Subcategories

• Nutrition Management

  Tips to stay healthy with nutritious diet.

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  @nalladurai Neuroprotective Potential
  Cranberries are particularly rich in (poly)phenols such as anthocyanins, proanthocyanidins (both A- and B-type), flavonols, and hydroxycinnamic acids. These compounds are known to have antioxidant and anti-inflammatory effects, and are increasingly recognized for their neuroprotective potential.

  High-molecular-weight polyphenols such as proanthocyanidins also affect the gut microbiota and may improve cognition by modulating the gut-brain axis.

  In the current study, 60 healthy adults (mean age, 65 years) consumed cranberry powder that was equivalent to 100 g of fresh cranberries or matching placebo for 12 weeks.

  Before and after the intervention, all participants underwent a battery of cognitive tests in combination with comprehensive biochemical and neuroimaging assessments.

  The total concentration of (poly)phenol metabolites in plasma increased by 1.82 μM in the cranberry group, with no increase observed in the placebo group.

  At baseline, there were no significant differences in regional brain perfusion between the cranberry and placebo groups.

  Clinically Relevant?
  Mixed linear modeling controlling for age and education showed an increase in perfusion between baseline and follow-up in the cranberry group compared with a relative decrease in perfusion over time in the placebo group.
  In the cranberry group, increased regional perfusion was observed in the right entorhinal cortex, the accumbens area, and the caudate. This was accompanied by significantly improved visual memory, as assessed by delayed recall on the Rey Complex Figure Test (P = .028).

  However, the cranberry intervention did not improve other neurocognitive domains, such as working memory and executive functioning.

  The cranberry group did show a significant decrease in LDL cholesterol levels, suggesting that cranberries can improve vascular health and may in part contribute to the improvement in brain perfusion and cognition, the investigators note.
  It is currently unknown whether such effect may be translated to a clinical population of cognitively impaired adults in the context of neurodegenerative conditions such as mild cognitive impairment or dementia.

  Key Message: Eat Natural Foods

  Foods rich in phenolic compounds such as berries and other fruits have been shown to improve memory, especially visual memory.

• Medication Management

  The essence of effective treatment and care lies in medication adherence. Learn how technology can help adhere to the prescribed medicines.

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  @partha Many physicians still hold beliefs despite the existence of clear evidence that they are incorrect.
  These long-held pieces of dogma – or "medical myths" – were engraved during training or early in the careers of many physicians, and are difficult to overcome.
  The myths persist because medical professionals get taught one way in training, given a 'truth' or 'This is the way we do it,' and then do not ever rethink, 'Is it true?' Studies pop up to question conventional wisdom, but unless the studies get highly publicized, they aren't noticed.
  Three of what considered to be some of the some of the medical myths that are in greatest need of being dispelled.

  Shellfish Allergy and Radiocontrast
  A myth persists that people with a shellfish allergy could have an allergic reaction when a contrast agent is used for a scan. This belief arose, because fish and shellfish contain iodine, and allergic reactions to seafood are fairly common, and contrast agents contain iodine, too.
  The belief is widespread, with 65% of radiologists and 88.9% of interventional cardiologists saying they ask about seafood or shellfish allergies before administering contrast. And a third of radiologists and 50% of cardiologists said they would withhold contrast media or recommend a premedication for patients with such an allergy.

  But the belief makes no sense, Iodine is present in many other foods, including milk and bread, and allergies to shellfish are because of parvalbumin protein and tropomyosins, not iodine.

  Colonoscopy Dogma
  It's been long believed that people need to be on a clear, liquid diet for 1 or 2 days and need to drink a bowel-prep liquid before a colonoscopy.
  But the evidence shows this isn't necessary, he said.

  A 2020 study found that a low-residual diet, allowing foods such as meat, eggs, dairy, and bread, were comparable to the clear liquid diet in terms of bowel prep and detection of polyps during the exam. The patients on the low-residual diet had less nausea, less vomiting, and less hunger, and expressed more willingness to have a repeat colonoscopy.
  Metronidazole and Alcohol
  There is a belief that patients shouldn't drink alcohol if they are taking metronidazole, because of concerns about nausea, vomiting, flushing and other symptoms – also known as a disulfiram like reaction.

  Case reports have been published, but the cases were presented as though a metronidazole-ethanol reaction was an established fact, and the authors didn't provide evidence to justify this.

  But it's been shown in rat models that metronidazole can increase levels of acetaldehyde, the trigger of symptoms, in the colon, but not in the blood. And in a small placebo-controlled, randomized trial, six people were given metronidazole and ethanol and, after regular blood testing, no difference was seen in acetaldehyde blood levels, vital signs, or symptoms.The Centers for Disease Control and Prevention has said that avoiding alcohol while taking metronidazole is unnecessary.

  Sinus Headaches
  Contrary to common belief, headaches thought to be "sinus headaches" are usually migraine headaches. In one study, 2,991 patients with six headaches in the previous 6 months were self-diagnosed or were physician-diagnosed with sinus headaches. But 88% of these headaches met the International Headache Society criteria for migraine headache.

  The clinicians should reconsider the evidence regularly when deciding how to treat their patients, and not rely on bits of dogma.

• Exercise Management

  Following an active lifestyle to meet health goals. Discussion around various forms of exercise and how health apps can help follow a regime.

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  @sajjan The study covered in this summary was published in papers.ssrn.com as a preprint and has not yet been peer-reviewed.
  Key Takeaways
  The inverse relation between resting heart rate and maximal oxygen consumption is directly correlated with physical fitness and adiposity.
  Resting heart rate is a biomarker for fitness and, therefore, a predictor of cardiorespiratory health.
  Why This Matters
  An increase in resting heart rate has been linked to an increase in all-cause mortality from chronic diseases, such as type 2 diabetes and cancer.
  Resting heart rate can be used as a low-cost, noninvasive way to assess risk for cardiovascular disease and the effectiveness of interventions related to physical activity.
  Study Design
  The population-based study cohort consisted of 5722 women and 5143 men 29 to 65 years of age.
  Resting heart rate and fitness were assessed at baseline and a median of 6 years later.
  Resting heart rate was measured with two standard electrocardiogram electrodes while the patient was seated, supine, and sleeping.
  A sensor worn for 6 days and nights was used to monitor heart rate during sleep.
  To measure fitness, participants walked, walked on an incline, and ran on a treadmill.
  Physical activity was measured over a 6-day period using a combined heart rate and movement sensor, and those data were correlated with data collected from the treadmill exercise.
  Other parameters assessed, along with their possible influence, included body mass index, alcohol consumption, smoking status, ethnicity, and body composition (assessed with dual-energy x-ray absorptiometry).
  Key Results
  Mean resting heart rate while seated was 67 beats per minute, while supine was 64 beats per minute, and while sleeping was 57 beats per minute.
  An increase of one beat per minute in supine heart rate was associated with a decrease in fitness level of 0.23 mL/min per kg.

• Symptoms Management

  Tips and insights to identify symptoms of diseases as well as side effects of different treatments and medications.

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  @shripad Eating disorders are among the most prevalent, disabling, and potentially fatal psychiatric illnesses, and the COVID-19 pandemic has exacerbated their burden, with a 15.3% increase in incidence in 2020 compared with previous years. This increase was almost solely among adolescent girls with anorexia nervosa (AN), which is often insidious in onset and more difficult to treat as it advances.

  Adolescents with AN are most likely to present to their pediatricians, so awareness and early recognition of the symptoms is critical. Pediatricians are also an integral part of the treatment team in AN and can offer monitoring for serious complications, alongside valuable guidance to parents, who are central to treatment and the reestablishment of healthy eating habits in their children. Here we will review the epidemiology, diagnosis, and treatment of anorexia, with an emphasis on what pediatricians need to know to screen and to facilitate treatment.

  Epidemiology
  AN is marked by a fear of gaining weight or behaviors that interfere with weight gain and a self-evaluation unduly influenced by weight and body shape. Youth with AN often deny the seriousness of their malnutrition, although that is not required for diagnosis. AN can be of a restrictive or binge-purge subtype, and amenorrhea is no longer a requirement for diagnosis.
  There is not a specific weight or body mass index cutoff for the diagnosis, but the severity of AN is determined by the BMI percentile normed to age and sex. The average age of onset is 18, and the pre-pandemic prevalence of AN was about 1% of the population. It affects about 10 times as many females as males. It is quite rare prior to puberty, affecting about 0.01% of that age group. There is a heritable component, with a fivefold relative risk in youth with a parent with AN, and twin studies suggest heritability rates as high as 75%.
  Youth with rigid cognitive styles appear more vulnerable, as do those who participate in activities such as ballet, gymnastics, modeling, and wrestling because of the role of appearance and weight in performance. More than half of patients with AN will have another psychiatric illness, most commonly anxiety disorders, depression, or obsessive-compulsive disorder. AN becomes chronic in up to 15% of sufferers and the mortality rate is close to 10%, with approximately half dying from medical complications and half dying by suicide.

  Screening
  Parents and pediatricians are usually the first to notice that a child has started to lose weight or is falling off the growth curve. But weight changes usually emerge after feelings of preoccupation with weight, body shape, and body satisfaction. If parents report escalating pickiness around food, increased or compulsive exercise, persistent self-consciousness and self-criticism around weight and body shape, it is worth starting with screening questions.

• Stress Management

  Share how to manage stress and lead a happier, healthier, & more productive life.

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  @hemant Posttraumatic stress disorder (PTSD) is a syndrome resulting from exposure to real or threatened serious injury or sexual assault. The signs and symptoms of PTSD appear to arise from complex interactions of psychological and neurobiological factors. Studies have found alterations in the amygdala, prefrontal cortex, hippocampus, and anterior cingulate, and corpus collosum as well as altered functioning of the hypothalamic pituitary axis (HPA).
  Signs and symptoms
  Symptoms of posttraumatic stress disorder (PTSD) include the following:
  Persistent re-experiencing of the event: intrusive thoughts related to the traumatic event, nightmares or distressing dreams, persistent or recurrent involuntary memories, dissociation (including flashbacks) and intense, negative emotional or physiological reaction on exposure to reminders (traumatic triggers)
  Avoidance of traumatic triggers or of thinking/talking about the experience
  Negative alterations in cognition and mood: inability to recall important aspects of the trauma; persistent negative beliefs and expectations about oneself, others, and the world; inappropriate blaming of oneself for the trauma; exaggerated negative beliefs about the consequences of the trauma; persistent negative emotional state (sadness, horror, guilt); a paucity of positive emotional experiences; loss of interest or participation in important activities; and detachment from people.

  Increased arousal or reactivity: irritability, problems with sleep or concentration, increased startle reaction, increased vigilance for potential danger, self-harming acts, or recklessness
  One cannot diagnose PTSD until one month has passed since the traumatic incident. Acute stress disorder, which has similar symptoms, is diagnosed during the first month.

  Diagnosis
  Diagnosing PTSD in adults, adolescents, and children older than 6 years of age using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1] requires a certain type and level of traumatic event, a combination of required symptoms, and the absence of exclusionary criteria.
  A) Causation: The victim was exposed to actual or threatened death, serious injury or sexual violence in one of four ways:
  Directly experiencing the traumatic event(s)
  Witnessing, in person, the event(s) as it occurred to others
  Learning that the traumatic event(s) occurred to a close family member or friend
  Experiencing repeated or extreme exposure to aversive details of the traumatic event(s); this does not apply to exposure through media such as television, movies, or pictures
  B) The traumatic event is persistently re-experienced:
  Nightmares
  Intrusive thoughts of the traumatic event
  Flashbacks
  Marked emotional distress when exposed to traumatic reminders
  Strong physiologic reaction when exposed to traumatic reminders
  Children may re-experience the event through repetitive play.
  C) Avoidance in one of two ways:
  Avoidance of thoughts, feelings, or conversations associated with the event
  Avoidance of people, places, or activities that may trigger recollections of the event
  D) Negative alterations in cognition and mood. Two of the following:
  Inability to remember an important aspect of the event(s)
  Persistent and exaggerated negative beliefs about oneself, others, or the world
  Persistent distorted cognitions about the cause or consequences of the event(s)
  Persistent negative emotional state
  Markedly diminished interest or participation in significant activities
  Feelings of detachment or estrangement from others
  Persistent inability to experience positive emotions
  E) Hyperarrousal: Two of the following:
  Irritable behavior and angry outbursts
  Reckless or self-destructive behavior
  Hypervigilance
  Exaggerated startle response
  Concentration problems
  Sleep disturbance
  F) The duration of symptoms is more than 1 month
  G) Disturbance causes clinically significant distress or impairment in functioning
  H) The disturbance is not attributable to the physiological effects of a substance or other medical condition

• Vital Management

  Vital signs are measurements of the body's most basic functions. Learn how vitals can be measured and recorded using different wearables and health apps.

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