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Red Meat Linked To Heart Disease In Diabetics

Red meat is one of the sources of protein, but doctors from the Harvard School of Public Health reporting in the January edition of Diabetes Care, that a type 2 diabetes diet should be lean in red meat.
Type 2 diabetics are at risk for subsequent coronary heart disease (CHD), and intake of iron rich food was significantly associated with a greater risk of fatal CHD. The results come from a prospective study of 6,161 women from the Nurses' Health Study. All of these patients reported a diagnosis of adult onset diabetes, and they were followed between 1980m through 2000, which amounts to an impressive 54,455 person-years follow-up. Attention was paid to the food questionnaires, which were monitored for the consumption of iron and red meat such as beef, pork or lamb as a main dish, also for the use of beef in roast beef sandwiches and mixed dishes, hamburger, hot dog, processed meat and bacon. Note was also taken of other nutrients such as seafood and poultry.
Women with diabetes who ate the most iron in the form of heme found in red meats had a 50% increased risk of total coronary heart disease as compared to those with the lowest intake. The risk ratio with women was more obvious in post menopause when compared with pre menopause.
While lean lean beef may be a good protein food to the average population, type 2 diabetics might choose to cut back on red meat and processed red meat sources and replace it with a heart-friendlier choice. Fresh seafood, rich in omega -3 fatty acids, would rank high on the list of a healthy eating plan.

The Medical Post, February 20, 2007, page21

Nitroglycerin Patch Helps Premature Babies

Nitroglycerine has been a tried and tested drug for patients who suffer from angina, but the chemical has other benefits: the drug can retard labor and delivery, if a woman is having premature labor. This result comes from research at Queen's University Perinatal Research Unit at Kingston General Hospital, Canada. Other tocolytics, which is the term for labor delaying drugs, are also on the market showing comparable results, but the nitro patch had an advantage, as it significantly reduced morbidity during the neonatal period.

The researchers worked with 158 women who went into premature labor between 24 and 32 weeks of pregnancy. In a randomized trial they either received a transdermal patch of nitroglycerine or placebo. If contractions continued an hour after the patch was put on the skin, another one was added. The following day treatment was repeated. Delivery was delayed 10 days for all, and a very significant 23 days for those in labor before 28 weeks. Any prolongation of pregnancy closer to a term delivery is helpful, but the greatest significance applies to those, where labor starts before 28 weeks. This is the group of babies that are most at risk, says lead author Dr. Graeme Smith of Kingston General.
There may be two reasons for the overall benefits of nitroglycerin treatment. On the one hand nitroglycerine protects pregnancy most in the most vulnerable group, where the mothers enter labor before 28 weeks. The other aspect may be that the nitro patch may be having effects beyond the labor-delaying properties such as better blood flow in the placenta, as there is enough of the medication that reaches the placenta.
Dr. Smith reports that at this point there is no "gold standard" tocolytic in Canada. Tocolytics have shown little improvement and frequent side effects. Compared to other tocolytic medications the main side effect of the nitro patch has been a mild headache. In most cases it was not necessary to remove the patch. It is estimated that nitroglycerin is now used in about a third of Canadian centers.

National Review Of Medicine, February 28, 2007, page 5

Quick Test Predicts Sepsis

One of the big risks for a patient undergoing abdominal surgery has been the threat of peritonitis, which means infection in the abdominal cavity. Apart from pneumonia, which can be another one of those life threatening diseases, peritonitis remains a severe threat even today, as it is accounting for roughly 60% of mortality in the surgical intensive care units. It is not the peritonitis itself that is the killer but the spread of the infection through the blood stream to vital organs. Once the vitals are affected, infection will lead to a general shutdown: multiple organ failure or septic multi-organ dysfunction syndrome known as MODS, which is what kills the patient.
Our ancestors could not control sepsis. Antibiotics had yet to be discovered. Today the main challenge remains a timely detection of sepsis. Once sepsis has overrun the body, even antibiotic treatment comes too late for the patient.
The best methods that are currently available for the detection of sepsis are CAT scans and fine needle aspiration. Both have their shortfalls: the CAT scan may be unavailable and fine needle aspiration can increase the infection risk. One biomarker, the C reactive protein has only a limited use to predict septic MODS, as C reactive protein levels show a sharp increase in the presence of surgical trauma, regardless whether there is infection or not. German research has tested another potential blood sepsis marker, procalcitonin. Unlike the C reactive protein procalcitonin levels are not affected by surgical trauma, but it shows an increase in the presence of bacterial or fungal infection. There is a rapid automated assay for procalcitonin, the Kryptor PCT essay. It can be completed in 20 minutes, which is important, as time is of essence in emergency situations. Among 82 recruited patients with peritonitis, more than half had infections due to E.coli. Nine had fungal infections. Procalcitonin levels were markedly higher in patients who later went on to suffer MODS. All patients in the study were tested within 96 hours of the onset of symptoms. C reactive protein levels were not useful in terms of a predictive value. The test is useful for two purposes: it helps with the early detection of a septic condition, so treatment can start early. It also identifies patients who won't develop septic MODS.The sensitivity and the accuracy of the test does not necessarily make it a true" sepsis marker". Researchers believe that the degree of systemic procalcitonin reflects a weak immune system. The test picks up those patients who are susceptible to severe infections. As a result timely treatments can be started for them right away.

National Review Of Medicine, March 15,2007, page 3

Disk Transplantation New For Herniated Disk

Back problems can be a source of chronic pain and it is a significant reason for disability in the general population. Often the patient lives with the problem, and treatment with pain killers or over the counter remedies proves to be useless. Once the symptoms are becoming more severe and there is a feeling of numbness that extends into the leg or foot, even the most stoic back pain sufferer will seek out medical advice. Tests such as a CAT scan or MRI scan will reveal that the reason for the chronic pain is a herniated disk.

The only treatment that could be offered has been a diskectomy which is performed by an orthopedic surgeon. So far fusion surgery has been the modality of choice, which has the unfortunate consequence of predisposing patients to degeneration in other levels of the spine as the wear and tear following fusion surgery is higher at the adjacent levels.

Dr. Dike Ruan from the Navy General Hospital in Beijing reports about a new treatment in the form of disk transplantation instead of fusion. Artificial materials have been tested and the results have been very variable. Contrary to organ transplantation it is possible to work with donor material from non-related persons as the inert disk material does not cause transplantation rejection. The herniated disk is removed including the adjacent end plate and a fresh-frozen composite disk with end plate is introduced. Five patients who underwent the procedure had improved neurological status after three months. Also the bony union at the end plate was nearly complete after three months. Long term follow up, which continued for at least five years, continued to show improvement. Contrary to organ transplants in which anti- rejection drugs have to be used, the disk transplants caused no immunological reaction. Motion and stability remained excellent, and only minor degenerative changes were observed after five years.

With further refinements, such disk transplants will likely become an effective alternative treatment for degenerative disc disease.

The Lancet, 2007; 369-993 and p.999

MRI Scan Finds Hidden Cancer in Opposite Breast

Approximately 1000 women from 25 cancer centers throughout the US who were recently diagnosed with breast cancer in one breast were all examined, radio graphed with conventional mammograms. They also received an MRI scan study of the opposite breast to make sure no hidden cancer would be overlooked. To the surprise of the investigators 1 in 10 women were found to have cancer in the opposite breast that would have conventionally passed as "normal". More than 90% of these women were picked up with an MRI scan of the opposite breast that up to now would not have been part of the routine work-up. Dr. Elias A. Zerhouni from the National Institutes of Health (NIH) said that it would be a great break through to have a new technique of diagnosing these women with early cancer in the opposite breast. By diagnosing this condition early, the cancer treatment can be customized to the exact breast cancer stage improving survival significantly for these women.

Dr. Constance Lehman, the principal investigator of this ACRIN Breast MRI Trial who is also professor of radiology as well as the director of breast imaging at the University of Washington and Seattle Cancer Care Alliance, pointed out that unnecessary bilateral mastectomies (= surgical breast removal) can be avoided in the 90% women whose opposite breasts were normal. At the same time the 10% of women who were accurately diagnosed with early breast cancer can be treated early and effectively.

This trial has been started in April of 2003 and follow-up examinations were done at 12-18 and 24-30 months. This already shows that the group of 30 patients diagnosed with breast cancer in the opposite breast has a much better survival than patients would have had in the past. However, the final figures will only be available several years into the future.

The cancer specialists in the US have estimated that in 2007 there will be approximately 178,480 women who will be diagnosed with breast cancer and about 40,460 will likely die from the disease.

Here is more information regarding the research team: http://www.acrin.org/breast_strategy.html

The New England Journal of Medicine (NEJM), Vol. 356, No.13, March 29, 2007

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