anti-oxidant

Pagi ini, saya terbaca beberapa pernyataan mengenai kebaikan anti-oksida. Antaranya adalah:

1. Jika kita minum 3 gelas jus segar pada tiap-tiap minggu, ia akan mengurangkan risiko penyakit pelupa atau 'dementia' sebanayk 76%
2.Caratenoid (makanan yang mimiliki pigmen kuning, seperti lobak, jagung dan labu) akan mengurangkan risiko penyakit regenatif pada makular mata yang menyebabkan kebutaan.
3. Peneliti dari Itali telah menemukan satu hasil iaitu apabila seseorng minum 'Dark chocolate', ia akan menurunkan tekanan darah seseorang sama dan lebih baik dari pengubatan alopathy.

Hebatkan..Sesungguhnya, apa yang tuhan ciptakan lebih hebat dr yg kita semua banggakan sekarang..:)

Causes of Anemia in Older Persons

Causes of anemia in the population over age 65 years are relatively few. According to an analysis of the Third National Health And Nutrition Examination Survey (NHANES III), 34% of anemia in older adults was due to folate, B12, or iron deficiency alone or in combination. Twenty percent had anemia of chronic disease (ACD), 12% were associated with renal insufficiency, and in this study, the remaining 34% were unexplained.5 While relative percentages vary between studies with the population being examined, the causes of anemia in all older patients are remarkably constant (Table).

Iron deficiency is frequently seen in the elderly and usually is a result of acute or chronic blood loss through the gastrointestinal tract. ACD is associated with several conditions more common in older persons: inflammatory diseases, malignancy, diabetes, heart failure, and stroke.

Normal B12 absorption requires gastric acid, intrinsic factor (IF), and a terminal ileum. Autoimmune destruction of IF-secreting parietal cells, or pernicious anemia, accounts for approximately 2% of the population over age 60 years. Atrophic gastritis and hypochlorhydria may progress with advancing age and may be partly responsible for the 12% of patients over age 75 years who will have a low B12. The majority of older patients with vitamin B12 deficiency are found to malabsorb dietary protein-bound vitamin B12.29 Short-term studies suggest that proton pump inhibitors and H2 blockers also produce malabsorption of protein-bound B12 by suppressing acid production further.30,31 Post-gastrectomy states, pancreatic insufficiency, and disease or resection of the terminal ileum also impair absorption of B12.

In most studies, 15-30% of patients studied will not have an explanation for their anemia. This may be a function of the intensity of the investigation.

Source: www.clinicalgeriatrics.com

adakah lemak merbahaya

Akhir-akhir ini, saya telah menelaah beberapa artikel mengenai keburukan dan kebaikan lemak. Mungkin ramai diakalangan kita berpendapat lemak adalah sesuatu yang buruk untuk dikonsumsi. Hal ini ada kebenaranya, namun kita jangan lupa mengenai khasiat sebenar lemak jika dikonsumsi dengan betul
Seperti yang kita semua ketahui, lemak terdiri daripada lemak jahat dan lemak baik.
Lemak baik terdiri daripada lemak tidak tepu atau 'unsaturated fatty acid'. Ia dibahagikan lagi kepada 'monosaturated fatty accid' dan' polysaturated fatty acid'. Penamaan ini berkaitan dengan kandungan ikatan hidrogen didalam struktur kimianya.
Semua molekul lemak terdiri daripada unsur-unsur karbon, hidrogen dan oksigen. Saturated fat memiliki struktur hidrogn yang penuh, manakala monosatureted fat kehilangan satu ikatan hidrogen. Begitu juga bagi polyunsaturated, diamana kandungan ikatan hidrogennya lebih banyak yang hilang.
Hal ini memeri peranan yang penting terhadap struktur mata kasar bagi lemak. Bagi saturated fat, ia cenderung untuk menjadi pepejal dgn lebih cepat pada suhu bilik. Hal ini turut berlaku dalam tubuh badan kita. Cuba anda semua bayangkan sendiri.
'Monosaturated fatty acid' banyak terkandung didalam minyak zaitun dan juga pelbagai jenis kekacang. kandungan lemaknya hampir menyamai kandungan lemak didalam sekeping daging 'burger', tetapi bezanya ia adalah lemak baik.
kita beralih pula kepada 'polyunsaturated fatty acid'. Contoh bagi golongan lemak ini adlah minyak ikan. Minyak ikan adalah sumber terbaik untuk EPA dan DHA (omega-3)
Mungkin para pembaca pernah mendengar akan khasiatnya terhadap kesihatan tubuh badan kita.
Omega-3 banyak terkandung didalam ikan-ikan laut dalam. Berikut merupakan senarai ikan berserta kandungan omega-3.

Type of fish	Total omega-3 content per 3.5 ounces (grams)
Mackerel	2.6
Trout, lake	2.0
Herring	1.7
Tuna, bluefin	1.6
Salmon	1.5
Sardines, canned	1.5
Sturgeon, Atlantic	1.5
Tuna, albacore	1.5
Whitefish, lake	1.5
Anchovies	1.4
Bluefish	1.2
Bass, striped	0.8
Trout, brook	0.6
Trout, rainbow	0.6
Halibut, Pacific	0.5
Pollock	0.5
Shark	0.5
Sturgeon	0.4
Bass, fresh water	0.3
Catfish	0.3
Ocean perch	0.3
Flounder	0.2
Haddock	0.2
Snapper, red	0.2
Swordfish	0.2
Sole	0.1

Source: The Health Effects of Polyunsaturated Fatty Acids in Seafoods

Omega-3 memiliki khasiat yang berupa anti-kanser, anti-depresi, memperbaiki memori otak, melawan reaksi inflamasi didalm tubuh dan mencegah penyakit jantung.
Untuk catatan yang akan datang, saya akan menceritakan sedikit sebanyak mekanisma yang berlaku berikutan khasiat omega-3

Possible Association of Takotsubo Cardiomyopathy During COPD Exacerbation

Authors:

Raghavendra Makam, MD, MPH, Jeffrey Leppo, MD, and William Levy, MD

Introduction
Takotsubo cardiomyopathy (TCM), or stress cardiomyopathy, is an increasingly recognized clinical entity that often presents with chest pain and dyspnea, with a significant overlap in presenting features with that of acute coronary syndrome (ACS) but with a very different therapeutic approach and prognosis. Significant emotional events and/or serious physiological stressors such as trauma, sepsis, and multiorgan failure are the commonly reported triggering factors for TCM. Though often observed, a definite correlation between severe pulmonary infections and precipitation of TCM has not yet been well established. In our experience, acute respiratory failure during chronic obstructive pulmonary disease (COPD) exacerbation has been the most common physiological triggering factor for TCM in the critical care setting. We present such a case to illustrate the importance of recognizing TCM in a patient presenting with dyspnea and elevated cardiac enzymes during COPD exacerbation.

Case Presentation
A 67-year-old lady with a history of emphysema and hypertension presented to the Emergency Department with fever, cough, and progressively worsening dyspnea for three days. She denied any chest pain or diaphoresis and had no cardiac history. She had had multiple admissions in the preceding few years for COPD exacerbation. On admission, she was febrile and had bilaterally decreased breath sounds with mild wheezing. Thoracic radiographs showed emphysematous changes but no evidence of heart failure.

After collecting blood, urine, and sputum samples, the patient was immediately started on supplemental oxygen, bronchodilators, intravenous steroids, and antibiotics for COPD exacerbation. Meanwhile, an electrocardiogram showed decreased R waves and minimal ST elevations in the anterior leads, but was basically unchanged from previous readings. Her brain-type natriuretic peptide was 609 pg/mL, and troponin I was found to be significantly elevated at 6.5 ng/mL. An emergency echocardiogram demonstrated a left ventricular ejection fraction of 20% with akinesis and ballooning of left ventricular apex (Figure 1A, 1B). An echocardiogram done three weeks earlier had been normal.

This typical presentation raised the possibility of a new anterior infarction versus apical ballooning syndrome, also known as TCM. The patient was treated with aspirin, atorvastatin, metoprolol, and lisinopril, and was hemodynamically stabilized. She was transferred to a tertiary care facility for cardiac angiography, which demonstrated severe left ventricular dysfunction with active contraction only at the cardiac base and no significant obstructive coronary artery disease. This was consistent with TCM, and recommendation was for conservative medical therapy with aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors.

A follow-up echocardiogram six weeks later revealed absence of any regional wall motion abnormalities noted in earlier study and preservation of left ventricular ejection fraction at 55-60% (Figure 1C, 1D). A repeat study done six months later also remained normal.

Discussion
Takotsubo cardiomyopathy was first described by Dote et al¹ in 1991. The name refers to the way the left ventricle has a characteristic resemblance to takotsubo, a Japanese ceramic pot used for trapping octopus. The end systolic picture on echocardiogram during an acute episode resembles this pot, with a narrow base and a broad apex.

TCM, also referred to as stress cardiomyopathy and transient left ventricular dysfunction, is an acute, transient, and distinctly nonischemic cardiomyopathy, often precipitated by severe emotional or physiological stressors. Although the etiology of TCM is unclear, the characteristic transient left ventricular apical ballooning is generally considered to be a form of myocardial stunning. It is generally believed that acute catecholamine surges that occur secondary to severe emotional or physiological stressors such as infection lead to left ventricular dysfunction. Neither coronary ischemia nor vasospasm appears to play any significant role in the pathogenesis of TCM.^2,3

A typical patient with TCM presents with dyspnea and/or chest pain following an episode of severe emotional trauma or sepsis. Electrocardiography demonstrates ST-T changes often in the precordial leads with modest elevations of cardiac enzymes. Echocardiogram shows the characteristic picture of extensive wall motion abnormality involving the apex of the heart with apical ballooning. It is interesting to note that the wall motion abnormality is, however, out of proportion to the cardiac enzyme elevation. The nonischemic etiology is furthermore confirmed by cardiac catheterization, which fails to demonstrate the presence of any hemodynamically significant luminal obstruction.^4,5

The differentiation between TCM and acute myocardial infarction is often difficult due to overlapping initial presentation. The current consensus, however, is to manage nonischemic and presumed cardiomyopathic patients with aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors, along with nitrates and intravenous diuretics as needed. An echocardiogram is generally repeated in one to four weeks to confirm complete resolution of wall motion abnormalities. Acute respiratory failure occurring in episodes of severe asthma and acute airway obstruction has been reported to be associated with TCM in critically ill patients.^6,7 Pediatric models of acute respiratory distress syndrome requiring the use of extracorporeal membrane oxygenation and experimental animal models for acute lung injury and pulmonary embolism have also been found to develop a similar clinical presentation to TCM. Furthermore, a clear relationship between the severity of the pulmonary lesion and TCM presentation has also been demonstrated.⁸

In our institution, acute exacerbation of COPD has been a common scenario in which TCM has occurred. Presumably, the combination of both physiological stress of hypoxia and psychological stress of acute dyspnea plays a role in triggering the syndrome. COPD exacerbation thus seems to be a definite and possibly common triggering factor for TCM. However, this direct relationship has, unfortunately, not been well described in the literature. The above case also demonstrates the need to recognize TCM in a patient presenting with dyspnea, as in COPD exacerbation, and to differentiate it from ACS as quickly as possible, due to the significant differences in the management and prognosis of either condition.

Conclusion
Clinicians should consider ACS versus TCM in the differential for chest pain and/or dyspnea in a patient presenting with COPD exacerbation. Early recognition of the risk factors and typical presentation should prompt the clinician for confirmation by cardiac catheterization, after initial hemodynamic stabilization. This would not only aid in avoiding the unnecessary risk of thrombolytic therapy, but also guide in more accurate prognostication of the patient’s condition. While the association between respiratory failure and COPD exacerbation with TCM is evident, the pathophysiology and exact role in precipitating the syndrome still remains unclear, and further research is needed to establish and clarify these issues.

Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients.

Background

The risk of upper gastrointestinal bleeding (UGIB) is increased among end-stage renal disease (ESRD) patients compared to the general population. However, correlates of UGIB among ESRD patients remain unknown. We conducted a cohort study of dialysis patients to ascertain risk factors for UGIB.

Methods

Data from the United States Renal Data System Dialysis Morbidity and Mortality Studies, Waves 2–4 were used to identify risk factors for incident UGIB among ESRD patients. First hospitalizations for UGIB were identified using hospital diagnosis codes between 12/31/93 and 12/31/99. Cox regression was used to estimate the association between predictors of interest and first diagnosis of UGIB.

Results

Cases of UGIB (698) were observed over 30,648 patient years of follow-up. Before adjustment for confounding factors, increasing age, diabetes, former and current smoking, cardiovascular disease (CVD), lower serum albumin, malnutrition, and inability to ambulate independently were associated with an increased risk of UGIB, while African Americans and transplant patients had a lower risk of UGIB. After adjustment, African American race was associated with a lower risk of UGIB (RR = 0.90; 0.82, 0.98), while current smoking (RR = 1.11; confidence interval 1.03, 1.19), history of CVD (RR = 1.32; 1.10, 1.59), and inability to ambulate independently (RR = 1.32; 1.07, 1.63) were associated with a higher risk of UGIB. Age, gender, diabetes, lower serum albumin, nourishment, treatment modality, aspirin use, nonsteroidal anti-inflammatory drug (NSAID) use, and antiplatelet or anticoagulant medication use were not found to be significantly related to the risk of UGIB after adjustment for potential confounding factors.

Conclusion

CVD, current smoking, and risk factors suggesting more disability are associated with a greater risk of UGIB among patients with ESRD.

Kidney International (2003) 64, 1455–1461; doi:10.1046/j.1523-1755.2003.00225.x

n–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction

Background

Results from prospective cohort studies and randomized, controlled trials have provided evidence of a protective effect of n−3 fatty acids against cardiovascular diseases. We examined the effect of the marine n−3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and of the plant-derived alpha-linolenic acid (ALA) on the rate of cardiovascular events among patients who have had a myocardial infarction.

Methods

In a multicenter, double-blind, placebo-controlled trial, we randomly assigned 4837 patients, 60 through 80 years of age (78% men), who had had a myocardial infarction and were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy to receive for 40 months one of four trial margarines: a margarine supplemented with a combination of EPA and DHA (with a targeted additional daily intake of 400 mg of EPA–DHA), a margarine supplemented with ALA (with a targeted additional daily intake of 2 g of ALA), a margarine supplemented with EPA–DHA and ALA, or a placebo margarine. The primary end point was the rate of major cardiovascular events, which comprised fatal and nonfatal cardiovascular events and cardiac interventions. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models.

Results

The patients consumed, on average, 18.8 g of margarine per day, which resulted in additional intakes of 226 mg of EPA combined with 150 mg of DHA, 1.9 g of ALA, or both, in the active-treatment groups. During the follow-up period, a major cardiovascular event occurred in 671 patients (13.9%). Neither EPA–DHA nor ALA reduced this primary end point (hazard ratio with EPA–DHA, 1.01; 95% confidence interval [CI], 0.87 to 1.17; P=0.93; hazard ratio with ALA, 0.91; 95% CI, 0.78 to 1.05; P=0.20). In the prespecified subgroup of women, ALA, as compared with placebo and EPA–DHA alone, was associated with a reduction in the rate of major cardiovascular events that approached significance (hazard ratio, 0.73; 95% CI, 0.51 to 1.03; P=0.07). The rate of adverse events did not differ significantly among the study groups

Conclusions

Low-dose supplementation with EPA–DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy. (Funded by the Netherlands Heart Foundation and others; ClinicalTrials.gov number, NCT00127452.)

principle of family medicine

There are six principles of family medicine:

a) Continuity of care

This is involves in many episode of seeing the patient, whether the chronic illness or during well-person visit. In this scenario, maintain rapport with that patient is required. Family physician is committed to providing care to the patient and their family over the time.

b) Comprehensiveness

It is implied that the patient is not only viewed from biological aspect but also from social and psychological one.

So that, should considers the entire factor when designing diagnostic procedure and treatment to the patient/ they are not involve in caring the patient but also required in access to the case.

c) Coordination of care

The family physician is responsible to coordinate the patient’s health service. These include outside specialist as well as other health care profession.

d) Community

Community always influenced the patient health care. The family physicians play role to help community education and health service.

e) Prevention

Preventing illness has many aspects. These include recognizing the risk factor of the disease, delaying the consequence of chronic disease and promoting healthy lifestyle. Family Physician should participate in make prevention such illness event.

f) Family

Family physician regards the patient as a family system and recognize the influences of the illness on families as well as influences family to the illness.