Category: health

Younger women more likely to get urine infections with Flozins

kaitiscotland3 Comments

From Univadis Nakhleh A et al. Journal of Diabetes Complications 18th April 2020

It is well known that patients on Flozins are much more prone to urine infections and thrush due to the extra sugar in the urine which is excreted by taking these drugs, also known as SGLT2 inhibitors.

An Israeli study of over 6 thousand women with type two diabetes sought to clarify who was more or less likely to be affected by this very annoying problem.

They found that those most likely to get urine infections were:

Women who had existing gastro intestinal problems

Pre-menopausal women

Women who had been taking oral oestrogen in the form of the contraceptive pill or HRT

Women less likely to be affected:

were older (over 70)

had prior existing chronic kidney disease

My comment: From my GP experience I found that these drugs were highly effective and generally well tolerated. A few patients were indeed badly affected by recurrent urine infections and thrush and had to discontinue the drugs.

 

 

NICE: Hydrogen peroxide for impetigo

kaitiscotland2 Comments

 Adapted from :NICE issues antimicrobial prescribing guidance for impetigo

curated by Pavankumar Kamat UK Medical News 28 Feb 2020

National Institute for Health and Care Excellence (NICE) recently published antimicrobial prescribing guidance which describes the antimicrobial strategy for adults, young people and children aged ≥72 hours with impetigo.

According to the new NICE guidance, GPs should prescribe topical hydrogen peroxide 1% instead of topical antibiotics for patients with localised non-bullous impetigo.
The guidance states that hydrogen peroxide 1% cream is as effective as topical antibiotics in patients with localised, non-bullous impetigo, provided they are not systemically unwell or at risk for complications.

If hydrogen peroxide 1% cream is not suitable or if symptoms have worsened or not improved, a short course of a topical antibiotic may be considered.
A topical or oral antibiotic is recommended for patients with widespread non-bullous impetigo, provided they are not systemically unwell or at risk for complications. Oral antibiotic treatment is recommended for patients who have bullous impetigo or if they are systemically unwell or at high risk for complications.
NICE does not recommend a combination of topical and oral antibiotic. There is no evidence that the combination works more effectively than a topical treatment alone.
The primary choice of topical antibiotic is fusidic acid 2%, and the secondary option is mupirocin 2%. The drug of choice for first-line oral antibiotic therapy is flucloxacillin, with clarithromycin and erythromycin (for pregnant women) as secondary choices.

References
Impetigo: antimicrobial prescribing: NICE guideline [NG153]. National Institute for Health and Care Excellence. 2020 February.

My comment: Impetigo is a common skin infection caused by staphloccus which tends to colonise up people’s noses. It spreads rapidly in the nursery and primary school environments. Previously it was treated with oral penicillin. Children are advised to stay off school to reduce spread. Any effective topical, non antibiotic treatment, is welcome as this will help reduce antibiotic resistance.

Low carb store: Aubergine bake

kaitiscotland5 Comments

AUBERGINE BAKE

INGREDIENTS
2 shallots, peeled & chopped
100g mushrooms, sliced
2 garlic cloves, peeled and crushed
2 large tomatoes, thinly sliced
1 aubergine
1 tin chopped tomatoes (400g)
2 tbsp fresh basil leaves, torn
Sea salt & black pepper
3 tbsp olive oil
1 mozzarella ball, roughly chopped
100g strong cheddar, grated

CREATE IT
1. Heat 1tbsp of olive oil in a large frying pan and soften the shallots over medium heat.
2. Add the mushroom and cook until beginning to soften (use more oil if needed).
3. Add the garlic and cook for a further 1 minute.
4. Drain most of the liquid from the tinned tomatoes and add to the pan with a pinch of salt and pepper, keep on a low heat whilst you cook the aubergine.
5. Slice the aubergine into rounds about 1/2cm thick and use the remaining olive oil to brush each side.
6. Cook the aubergine in batches in a hot griddle pan to soften and colour, turning half way through (2-3 minutes each side). Place on a plate to uselater.
7. Take an oven dish and add a layer of the tomato sauce to just cover the base.
8. Layer half the aubergine on the sauce and top with the tomato slices.
9. Scatter the chopped mozzarella on the tomatoes.
10. Use the remaining aubergine to add another layer.
11. Stir the basil through the remaining tomato sauce and pour over the aubergine.
12. Top with the grated cheddar cheese.
13. Place in a pre-heated oven on medium heat for 30-40 minutes until the cheese is melted and bubbling.
14. Serve with a fresh green salad.

Dr Michael Eades: Omega 6 fats make you fat way beyond their caloric value

kaitiscotland2 Comments

There is a hypothesis gaining ground which is that the omega 6 fats in vegetable oil disrupt metabolism and promote fat gain way beyond their simple caloric value.

Dr Michael Eades explains the epidemiology which suggests that this is the case and then the biochemistry which provides a plausible explanation.

This video is 45 minutes long and is quite technical in parts.

 

Abstract and video here:

https://denversdietdoctor.com/dr-michael-eades-a-new-hypothesis-of-obesity/

 

 

 

 

NICE: Blood Pressure Update

kaitiscotland2 Comments

From Diagnosis and management of hypertension in adults. NICE guideline update 2019

BJGP Feb 2020 by Nicholas R Jones et al.

The last update by NICE was in 2011. The key changes are explained in this article.

High blood pressure is blood pressure over 140/90 if measured in the clinic.

Home measurements can be more reliable due to a natural rise in blood pressure in the clinic setting. Ambulatory monitoring can be done, but it is not always available or tolerated. My comment: The machine can be very uncomfortable and disrupts sleep. 

To take your blood pressure at home, take two readings, one minute apart, twice a day for 4 to 7 days.  Don’t count the first days readings. Then take the average of the others.

Hypertension is diagnosed if the average of home or ambulatory monitoring is over 135/85.

The BP should be taken standing for those people over 80, who have type two diabetes and if you have postural hypotension. You need to stand for at least a minute before taking the blood pressure and it is best to avoid talking. 

A blood pressure difference between the arms of over 15 mmHg is a marker for vascular disease. Thereafter the arm with the highest measurements should be chosen for monitoring.

Urgent admission is needed if the bp is over 180/110.

Target organ damage is assessed with looking at the retina, urine testing, U and E and eGFR, ECG and a cardiovascular risk score such as QRISK. Check up should be annually.

Lifestyle advice should be emphasised as this can result in taking fewer drugs.

People with blood pressures over 140/90 at the clinic or 135/85 who are aged 60 to 80 are currently advised to have treatment for their blood pressure. People over the age of 80 are fine with blood pressure targets lower than 150 systolic.

The treatment target for people with diabetes is now 140 systolic which is now the same as the general population.

The drugs to treat hypertension are:

ACE or ARB if type 2 diabetes, age under 55 or African or Caribbean origin.

The next step is to add a calcium channel blocker or thiazide like diuretic.

The next step is a combination of ACE or ARB, CCB and Thiazide.

If the potassium is less than 4.5, Spironolactone can be added as a next step.

If the potassium is over 4.5 then an alpha or beta blocker.

For all other patients the first step is a CCB or Thiazide. 

The next step is an ACE, ARB or Thiazide.

Then any combination of these.

If the potassium is under 4.5 then spironolactone can be added.

If the potassium is over 4.5 then an alpha or beta blocker can be added.

 

Sheri Colberg: Motivate yourself to exercise

kaitiscotland2 Comments

From Diabetes in Control: Getting and Staying Motivated to Be Physically Active
Jan 4, 2020

Author: Sheri R. Colberg, PhD, FACSM

Every New Year all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?
Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.
Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:
Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
Get yourself an exercise buddy (or a dog that needs to be walked, you can borrow one!).
Use sticker charts or other motivational tools to track your progress.
Schedule structured exercise into your day on your calendar or to-do list.
Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
Reward yourself for meeting your goals with noncaloric treats or outings.
Plan to do physical activities that you enjoy as often as possible.
Wear a pedometer (at least occasionally) as a reminder to take more daily steps.  You can get free pedometer apps that turn your mobile into a pedometer.
Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
Do not start out exercising too intensely, or you may become discouraged or injured.
If you get out of your normal routine, and are having trouble getting restarted, take small steps in that direction.
As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension.

Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.
From Colberg, Sheri R., Chapter 6, “Thinking and Acting Like an Athlete” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
Sheri R. Colberg, Ph.D., is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), available through Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 28 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).

 

Jovina cooks seafood: Stuffed sole fillets

kaitiscotland3 Comments

Stuffed Sole Fillets
Stuffing Ingredients
4 large shrimp, peeled, deveined, tails removed, finely chopped
1 tablespoon olive oil
1 scallion, minced
1 medium garlic clove, minced
½ celery stalk, finely chopped
1 mini bell pepper, finely chopped
1 tablespoon fresh parsley, minced
1 tablespoon chopped chives
Salt and pepper
½ oz oyster crackers crushed (optional)
Fish
12 oz sole fillets
Lemon juice
Butter
Directions
Preheat oven to 400°F. Coat a baking dish just large enough to hold the fish with olive oil cooking spray.

Combine the filling ingredients in a medium mixing bowl. Spread the filling evenly over each fillet and add a few drops of lemon juice over the stuffing.

Roll each fillet, jelly-roll fashion, and skewer it with toothpicks and place in the prepared baking dish.

Dot each roll-up with butter and cover the baking pan loosely with foil. Bake for 10 minutes. Then remove the foil and bake for a further 10 to 15 minutes till the fish flakes with a fork so you know it is ready.

Stress may damage your immune response long term

kaitiscotland3 Comments

Adapted from: Stress related disorders and physical health.  Song H. et al. BMJ 26 Oct 19.

This Swedish study of almost 145,000 brothers and sisters showed that any sort of anxiety or stress disorder was associated with an increased risk of life threatening infections, even when familial background, physical and psychiatric problems were adjusted for.

The study went on between 1987 and 2013. The stresses included post traumatic stress disorder, acute stress reaction, adjustment disorder and others. The patients were matched with healthy siblings when possible or matched comparative children from the general population.  They then looked for diagnosis of severe infection in the coming years such as sepsis, endocarditis, meningitis and other infections.

Severe infection rates per 1,000 person years were 2.9 for the stressed person, 1.7 for the healthy sibling, and 1.3 for the matched person in the general population.

They found that the effects were worse the earlier the age the diagnosis of the stress occurred.

Treatment with serotonin re-uptake inhibitors for PTSD seemed to reduce the negative effects on the immune system when given within a year of the stress diagnosis.

This research builds on information that PTSD produces more gastrointestinal, skin, musculoskeletal, neurological, heart and lung disorders.  Cardiac mortality has been found to be raised 27% and autoimmune disorder by 46%.

Why this happens could be due to the interplay between biological, psychological and social factors. Increased inflammatory response is considered by Song and colleagues to be a likely mechanism. Increased levels of interleukin 6, interleukin 1 beta, tumour necrosis factor alpha and interferon gamma have been found in those with PTSD.

PTSD has a heritability factor of 5-20% which is similar to what is found in families with depression.  It is likely to be polygenic.

Talking based therapies are generally even better for PTSD than drugs, so earlier intervention may have long term benefits not just on mental health, but physical health as well.

BMJ 2019;367:16036

Fitter, better, sooner

kaitiscotland2 Comments

From BJGP May 2020 by Hilary Swales et al.

Having an operation is a major event in anyone’s life. There is a lot a patient can do to improve their physical and mental health before surgery that will improve their recovery and long term health.

Fitter, better, sooner is a toolkit was produced by the Royal College of Anaesthetists with input from GPs, surgeons and patients.

The toolkit has, an electronic leaflet, an explanatory animation and six operation specific leaflet for cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy and total knee joint replacement.

These can be seen at: https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner

The colleges want more active participation with patients in planning for their care.

The most common complications after surgery include wound infection and chest infection. Poor cardiorespiratory fitness worsens post op complications. Even modest improvement in activity can improve chest and heart function to some extent.  Keeping alcohol intake low can improve wound healing. Stopping smoking is also important for almost all complications. Measures to reduce anaemia also reduce immediate and long term problems from surgery and also reduce the need for blood transfusion. Blood transfusion is associated with poorer outcomes particularly with cancer surgery. HbA1Cs over 8.5% or 65 mmol/mol causes more wound complications and infections.  Blood pressure needs to be controlled to reduce cardiovascular instability during the operation and cardiovascular and neurological events afterwards.

This toolkit is already being used in surgical pre-assessment clinics but access to the materials in GP practices will also help. After all, the GPs are the ones who are initially referring the patients for surgery, and improving participation early can only be helpful.

It is hoped that this initiative will result in patients having fewer complications, better outcomes from surgery but also from their improved lifestyle.

 

Jovina bakes low carb: Banana bread

kaitiscotland7 Comments

Banana Bread
Ingredients
1 banana
1 and 1/2 cups + 1 tablespoon almond flour (ground almonds)
3 eggs
2 tablespoon unsalted butter, melted
2 teaspoons cinnamon
1 teaspoon baking powder
1/4 teaspoon salt
1 teaspoon vanilla extract
1/4 cup low carb sugar substitute
1/2 cup finely chopped walnuts plus 15 walnut halves
Directions
Preheat the oven to 350 degrees F.
Mash the banana with a fork.
Process the eggs together with the mashed banana and the melted butter with a hand
blender or hand mixer to a smooth dough.
Mix the dry ingredients in another bowl. Pour into the bowl with the egg and banana
mixture and stir well.
Add the chopped walnuts and fold into the batter.
Line an 8-inch bread/loaf pan with baking paper/parchment with the paper extending over the ends of the pan. Coat lightly with cooking spray. Pour in the bread dough into the pan and place the walnut halves in five rows across the top of the dough.
Bake the bread for 45 minutes or until an inserted knife comes out clean. Check the bread after 30 minutes. If the top is brown, cover it loosely with aluminum foil to prevent the low-carb banana bread from burning.
Let the banana bread cool and then lift out with the aid of the parchment paper. Cool completely before slicing.