Lowering one’s blood pressure to reach ‘ normal’ values is known to have little clinical benefit according to Cochrane analysis.
 
According to Cochrane Review’s systematic analysis  of available  evidence, researchers found that the use of  anti -hypertensive drugs to bring down the  blood pressure below  140/90 mm Hg did not reduce associated  death rates or the morbidity linked to  high BP.

A number of publications suggest that “lower is better” and recommend aiming for lower BP targets. The present study does not endorse this view.

The review included seven trials involving 22,089 people. It showed that there was no difference, between the standard group (aiming for a BP of  140/90Hg) and the second group (aiming for 135/85Hg), in terms of death rates or associated morbidities like heart attacks, strokes and  heart  or kidney failure.
 
Says Jose Arguedas, lead researcher of the Faculty of Medicine at the University of Costa Rica, “At present there is no evidence from randomized trials to support aiming for a blood pressure target lower than 140/90, in the general population of patients with elevated blood pressure,”
 
“Our research included patients with diabetes or chronic renal disease, and the evidence was slightly less robust for those subgroups of patients. We intend to carry out separate systematic reviews for those subgroups, especially because guidelines recommend even lower blood pressure targets for them”, states Arguedas.
 
Perhaps the trick to increase one’s life span is to keep lifestyle diseases, like diabetes, at bay. This can be realized by   following the ‘take it easy’ policy to reduce stress and by maintaining a healthy lifestyle regime. Life then becomes more pleasurable and worth every living  minute!

Dr.Reeja Tharu

Related links

1. Quiz on Hypertension

2. Blood Pressure charts

3. Stroke – First Aid and Emergency Treatment Guide

There are over a million alcohol- related deaths each year, world wide. A considerable number of these deaths occur among the young, including students.

Cochrane Systematic Review came with the following interesting observation — providing students with personalized feedback regarding their penchant for drinking, and how their behavior compares to social norms, might help to reduce alcohol misuse.

Substantial social science research has revealed  that students are inclined to verestimate the quantity of alcohol that their peers consume. This overestimation has an impact on their behaviors and contributes to the escalating numbers of alcohol-related deaths among them.

According to the 22 trials conducted by  Cochrane research, providing personalized  feedback about students’ drinking  behaviors (and that of their peers’) using the internet or individual face- to- face  counseling sessions may help to address these misconceptions  and to minimize alcohol – related problems!

Group counseling and mailed feedback did not produce the necessary impact.

Lead researcher Maria Teresa Moreira, from the School of Health and Social Care, Oxford Brookes University, UK says “We can’t make direct comparisons between the different interventions, but ,based on a small number of studies, web-based interventions would certainly seem to be a cost-effective option for reducing alcohol misuse.”

“We know that social norms have a powerful impact on thought and behaviour, so changing people’s perceptions about what is normal can really help. Most of the effects lasted for a few months, but some lasted over a year, particularly for the web-based feedback,”  Moreira added.

So the next time your teen binges on alcohol, feed him back his drinking behavior and don’t forget to use the net!

Dr.Reeja Tharu

Related links

1. Alcohol abuse

2. Natural Remedy – Alcoholism

Endometriosis is a gynecological disorder that causes irregular, often painful menstrual periods and pelvic pain. It commonly occurs in women in the reproductive age group and is a cause of infertility in them.

Several treatments are available for endometriosis –the most common being laproscopic surgery and medications. However, surgery does always guarantee a complete cure; drugs, on the other hand, may have unpleasant side effects—acne, hot flushes and weight gain being a few of them.

There was news doing the rounds in the scientific circles that Chinese herbal medicine (CHM)  had an impressionable  effect on patients suffering from endometriosis and that these herbs have less side effects.

The stake was too good – which led the Cochrane review researchers to conduct systematic study on the effect of Chinese herbs on endometriosis patients.

Two trial studies were conducted —one trial proved that the symptomatic relief provided by CHM was comparable to that provided by the hormonal drug gestrinone;  the good news was that there were fewer side effects.

The other trial revealed that CHM provided greater relief than the drug danazol and therefore was much effective .It also resulted in fewer side effects.

Lead researcher Andrew Flower of the Complementary Medicine Research Unit at the University of Southampton in the UK says, “These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis, but at present we don’t have enough evidence to generalize the results”.
It may be interesting to see how long the symptom relief provided by CHM lasted in comparison to the conventional drugs. One is also curious to find out if the CHM resulted in side effects that appeared with time.

The Cochrane review researchers apparently had a difficult time selecting the studies for review because many of them had poor research methodology and poor reporting quality. These are the features that future studies must look into  in order for CHM to be accepted by the scientific world and for the majority to benefit from them!
 
Dr.Reeja Tharu

Related links

1. Endometriosis

2. Alternative medicine

Creativity springs from near-desperation it is said. Ransacking the imagination in a near-desperate situation does throw up an inimitable Mickey Mouse every once in a while. But imagine the marriage ceremony of a couple of frogs solemnized by a huge group of people, who then reverently looked heavenwards for rain! That is precisely what the villagers in Padapalli, a drought-hit village in the southern state of TamilNadu did to invoke the rain gods.

Assam, Orissa, West Bengal, Maharashtra, Karnataka and TamilNadu are among the many states that have performed “froggy” weddings since the beginning of the year as a desperate resort to ward off the looming threat of drought and a season of failed food and cash crops. Villages in India abound in superstitious beliefs that rush to the forefront during a crisis. Getting a nude virgin to run around the village when it is pitch dark and getting a couple of donkeys or asses “married” are some weird customs raked from the hoary past by desperate villagers waiting for rain.

Encouraged by a report in the local newspaper of a downpour in Udipi, Karnataka (another south Indian state) after a marriage ceremony of frogs was performed, enthusiastic villagers in Padapalli, Tamil Nadu, decided to follow suit.

On an auspicious hour last Friday evening, the people caught a male and a female frog from the village well, placed them in a brass pot in the village temple, garlanded them and married them off amidst the chanting of mantras, drum beat and bursting of fire crackers. The frogs were then fed with banana and milk—a ritual feeding of the bride and the bridegroom soon after many Indian marriages. About 2000 people from neighboring villages joined in the fanfare.

Will the froggy couple live together happily ever after? Nobody knows. And did it rain in Padapalli after the froggy wedding? Well, there was a drizzle on Tuesday, said the villagers defensively. They are certainly praying for more!!

Thilaka Ravi

Hopes of arriving at a global consensus to tackle the serious challenge of climate change were dashed last week at L’Aquila, Italy, when the developed nations dragged their feet on arriving at concrete short term plans and a definite roadmap to reduce polluting emissions that can cause disastrous global climate change. Instead, the developed nations chose to pass the buck to the developing nations.

Close on the heels of this setback to set right the emission cuts of green house gases (GHG) that threaten to play havoc on global climate, comes the bombshell in the guise of the El Niño update that can spell disaster for Asian climes. Australia’s weather bureau has reported a spike in the El Niño weather pattern that is gaining in strength at the moment.

El Niño (literally “little boy” in Spanish) is the term used for the abnormal warming pattern in the Eastern Pacific Ocean which has the potential to dramatically change weather patterns across the Asia-Pacific region for the worse. A heightened El Niño can result in monsoon failure in Asia, cause drought in Australia and a horrendous downpour in parts of South America.

“We are warming reasonably rapidly,” said Andrew Watkins from Australia’s meteorological department. The speed with which the equatorial Pacific region warms up will determine how the monsoon is gearing up to show its presence in India. The Indian meteorological department recently forecast a ‘near normal’ monsoon but with a reduced 81% of the normal rain. According to the director of Indian Meteorological Department (IMD), Pune’s National Climate Center, D.S. Pai, if the warming spikes faster its effect may weaken the monsoon earlier and drastically reduce the predicted rainfall.

North India is already gearing up to face the impending threat of drought in most areas. The repeat of the bumper paddy crop as in 2008 in places like Punjab is clearly ruled out this year. The sowing of wheat, paddy, pulses and sugarcane has been delayed following the rains playing truant.

Changing climate and weather patterns make a global impact, no doubt. But it is inevitably the developing nations that take the hit badly.

Thilaka Ravi

Have u come across anyone who is obsessively preoccupied with her dark skin or worried  beyond redemption about his ‘larger than normal’ nose?

Well, it may help to know that we are dealing with someone suffering from a psychological condition called the Body Dysmorphic disorder (BDD)  also known as ‘Dysmorphic syndrome’ or ‘Body dysmorphia’.

The disorder shot to  prominence recently with  the king of pop – Michael Jackson- himself being diagnosed with  it.

Obsessive-compulsive traits are clearly seen in several individuals with this disorder — which usually sets in during adolescence.

Several symptoms are exhibited by the BDD sufferers but the most prominent feature is the  heavy grooming that they indulge in and the gargantuan amount of time that they spend before the mirror, worrying  about a  perceived defect (often non existent) .

The illness causes psychological distress to the point of severe anxiety, depression  and  impaired  social functioning. Social phobia and  eating disorders like anorexia  nervosa are some of the co- morbidities associated with  BDD (Little wonder that  MJ faded out on an empty stomach!).

In an attempt to set right their ‘mal-aligned’ features many of these patients seek the help of dermatologists and plastic surgeons. One surgery is often followed with requests for more!! (don’t we know all know that MJ’s later day identity became synonymous with his much- operated -upon nose?)

BDD is a chronic condition that could worsen with lack of treatment. However, it must be appreciated that Cognitive behavior therapy (CBT) has proven beneficial for many.

Dr. Reeja Tharu

Related links

1. Michael Jackson’s Swan Song : Sans Voice

2. Michael Jackson’s tryst with Vitiligo

It may be a boon where the population is exploding but… the distant toll of humanity’s  death bell can also be heard!

Apparently man has been paying , and will continue to pay, a heavy ransom for his tryst with technology and for his penchant for modern living.

Cell phones Stunt Sperm Count

“Mobile phones are sperm suckers”,  screamed  headlines in the United Kingdom a few years ago, striking panic  into the hearts of nearly  72 per cent of mobile-touting men keen on starting  a family.

Scientists  from Hungary’s  University of Szeged have proved that  mobile phones could reduce sperm count by a third, thanks entirely to the radiation these phones  emit.

Some scientists believe that there is much ado about nothing and that more studies need to be carried out to endorse the Hungarian study. Nevertheless the verdict is out. Beware of thy mobile!

Daddy Cool

There is some bad news for young dads- to- be who spend long hours behind  wheels. Italian researchers claim that driving for prolonged periods is detrimental to the life and quality of  sperms—a fact confirmed by research on  taxi drivers and other men with driving jobs.

Sperms even find body heat harmful — which is why they are stored in  testicular pouches (outside the body) that provide a cooler ‘ambience’. Driving long hours increases testicular temperature, which hampers sperm survival. This damage can be minimized by taking intermittent  breaks.

The above fact also means no steam baths and Jacuzzi when the wife is ovulating. Also remember to wear clothes that allow your ‘two little boys’ to breathe!

Baby Dreams go up in Smoke

Smoking tobacco in any form — be it the ubiquitous cigarette or the more destructive ‘pot’— has a negative impact on sperm production. This is due to the  damaging effect of tobacco on the sperm DNA.

Starting family-Waisted effort

Obese men too have far little chance of fathering children when compared to men of average weight –this  is because  localized fat is capable of generating heat that is potent enough to harm  sperms.

A waist that measures 40 inches warrants weight reduction in order to start a family.

Stress and Sperms

Stress has long been known to have a negative impact on sperm count. So melt the stress if you are really keen to increase your chances to make babies.

Others

Those men who are exposed to solvents such as decorators, painters, dry cleaners and builders run the risk of low  sperm count .Using gloves and wearing a mask is known to help.

Sexually transmitted diseases also affects male fertility negatively. Practice safe sex…always!

All these efforts and sacrifices may be worth their while when you see your baby smiling toothlessly at you.
What then are you waiting for?

Dr. Reeja Tharu

RELATED LINKS

1. Genetics of  male infertility
2. Journey of male sperm- animation
3. Intracytoplasmic Sperm Injection (ICSI) – animation

Dr. Pauline W. Chen in her recent article on “patient centered care” (published in The New York Times) has debated the viability of a new medical model which centers on “shared decision making” between doctor and patient.

This, she believes, if made mandatory in all areas of care, will give
greater magnitude to patient preference, thereby (occasionally) putting evidence-based care on the back burner.

This novel system seems set to gain popularity even as an increasing number of stories have been reported from patients who feel doctors take them for granted.

The value of their individual experiences is diminished by doctors who are pressed for time and who are forced to make snap decisions that may, at times, be questionable.

Dr. Chen has pointed out that ” the system around clinicians makes it impossible to customize care the way it needs to be. We don’t have the standard of services or processes that are comfortable for the patients. We have built a technocratic castle, and when people come into it, they are intimidated.”

Any step taken in the direction of the new model would seem extremely challenging. At present, it is still very difficult for patients with chronic illnesses or rare diseases to find physicians who would genuinely consider their opinions and who would be
supportive of their needs.

Though initially you might be bogged down by the prospects of holding your own against a physician, the process might eventually help to generate optimum care.

Here are some suggestions on ‘How to handle a Difficult Doctor’ as suggested by the WEGO Health Dystonia Community:

* Try to approach the problem with the goal of minimizing friction, instead of attempting to prove who is right and who is wrong. The doctor’s office appointment can be reset with this goal in mind.

* Before an appointment, list out the questions that you need to ask the doctor. Acting professionally is paramount to get the doctor to value your opinion.

* Listening to what the doctor has to say is vital. It is also important to note the tone of his voice. Being defensive does not mean that the doctor is sidelining your suggestions; instead it may merely mean that he is frustrated by results. So weigh out the situation and act /talk accordingly.

* Be assertive and not confrontational while dealing with the problem. While expressing your opinion your words should be assertive and firm but the tone of your voice should not convey anger or annoyance.

* Sometimes it may be imperative to have an intervention with the difficult doctor. In this case a social worker or behavioral health specialist may be consulted on how best to approach the problem without making the doctor go on the defensive. It may be well for the patient to remember that, more often than not, a compromise may be unavoidable.

Related Links

Should Docs Wear a White Coat?

Scientists don’t know yet what causes dreams, but we do know something about the state of dreaming.

Immediately after we go to sleep, our brains enter a stage called ’slow wave’ sleep. The brain waves (electrical activity in the scalp) slow down distinctly from the awake stage,  the muscles are completely relaxed, and the heart beat, blood pressure, and body temperature reduce. If someone is woken up at this stage, they don’t remember dreams.

Then the brain waves change: as we enter what is known as ‘rapid eye movement’ (REM) sleep, the brain waves are indistinguishable from when we are awake. This is when we dream.

When we dream, our heart rate and blood pressure may rise, and the eyes move behind the eyelids (hence the term REM sleep). The rest of the muscles, though, are in a state of paralysis (except for those that control the basic body processes). This is what prevents us from acting out our dreams.

Normally,  slow-wave sleep alternates with REM sleep. Over one night of sleep for the normal adult, the REM sleep stages become gradually longer till the person awakens. Babies, though, spend much of their sleep in slow-wave sleep.

When the switch between slow-wave sleep and REM sleep does not work properly, it can cause a lot of trouble. In people who walk or talk in their sleep the mechanism that causes low muscle tone during REM sleep doesn’t seem to switch on. On the other hand, in people with narcolepsy,  the muscles may suddenly lose tone (like during REM sleep) when the person is awake. The person will not be able to move – a state called cataplexy. People with narcolepsy also switch between the waking and sleeping states suddenly (they may have a sleep attack in the middle of a cooking or driving, for example) as well as between slow-wave and REM sleep.

Why? Scientists suspect that a mixture of genetics and environmental factors cause narcolepsy. But like so many things connected with sleep, we don’t understand much about what is the trigger.

Susan Vinodh Pandian

Read more about dreaming and sleep:

1. Sleepiness calculator

2. A brain scanner that can reconstruct dreams?

3. Dreams affect our judgement and behavior

4. Why sleep deprivation affects some people more than others

Poverty and mental illnesses often go together. Depending on the studies you follow, poor people are between two to nine times as likely as wealthy people to suffer from mental illness, whether depression, schizophrenia, or substance abuse.

So does poverty cause mental illness? Most researchers today acknowledge that an intersection of social, environmental, psychological, and genetic causes lead to mental disorders, though research into causes and cures have tended to focus disproportionately on genetics and drugs in recent years.

But public health experts acknowledge that the conditions of poverty – poorer medical care, fewer resources, higher levels of mortality and substance abuse – seem to themselves lead to mental disorders. Poorer people also recover at lower rates from mental illness and they are more often admitted to institutions, less likely to have jobs, and are more alone and stigmatized.

But there is one surprise: mentally ill people from developing countries are more likely to recover than those from developed countries, with double the rates of remission. This goes against experience in every other medical field, where fewer hospitals and less availability of drugs, for example, produce worse outcomes in public health.

Why? We don’t really know. The WHO in its World Mental Health Report of 2001 speculated that the greater familial support, lesser stigma, and the fact that it is easier to go back to earning your livelihood in developing countries, for example with domestic or other kinds of physical labor, help mentally ill people in countries like India do better than mentally ill people in wealthier countries.

Which is something that reinforces what I believe in: where mental illnesses and disorders are concerned, drugs alone are simply not enough. You also need to provide shelter, food – and sympathy and respect for the person who is suffering.

Susan Vinodh Pandian

Read more about it:

1. Poverty and health

2. Financial crises affect the mental health of children

3. War makes Afghan children more vulnerable to Post Traumatic Stress Disorder

4.  Global recession can cause rise in mental health problems

5. Poverty forces couple into depression and suicide

The bladder shows one example of the mind-body connection: many children lose bladder control when they are afraid, or in periods of stress like when a new brother or sister is born.

Perfectly healthy adults, with no previous incontinence problems, have been known to urinate when in extreme fear. There is also a connection between incontinence and depression – depressed women are more likely to be incontinent, and incontinent women are more likely to be depressed, though the causal link is not clear.

We don’t know yet how this happens: the walls of the bladder are normally relaxed and the sphincter (the ring-shaped muscle leading out of the bladder which dilates to allow urine to flow out) closed in the ‘fight or flight’ response to stress or fear. In extreme cases, though, it seems the digestive system in effect ’shuts down’, and a person will have an urge to urinate, or feel as if he has an attack of diarrhea.

The mind-body connection works the opposite way too. So if you suffer from incontinence, some mental training can help. A study by the Loyola University Health System, reported in the April issue of the Journal of Urology, showed that cognitive behavior therapy (CBT) and meditation helped ten patients (mean age: 62) reduce their episodes of incontinence to almost one-fourth of what it was before the therapy.

So should those who suffer from incontinence choose meditation and CBT over the many other surgical treatments, exercises, and drugs available for urinary incontinence? Is it a sign of mental strength? Not necessarily – some people try CBT and meditation and if they are not successful look for other options.  Others find surgery and drugs have not helped so much, and try out meditation and CBT as their final desparate resort.

It’s a cliche, but it’s true: combining positive mental imaging, CBT, bladder retraining (learning how to predict and control urination, for example, through keeping a bladder diary), pelvic-floor exercises, and if necessary drugs and surgery, will help you most.

Susan Vinodh Pandian

Read more about it:

1. Urinary incontinence calculator for women

2. For women with incontinence: keeping a bladder diary

3. Stress incontinence

4. Scientists try to identify mechanism of mind-body connection

Everyone has some risk for mental illness, like everyone has some risk getting a disease. Today, scientists believe that mental illness is at least partly genetic but there are strong social and environmental triggers. So the risk may be higher for one person and lower for another.

Things that increase risk of mental illness:

• Physical factors: having older parents increases the risk of Down Syndrome (old mother) and autism and schizophrenia (older father).
• Some infections like syphilis and meningitis can cause dementia, as do other diseases like pellagra (vitamin B3 deficiency) and head injuries.
• Alcoholism and substance abuse.
• Family history of psychotic illness.
• Breakdown and conflict in the family or at work.
• Emotional trauma, being a victim of violence.
• Poverty.

Things that protect from mental illness:

• Strong family ties or ties with other people in religious or social contexts.
• Parents who are functioning well in the family and at work, who are loving and supportive.
• At least one person to connect with and who is dependably around.
• Good relationship with peers and other adults outside the family.
• Personal resilience and emotional skills.
• Religious faith.
• Economic security.
• Good physical health.
• Success at school and work.

Susan Vinodh Pandian

Read more about mental illnesses:

1. About mental health on Medindia

2. Understanding mental illnesses through gene-environment interactions

3. Twenty million Indians have serious mental disorders

4.  Support groups for mental illnesses and addiction

Today (July 1) is Doctor’s Day in India, and, in the din of malpractice, side effects, and conflicts of interest, we often forget what a service many nameless doctors do. Look at these statistics:

The baby born today will live to be 66 years on average. In 1900, he could live to be 30.

In the beginning of the  last century, 10% of babies died before they were one year old. Today, the figure is 0.7%.

In the beginning of the twentieth century,  ten mothers died for every 1000 babies born. Today, the figure is just 1% of that, <0.1 death per 1000 births.

Almost one person in three was infected with smallpox in 1900, and of those infected one in three would die. Today, smallpox is eradicated. Many other infectious diseases like polio and  guinea-worm disease are much less common than they used to be. Seventy percent of people infected with cholera would die because of fluid loss due to diarrhea in the nineteenth century. Today, with oral rehydration therapy, less than 3% die.

Let’s give credit where credit is due.  A lot of this is due to modern medicine and its practitioners, and public health measures spearheaded by them.

Susan Vinodh Pandian

Read more:

1. Health facts

2. Top ten facts about senior health

3. AIDS statistics

4. Understanding epidemics using statistics

We have heard of individuals who perennially complain of fatigue. A visit to the doctor does not usually bear fruit as no illness is diagnosed… and the person’s tired state continues.

Welcome to the world of Chronic Fatigue Syndrome (CFS)!

CFS has finally managed to garner enough support and harness the recognition it deserves.

The Centers for Disease Control and Prevention (CDC), USA, now recognizes the fact that 1 million to  4 million Americans are affected by Chronic Fatigue Syndrome( CFS). However, only half these numbers seek medical attention for their illness.

What triggers this condition still remains a mystery. Epstein –Barr virus, anemia, allergies and other factors have been implicated.

As can be guessed by the name, CFS causes severe fatigue in the sufferers to the extent that their normal life is seriously impaired. Pain (non specific) and debilitating fatigue are common hallmarks of this condition. A wide range of symptoms  have been listed including flu-like symptoms and memory loss. The vast majority of CFS patients are women and no one knows why!

Depression in these patients is quite common as the current medicines are unable to relieve the pain. However anti depressants and anti histamines are used to treat this condition. Alternative therapies, like acupuncture, are  known to relieve the pain.

Dr. Reeja Tharu

Related Links

1. Chronic Fatigue Syndrome- An Overview

2. Chronic Fatigue Syndrome Calculator

3. CPAP Treatment Improves Complaints of Fatigue and Tiredness in People With OSA