Charlestown Medical Centre - Our Blog - Charlestown Medical Centre

Do cherries help in Gout?

22/8/2015

In December 2012, Zhang and the colleagues from Boston University Medical Centre conducted a very interesting case/control study with patients with gout enrolled in an internet-based registry. Investigators picked a 2-day period just before an attack of gout and compared that period with the 2 preceding days and the 2 subsequent days as control periods unrelated to an attack of gout.

The investigators looked at various self-reported dietary items, including cherries and other unrelated foods. They found that the intake of cherries before an attack of gout reduced the likelihood of experiencing an acute attack of gout by one thirdcompared with the intake of unrelated foods.

Possible explanations:
Cherry extract blocks the tubular reabsorption of urate and increases urate excretion in the urine. Cherry juice may also block xanthine oxidase and reduce the production of uric acid.
Cherry extract has a synergistic effect with allopurinol. Moreover, cherries contain anthocyanins, which are somewhat anti-inflammatory.
(source: Medscape News, Jonathan Kay MD)

Whooping cough vaccine advised for pregnant women

22/8/2015

The National Immunisation Advisory Committee is strongly advising for pertussis vaccination for pregnant women.

All pregnant women at 16 - 36 weeks should receive a dose of Tdap vaccine against pertussis in order to ensure the transfer of specific antibodies to their babies.

Usually, the newborn babies receive the Tdap as part of the 6-in-one vaccine (Infanrix Hexa) at 2, 4 and 6 months of age. The single Tdap vaccination for pregnant women aims therefore to offer protection for newborn babies from birth and till they will reach 2 months.

Pregnant women may receive this vaccine after their 36th week of the pregnancy, but it may not provide a maximum protection.

In the case of babies born before 32 weeks, it is recommended that the family contacts to receive the Tdap vaccine to protect the newborn.

Benzodiazepines (BZDs) use increase the risk of respiratory tract infections

22/8/2015

BZDs are widely used for conditions like anxiety, alcohol withdrawal, epilepsy and they act by activating inhibitory gamma-amino butyric acid type A receptors (GABAA) in the brain.

An observational study (Thorax) looked at the effects of BZDs, and the non-BZD Zopiclone, to determine if they were associated with an increased risk of pneumonia and mortality from pneumonia.

The results found that, after adjusting for potential confounding factors (including current smoking, presence of lung disease, depression, psychosis, co-morbidity, deprivation score and previous pneumonia episodes) there was a significant association (54% increased risk) seen between BZD use and increase in pneumonia risk. No interactions were found with age or gender for drug exposure.

Diazepam, Lorazepam and Temazepam were associated with an increased risk of pneumonia. The use of Zopiclone also showed a higher risk (98% increased risk) of pneumonia.

Use of BZDs was also associated with an increased risk of 30 days mortality and long-term mortality following pneumonia compared with the controls (placebo).
(source: National Medicines Information Centre)

Group A Streptococcal (GAS) infections

12/10/2013

Group A Streptococci infections account for about 15-30% of the cases of acute pharyngitis in children and 5-10% in adults, and this places these germs on the top of the podium for this type of infection.

They may as well be the cause for other kind of infections like:

rheumatic fever
acute glomerulonephritis
toxic shock syndrome
necrotizing fasciitis
cellulitis
pneumonia
impetigo
sinusitis
meningitis
osteomyelitis
otitis media
brain abscess

Acute pharyngitis caused by GAS

The presence of Streptococcal throat infection is suggested by the presence of: fever, whitish spots/patches on the tonsills, tender and enlarged anterior cervical lymph nodes (glands) and the absence of cough. It takes 2 to 4 days to become clinically manifested (sudden onset of sore throat, malaise, headache and fever; in small children nausea, vomiting and abdominal pain could be present as well).

A rapid test for detection of Group A Streptococcus infections is now available at Charlestown Medical Centre (results ready in 5 - 10 minutes).

Hemochromatosis (iron overload) leads to liver cancer

29/9/2013

Hemochromatosis is the excessive accumulation of iron in the internal organs leading to toxic reactions. It is a genetic (autosomal recessive) disorder and the most common cause of iron overload.

Hereditary hemochromatosis may be asymptomatic in 75% of patients or may present with general and/or organ-related signs and symptoms. Early symptoms include severe fatigue, impotence and arthralgia (joint pain).

Clinical manifestation of hemochromatosis includes:

liver disease: hepatomegaly (enlargement of liver), cirrhosis (fibrous degeneration of liver)
diabetes mellitus (48% of cases)
skin bronzing or hyperpigmentation (70% of cases)
impotence, amenorrhoea (absence of periods), hypogonadism (reduced sexual characteristics)
arthropathy (disease of the joint/s)
cardiomyopathy (disease of the heart muscle)
osteoporosis (brittle and fragile bones from loss of tissue)
koilonychia (spoon-shaped nails)
hair loss

Complications of hemochromatosis:

If untreated, hemochromatosis may lead to death from cirrhosis, diabetes mellitus, malignant hepatoma (liver cancer) or cardiac disease. The following is a full list of possible complications related to this disease:

liver cirrhosis
hepatocellular carcinoma (liver cancer)
congestive heart failure (enlargement of heart and loss of its pump function)
cardiac arrhythmias (irregular heart beats - palpitations)
diabetes mellitus
hypogonadism (incomplete/reduced sexual development)
impotence
arthropathy
thyroid dysfunction
sepsis (generalized infection)

Diagnosis is established by the presence of clinical features (diffuse hyperpigmentation, hepatomegaly, diabetes mellitus) and biochemical abnormalitis of the iron metabolism and genotypic investigations.

If you present any of the above symptoms, early presentation to your GP for differential diagnosis could help the prognosis of this disease.
Charlestown Medical Centre could organise this for you if needed.

Helicobacter Pylori - a bacteria that can cause gastric cancer

20/9/2013

Helicobacter Pylori (HP) is a bacteria that is present in about 50% of the global population. Chronic (lasting for more than 3 months) infection causes atrophic or even metaplastic (normal cells transform into abnormal ones) changes in the stomach and is often associated with gastric or duodenal ulcer. The most common route of infection with HP is either oral-to-oral or fecal-to-oral contact.
Signs and symptoms

In general, those infected with HP are asymptomatic. When signs or symptoms are present, they may include the following:

Nausea
Vomiting
Heartburn
Abdominal pain (most often in the central-upper area)
Diarrhoea
Hunger in the morning
Halitosis (smelly mouth/breath)

Staging of the infection/disease

Although a staging system for the HP infection does not exist, some steps of the disease are well described.
The first step is chronic gastritis (inflammation/irritation of the internal layers of the stomach lasting for at least 3 months), followed after a time by the second step, atrophic gastritis (thinning of the internal layers of the stomach, usually as a result of a chronic gastritis). The third step is intestinal metaplasia (normal cells transform into abnormal ones), which may evolve into dysplasia (cellular changes often indicative of an early cancer). The last step in this process is gastric adenocarcinoma.

Diagnostic tests

Urea breath test (UBT)
HP fecal antigen test
HP serology (H. Pylori antobody screening blood test available now at Charlestown Medical Centre - results given in 15 minutes)

Myocardial Infarction (MI) - warning signs

26/8/2013

Myocardial infaction (MI) occurs most often in the early hours of the morning partly because of increased platelet aggregation and increased serum concentration of plasminogen activator inhibitor -1 (PAI-1) that occur after awakening.

In most situations, the onset is not associated or triggered by severe exertion. The immediate risk of MI increases 6 to 30 folds in sedentary people.

An increased suspicion for a possible MI should be maintained especially when it comes about the following groups in the presence of typical symptoms: cocaine users, elderly people, those with a history of heart failure, dementia, diabetes mellitus, hypercholesterolaemia or those with a strong family history of early coronary disease (any first-degree male relative aged 45 years or younger or any first-degree female relative aged 55 years or younger who experienced a MI).

Preceeding symptoms (within days before an acute attack):

fatigue
chest discomfort
malaise

Typical characteristics of the chest pain in MI:

intense and unremitting for 30 - 60 minutes
felt behind the sternum bone and often radiating into the jaw, neck and down to the ulnar aspect of the left arm
most commonly described as a retrosternal pressure sensation or sometimes as a squeezing, aching or burning sensation
in certain individuals the symptoms are those of an indigestion or of fulness or gas (digestive symptoms)

Accompanying symptoms and signs:

excessive anxiety (sensation of imminent death)
excessive perspiration (excessive sweating)
increased and/or irregular pulse (sometimes felt like palpitations)
increased respiratory rate
coughing, wheezing and production of aerate (bubbly) sputum (phlegm)
increased temperature (fever of around 38C) for the first 24 - 48 hours

Polycystic ovary syndrome (PCOS) and its psychological implications

26/8/2013

Polycystic ovary syndrome (PCOS), a frequently diagnosed condition in both young and elder women can produce different effects on quality of life, psychosocial well-being and sexual satisfaction.

The major features of PCOS are obesity, excessive body hair, acne, increased serum testosterone levels, disturbed insulin metabolism, menstrual cycle disturbances and infertility.

PCOS patients show significant reductions in quality-of-life, increased psychological disturbances and a decreased sexual satisfaction compared with those undiagnosed with this condition. Among the changes mentioned above, the increased BMI (obesity) and hirsutism have been shown to cause the greatest negative impact on quality-of-life and sexual satisfaction. Metabolic and endocrine parameters along with menstrual irregularities and infertility appear to have a lower impact.
(source: European Journal of Endocrinology, 2005 Dec.)

The less known uses of cumin - traditional (herbal) medicine

26/8/2013

Just a few of us have heard of the benefits this tiny seeds could offer for a series of medical conditions. If you would ask your granny, you might find out even more about it.

Cumin is very rich in iron and magnesium and therefore could be used as an add-on natural remedy to treat conditions like iron deficiency anaemia, stress, anxiety and fatigue. The long term intake might also prevent cancer.

Cumin is famous for its effects on the digestive tract. It proves a great fighter against diarrhoea, flatulence, indigestion, nausea and vomiting.

How to use the cumin seeds?

The best way of taking advantage of its miraculous properties is to make a cumin seeds tea.

Here's my recipe:

Put to boil one or more cups (~250 - 300ml each) of water and add one heaped tablespoon of cumin seeds to each cup of water; boil them together for about 10 to 15 minutes or until the boiling liquid is turning brownish; leave it to cool down until just slightly warm and drink 1 - 2 cups of unsweetened tea per day (kids could use half of this amount). As a note: excessive use of cumin tea can promote constipation.

Psyllium seeds husk - a natural remedy for IBS

26/8/2013

Psyllium seeds (Plantago ovata seeds) are originary from India. They are indigestible, hygroscopic (they have the property of absorbing high quantities of water) and a source of soluble dietary fiber.

They are mainly used as an add-on treatment for IBS and hypercholesterolaemia. The improvement of diarrhoea, and a colon cleasing action (in those suffering from IBS) and a reduction of coronary heart disease (CHD) events (in those suffering from high cholesterol levels) are the benefits this seeds offer.

On the other hand, the long term ingestion of Psyllium seeds might give abdominal cramping, increased flatulence (increased passing of bowel wind) and constipation.
Psyllium seeds are contraindicated in case of oesophageal and gastrointestinal obstruction or difficult swallowing and also in case of fecal impaction, symptoms of appendicitis (lower right abdominal pain, nausea/vomiting, reduced/absent bowel motions, high temperature, altered general state), gastritis or gastro/duodenal ulcers, rectal bleeding.

Dosing: 1 teaspoon or tablespoon of seeds in 8 oz (~ 240 ml) of water for up to three times per day. An increased daily ingestion of water (fluids) is recommended during the treatment with these seeds.