Tag Archives: Bone fracture

Should Statins be Available for Everyone?

They lower cholesterol and heart attack risk and may hold promise against other diseases, including cancer. Doctors consider broadening their use.
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Should statin drugs be put in the water, or what? ¶ More than 13 million Americans are taking these medications to lower their cholesterol and hopefully stave off heart disease — a job the drugs appear to excel at. Statins can lower “bad” LDL cholesterol by 20% to 60%. Over time, this can lower the risk of having a heart attack by about the same amount. ¶ For many years, it was believed that statins worked solely by reducing blood cholesterol, which can build up in sticky plaques in the arteries that supply blood to the heart, potentially blocking blood flow and causing heart attacks. But evidence is mounting that the drugs reduce heart disease risk through more than just their cholesterol-lowering effects. New research suggests they may be beneficial even for people with cholesterol in the normal range. ¶ This has doctors and medical researchers debating whether many more people should be on statins than currently fall under treatment guidelines. Some drug companies and doctors have even argued that low doses of the drugs should be available over the counter, as they are in the United Kingdom.

At the same time, other studies are reporting that statins might help prevent or treat a number of noncardiovascular conditions — including multiple sclerosis, cancer and Alzheimer’s disease. With all this news, many may be wondering, “Should I take a statin, just in case?”

Experts, for the most part, will say only, “Maybe.”

Most of the people at high risk of cardiovascular disease “are going to be safer and live longer if they’re on a statin than if they’re not,” says Nathan Wong, director of the UC Irvine Heart Disease Prevention Program. But that doesn’t hold for people whose risk for heart attacks is very low to begin with, he adds. “I’m not saying that everyone is going to be better on a statin. They need to be used with discretion.”

All six statins available today — atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol) and fluvastatin (Lescol) — work by blocking an enzyme called HMG-CoA reductase.

In the liver, blocking this enzyme shuts down cholesterol production and increases the amount of cholesterol the liver takes out of the bloodstream.

But statins also block HMG-CoA reductase in the cells lining blood vessels, where, among other things, they can reduce inflammation.

Dramatic results
The anti-inflammatory effect of statins has been on many heart experts’ minds since the Nov. 9 announcement of the results of a clinical trial called JUPITER. The trial showed that statin treatment can reduce the risk of heart disease in people with normal cholesterol levels but high levels of inflammation as measured by blood levels of a marker called C-reactive protein (CRP).

A team led by Dr. Paul Ridker of Brigham and Women’s Hospital in Boston and Harvard Medical School found that in 8,901 people with high blood CRP levels, rosuvastatin (Crestor) reduced the risk of a heart attack by 54% and the need for bypass surgery or angioplasty by 46% compared with an equal number of people taking a placebo.

There were 68 heart attacks and 131 bypass surgeries/angioplasties in the placebo group, but only 31 and 71, respectively, in the group taking the statin. There were 48% fewer strokes — 64 versus 33. These effects were so dramatic that regulators stopped the trial, slated to go for four years, after less than two. AstraZeneca, the company that makes Crestor, funded the JUPITER trial.

The results raise an obvious question: Are the cholesterol-lowering effects or the inflammation-reducing effects of statins more important?

Dr. Christopher Cannon, a cardiologist at Brigham and Women’s, says they both play a part: “You have to have some cholesterol get into the arteries [and cause damage]. And if you have inflammation that damages the lining of the arteries, the cholesterol gets in more easily.”

Inflammation can also encourage plaques to rupture, causing clots that block blood flow. “Both [cholesterol buildup and inflammation] are happening simultaneously, and both are inhibited simultaneously with statins,” Cannon says.

Currently, more than 13 million people take statin drugs for elevated LDL cholesterol, and at least 47 million more have cholesterol levels high enough to make them eligible by current National Heart, Lung, and Blood Institute cholesterol guidelines.

Ridker estimates an additional 4 million to 6 million people would be added to the mix if everyone who would have qualified for the JUPITER trial (men over 50, women over 60, LDL cholesterol below 130 mg/dL and CRP above 2 mg/L) started taking a statin.

Anti-inflammatory:

Statins may be good for more than just fighting heart disease.

Very preliminary studies suggest that the anti-inflammatory effects of statins could help treat autoimmune diseases. A small, nine-month study of 36 patients with multiple sclerosis published in April in the journal PLoS One showed that statin treatment, either alone or combined with standard MS treatment, reduced the number of brain lesions characteristic of the disease by 24% and reduced their size by about 12%.

Another pilot study of just seven people, published in September 2007 in the Journal of the American Academy of Dermatology, showed that a statin reduced the severity of the skin disease psoriasis

A combined analysis of 19 studies, published in August in the International Journal of Cancer, found that statin use reduced the risk of advanced prostate cancer by 23%.

And a study published in November in the Journal of the National Cancer Institute showed that men prescribed statins had a 4.1% decline in their blood levels of prostate-specific antigen (PSA), a marker of prostate cancer.

There is some evidence that statins can lower the risk of developing Alzheimer’s disease. An October study of almost 7,000 people in Rotterdam, Netherlands, found that people taking a statin had about a 50% lower risk of Alzheimer’s compared with those who had never used cholesterol-lowering medication. Other studies, however, have failed to find an effect of statins on the risk for dementia or Alzheimer’s disease.

As the benefits of these drugs are experienced by more people, the risks will be too. Though statins are generally considered safe, they do have side effects.

Drugs’ side effects:-
The most commonly reported adverse event associated with statins is muscle pain. A 2006 analysis of seven clinical trials published in Medscape General Medicine found that 2.5% to 6% of patients taking statins reported aches and pains related to their drugs.

Rhabdomyolysis, a breakdown of skeletal muscle that can lead to kidney failure and sometimes death, has also been linked to statins. According to the 2006 Medscape report, less than 0.1% of patients taking statins reported rhabdomyolysis. There was only 0.15 death from rhabdomyolysis per 1 million prescriptions.

Liver effects are also seen in some patients taking statins. In less than 1% of patients taking moderate doses of statins, and in about 2% to 3% of those taking high doses, liver enzyme levels are abnormally high. But the enzyme changes usually subside after discontinuing statin use or switching to a different statin, says Dr. Antonio Gotto, dean of Weill Cornell Medical College in New York.

In 2007, the Food and Drug Administration conducted an investigation into whether statins increase the risk of the fatal neurodegenerative disease amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, when the agency received a higher than expected number of reports of the disease in people taking statins. Although an analysis of 41 long-term controlled clinical trials reported in September detected no such link, the FDA has said it plans to continue studying the issue.

Dr. Scott Grundy, a professor of internal medicine and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas, says he thinks the drugs, on balance, are safe. But he adds that caution is still warranted, especially when it comes to considering a broad expansion of their use or prescribing them earlier in people’s lives.

Statins have been in use only since the late 1980s, he notes, and so there hasn’t been enough time yet to learn what might happen if someone were to be on the drugs for 30 or 40 years. “It is possible that some of these rare side effects might turn out to be quite important if [statins are] started early in life and continued for years and years,” he says.

Whether statin use is substantially expanded may depend on how the results of the JUPITER trial and other recent research are incorporated into new cholesterol guidelines slated to be released next year by the National Heart, Lung and Blood Institute.

If CRP testing becomes part of the standard battery of tests that guide risk assessment and statin treatment decisions, millions more Americans could find themselves filling a prescription.

Currently, most doctors use CRP testing as a sort of tie-breaker when they are on the fence as to whether a patient is at high enough risk of heart disease to warrant statin therapy. Patients might, for example, have intermediate cholesterol levels but a family history of heart attacks or some other risk factor.

Dr. Mary Malloy, co-director of the adult lipid clinic and director of the pediatric lipid clinic at the UCSF Medical Center, does not think this should change, even though she characterizes the JUPITER results as “very impressive.”

“I am personally not ready to corral everyone over 35 and do CRP testing,” she says.

Wong says it’s important that people take into account a person’s absolute risk when judging whether or not a patient needs a statin.

Of the JUPITER trial, he says, “There was a 44% reduction in cardiovascular events. This sounds very dramatic, and it is.” But the risk of heart attack in those patients was pretty tiny to begin with — 2.8%. The 44% drop took it down to 1.6%.

The bottom line is that monetary cost as well as potential side effects of statins must be weighed against the potential benefits.

Wong’s biggest concern is that people will get the idea that statins are a cure-all — and they’ll stop bothering about habits that could affect their heart health just as much.

“People think statins are magic pills,” he says. “You can’t forget about other risk factors like smoking, diabetes and blood pressure. . . . you have to make sure all these things are adequately controlled.”

Sources: Los Angles Times

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Bone Fracture

DEFINITION:-
If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures the skin, it is called an open fracture (compound fracture)….>…..click & see

A stress fracture .>....(click & see)...is a hairline crack ->. (click & see).….in the bone that develops because of repeated or prolonged forces against the bone.

A bone fracture (sometimes abbreviated FRX or Fx or Fx) is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cancer or osteogenesis imperfecta. Although fractures are commonly referred to as bone breaks, the word break is not part of formal orthopaedic terminology.

Fractures, broken bones–you can call it what you wish, it means the same thing–are among the most common orthopedic problems, about 6.8 million come to medical attention each year in the United States. The average citizen in a developed country can expect to sustain two fractures over the course of their lifetime.

Fractures happen because an area of bone is not able to support the energy placed on it (quite obvious, but it becomes more complicated). Therefore, there are two critical factors in determining why a fracture occurs:

*the energy of the event

*the strength of the bone

The energy can being acute, high-energy (e.g. car crash), or chronic, low-energy (e.g. stress fracture). The bone strength can either be normal or decreased (e.g. osteoporosis). A very simple problem, the broken bone, just became a whole lot more complicated!

Different Types of Fractures:-
A doctor may be able to tell whether a bone is broken simply by looking at the injured area. But the doctor will order an X-ray to confirm the fracture and determine what type it is.

Reassure your child that, with a little patience and cooperation, getting an X-ray to look at the broken bone won’t take long. Then, he or she will be well on the way to getting a cool — maybe even colorful — cast that every friend can sign.

For little ones who may be scared about getting an X-ray, it might help to explain the process like this: “X-rays don’t hurt.

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Doctors use a special machine to take a picture to look at the inside of your body. When the picture comes out, it won’t look like the ones in your photo album, but doctors know how to look at these pictures to see things like broken bones.”However, a fracture through the growing part of a child’s bone (called the growth plate) may not show up on X-ray. If this type of fracture is suspected, the doctor will treat it even if the X-ray doesn’t show a break.

You may click to see the different pictures of broken bones

Children’s bones are more likely to bend than break completely because they’re softer. Fracture types that are more common in kids include:

*buckle or torus fracture: one side of the bone bends, raising a little buckle, without breaking the other side

*greenstick fracture: a partial fracture in which one side of the bone is broken and the other side bends (this fracture resembles what would happen if you tried to break a green stick)

Mature bones are more likely to break completely. A stronger force will also result in a complete fracture of younger bones.

A complete fracture may be a:

*closed fracture: a fracture that doesn’t break the skin

*open (or compound) fracture: a fracture in which the ends of the broken bone break through the skin (these have an increased risk of infection)

*non-displaced fracture: a fracture in which the pieces on either side of the break line up

*displaced fracture: a fracture in which the pieces on either side of the break are out of line (which might require surgery to make sure the bones are properly aligned before casting)

Other common fracture terms include:

*hairline fracture: a thin break in the bone
*single fracture: the bone is broken in one place
*segmental: the bone is broken in two or more places in the same bone
*comminuted fracture: the bone is broken into more than two pieces or crushed

CAUSES:-
The following are common causes of broken bones:

*Fall from a height

*Motor vehicle accidents

*Direct blow

*Child abuse

*Repetitive forces, such as those caused by running, can cause stress fractures of the foot, ankle, tibia, or hip

In children:-
In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture.

*A greenstick fracture occurs because the bone is not as brittle as it would be in an adult, and thus does not completely fracture, but rather exhibits bowing without complete disruption of the bone’s cortex.

*Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.

*Plastic deformation of the bone, in which the bone permanently bends but does not break, is also possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.

SYMPTOMS:

*A visibly out-of-place or misshapen limb or joint

*Swelling, bruising, or bleeding

*Intense pain

*Numbness and tingling

*Broken skin with bone protruding

*Limited mobility or inability to move a limb

TREATMENT:-
FIRST AID :

*Check the person’s airway and breathing. If necessary, call 911 and begin rescue breathing, CPR, or bleeding control.Keep the person still and calm.

*Examine the person closely for other injuries.

*In most cases, if medical help responds quickly, allow the medical personnel to take further action.

*If the skin is broken, it should be treated immediately to prevent infection. Don’t breathe on the wound or probe it. If possible, lightly rinse the wound to remove visible dirt or other contamination, but do not vigorously scrub or flush the wound. Cover with sterile dressings.

*If needed, immobilize the broken bone with a splint or sling. Possible splints include a rolled up newspaper or strips of wood. Immobilize the area both above and below the injured bone.

*Apply ice packs to reduce pain and swelling.

*Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches above the head, and cover the person with a coat or blanket. However, DO NOT move the person if a head, neck, or back injury is suspected.

CHECK BLOOD CIRCULATION:-
Check the person’s blood circulation. Press firmly over the skin beyond the fracture site. (For example, if the fracture is in the leg, press on the foot). It should first blanch white and then “pink up” in about two seconds. Other signs that circulation is inadequate include pale or blue skin, numbness or tingling, and loss of pulse. If circulation is poor and trained personnel are NOT quickly available, try to realign the limb into a normal resting position. This will reduce swelling, pain, and damage to the tissues from lack of blood.

TREAT BLEEDING:-
*Place a dry, clean cloth over the wound to dress it.

*If the bleeding continues, apply direct pressure to the site of bleeding. DO NOT apply a tourniquet to the extremity to stop

the bleeding unless it is life-threatening.

DO NOT:-
*DO NOT move the person unless the broken bone is stable.

*DO NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you must move the

person, pull the person to safety by his clothes (such as by the shoulders of a shirt, a belt, or pant-legs).

*DO NOT move a person who has a possible spine injury.

*DO NOT attempt to straighten a bone or change its position unless blood circulation appears hampered.

*DO NOT try to reposition a suspected spine injury.

*DO NOT test a bone’s ability to move.

Call immediately for emergency medical assistance if:
Call 911 if:

*There is a suspected broken bone in the head, neck, or back.

*There is a suspected broken bone in the hip, pelvis, or upper leg.

*You cannot completely immobilize the injury at the scene by yourself.

*There is severe bleeding.

*An area below the injured joint is pale, cold, clammy, or blue.

*There is a bone projecting through the skin.

Even though other broken bones may not be medical emergencies, they still deserve medical attention. Call your health care  provider to find out where and when to be seen.

If a young child refuses to put weight on an arm or leg after an accident, won’t move the arm or leg, or you can clearly see a deformity, assume the child has a broken bone and get medical help.

First aid for fractures includes stabilizing the break with a splint in order to prevent movement of the injured part, which could sever blood vessels and cause further tissue damage. Waxed cardboard splints are inexpensive, lightweight, waterproof and strong. Compound fractures are treated as open wounds in addition to fractures.

At the hospital, closed fractures are diagnosed by taking an X-ray photograph of the injury.

Since bone healing is a natural process which will most often occur, fracture treatment aims to ensure the best possible function of the injured part after healing. Bone fractures are typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. To put them back into the natural positions, the doctor often “snaps” the bones back into place. This process is extremely painful without anesthesia, about as painful as breaking the bone itself. To this end, a fractured limb is usually immobilized with a plaster or fiberglass cast which holds the bones in position and immobilizes the joints above and below the fracture. If being treated with surgery, surgical nails, screws, plates and wires are used to hold the fractured bone together more directly. Alternatively, fractured bones may be treated by the Ilizarov method which is a form of external fixator.

Occasionally smaller bones, such as toes, may be treated without the cast, by buddy wrapping them, which serves a similar function to making a cast. By allowing only limited movement, fixation helps preserve anatomical alignment while enabling callus formation, towards the target of achieving union.

Surgical methods of treating fractures have their own risks and benefits, but usually surgery is done only if conservative treatment has failed or is very likely to fail. With some fractures such as hip fractures (usually caused by osteoporosis or Osteogenesis Imperfecta), surgery is offered routinely, because the complications of non-operative treatment include deep vein thrombosis (DVT) and pulmonary embolism, which are more dangerous than surgery. When a joint surface is damaged by a fracture, surgery is also commonly recommended to make an accurate anatomical reduction and restore the smoothness of the joint. Infection is especially dangerous in bones, due to their limited blood flow. Bone tissue is predominantly extracellular matrix, rather than living cells, and the few blood vessels needed to support this low metabolism are only able to bring a limited number of immune cells to an injury to fight infection. For this reason, open fractures and osteotomies call for very careful antiseptic procedures and prophylactic antibiotics.
Sometimes bones are reinforced with metal, but these fracture implants must be designed and installed with care. Stress shielding occurs when plates or screws carry too large of a portion of the bone’s load, causing atrophy. This problem is reduced, but not eliminated, by the use of low-modulus materials, including titanium and its alloys. The heat generated by the friction of installing hardware can easily accumulate and damage bone tissue, reducing the strength of the connections. If dissimilar metals are installed in contact with one another (i.e., a titanium plate with cobalt-chromium alloy or stainless steel screws), galvanic corrosion will result. The metal ions produced can damage the bone locally and may cause systemic effects as well.

Herbal Treatment For Bone Broken for quicker bone groth & healing:-

By eating garlic buds, frying it in ghee joins the broken bone and releives the fracture pain. Eat Agar Agar – sea weed boiled with water. Eat the powder of Vajiram – Pirandai.

Prevention:
*Wear protective gear while skiing, biking, roller blading, and participating in contact sports. This includes helmets, elbow pads, knee pads, and shin pads.

*Create a safe home for young children. Gate stairways and keep windows closed.

*Teach children how to be safe and look out for themselves.

*Supervise children carefully. There is no substitute for supervision, no matter how safe the environment or situation appears to be.

*Prevent falls by not standing on chairs, counter tops, or other unstable objects. Remove throw rugs and electrical cords from floor surfaces. Use handrails on staircases and non-skid mats in bathtubs. These steps are especially important for the elderly.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Bone_fracture
http://www.herbalking.in/diseases_b.htm#bonebroken
http://orthopedics.about.com/cs/otherfractures/a/fracture.htm
http://kidshealth.org/parent/general/aches/broken_bones.html

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Injuries in Toe, Foot, and Ankle

The mucous sheaths of the tendons around the a...

The mucous sheaths of the tendons around the ankle. Lateral aspect. (Photo credit: Wikipedia)

At one time or another, everyone has had a minor toe, foot, or ankle injury that caused pain or swelling. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or an injury. Toe, foot, or ankle injuries most commonlyoccur during:

You may click to see the picture

*Sports or recreational activities.
*Work-related tasks.
*Work or projects around the home.

In children, most toe, foot, or ankle injuries occur during sports or play or accidental falls. The risk for injury is higher in sports with jumping, such as basketball, or sports with quick direction change, such as soccer or football. Any bone injury near a joint may injure the growth plate (physis) in a child and needs to be evaluated.

Certain athletes, such as dancers, gymnasts, or soccer or basketball players, have an increased risk of toe, foot, or ankle injuries.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk for accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Your pain may be sudden and severe. Bruising and swelling may develop soon after your injury. Acute injuries include:

*Bruises. After an ankle injury, bruising may extend to your toes from the effects of gravity.

See a illustration of a bruise (contusion)->

*Injuries to ligaments that support your joints. See an illustration of a ligament tear……

*Injuries to tendons, such as ruptured tendons in your heel (Achilles tendon). Young boys between 8 and 14 years old may have a condition known as Sever’s disease, which causes injury to the growing bone where the Achilles tendon is attached. This usually occurs during activity and is relieved with home treatment……

*Injuries to your joints (sprains). If a sprain does not appear to be healing, a condition known as osteochondritis dissecans may be present, causing persistent symptoms. See an illustration of a sprained ankle…….

*Pulled muscles (strains). Muscles of the foot and ankle can be strained and can also rupture.

*Broken bones (fractures), such as a broken toe.

*A bone moving out of place (dislocation).

*A crushing injury, which can lead to compartment syndrome.

Overuse injuries:

Overuse injuries occur when too much stress is placed on your joint or other tissue, often by “overdoing” an activity or repeating the same activity over and over. Overuse injuries include:

*Retrocalcaneal bursitis, which is inflammation of the bursa. This condition causes swelling and tenderness of the heel. Pain usually worsens while wearing shoes and during activity and improves during rest. See an illustration of the back of the heel and ankle.

*Achilles tendinitis or tendinosis (tendinopathy), which is the breakdown of soft tissues in and around the Achilles tendon that connects the calf muscles to the heel bone.

*Stress fracture, which is a hairline crack in a bone. See an illustration of stress fractures of the foot.
Plantar fasciitis, which is an inflammation of the plantar fascia, a broad, flat ligament on the bottom of the foot that extends from the front of the heel to the base of the toes and helps maintain the arch of the foot. See an illustration of the plantar fascia.

*Metatarsalgia, which is pain in the front (ball) of the foot. See an illustration of metatarsalgia.

Treatment:
Treatment for your toe, foot, or ankle injury may include first aid measures (such as the application of a brace, splint, or cast), a special shoe (orthotic device), physical therapy, medicine, and in some cases surgery. Treatment depends on:

*The location, type, and severity of your injury.

*When the injury occurred.

*Your age, your overall health condition, and your activities (such as work, sports, or hobbies)

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Click for :->Emergency

>Prevention

>Home Treatment

Sources: MSN Health.

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