Dr. C’s Journal: Some Facts Regarding Tuberculosis

Tuberculosis is an ancient killer, and is one of the few diseases that has been traced back to Ancient Egypt and beyond. TB has ravaged humanity for millennia, and was commonly called consumption due to its tendency to produce weight loss.

Once thought to be under control, TB has received a new lease on life with the emergence of AIDS. All countries except North America, western Europe, and Australia have a problem with tuberculosis, which kills more than 1 million people each year.

The tuberculosis germ is unusual in that It has a cell wall high in the lipid, mycolic acid. This protects the germ when it is engulfed by first responders such as macrophages. The infected cell Is surrounded by other macrophages, lymphocytes and Fibroblasts to form a granuloma. This creates a standoff, where the tuberculosis germ is still alive, but walled off, and becomes an inactive or “latent” case of tuberculosis, a small percentage of which become active each year.

Active tuberculosis produces the usual infectious symptoms of fever, chills, and cough, often productive with blood. The tuberculosis germ multipliesu much more slowly than most other bacteria and the symptoms are long and drawn out; a cough lasting for more than a month, especially if accompanied by weight loss, should raise the suspicion of TB.

TB can spread to infect bones, kidneys, liver, and brain,  but prefers the lung.

A spot on the Lung, confirmed by a Tuberculin test, or a blood test called a T-spot, will confirm the diagnosis.

The slow multipication of the tuberculosis Germ requires much longer treatment, and the combination with AIDS has caused a  rapid development of resistant organisms. Fortunately, there are several drugs available.

Only one immunization is currently available, namely BCG. This has been used a lot in Europe and other countries . BCG produces a weekly positive tuberculin test.

A large number of conditions which reduce immunity, such as cigarette smoking, drug use, and immunosuppressive treatments associated with organ transplants and cancer will  predispose a person to catching tuberculosis. TV is transmitted in the tiny droplets from sneezing, coughing, or talking such as we were accustomed to thinking about during Covid. The same preventative measures, such as  masks and avoiding close contact with infected individuals should be practiced to prevent spread from an infected person.

If you follow a healthy lifestyle and are careful when traveling, you will most likely have no trouble with this nasty infection. Please check with the following reference or more complete information.

—Dr. C.

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BMJ Podcast: Diagnosis & Management Of Heart Failure – Dr. Carolyn Lam

In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Professor Carolyn Lam, a world expert in heart failure from the University of Singapore and the National Heart Centre, also in Singapore.

They discuss updates in the diagnosis and management of heart failure, including wearables, biomarkers, the 4 pillars of therapy, and how and why there has historically been an under-representation of women in heart failure trials. This episode is sponsored by an educational grant from the Boehringer Ingelheim-Lilly Alliance. The sponsor has no influence over podcast content, the selection of speakers or any associated educational material.

Professor Carolyn Lam is a Senior Consultant from the Department of Cardiology and Director of Women’s Heart Health at the National Heart Centre Singapore, having pioneered the first Women’s Heart Clinic in Singapore.  Academically, she serves as a tenured Full Professor at the Duke-National University of Singapore, having also graduated from the Standford Executive Programme in 2015, and obtained a PhD at the University Medical Centre Groningen, the Netherlands in 2016. In the field of MedTech, Prof Lam is co-founder of Us2.ai, an award-wining startup dedicated to the automation of the fight against heart disease by applying artificial intelligence to echocardiography (ultrasound of the heart). 

Prof Lam is a world-renowned specialist in heart failure (particularly heart failure with preserved ejection fraction [HFpEF]). Her work in the PARAGON-HF and EMPEROR-Preserved trials led to the first FDA-approved treatment for HFpEF and the first robustly positive clinical outcomes trial in HFpEF to-date, respectively. She leads several multinational global and regional clinical trials, and has received numerous prestigious awards and global recognition for her work. Her recent appointments on the 2021 European Society of Cardiology Heart Failure Guidelines Task Force, and as International Honorary Fellow of the Heart Failure Society of America 2021, attest to her contributions in both cardiology and research fields. 

Prof Lam is a proud recipient of the National Medical Research Council (NMRC) Senior Investigator Clinician Scientist Award in 2020, and served as the Founding Programme Lead of A*STaR’s Asian neTwork for Translational Research and Cardiovascular Trials (ATTRaCT) and Principal Investigator of ASIAN-HF (a multinational study across 11 Asian countries). In 2019, She initiated the Asian Diabetes Outcomes Prevention Trial (ADOPT), an ongoing trial involving 5 countries and aimed at reducing the cardiovascular adverse outcomes of diabetes in Asian patients.

She has published with over 350 articles in major high impact journals including New England Journal of Medicine, Journal of the American Medical Association (JAMA), Lancet, Circulation, and European Heart Journal; and has been recognised as a World Expert by Expertscape’s PubMed-based algorithms (top 0.1% of scholars writing about Heart Failure over the past 10 years; Heart Failure: Worldwide – Expertscape.com). Besides being an Associate Editor for Circulation (top Cardiology Journal) and European Journal of Heart Failure, she is also the lead author of the chapter on HFpEF for Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 12th Edition – the award-winning textbook trusted by generations of cardiologists for the latest, most reliable guidance in the field.

Cardiology: What Is A Calcium Heart Scan?

A CT scan of the heart measures the amount of calcium in the heart’s arteries. The more calcium in the arteries, the greater your risk of a heart attack or stroke. 

Knowing your coronary artery calcium (CAC) score can help you and your care team decide how best to lower your risk of heart problems. But it’s only once piece of the puzzle. 

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Survey: 85% Of Physicians Favor Telehealth To Treat Opioid Use Disorder (Yale)

Asurvey of more than 1,000 registered physicians who used telehealth services to treat patients with opioid-use disorder during COVID-19 found that an overwhelming majority favor making telehealth a permanent part of their practice.

Yale School of Public Health – The findings of the Yale School of Public Health (YSPH) study provide new support for the use of telehealth technology in treating opioid-use disorder. Policymakers currently are debating whether existing regulations allowing for telehealth during the COVID pandemic should be extended temporarily as the pandemic wears on — or made a permanent part of treatment practice options.

“Recent exposure to telehealth due to the COVID-19 pandemic has promoted the perspective among the physicians surveyed that it is a viable and effective treatment option for patients,” said the study’s lead author Tamara Beetham, MPH, a PhD student in health policy and management at YSPH. “Findings like these could have major implications for the future of telehealth regulation. Continued flexibility would allow more individuals to access life-saving treatment.”

A staggering 107,622 people in the U.S. died of drug overdose in 2021, a 15% increase from 2020, according to the U.S. Centers for Disease Control and Prevention. Physicians frequently prescribe buprenorphine to treat opioid-use disorder and reduce the risk of overdose. Patients must regularly follow up with their provider as part of their treatment.

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C. diff Bacteria: What Is Clostridioides difficile

“C. diff is a severe, difficult-to-treat infection,” says family medicine specialist Daniel Allan, MD.
Studies show that you’re seven to 10 times more likely to get C. diff while you’re taking antibiotics or right after.”

Cleveland Clinic – Clostridioides difficile (C. diff) is a type of harmful bacteria that causes inflammation in your large intestine (also known as pseudomembranous colitis). The main symptom of a C. diff infection is frequent, watery and sometimes bloody diarrhea. If diarrhea persists, it can lead to:

  • Dehydration.
  • Weight loss.
  • Sepsis.
  • Death.

C. diff is common in the environment. Some people even carry C. diff in their gut but don’t have any signs of illness. Most of the time, the “good” bacteria in your gut prevent a C. diff infection. But certain antibiotics can wipe out your gut bacteria. If you encounter C. diff while taking antibiotics, the bacteria can flourish and grow and make you sick.

“Think about your colon as a plush green lawn. The thick grass crowds out the weeds,” illustrates Dr. Allan. “But if your yard is mostly dirt, all kinds of weeds will grow. Antibiotics reduce the rich collection of bacteria in your gut (the thick grass). This gives C. diff (the weeds) an opportunity to take hold.”

C. diff is most dangerous for people age 65 or older or with a weakened immune system. People who are healthy can also develop life-threatening complications if they don’t receive prompt care.

Weight Loss: Bariatric Surgery Explained (UCLA)

UCLA Health – Dr. Erik Dutson, surgical director of the Center for Obesity and METabolic Health (COMET), provides an overview of bariatric surgery at UCLA Health. See how this minimally invasive surgery changes lives.

Bariatric surgery, also known as weight loss surgery, helps you lose weight by removing or rerouting a portion of your stomach. The surgery limits the amount of food you can eat or the amount of calories your body can absorb. Research has shown that bariatric surgery can help you lose up to 85% of excess weight.

These types of procedures have also been shown to:

  • Control high blood pressure
  • Improve sexual dysfunction
  • Increase fertility
  • Increase life expectancy
  • Provide pain relief
  • Treat conditions such as type 2 diabetes and sleep apnea

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Hearing Aids: Over-The-Counter vs Prescription

Hearing aids are not one-size-fits all. “While OTC devices may help many people with mild or moderate hearing loss, they might not be appropriate for all types of hearing loss,” says Dr. Naples.

Harvard Health Publishing – A change in FDA regulations has cleared the way for over-the-counter (OTC) hearing aids. What does this mean for you if you’re among the approximately 48 million Americans with some degree of hearing loss? We asked Dr. James Naples, assistant professor of otolaryngology/head and neck surgery at Harvard-affiliated Beth Israel Deaconess Medical Center, to help explain potential pros and cons.

The basics: Hearing aids versus amplification products

There are various types of hearing aids that largely work in the same way. Whether the style is behind the ear or in the ear canal, they amplify sounds to make them louder. They also help filter out certain types of noise. “All hearing aids use a combination of signal processing and directional microphones to filter out some unwanted noise and to improve our ability to hear sounds,” says Dr. Naples.

Don’t confuse prescription or OTC hearing aids with personal sound amplification products (PSAPs) sold at most drug stores. Such products merely amplify nearby sounds. They’re not tailored to an individual’s hearing loss, and aren’t regulated by the FDA or intended to treat hearing loss.

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COMMENTARY:

Humans and their mammalian cousins have lost the ability to regenerate the hair cells in the inner ear. In preindustrial society(how could they know?) people apparently didn’t lose hearing as they aged. However, in the Industrial Age, the prevalence of noise has been increasing along with our power consumption,  and loss of hearing consequently occurs along with Aging.

High frequency loss is the most prominent, and this leads to inability to hear consonants, and have more difficulty with the voices of children and women which tend to be of a higher frequency. The ability of young people to hear high frequencies better than older people has led to various ringtones and songs favoring high frequencies, which the children can hear and older people cannot.

There are a number of things that can add to this hearing loss, such as chronic exposure to loud sounds (such as rock concerts), exposure to drugs that damage hearing, such as certain antibiotics and even aspirin. Otosclerosis and repeated middle ear infections can also accentuate the problem by interfering with sound conduction.

Ringing in the ears, tinnitus, is also associated with accelerated hearing loss.

I have had tinnitus for a long time, and at the age of 90, I have definite hearing loss. Even a couple of decades ago my high frequency loss was quite demonstrable by audiogram. I am resisting the temptation to get it corrected, since the louder sounds from the device would probably gradually reduce my baseline hearing ability. Also  I am now forced to pay strict attention when listening to people. This may slow down the tendency of older people to have a greater difficulty in “decoding” the  spoken word, due to decreased brain processing.

With the passage of a new law permitting people to access hearing aids without a prescription, the price of hearing aids is bound to go down, another reason for waiting.

If you are considering getting a hearing aid, an audiologist would prepare one that is tuned to your specific hearing loss.

The best is none too good.

—Dr. C.

Digestive: Gallstones VS Kidney Stones Symptoms

Gallstones (gallbladder stones) develop in your digestive tract and can be as small as a grain of sand or as large as a golf ball. Gallstones can cause a blockage in your gallbladder or bile ducts. A diet high in fat or cholesterol can contribute to the development of gallstones.

CLEVELAND CLINIC

Kidney stones develop in your urinary tract and can be as small as a grain of sand but can grow to several inches in diameter. Kidney stones move through your urinary tract into your ureter and block the flow of urine. A diet high in sodium, oxalates or animal protein can contribute to the development of kidney stones. An insufficient intake of fluids or calcium can also lead to the formation of kidney stones.

Symptoms of gallstones

If you have gallstones, you may experience the following symptoms:

  • Abdominal pain.
  • Back pain.
  • Chest pain.
  • Nausea and vomiting.
  • Fever and chills.
  • Jaundice.
  • Dark-colored urine.  

Where does it hurt?

Gallstones cause pain in your mid-upper abdomen that may radiate to your back or under your right shoulder.

Symptoms of kidney stones

If you have kidney stones, you may experience the following symptoms:

  • Severe back pain that may travel down to your groin.
  • Nausea and vomiting.
  • Blood in your urine.
  • Painful urination.
  • Increased frequency or urgency of urination.
  • Foul-smelling or cloudy urine.
  • Fever and chills.

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Empowering Patients Through Education And Telemedicine