Tag Archives: The New England Journal of Medicine

Normal Blood pressure: How low should a person can go?

A new study suggests greater health benefits with a lower-than-standard number.

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Blood pressure has long been one of the best markers of your health. It is a number you can remember and monitor. High blood pressure (hypertension) is linked to a greater risk of heart attacks and strokes.

About one out of three adults has high blood pressure, which is usually defined as a reading of 140/90 millimeters of mercury (mm Hg) or higher.

The first, or upper, number (systolic pressure) represents the pressure inside the arteries when the heart beats, and the second, or lower, number (diastolic pressure) is the pressure between beats when the heart rests.

Blood pressure rises with age because of increasing stiffness of large arteries, long-term buildup of plaque, and the effects of other diseases involving the heart and blood vessels. Typically, more attention is given to the diastolic reading as a major risk factor for cardiovascular disease.

“In fact, for a long time, some physicians felt that a systolic (upper) number higher than 140 could be tolerated in older people,” says Dr. Paul Huang, a cardiologist with Harvard-affiliated Massachusetts General Hospital. “But both upper and lower numbers are equally important.”

A new number to aim for

While 140/90 continues to be the blood pressure cutoff, a study published in the Nov. 26, 2015 issue of The New England Journal of Medicine shows that lowering pressure to around 120/80 may reap greater benefits.

Researchers examined the initial results from the Systolic Blood Pressure Intervention Trial, or SPRINT, which studied 9,361 adults over age 50 who either had hypertension or were at a high risk for cardiovascular disease.

The subjects were divided into two groups. The first received an intensive treatment to lower blood pressure to less than 120/80. The other group followed a standard treatment to lower it to less than 140/90.

After three years, the researchers found that the group with the target of below 120/80 had a 25% lower risk of heart attack, stroke, or cardiovascular death compared with those with the standard target of less than 140/90. They also had 27% fewer deaths from any cause. (The study was stopped early because the outcome in the intensive treatment group was so much better than in the standard treatment group.)
Ups and downs of lower numbers

This study supports observational studies that have found that lower blood pressure reduces cardiovascular risk.

But what does it take to get to the lower numbers? “On average, the people in the intensive treatment group took three blood pressure medications, while those in the standard treatment group only took two,” says Dr. Huang.

Moreover, the study found that the benefits in reducing heart attacks, strokes, and death were found equally in those older or younger than age 75. “So we can no longer say that a higher blood pressure is okay just because someone’s older,” he says.

But should older men focus on going lower? Is lower than 140/90 good enough, or should you be more aggressive and get that number down as close as possible to 120/80?

“If you currently are on blood pressure medicine, and your pressure is lower than 140/90, you should discuss with your doctor whether you should aim to go even lower,” says Dr. Huang. “There may be additional benefits to further reducing your stroke and heart attack risk.”

Still, there may be some downsides to going lower. For instance, many people may not want to take any additional medication. They may be concerned about battling common side effects, such as extra urination, erection problems, weakness, dizziness, insomnia, constipation, and fatigue. They also may have enough trouble monitoring their current medication without adding more to the mix.

Another potential problem: pressure that drops too low. “This could lead to dizziness and lightheadedness, especially when suddenly rising from a seated position, and increase your risk of falls,” says Dr. Huang.

Also, because the study was stopped early, other possible downsides of the extra medications, such as effects on cognitive function or kidney function, remain unknown.

Monitor your blood pressure:

If anything, this study reinforces the need for men to be more diligent about maintaining a healthy level, says Dr. Huang. He suggests older men follow these basic guidelines:

*Check your pressure every month and alert your doctor to changes. “If the upper number is repeatedly higher than 140, or the lower number higher than 90, let your doctor know,” he says.

*Continue to take your medications as prescribed. “If you suffer from any side effects, talk with your doctor about changing the dosage or drug.”

*Reduce your salt intake. “You do not have to go sodium-free, but be more aware of how much sodium is in the foods you eat,” he says. In general, try to keep your sodium intake below 2,000 milligrams a day. Foods that include the words “smoked,” “processed,” “instant,” or “cured” in the name or on the label are often quite high in sodium.

*Continue to exercise or adopt some kind of workout routine. “Activity and weight loss can help lower and maintain a healthy blood pressure,” says Dr. Huang.

From : Harvard Health Publications
Harvard Medical School

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Chronotherapy

Definition:   Chronotherapy refers to the use of circadian or other rhythmic cycles in the application of therapy. Examples of this are treatments of psychiatric and somatic diseases that are administered according to a schedule that corresponds to a person’s rhythms in order to maximize effectiveness and minimize side effects of the therapy.

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Chronotherapy is used in different fields, examples of this are the treatment of asthma, cancer, hypertension, and multiple types of depression, among others seasonal affective disorder and bipolar disorder. Apart from the clinical applications, chronotherapy is becoming increasingly popular in non-clinical settings, for example on the work floor, where it is used to increase productivity and performance.

*Methods of pharmaceutical chronotherapy:
*Imitative/Mimetic: Imitating the natural changes in a certain substance in the body.
*Preventive/Precautionary: Taking medicines at the moment that they are most necessary, for example taking hypertension medicine at the time of day that the blood pressure is rising.
*Wake therapy

Chronotherapy is a successful treatment of diseases may depend on the time of day or month that a medicine is taken or surgery performed. Asthma and arthritis pain are examples of conditions now being treated by the clock or calendar.

How our bodies marshal defenses against disease depends on many factors, such as age, gender and genetics. Recently, the role of our bodies’ biological rhythms in fighting disease has come under study by some in the medical community.

Our bodies’ rhythms, also known as our biological clocks, take their cue from the environment and the rhythms of the solar system that change night to day and lead one season into another. Our internal clocks are also dictated by our genetic makeup. These clocks influence how our bodies change throughout the day, affecting blood pressure, blood coagulation, blood flow, and other functions.

Some of the rhythms that affect our bodies include:

*Ultradian, which are cycles shorter than a day (for example, the milliseconds it takes for a neuron to fire, or a 90-minute sleep cycle)
*Circadian, which last about 24 hours (such as sleeping and waking patterns)
*Infradian, referring to cycles longer than 24 hours (for example monthly menstruation)
*Seasonal, such as seasonal affective disorder (SAD), which causes depression in susceptible people during the short days of winter.

Chronotherapy (sleep phase)
In chronotherapy, an attempt is made to move bedtime and rising time later and later each day, around the clock, until the person is sleeping on a normal schedule. This treatment can be used by people with delayed sleep phase disorder who generally cannot reset their circadian rhythm by moving their bedtime and rising time earlier.

Here’s an example of how chronotherapy could work over a week’s course of treatment, with the patient going to sleep 3 hours later every day until the desired sleep and waketime is reached. (Shifting the sleep phase by 3 hours per day may not always be possible; shorter increments of 1–2 hours are needed in such cases.)[citation needed]

Day 1: sleep 04:00 to 12:00
Day 2: sleep 07:00 to 15:00
Day 3: sleep 10:00 to 18:00
Day 4: sleep 13:00 to 21:00
Day 5: sleep 16:00 to 00:00
Day 6: sleep 19:00 to 03:00
Day 7 to 13: sleep 22:00 to 06:00
Day 14 and thereafter: sleep 23:00 to 07:00
While this technique can provide temporary respite from sleep deprivation, patients may find the desired sleep and waketimes slip. The desired pattern can only be maintained by following a strictly disciplined timetable for sleeping and rising.
Other forms of sleep phase chronotherapy:
A modified chronotherapy is called controlled sleep deprivation with phase advance, SDPA. One stays awake one whole night and day, then goes to bed 90 minutes earlier than usual and maintains the new bedtime for a week. This process is repeated weekly until the desired bedtime is reached.

Sometimes, although extremely infrequently, “reverse” chronotherapy – i.e., gradual movements of bedtime and rising time earlier each day – has been used in treatment of patients with abnormally short circadian rhythms, in an attempt to move their bedtimes to later times of the day. Because circadian rhythms substantially shorter than 24 hours are extremely rare, this type of chronotherapy has remained largely experimental.

Chronotherapy is not well recognized in the medical community, but awareness is increasing. The implications are broad in every area of medicine.”

CLICK & SEE :Biologic Rhythms   & LEARN  HOW IT HELPS   Angina, Heart Attack,  Allergies,Asthma,High Blood Pressure, Symptoms of Illness and  Diagnostic Testing

Side effects:
The safety of chronotherapy is not fully known. While chronotherapy has been successful for some, it is necessary to rigidly maintain the desired sleep/wake cycle thenceforth. Any deviation in schedule tends to allow the body clock to shift later again.

Chronotherapy has been known to cause non-24-hour sleep–wake disorder in at least three recorded cases, as reported in the New England Journal of Medicine in 1992. Animal studies have suggested that such lengthening could “slow the intrinsic rhythm of the body clock to such an extent that the normal 24-hour day no longer lies within its range of entrainment.

Resources:
http://en.wikipedia.org/wiki/Chronotherapy_(treatment_scheduling)
http://www.medicinenet.com/script/main/art.asp?articlekey=551
http://www.medicinenet.com/script/main/art.asp?articlekey=551&page=5
http://en.wikipedia.org/wiki/Chronotherapy_(sleep_phase)

Gnaphalium Obtusifolium

Botanical NameGnaphalium polycephalum/ Gamochaeta purpurea/Gnaphalium uliginosum /Pseudognaphalium macounii
Family: Asteraceae
Subfamily: Asteroideae
Tribe:     Gnaphalieae
Genus:     Gnaphalium
Kingdom: Plantae
Order: Asterales

Synonyms: Indian Posy. Sweet-scented Life Everlasting. Old Field Balsam. Gnaphalium Obtusifolium or Blunt-leaved Everlasting. Gnaphalium Connoideum. Fragrant Everlasting. None-so-Pretty. Catsfoot. Silver Leaf.

Common Names : White Balsam

Habitat:White Balsam is native to  Virginia, Pennsylvania and New England. This plant is common in old fields and pastures throughout the United States and Canada.

Description:
Natural Order, Compositae. This belongs to a genus of woolly herbs, which are peculiar for their downy and tomentose appearance. Their flowers are borne in many compact heads, closely arranged in a large terminal corymb, and all tubular. The species here spoken of is an annual, one to two feet high, the whole plant (stem, leaves, and peduncles) gray with a short and silky wool. Stem erect, branched above. Leaves alternate, three inches long by one-fourth of an inch broad, tapering at the base, sessile, margins a little wavy, smoothish above. Flowers tubular, white, in obovate heads; heads in a terminal and close panicled corymb, of a pretty appearance. Whole plant slightly fragrant. July and August.

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The leaves and yellow flower-heads are used medicinally, though the whole plant is gathered. Its aroma is rather pleasant, its taste slightly bitter and aromatic, and its properties are extracted by water and alcohol. Several other species of the same genus are used indiscriminately with this one, among which may be named G. decurrens, with yellowish-white flowers and decurrent leaves; G. uliginosum, about five inches high, and with the clusters of flower-heads sitting down below the upper leaves; and G. purpureum, branching from the base, with the leaves green above, and the flowers in a wand-like terminal spike.

Medicinal Uses:

Parts Used: Herb, leaves, flowers.
This plant combines relaxing and stimulating properties with a moderate portion of demulcent quality. In cold preparations, its action is mainly expended upon mucous membranes; and as it soothes and strengthens these tissues, it has been pronounced astringent, though it is faintly tonic and not drying. It has been used in sore-mouth, sub-acute coughs, feebleness of the lungs, leucorrhea, catarrh of the bladder, and the latter stages of dysentery. It is really an excellent article in such cases; and though it is too mild to be of use in degenerate conditions, it is useful for its gentle influence. In warm infusion, it promotes mild diaphoresis, and is a popular remedy in recent colds and light fever; and a strong preparation is said to relieve mumps, quinsy, the tenesmus of dysentery, and excessive menstruation. In some respects it acts on the assimilative organs much as avens root does–toning them and abating a tendency to curdy diarrhea. From being at one time over-rated, it has fallen into undeserved neglect. An ounce may be digested in a pint and a half of water till a pint remains, and two fluid ounces of this used once every two hours or oftener. It is sometimes combined with other agents in pulmonary sirups.

Disclaimer:
The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://en.wikipedia.org/wiki/Gnaphalium
http://www.henriettes-herb.com/eclectic/cook/GNAPHALIUM_POLYCEPHALUM.htm
http://www.botanical.com/botanical/mgmh/b/balwhi08.html

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Mangoes are High on Health

The King of Fruits has several benefits, so indulge your senses this season in some mangoes.

Not only do they taste great, but mangoes are also loaded with several qualities that are excellent for your health. They are rich in powerful antioxidants that are known to neutralise free radicals that cause damage to cells and lead to health problems like heart disease, premature aging and cancer among other things. Here’s why you should consume them…...CLICK & SEE

– With its high iron content, mangoes are excellent for pregnant women and those who suffer from anaemia. But do consult with your doctor beforehand on how much is suitable.

– Constantly complaining about clogged pores? Place mango slices on your skin and then wash off after 10 minutes.

– If you suffer from indigestion problems, nothing will help you as much as a mango. They’re known to give relief from acidity and aid proper digestion since they contain digestive enzymes that help break down proteins.

– Rich in potassium, mangoes reduce high blood pressure. They also contain pectin, a soluble dietary fibre that is known to lower blood cholesterol levels.

– Trying to put on weight? Include mangoes in your diet. Since it is rich in calories as well as carbohydrates, it could be the perfect fruit to have.

– Some studies say that eating mangoes reduces the risk of kidney stone formation.

– In Chinese medicine, mangoes are considered sweet and sour with a cooling energy. They are useful for those suffering from anaemia, bleeding gums, cough, fever, nausea and even sea sickness.

– Studying for exams? This fruit is rich in glutamine acid— an important protein for concentration and memory. Instead of snacking on unhealthy chips and cookies, why not feast on slices of mangoes instead.

– Though they are traditionally not considered as aphrodisiacs, mangoes contain Vitamin E which helps boost one’s sex life. The vitamin works to regulate the body’s sex hormones.

If nothing else, eat a mango just because it won’t be in season forever.

Source : The Times Of India

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Abdominal CT Scan

Introduction:
An abdominal CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomography.
CT scans are pictures taken by a specialized x-ray machine. The machine circles your body and scans an area from every angle within that circle. The machine measures how much the x-ray beams change as they pass through your body. It then relays that information to a computer, which generates a collection of black-and-white pictures, each showing a slightly different “slice” or cross-section of your internal organs. Because these “slices” are spaced only about a quarter-inch apart, they give a very good representation of your internal organs and other structures. Doctors use CT scans to evaluate all major parts of the body, including the abdomen, back, chest, and head.

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CT stands for computerized tomography. In this procedure, a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes called algorithms, the computer is able to generate a 3-D image of a section through the body. CT scans are very detailed and provide excellent information for the physician.

A CT scan is an excellent way to view the organs inside your abdomen. It is especially useful for looking at solid organs, such as the liver, pancreas, spleen, kidneys, and adrenal glands. It is also excellent for viewing the large blood vessels that pass through the abdomen (the aorta and vena cava) and for finding lymph nodes in the abdomen. Organs that can change their shape when they are empty or full, such as stomach and intestines, are harder for a CT scan to evaluate well, because it is sometimes difficult for a doctor to tell for sure if they are abnormal. Often the CT can give some information about these organs, though. Abdominal CT scans are often used to look for signs of inflammation or infection inside the abdomen in different organs, to look for cancer, or to look for injury to one or another internal organ.

A CT scan provides a better picture of internal organs than traditional x-rays. The benefits of an abdominal CT scan usually far outweigh the risks of radiation exposure.

How the Test is Performed
You will be asked to lie on a narrow table that slides into the center of the CT scanner. Usually, you will lie on your back with your arms raised above the head.

The health care provider may inject a dye into one of your veins. This helps certain diseases and organs show up better on the images.

Once inside the scanner, the machine’s x-ray beam rotates around you. Small detectors inside the scanner measure the amount of x-rays that make it through the abdomen. A computer takes this information and creates several individual images, called slices.

You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.

The actual scan time only takes a few minutes, although the entire procedure usually takes much longer.
A CT scan is an excellent way to view the organs inside your abdomen. It is especially useful for looking at solid organs, such as the liver, pancreas, spleen, kidneys, and adrenal glands. It is also excellent for viewing the large blood vessels that pass through the abdomen (the aorta and vena cava) and for finding lymph nodes in the abdomen. Organs that can change their shape when they are empty or full, such as stomach and intestines, are harder for a CT scan to evaluate well, because it is sometimes difficult for a doctor to tell for sure if they are abnormal. Often the CT can give some information about these organs, though. Abdominal CT scans are often used to look for signs of inflammation or infection inside the abdomen in different organs, to look for cancer, or to look for injury to one or another internal organ.

Why the Test is Performed
An abdominal CT rapidly creates detailed pictures of the belly area. The test may be used to:

*Study blood vessels
*Identify masses and tumors, including cancer
*Look for infections, kidney stones, or appendicitis
.How to Prepare for the Test
If you are having an abdominal CT scan, you might have to fast 2–4 hours before your test. You also may have to drink a large quantity of oral contrast, a fluid that will show up on the CT scan and help define the lining of some internal organs.

Tell your doctor if you’re allergic to x-ray contrast dyes, may be pregnant, or have diabetes and take insulin. Insulin can cause hypoglycemia after missing a meal. or have had difficulty with previous CT scans.

If contrast or sedation is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.

Since x-rays have difficulty passing through metal, you will be asked to remove jewelry and wear a hospital gown during the study.

What happens when the test is performed?
The test is done in the radiology department of a hospital or in a diagnostic clinic. You wear a hospital gown and lie on your back on a table that can slide back and forth through the donut-shaped CT machine. A technician or other health care professional inserts an IV and injects more contrast dye through it. This dye outlines blood vessels and soft tissue to help them show up clearly on the pictures.

The technologist moves the table with a remote control to enable the CT machine to scan your body from all of the desired angles. You will be asked to hold your breath for a few seconds each time a new level is scanned. The technologist usually works the controls from an adjoining room, watching through a window and sometimes speaking to you through a microphone. A CT scan takes about 30–45 minutes. Although it’s not painful, you might find it uncomfortable if you don’t like to lie still for extended periods.

How the Test Will Feel
The x-rays are painless. Some people may have discomfort from lying on the hard table.

Contrast give through an IV may cause a slight burning sensation, a metallic taste in the mouth, and a warm flushing of the body. These sensations are normal and usually go away within a few seconds.

Risk Factors:-
There are a few small risks. The contrast dye used in the test can damage your kidneys, especially if they are already impaired by disease.However, some newer dyes are less likely to cause kidney injuries. If kidney damage does occur, this is usually temporary, although in some rare cases it becomes permanent. If you are allergic to the dye used in the procedure, you may get a rash or your blood pressure may drop enough to make you feel faint until you get treatment. As with x-rays, there is a small exposure to radiation. The amount of radiation from a CT scan is greater than that from regular x-rays, but it’s still too small to be likely to cause harm unless you’re pregnant.

An abdominal CT scan is usually not recommended for pregnant women, because it may harm the unborn child. Women who are or may be pregnant should speak with their health care provider to determine if ultrasound can be used instead.

CT scans and other x-rays are strictly monitored and controlled to make sure they use the least amount of radiation. CT scans do create low levels of ionizing radiation, which has the potential to cause cancer and other defects. However, the risk associated with any individual scan is small. The risk increases as numerous additional studies are performed.

In some cases, a CT scan may still be done if the benefits greatly out weigh the risks. For example, it can be more risky not to have the exam, especially if your health care provider thinks you might have cancer.

The most common dye used is iodine based. A person who is allergic to iodine may have nausea, sneezing, vomiting, itching, or hives. Rarely, the dye may cause anaphylaxis (a life-threatening allergic response).

Results:-
What Abnormal Results Mean

The CT scan may show the following:

*Abdominal aortic aneurysm
*Abscesses
*Acute bilateral obstructive uropathy
*Acute cholecystitis
*Acute unilateral obstructive uropathy
*Addison’s disease
*Amebic liver abscess
*Appendicitis
*Bilateral hydronephrosis
*Bowel wall thickening
*Carcinoma of the renal pelvis or ureter
*Cholangiocarcinoma
*Choledocholithiasis
*Cholelithiasis
*Chronic bilateral obstructive uropathy
*Chronic cholecystitis
*Chronic pancreatitis
*Chronic unilateral obstructive uropathy
*Complicated UTI (pyelonephritis)
*Cystinuria
*Cysts
*Echinococcus
*Enlarged lymph nodes
*Enlarged organs
*Gastrointestinal or bowel obstruction
*Glucagonoma
*Hairy cell leukemia
*Hepatocellular carcinoma
*Histoplasmosis; disseminated
*Hodgkin’s lymphoma
*Islet of Langerhans’ tumor
*Multiple endocrine neoplasia (MEN) II
*Nephrocalcinosis
*Nephrolithiasis
*Non-Hodgkin’s lymphoma
*Ovarian cancer
*Pancreatic abscess
*Pancreatic carcinoma
*Pancreatic pseudocyst
*Pancreatitis
*Pheochromocytoma
*Primary hyperaldosteronism
*Pyelonephritis – acute
*Pyogenic liver abscess
*Renal cell carcinoma
*Retroperitoneal fibrosis
*Sclerosing cholangitis
*Stones (bladder, kidney, liver, gall bladder)
*Testicular cancer
*Tumors
*Unilateral hydronephrosis
*Ureterocele
*Wilms’ tumor
*Wilson’s disease
*Zollinger-Ellison syndrome

Additional conditions under which the test may be performed include the following:-
*Acute renal failure
*Alcoholic liver disease (hepatitis/cirrhosis)
*Atheroembolic renal disease
*Chronic glomerulonephritis
*Chronic renal failure
*Cushing syndrome
*Cushing syndrome caused by adrenal tumor
*Injury of the kidney and ureter
*Medullary cystic kidney disease
*Multiple endocrine neoplasia (MEN) I
*Polycystic kidney disease
*Reflux nephropathy
*Renal artery stenosis
*Renal vein thrombosis
*Skin lesion of histoplasmosis

How long is it before the result of the test is known?
The radiologist can probably give you preliminary results within a day. The formal reading of your CT scan might take another day.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/abdominal-ct-scan.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003789.htm