[Vol 29] Medi-Scene: Your Weekly Health News Update

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MediScene Magazine Vol 29

1. Progression of diabetic retinopathy linked to cardio risk

Results from a new study show that as the severity of diabetic retinopathy increases, the risk of heart attack, stroke and even death increases. Acute retinopathy is linked to a doubling of the risk for cerebrovascular accident or myocardial infarction. Dr Bobeck Modjtahedi, MD, from Southern California Permanente Medical Group in Pasadena told a medical news portal that, “These findings highlight the importance of coordinated care between ophthalmologists and other physicians. It also provides a good opportunity for ophthalmologists to use what they find as an educational and motivational tool.” For their retroactive examination, Modjtahedi and his colleagues studie data from patients with type 2 diabetes enrolled in Kaiser Permanente health plans and identified cerebral vascular accidents, myocardial infarctions, and all-cause mortality that occurred in the 5 years after those patients underwent evaluation for retinopathy. In the study cohort of 68,206 patients who underwent retinal evaluation, 1680 (2.5%) myocardial infarctions, 2269 (3.3%) cerebrovascular accidents, and 3756 (5.5%) deaths occurred in the subsequent 5 years. Dr Bobeck Modjtahedi said, “The patients with worse retinopathy had worse outcomes. These correlations can help ophthalmologists persuade their patients to check in with their primary care physicians. what I see inside your eye is a reflection of other damage that’s probably building in your kidney and your heart. In some cases, some patients see ophthalmologists more regularly than they see other healthcare providers. Sometimes they fall through the cracks and might be missing statins or not controlling blood pressure.” Dr Gaurav Shah, MD, from The Retina Institute of St. Louis in Missouri said, “I think the study gave us really important numbers. It actually gave us odds ratios that you could predict with a good amount of certainty that these patients who have these changes are at a higher likelihood of having this problem.”

2. Adding plant protein to your diet can reduce mortality

A U.S. study suggests that replacing animal protein with plant protein is linked with lower all-cause mortality and cardiovascular disease mortality. Scientists studied data on 237,036 men and 179,068 women who took part in the U.S. National Institutes of Health-AARP Diet and Health Study from 1995 to 2011. Among men, each additional 10 grams of plant protein per 1,000 calories of food intake was associated with a lower risk of all-cause mortality (HR (0.88) as well as mortality due to cardiovascular disease (HR 0.88), stroke (HR 0.70), and injuries and accidents (HR 0.76) during a median 15.5-year follow-up period. Among women, each additional 10 grams of plant protein per 1,000 calories was associated with lower all-cause mortality (HR 0.86) as well as mortality from cancer (HR 0.91), cardiovascular disease (HR 0.83), stroke (HR 0.73) and infection (HR 0.73) over the same period. Lead study author Jiaqi Huang of the National Cancer Institute’s Division of Cancer Epidemiology and Genetics said, “These small reductions in risk of overall and cardiovascular disease mortality resulting from increased plant protein intake provide evidence for public health recommendations regarding how dietary modifications including choice of protein sources may influence longevity.” Dr. Frank Hu, chair of the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston said, “The dietary data are also self-reported, and thus measurement errors are inevitable, although such noises in the data tend to obscure the true relationship.” Dr. Frank Hu further commented that, “Swapping some animal foods especially red meat for healthy plant-based protein foods such as nuts, legumes, and whole grains can help to prevent chronic diseases and improve longevity. However, not everyone should be a vegetarian, and for individuals who consume a meat-centric diet, even a partial shift from meat to plant protein foods can confer some health benefits.”

3. Postmenopausal estrogen can help lower breast cancer risk

A new follow-up study of menopausal hormone therapy found that prior use of conjugated equine estrogen (CEE) reduced both breast cancer incidence and mortality, while prior use of CEE plus medroxyprogesterone acetate (MPA) was associated with an increase in incidence. Rowan T. Chlebowski, MD, PhD, of the Lundquist Institute for Biomedical Innovation in Torrance, California said, “Prior use of CEE alone is, to our knowledge, the first pharmacologic intervention demonstrated to be associated with a statistically significant reduction in deaths from breast cancer.” the researchers analyzed the long-term follow-up of two randomized trials that included 27,347 postmenopausal women with no prior breast cancer and negative mammograms at baseline. Their mean (SD) age was 63.4 (7.2) years. The first trial included 16,608 women with a uterus. Among these women, 8,506 received 0.625 mg/day of CEE plus 2.5 mg/day of MPA, and 8,102 received placebo. The second trial included 10,739 women who’d gotten a hysterectomy, 5,310 of whom received 0.625 mg/day of CEE alone and 5,429 of whom received placebo. An analysis in 2015 found that CEE alone was associated with lower risk of breast cancer and CEE plus MPA was associated with increased risk. Furthermore, CEE alone was also associated with lower mortality (30 deaths, annualized mortality rate 0.031%), compared with placebo. Dr. Chlebowski in an interview said, “The big thing to think about is estrogen alone reducing breast cancer mortality by 40%. None of the other interventions, including tamoxifen, had any change on mortality. This should change the way we look at breast cancer prevention, though we might have to be a little creative about it. I think you have to be a little away from menopause for it to reduce breast cancer. But we wanted to start that debate. On the other hand, a woman takes estrogen plus progestin and when you look at that curve, it’s staying about 25% increased. You take it for 5.6 years and the increase continues through 20 years, so you’re maybe buying a lifetime of increase in breast cancer by taking estrogen plus progestin for 5 years. When you hook up to the National Death Index, they find 98% of all deaths in the United States. That’s really remarkable; you retain the whole power of the randomization. It means our data, between the death index and our follow-up of participants, is essentially complete.”

4. COPD patients who have sleep problems should be screened for mood disorders

A new research has shown a strong link between depression and improper sleep in patients with chronic obstructive pulmonary disease. In a study done on 245 COPD patients, it was found that those who outlined sleep problems were notably more likely to report depression or anxiety, poor self-efficacy, and poor health-related quality of life. Sang Hee Lee, MD, of Wonkwang University Sanbon Hospital, Gunpo-si, South Korea said, “Sleep problems are common in patients with COPD and have been associated with poor COPD-related outcomes. However, there is a lack of research on factors associated with sleep disturbance in patients with COPD.” The researchers enrolled 245 adults with COPD who completed the COPD and Asthma Impact Scale (CASIS) to determine sleep impairment. The CASIS was developed to measure sleep-related problems associated with respiratory disease, and scored on a scale of 1-100, with higher scores indicating greater sleep impairment. The researchers said, “Although the CASIS did not allow for measurement of symptom severity and did not include many items related to breathing problems, the test shows good internal consistency, test-retest reproducibility, and construct validity according to previous studies. The CASIS may be a good tool for evaluating sleep disturbances in COPD patients, and further study is needed.” The results highlight the association between depression, poor quality of life, and self-efficacy in relation to poor sleep, and suggest that “Sleep quality could be improved by enhancing HRQL and self-efficacy,” the researchers said.

5. India’s Covid count was highest in the world on Sunday

According to the data from worldometers.info, India recorded the highest number of coronavirus cases amongst all countries on Sunday 2nd Aug. India’s count of 53,641 cases on the day was higher than the infections detected in the US (49,038) and Brazil (24,801). India reported 3,69,588 cases during last week (July 27-Aug 2), higher than Brazil’s count of 3,13,776. The US logged 4,41,808 cases during the period. In the previous week (July 20-26), India’s count (317,892) was just behind Brazil, which had added 320,005 cases. The US had recorded 4,73,289 cases that week. Tamil Nadu recorded 5,609 new cases on Monday, its lowest count since July 21. However, the state’s Covid-19 toll has been rising even as the number of fresh cases slowly dip. For the third day in a row, Maharashtra’s discharges were more than its fresh addition of Covid-19 cases. Maharashtra on Monday added 8,968 new cases, taking its total cases to over 4.5 lakh. A total of 10,221 patients were discharged on Monday. Telangana reported a sharp dip in cases, from 1,891 on Sunday to 983 on Monday, while 11 deaths were reported. Karnataka reported 4,752 new cases while recording an all-time high number of discharges for the second consecutive day. While 4,776 patients were declared cured and discharged. 

6. Reports surge in health anxieties during lockdown: Study

The new research has been published in the journal American Psychologist draws on survey responses from over 800 people recruited online and via social media who answered questions over a ten-day period from 17 – 26 April 2020. Results suggest that a quarter of all participants revealed significantly elevated anxiety and depression, exacerbated by lockdown and isolation. Nearly 15 per cent reached clinical levels of health anxiety, which reflects that health-related anxiety has become distressing and is likely to be causing preoccupation and disruption to normal activities. Average age of participants in the study was 38 years old, 22 percent of whom had a pre-existing medical condition. The majority of respondents were female (80 percent female: 20 percent male). Lead author, Dr Hannah Rettie from the University of Bath’s Department of Psychology said, “The Covid-19 pandemic has caused global uncertainty which has had a direct, detrimental effect on so many people across the UK and around the world. People have been unsure when they would see relatives again, job security has been rocked, there is an increased threat to many people’s health and government guidance is continuously changing, leading to much uncertainty and anxiety. What our research focused on is how some individuals have struggled to tolerate and adapt to these uncertainties – much more so than in normal times. These results have important implications as we move to help people psychologically distressed by these challenging times in the weeks, months and years ahead.” Research lead Dr Jo Daniels also of the Department of Psychology at Bath said, “This is important research which looks at the potential mechanisms in Covid-19 related distress, a recently prioritised area of research. These findings can help us to tailor our existing psychological treatments to help those most in need but may also be useful in considering what coping strategies might be particularly helpful at a new time of uncertainty. We are also now better informed as to the likely number of the population that are experiencing clinical levels of health-related anxiety. This may serve to normalise distress at this difficult time and promote the uptake of emerging models of Covid-19 related distress for those who may need support at this time of uncertainty. While this research offers important insights into how common distress was during ‘lockdown’, it is important to stress that anxiety is a normal response to an abnormal situation such as a pandemic. It can be helpful to mobilise precautionary behaviours such as hand-washing and social distancing. Yet for many, as reflected in our findings, anxiety is reaching distressing levels and may continue despite easing of restrictions – it is essential we create service provision to meet this need, which is likely to be ongoing, particularly with current expectations of a second wave. Further longitudinal research is needed to establish how this may change over time.”  

Reference links:

  1. https://www.medscape.com/viewarticle/935014
  2. https://www.medscape.com/viewarticle/933922
  3. https://www.medscape.com/viewarticle/934885
  4. https://www.medscape.com/viewarticle/935158
  5. https://health.economictimes.indiatimes.com/news/industry/indias-covid-count-on-sunday-highest-in-world/77341695
  6. https://health.economictimes.indiatimes.com/news/industry/lockdown-study-reports-surge-in-health-anxieties/77345116

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