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In-flight exercises

Posted: November 7, 2010 at 9:21 am

Prolonged immobilization can cause circulatory stasis which is one of the predisposing factors for DVT described by Virchow in his famous triad: endothelial injury, stasis and hypercoagulability.

In a trial of previously healthy patients who traveled at least 8 hours per flight (median duration 24 hours), duplex ultrasound showed an asymptomatic DVT in 10 % of participants. In other studies, the reported risk of symptomatic DVT after flights of more than 12 hours was 0.5%. According to a 2006 Lancet study, activation of coagulation occurs in some individuals after an 8-hour flight.

This Chicago Tribune article lists some useful in-flight exercises:

In-flight exercises for beginners

– Shoulder shrugs, shoulder rolls. Ten each.
– Short sets of bending and straightening the elbows and knees.
– Walk through the plane every two hours.
– March your knees up and down in your seat.
– Lift and lower your feet on tiptoes to work the calves.

Advanced In-flight exercises

– Neck stretches; hold on each side for 15 to 20 seconds.
– If you can find space (near an exit), work the core with yoga stretches. Pigeon pose — an intermediate move of folding one leg under the body while stretching the back leg out — is an in-flight favorite of hers.
– In your seat, lift your arms over your head, grip your hands together and lean from side to side for a few seconds on each side. Repeat.
– Walk the length of the plane every hour, incorporating deep lunges. Unless you want air marshals on your case, it might be wise to notify a flight attendant.
– Put a small flight pillow in small of back to keep posture upright.

References:
Midair exercise makes for happier landings. Chicago Tribune, 10/2010.

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Recommendation and review posted by Guinevere Smith

Happiest people were 22% less likely to develop heart disease

Posted: November 7, 2010 at 9:21 am

From WebMD:

Happiest people were 22% less likely to develop heart disease over the 10 years of follow-up than people who fell in the middle of the negative-positive emotion scale.

People with the most negative emotions had the highest risk for heart disease and people who scored highest for happiness had the lowest risk.

Possible explanations for how happiness may protect the heart:

– Healthier lifestyle: Happy people tend to sleep better, eat better, smoke less, and get more exercise.
– Physiological impact: Happiness may produce a host of positive chemical changes — such a reduction in stress hormones.
– Genetic influences: It could be that people who are predisposed to happiness are also predisposed to have fewer heart attacks.

Devote 15-20 minutes a day to doing something enjoyable and relaxing.

Strategies that could help naturally negative people become happier:

– Express gratitude on a regular basis.
– Practice being optimistic.
– Engage in frequent acts of kindness.
– Visualize one’s best self.
– Savor joyful events.
– Practice forgiveness.

Regular exercise, sexual activity and good sleep are associated with increased self-reported happiness.

References:

Study: Happiness Good for the Heart. WebMD.
Image source: OpenClipArt.org, public domain.

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Recommendation and review posted by Guinevere Smith

What’s new in gastroenterology and hepatology from UpToDate

Posted: November 7, 2010 at 9:21 am

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via “What’s new” page. I selected the brief excerpts below from What’s new in gastroenterology and hepatology:

Hepatitis C virus (HCV) infection

Peginterferon alfa-2a was superior to peginterferon alfa-2b with regard to virologic response rates in patients with chronic hepatitis C virus infection, genotypes 1, 2, 3, or 4. Patients being treated for chronic hepatitis C virus infection should receive peginterferon alfa-2a rather than peginterferon alfa-2b.

72 weeks of therapy with peginterferon alfa-2a plus ribavirin in patients with HCV genotype 1 or 4 was not better than 48 weeks.

Chronic use of proton pump inhibitors (PPIs)

Chronic use of proton pump inhibitors (PPIs) may lead to an increased risk of fractures. FDA recommends that healthcare professionals who prescribe proton pump inhibitors should consider whether a lower dose or shorter duration of therapy would adequately treat the patient’s condition.

Ulcerative colitis

Once daily dosing of delayed-release mesalamine (Asacol 400 mg tablets) 1.6 to 2.4 g/day was as effective as twice daily dosing for maintenance of clinical remission in patients with ulcerative colitis. Remission rates were 85% in both groups.

Crohn’s disease

Capsule endoscopy was not a cost-effective third test for establishing the diagnosis of Crohn’s disease after a negative ileocolonoscopy and either a CT enterography or small bowel follow-through x-ray.

Azathioprine in combination with infliximab or infliximab alone had a higher rate of glucocorticoid-free clinical remission than those treated with azathioprine alone. Combination therapy and infliximab monotherapy led to significantly more complete bowel healing than azathioprine alone.

Obscure gastrointestinal bleeding

Double balloon enteroscopy (DBE) detected bleeding sources in 78% of patients with obscure gastrointestinal bleeding. Small intestinal ulcers and erosions were the most common findings.

References:
What’s new in gastroenterology and hepatology. UpToDate.

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Recommendation and review posted by Guinevere Smith

"Talk to Frank" – British government website for drug abuse prevention and treatment

Posted: November 7, 2010 at 9:21 am

Talk to Frank” is a British government-funded website for drug abuse prevention and treatment tips for the general public available at http://www.talktofrank.com

“A to Z” list of substances explains appearance and use, effects, chances of getting hooked, health risks and the UK law. It also includes information on peer pressure, etc.

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Recommendation and review posted by Guinevere Smith

Statins Use in Presence of Elevated Liver Enzymes: What to Do?

Posted: November 7, 2010 at 9:21 am

The beneficial role of statins in primary and secondary prevention of coronary heart disease has resulted in their frequent use in clinical practice.

However, safety concerns, especially regarding hepatotoxicity, have driven multiple trials, which have demonstrated the low incidence of statin-related hepatic adverse effects. The most commonly reported hepatic adverse effect is the phenomenon known as transaminitis, in which liver enzyme levels are elevated in the absence of proven hepatotoxicity.

“Ttransaminitis” is usually asymptomatic, reversible, and dose-related.


Lovastatin, a compound isolated from Aspergillus terreus, was the first statin to be marketed for lowering cholesterol. Image source: Wikipedia, public domain.

The increasing incidence of chronic liver diseases, including nonalcoholic fatty liver disease and hepatitis C, has created a new challenge when initiating statin treatment. These diseases result in abnormally high liver biochemistry values, discouraging statin use.

A PubMed/MEDLINE search of the literature (1994-2008) was performed for this Mayo Clinic Proceedings review. The review supports the use of statin treatment in patients with high cardiovascular risk whose elevated aminotransferase levels have no clinical relevance or are attributable to known stable chronic liver conditions.

References:
Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma. Rossana M. Calderon, MD, Luigi X. Cubeddu, MD, Ronald B. Goldberg, MD and Eugene R. Schiff, MD. Mayo Clinic Proceedings April 2010 vol. 85 no. 4 349-356.

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Recommendation and review posted by Guinevere Smith

What’s new in obstetrics and gynecology from UpToDate

Posted: November 7, 2010 at 9:21 am

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via “What’s new” page. I selected the brief excerpts below from What’s new in obstetrics and gynecology:

Obstetrics

Influenza vaccination with inactivated vaccine is recommended for pregnant women, regardless of the stage of pregnancy. The 2010-2011 influenza vaccine is trivalent and includes antigens from both the 2009 pandemic H1N1 influenza virus and seasonal influenza viruses.

Use of acetaminophen during pregnancy was associated with a reduction in neural tube defects, as well as cleft lip/palate and gastroschisis. These data support the safety of acetaminophen for relief of fever and pain.

Gynecology

Like CA 125, human epididymal secretory protein E4 (HE4) is a promising biomarker for ovarian cancer. In contrast to CA 125, HE4 levels do not appear to be elevated in women with endometriosis, and thus can be useful to rule out ovarian cancer in patients with endometriosis and a pelvic mass suspected to be an endometrioma.

Sterilization does not impact sexual function. Sexual function appears to be unchanged or improved in women following tubal sterilization.

Botulinum toxin may be useful for overactive bladder syndrome (onabotulinumtoxinA, Botox®). Detrusor injection of botulinum toxin (BoNT) had a transient effect. The average time between injections was 8 to 12 months.

References:
What’s new in obstetrics and gynecology. UpToDate.

Image source: Wikipedia, GNU Free Documentation License.

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


Recommendation and review posted by Guinevere Smith


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