns in Scott Routley.
    Photograph by: Miguel Alvarez , AFP/Getty Images

    Story:

    For more than a decade, Scott Routley has been living in a vegetative state.

    He can’t talk. He can’t move. And although his eyes are open, no one is sure whether he can see.

    But now, for the first time, doctors caring for the 39-year-old London, Ont., man say they know he’s not in pain.

    And they learned it from Routley himself, by analyzing his brain waves when they asked him.

    “This was a landmark moment for us because for the first time, a patient can actually tell us information, important information about how they’re feeling and their current situation,” said lead researcher Dr. Adrian Owen on Tuesday.

    The medical breakthrough, believed to be the only time a severely brain injured patient has been able to relay clinically relevant information to their doctors, is being touted as a new way to possibly improve their quality of care.

    Owen, who is the head of the Brain and Mind Institute at the University of Western Ontario, says research published online last year in The Lancet shows that one in five of these patients are conscious, but essentially trapped in their bodies because they’re unable to communicate verbally or physically.

    His team has been working for the past year trying to determine whether Routley, who became vegetative following a car crash 12 years ago, had any “residual brain activity” and how much he was able to understand them.

    Last June, the doctors employed a functional magnetic resonance imaging machine (fMRI) to see if they would be able to analyze his brain patterns.

     http://www.vancouversun.com/health/Breakthrough%20lets%20Canadian%20vegetative%20state%20communicate%20with/7540940/story.html#ixzz2CB4Bbwbv

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  • Ultra Sound Scan Unsafe For Babies,Scientific Study

    There is a fad going on Ultra Sound Scan.

    Ultrasound scan. Provided as-is. Please feel f...
    Ultrasound scan. Provided as-is. Please feel free to categorise, add description, crop or rename. (Photo credit: Wikipedia)

    Doctors suggest Ultra Sound Scan the moment you go to check your pregnancy.

    Immediately thereafter, they( at least in India), they ask you to do a Scan on the 45 th /90 th Day.

    In between they tell you to do it a couple of times more, ostensibly  to check whether the Foetus is developing normally.

    Some times they tell you they could not get the image clearly as the Foetus was turnng its head the otherside!

    Beware of these 15% Commission Doctors.

    Because the Foetus can not express its thoughts, do not harm it.

    Is ultrasound safe … or worth it?
    Although women are now routinely offered several ultrasound scans during a pregnancy, costing health services worldwide millions of pounds every year, its safety has never been tested. This assumption of safety has led to:

    • researchers who are studying foetal behaviour reassuring women volunteering to take part in their trials that exposures of up to an hour and a half are safe
    • commercial companies offering parents lengthy ‘videos’ of their baby moving inside the womb. (The US Food and Drink Administration (FDA) warns that ultrasound cannot be considered harmless, even at low levels, and is considering regulatory action against these companies)
    • companies being granted safety licenses to offer parents- to-be hand-held Doppler ultrasound devices with which, theoretically, they could expose their babies to hours of ultrasound every day

    Several trials suggest that Governments should be more concerned, e.g.:

    • When women at risk of giving birth preterm were examined once a week to determine the state of their cervix, just over half (52%) of those who were examined using ultrasound went on to have a preterm birth compared to a quarter (25%) of those given a manual pelvic examination.
      Ultrasound scanning gave no benefit over manual examination [1]
    • When 1,246 UK women were given a monthly Doppler ultrasound scan of their umbilical and uterine arteries from the 19th to the 32nd week of pregnancy, seventeen of their babies died at or around the time of birth, as opposed to only seven in the 1,229-strong unDopplered control group. The Doppler scanning had only identified a possible problem in one of the babies [2]

    Ed.- (i) AIMS Journal’s Jean Robinson is concerned that no research has ever been done on the effects of:

    • exposing even younger foetuses to ultrasound, an increasingly common practice
    • submitting foetuses to exposures of an hour or more, as in the commercial applications described above

    She also points out that:

    • because ultrasound is now almost universally used, it has become almost impossible to assemble a control group of completely unexposed children. Only degrees of exposure can now be compared
    • the claim that ultrasound encourages bonding between mother and child has also never been demonstrated scientifically

    (ii) Other studies, however, suggest that ultrasound is more efficient than manual pelvic examination at detecting major malformations and twins early. [3]

    [1] Lorenz,RP et al. American Journal of Obstetric Gynaecology 1990;162(6):1603-607
    [2] Davies,JL et al. Lancet 1992;ii:1299-303
    [3] Saari-Kemppainen,A et al. Lancet 1990;336(8712):387-91

    (11453) Beverley Beech. AIMS Journal

     

    Yes, just looking can hurt

    Having one or more ultrasound scan to see your baby in the womb has become almost the norm. Although there has never been any significant research to prove it, the practice is assumed totally safe by doctors and parents-to-be alike. In fact, the opposite is true.

    Three randomised controlled trials of Doppler Sound, the powerful form of ultrasound now used in most hospitals, have found an up to fourfold increase in perinatal (just before or after birth) deaths. [1] One large study found 20 miscarriages in the group given ultrasound scans, but none in the group which was not. [2] Another reported a doubling of pre-term labour in the scanned group. [3] Another linked ultrasound scanning to retardation of the baby’s growth in the womb. [4]

    Animal-based studies suggest that there may be subtler effects which have, to date, not been measured in humans. Monkeys repeatedly exposed to ultrasound showed clear behavioural problems, such as social withdrawal. Another study using monkeys found evidence of low body weight and poor muscle tone.

    Experiments with guinea pigs showed that it could raise the temperature of brain tissue near bone by as much as 5.1°C. [5] If the same occurs in human babies at the time the developing brain is at its most vulnerable (16 weeks old, when ultrasound scanning tends to be carried out), it is possible that vital cells could be damaged or destroyed with little possibility of replacement. This could lead to long-term neurological damage. [6] Changes in brain development sometimes lead to lefthandedness. [7] Not a problem in itself, but lefthandedness is linked to an increased risk of dyslexia, [8] learning difficulties[9] and speech delay. [10]

    The argument for ultrasound scanning revolves around its ability to detect abnormalities early enough to abort. Firstly, several studies have shown that ultrasound does not improve outcomes for babies overall, and that there is no medical reason to propose a scan in 80% of cases. Secondly, ultrasound can only detect a handful of the 5000+ potential chromosomal abnormalities. It is most successful at detecting Down’s syndrome, picking up 80% of cases, but even here can diagnose Down’s syndrome when it isn’t actually present. Scanning can pick up `things that shouldn’t be there’ – resulting, again, in the abortion of healthy foetuses – when that `thing’ often disappears during the pregnancy. Parents who decide not to abort are put through months of unnecessary worry. In one instance at a hospital in Cardiff (Wales), scans detected `dead’ babies which were subsequently found to be alive just before the induced miscarriage was to be performed.

    Finally, scans can pick up abnormalities about which nothing can be done.

    [1] Lancet 1992;340:1229-303
    [2] Lancet 1990;336:387-91
    [3] American Journal of Obstetric Gynaecology 1990;162:1603-10
    [4] Lancet 1993;342:887-91
    [5] Horder,MM et al. Ultrasound in Medicine & Biology 1998;24(5):697-704
    [6] Birth 1986;13:29-37
    [7] Kieler,H et al. Epidemiology 2001;12(6):618-23
    [8] Obstetrics & Gynaecology 1984;63:194-200
    [9] Neurotox. Teratol. 1995;17:179-88
    [10] Canadian Med. Assoc. Jnl. 1993;14 9:1435-40

    (6698) Pat Thomas. Natural Parent 1.5.00 p26

    Left handedness in ultrasound babies

    New research suggests that ultrasound tests may affect babies’ brains. Looking back at 2161 babies born 1979-81 Norwegian researchers found that those who had been exposed to ultrasound were 30% more likely to be left-handed. This could have happened by chance but they believe it may indicate “a sensitive index of subtle changes in the development of the brain”.
    (5135) Salvesen,KA et al. British Medical Journal 1993;307(6897):159-64

    Ultrasound scans linked to brain damage in babies
    A third study has linked lefthandedness to ultrasound scanning, suggesting that it has caused genetic damage in the brain. In this case 7000 men whose mothers had ultrasound scans in the ’70s were compared to 170,000 men whose mothers did not. There was a significant increased rate of lefthandedness in the 7,000 men who had been scanned when in the womb and, critically, an even higher increase in those born after 1975, when doctors introduced a routine second scan. Lefthandedness is linked to an increased risk of a range of conditions, e.g.learning difficulties, dyslexia and epilepsy. The study was conducted on men because male babies’ brains continue to develop later than female babies’ brains, making them more susceptible to damage from external factors.

    In Britain, lefthanded people now form 11% of the population, compared to just 5% in the 1920s. The researchers have estimated that only a fifth of this doubling can be accounted for by a relaxation on the old practice of suppressing lefthandedness.

    (8663) Kieler,H et al. Epidemiology 2001;12(6):618-23
    Courtesy of Robert Matthews. Sunday Telegraph 9.12.2001

    No link with childhood leukaemia
    A large case-controlled study from Sweden was unable to show any link between the use of ultrasound examination of babies in the womb and childhood leukaemia. In the preamble to the research description, however, the authors remind us that other studies have shown that ultrasound can cause membrane changes which might affect the embryo’s development as well as postnatal development, and that ultrasound has been associated with lefthandedness.

    (6146) Naumburg,E et al. British Medical Journal 29.1.00 p282

    Ultrasound – small babies catch up
    In 1993 Australian research [1] found some evidence that foetuses exposed to five sessions of ultrasound imaging and continuous-wave Doppler flow studies between the eighteenth and thirty-eighth week of pregnancy tended to be born smaller and shorter than babies given a single ultrasound scan in the eighteenth week.

    Some good news
    The team followed the babies’ progress for the next eight years. By the time the babies were a year old, there were no significant differences in size. When the children underwent standard tests of childhood speech, language, behaviour and neurological development at ages two, three, five and eight, it suggested that the children’s neurological development had been normal as well.

    Ed.- (i) These findings come as a relief, but the fact that the repeated ultrasound or Doppler scans reduced the foetus’ growth is still cause for alarm. Doppler scans are not the same as ultrasound scans. They are used to measure blood flow in the foetus’s arteries and expose the foetus to larger doses of ultrasound.

    AIMS Journal’s Jean Robinson commented as follows:

    The Doppler and ultrasound imaging machines used in the original 1993 trial were weaker than those used these days. No research on the safety of today’s machinery has been carried out

    The researchers are still concerned by the apparent link between boy’s exposure to ultrasound and an increased likelihood of being left-handed.{2] They intended to examine this issue when the children were ten

    [1] Newnham,JP et al. Lancet 1993;342:887-91
    [2] Salvesen,KA and Eik-Ness,SH. Ultrasound Obstetrical Gynaecology 1999;13:241-46

    (11454) Newnham,JP et al. Lancet 2004;364(9450):2038-44

    http://www.greenhealthwatch.com/newsstories/newschildren/ultrasound-is-it-safe.html

  • Aspirin , To Be Prescribed For Cancer? Lancet Papers.

    Adenocarcinoma
    Adenocarcinoma (Photo credit: Pulmonary Pathology)

    Background

    Daily aspirin reduces the long-term incidence of some adenocarcinomas, but effects on mortality due to some cancers appear after only a few years, suggesting that it might also reduce growth or metastasis. We established the frequency of distant metastasis in patients who developed cancer during trials of daily aspirin versus control.

    Methods

    Our analysis included all five large randomised trials of daily aspirin (≥75 mg daily) versus control for the prevention of vascular events in the UK. Electronic and paper records were reviewed for all patients with incident cancer. The effect of aspirin on risk of metastases at presentation or on subsequent follow-up (including post-trial follow-up of in-trial cancers) was stratified by tumour histology (adenocarcinoma vs other) and clinical characteristics.

    Findings

    Of 17 285 trial participants, 987 had a new solid cancer diagnosed during mean in-trial follow-up of 6·5 years (SD 2·0). Allocation to aspirin reduced risk of cancer with distant metastasis (all cancers, hazard ratio [HR] 0·64, 95% CI 0·48—0·84, p=0·001; adenocarcinoma, HR 0·54, 95% CI 0·38—0·77, p=0·0007; other solid cancers, HR 0·82, 95% CI 0·53—1·28, p=0·39), due mainly to a reduction in proportion of adenocarcinomas that had metastatic versus local disease (odds ratio 0·52, 95% CI 0·35—0·75, p=0·0006). Aspirin reduced risk of adenocarcinoma with metastasis at initial diagnosis (HR 0·69, 95% CI 0·50—0·95, p=0·02) and risk of metastasis on subsequent follow-up in patients without metastasis initially (HR 0·45, 95% CI 0·28—0·72, p=0·0009), particularly in patients with colorectal cancer (HR 0·26, 95% CI 0·11—0·57, p=0·0008) and in patients who remained on trial treatment up to or after diagnosis (HR 0·31, 95% CI 0·15—0·62, p=0·0009). Allocation to aspirin reduced death due to cancer in patients who developed adenocarcinoma, particularly in those without metastasis at diagnosis (HR 0·50, 95% CI 0·34—0·74, p=0·0006). Consequently, aspirin reduced the overall risk of fatal adenocarcinoma in the trial populations (HR 0·65, 95% CI 0·53—0·82, p=0·0002), but not the risk of other fatal cancers (HR 1·06, 95% CI 0·84—1·32, p=0·64; difference, p=0·003). Effects were independent of age and sex, but absolute benefit was greatest in smokers. A low-dose, slow-release formulation of aspirin designed to inhibit platelets but to have little systemic bioavailability was as effective as higher doses.

    Interpretation

    That aspirin prevents distant metastasis could account for the early reduction in cancer deaths in trials of daily aspirin versus control. This finding suggests that aspirin might help in treatment of some cancers and provides proof of principle for pharmacological intervention specifically to prevent distant metastasis.
  • Malaria becomes Drug Resistant

    "Ring forms" of the Plasmodium falci...
    "Ring forms" of the Plasmodium falciparum (malaria) parasite, inside red blood cells. Microscope image using 100x oil-immersion lens. From a blood smear, stained with hematoxylin. (Photo credit: Wikipedia)

     

    Malarial Parasites have become drug resistant, team of Researchers in Thailand report.

    The reason attributed is over usage of the Drug which has made the parasite immune to the medication.

    Frequent and over usage of Antibiotics and drugs of any nature spoils one’s health and the bacteria/virus becomes drug resistant.

    Allow the body immune system reasonable time to take action by itself.

    Refers to:

    There are fears the disease could be spreading after a strain of Plasmodium falciparum has been discovered on the border of Thailand and Burma – 500 miles away from western Cambodia, where the first cases of the parasite were reported in 2009.

    Tests by a team of British and Thai scientists over a 10-year period have found the most dangerous species of malaria parasites, spread by mosquitoes, are becoming more resistant to the most effective treatments containing artemisinin, a drug derived from the sweet wormwood shrub.

    Report in Lancet.

    Background

    Artemisinin-resistant falciparum malaria has arisen in western Cambodia. A concerted international effort is underway to contain artemisinin-resistant Plasmodium falciparum, but containment strategies are dependent on whether resistance has emerged elsewhere. We aimed to establish whether artemisinin resistance has spread or emerged on the Thailand—Myanmar (Burma) border.

    Methods

    In malaria clinics located along the northwestern border of Thailand, we measured six hourly parasite counts in patients with uncomplicated hyperparasitaemic falciparum malaria (≥4% infected red blood cells) who had been given various oral artesunate-containing regimens since 2001. Parasite clearance half-lives were estimated and parasites were genotyped for 93 single nucleotide polymorphisms.

    Findings

    3202 patients were studied between 2001 and 2010. Parasite clearance half-lives lengthened from a geometric mean of 2·6 h (95% CI 2·5—2·7) in 2001, to 3·7 h (3·6—3·8) in 2010, compared with a mean of 5·5 h (5·2—5·9) in 119 patients in western Cambodia measured between 2007 and 2010. The proportion of slow-clearing infections (half-life ≥6·2 h) increased from 0·6% in 2001, to 20% in 2010, compared with 42% in western Cambodia between 2007 and 2010. Of 1583 infections genotyped, 148 multilocus parasite genotypes were identified, each of which infected between two and 13 patients. The proportion of variation in parasite clearance attributable to parasite genetics increased from 30% between 2001 and 2004, to 66% between 2007 and 2010.

    Interpretation

    Genetically determined artemisinin resistance in P falciparum emerged along the Thailand—Myanmar border at least 8 years ago and has since increased substantially. At this rate of increase, resistance will reach rates reported in western Cambodia in 2—6 years.
    1. “Study leader Professor Francois Nosten, director of the Shoklo Malaria Research Unit in Thailand, warned of a “race against time” to halt the spread of the potentially untreatable malaria.

    He told Sky News: “If the situation continues to deteriorate then it could mean that the newest drugs that we have to treat malaria now which are the derivatives of artemisinin, will be progressively inefficient, ineffective.

    “We know what the consequences of this will be because we have seen it in the past… it results in increasing number of cases of malaria and therefore more deaths, and so we are very concerned.”

    “It is not a new strain. It is the same species of parasite, but it is evolving rapidly.

    “The reason why it has evolved resistance to new treatments is probably because we have been using them a lot over the last 20 years. They were the only treatments that could effectively cure the disease.

    “We can still treat the patient with these drugs and they get better and they get cured, it just takes longer for them to clear the disease.

    “We don’t know yet whether this is a spreading phenomenon – whether this resistance has spread from Cambodia to the Thai-Burma border, or whether it is emerging spontaneously.”

    He said: “We have now seen the emergence of malaria resistant to our best drugs, and these resistant parasites are not confined to western Cambodia.

    “This is very worrying indeed and suggests that we are in a race against time to control malaria in these regions before drug resistance worsens and develops and spreads further. The effect of that happening could be devastating.

    http://news.sky.com/home/world-news/article/16203828

  • AntiBiotics-How to Use and Misuse.

    Usage of Antibiotics is very high.

    I have seen Doctors prescribing Antibiotics as soon as you finished narrating your symptoms.

    People also have a habit of buying the medicine across the counter.

    Remember, Antibiotic is to be used very sparingly and the body should be allowed to take care of the infections on its own.

    If the infection persists, if it is an infection at all, care should be exercised in taking the antibiotics, under the advice of a Doctor.

    Check the expiry date of the Drug.

    Over usage will result in your system not responding.

    The side effects of Antibiotics are, in some case, very severe.

    Read on.

    Misuse

    This poster from the U.S. Centers for Disease Control and Prevention “Get Smart” campaign, intended for use in doctor’s offices and other healthcare facilities, warns that antibiotics do not work for viral illnesses such as the common cold.

    The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them.
    —Paul L. Marino, The ICU Book

    Inappropriate antibacterial treatment and overuse of antibiotics have contributed to the emergence of antibacterial-resistant bacteria. Self prescription of antibacterials and their use as growth promoters in agriculture are additional examples of misuse.

    Many antibacterials are frequently prescribed to treat symptoms or diseases that do not respond to antibacterial therapy or are likely to resolve without treatment, or incorrect or sub-optimal antibacterials are prescribed for certain bacterial infections

    The overuse of antibacterials, like penicillin and erythromycin, have been associated with emerging antibacterial resistance since the 1950s.

    Widespread usage of antibacterial drugs in hospitals has also been associated with increases in bacterial strains and species that no longer respond to treatment with the most common antibacterials.

    Common forms of antibacterial misuse include excessive use of prophylactic antibiotics in travelers and failure of medical professionals to prescribe the correct dosage of antibacterials on the basis of the patient’s weight and history of prior use. Other forms of misuse include failure to take the entire prescribed course of the antibacterial, incorrect dosage and administration, or failure to rest for sufficient recovery. Inappropriate antibacterial treatment, for example, is the prescription of antibacterials to treat viral infections such as the common cold. One study onrespiratory tract infections found “physicians were more likely to prescribe antibiotics to patients who appeared to expect them”. Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescription of antibiotics.‘…

    http://en.wikipedia.org/wiki/Antibacterial

    Most antibiotics and antimicrobial medications are prescribed to adults based on broad dosage recommendations that do not take individual body mass into account, a system that is outdated, according to an editorial published in the current issue of the British medical journal The Lancet. Whereas children’s antibiotic dosing is generally calculated according to body mass, for adults, no such system is in place, and for those drugs that do have body mass specific guidelines for dosing, adherence is “inadequate,” according to the authors. Drs. Matthew E. Falagas and Drosos Karageorgopoulos of the Alfa Institute of Biomedical Sciences in Athens point out that, under current practices, a 200 lb., 6’2″ man (90kg, 1.9m) diagnosed with pneumonia would receive the same dose of antibiotics as a 124 lb., 5′ woman (56kg, 1.5m) with the same condition, despite their dramatically different body sizes. While dosage according to body mass is standard in anesthetics, pediatrics, oncology and other fields, when it comes to antibiotics and antimicrobials the dosing guidelines are too broad, the authors argue, and may undermine a medications efficacy. What’s more, in the face of both widespread obesity and the increasing prevalence of antibiotic-resistance, tailoring dosage for optimal results is increasingly important.


    http://healthland.time.com/2010/01/14/should-weight-factor-into-antibiotic-dosage/#ixzz1PKE5hFdh