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Monday 31 March 2008

Regular Drinking Raises Blood Pressure, Meta-Analysis Affirms


BRISTOL, England, March 4 -- Even moderate alcohol intake over a lifetime may have a marked effect on blood pressure, researchers said.
Action Points
________________________________________
• Explain to interested patients that the meta-analysis supported but does not prove a link between alcohol and blood pressure.
• Note that the studies in the meta-analysis included primarily Japanese men.

Men who averaged three drinks a day had more than twice the risk of hypertension as those who drank little, if at all, reported Sarah J. Lewis, Ph.D., of the University of Bristol, and colleagues online in Public Library of Science -- Medicine.
Men who had one drink a day were at 70% elevated risk, the researchers found.
Systolic and diastolic blood pressure was also elevated "to a much greater extent, even among moderate drinkers, than previously thought," they wrote.
Observational studies have generally found lower blood pressure with moderate alcohol intake compared with nonuse or heavy intake, but those studies had limited ability to control for diet, smoking, exercise, income, and reporting bias.
So to eliminate these sources of confounding, the investigators did a meta-analysis of studies that focused on genetic variations for the enzyme that removes alcohol from the body. "Analyzing individuals by genotype," they said, "is akin to a randomized controlled trial of different lifetime levels of alcohol intake."
While the aldehyde dehydrogenase 2 (ALDH2) genotype is not associated with confounding factors, people who inherit two copies of the ALDH2 *2*2 variant tend to drink little because their body does not efficiently metabolize alcohol and they become flushed and nauseated after drinking, the researchers said.
The meta-analysis included 10 studies reporting on associations between ALDH2 and hypertension or blood pressure. Most were cross-sectional; all were population-based.
The studies were mainly done in Japan, where the ALDH2 gene variant is common. One small study came from England.
As expected, the investigators found that alcohol intake was highest at around 20 to 30 g per day for men with the *1*1 genotype and lowest at 2 g or less per day for *2*2 homozygotes. Men with the *1*2 genotype had intermediate intake at 10 to 15 g per day on average.
Alcohol intake was minimal among the relatively few women included in the studies, "but studies showed trends in the same direction as men," the researchers said.
Smoking status, sex, and physical activity did not differ between genotype groups. Body mass index tended to be higher among men with the more common *1*1 genotype.
"As alcohol is an energy-dense macronutrient and has an appetite-enhancing effect," the researchers said, "it is likely that the increase in BMI among individuals with the *1*1 genotype is due to their increased alcohol consumption."
In the three studies that reported hypertension outcomes for a total of 4,219 participants, men who drank more were at higher risk.
Men with the *1*1 genotype had 2.42-fold higher risk than those with the *2*2 genotype (95% CI 1.66 to 3.55, P=0.0000048). Men with the *1*2 genotype had 1.72-fold higher risk than those with the *2*2 genotype (95% CI 1.17 to 2.52, P=0.006).
The same effect was seen in the five studies that reported blood pressure outcomes for a total of 7,658 participants.
Mean diastolic blood pressure was 3.95 mm Hg higher among men with the *1*1 genotype and 1.58 mm Hg higher among men with the *1*2 genotype compared with *2*2 homozygotes (P<0.00001 and P=0.016, respectively).
Mean systolic blood pressure was 7.44 mm Hg higher for men with the *1*1 genotype and 4.24 mm Hg higher among men with the *1*2 genotype compared with *2*2 homozygotes (P<0.00001 and P=0.00005, respectively).
Each gram per day of alcohol consumption was estimated to increase diastolic blood pressure 0.16 mm Hg (95% CI 0.11 to 0.21) and to raise systolic blood pressure 0.24 mm Hg (95% CI 0.16 to 0.32).
Although findings could have been caused by pleiotropic effects of ALDH2, "if either pleiotropic effects or confounding by linkage disequilibrium were operating, an effect on blood pressure would be seen in both sexes," they said.
Further large-scale studies are needed to confirm the findings, they noted.
The editors' summary pointed out that "although the Mendelian randomization approach [used by the investigators] avoids most of the confounding intrinsic to observational studies, it is possible that a gene near ALDH2 that has no effect on alcohol intake affects blood pressure, since genes are often inherited in blocks."
The editors also pointed out that in the U.S., one standard drink contains about 14 g of alcohol and in the U.K. 8 g. Recommended daily limits in these countries, they said, are 1-2 units and 3-4 units, respectively.

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Saturday 29 March 2008

Diabetes Information Has Many Sources

When a person is newly diagnosed as being diabetic many thoughts go through their mind, as well as numerous questions about the ailment. There are many good resources for obtaining diabetes information, not least of which is your medical care provider.

Principal among the diabetes information you will want to have is what to do in case of emergency such as a hypoglycemic event, which is a sudden drop in blood sugar level, which if left untreated, could lead to unconsciousness or a coma. It is important that not only the diabetic understand what steps need to be taken, by those caring for them should know this as well.

While an exact cause of diabetes is unknown and how it affects a person is different for each, the basic symptoms are the same. There are two commonly known types of diabetes, Type I, when the body fails to produce enough insulin to do it job, and Type II, when the insulin is produced but does not function as it should. Most diabetes information refers to Type II being the most common form.

Diabetes occurs when the body fails to produce enough insulin, or to properly use the insulin produced to convert sugars and starch to energy for the body to burn as fuel. Diabetics require insulin to help their body perform this function and the amount of insulin and the method of ingestion will vary based on the diabetes information available for each patient.

Tracking Sugar Levels Necessary For Health

A person with diabetes must track the glucose level in the blood several times throughout the day to help establish a normal reading for them at different times. For example, it may be acceptable for sugar levels to be slightly elevated immediately after eating and if the level drops after a meal, there may be some cause for concern. Without the diabetes information based on that person’s history, it is not possible to know.

Keeping current on medical records can provide much needed diabetes information for medical professionals supplying emergency care. Not all medications can work together and knowing a person is a diabetic and what medications they are on because of it can eliminate the possibility of mixing incompatible medicines.

The American Diabetes Association along with the American Medical Association are also great resources for diabetes information and can refer those believing they have symptoms of diabetes to appropriate medical professionals.

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HEART DISEASE

Heart Disease Reduction by Reducing Salt
"Across populations, the level of blood pressure, the...rise in blood pressure with age, and the prevalence of 'high blood pressure disease] are directly related to sodium 'salt] intake...
"In the continued absence of voluntary measures adopted by the food industry, new regulations will be required to achieve lower 'salt] concentrations in processed and prepared foods."
Editor's Comment: Whether or not one calls it Alternative Health, reducing salt and in a more concerted effort, adding to your intake of potassium-rich foods (potassium reduces sodium in the body) such as beans, orange juice and coffee should be helpful. Bananas are widely believed to contain much potassium and they are over-rated as an Alternative Health adjunct, though not useless.
From: Archives of Internal Med., vol. 167, July 23, 2007. By: Drs. Dickinson & Havas, for the Council on Science & Pub. Health, Amer. Med. Assn.

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Friday 28 March 2008

VITAMIN D AND CARDIOVASCULAR RISK

A national survey designed to estimate the prevalence of common chronic conditions and associated risk factors was conducted in the US between 1988 and 1994 (NHANES III). It provided a database which is constantly mined for information about specific questions. A study based on this data was recently published which addresses the question of the association between vitamin D status and the prevalence of risk factors for cardiovas cu lar disease (CVD) using the vitamin D serum marker 25-hydroxyvitamin D.


Data for over 15,000 adult participants were available. When individuals with 25-hydroxyvitamin D levels less than 52 nmol/L were compared with those with levels equal to or greater than 92 nmol/L, it was found that those in the low-level group had significantly higher probabilities of have hypertension, abnormal blood glucose, history of diabetes, obesity, and high triglycerides. However, for two prominent risk factors, high total cholesterol or non-HDL cholesterol, no correlations were found.

The authors claim that to the best of their knowledge this is the first study to demonstrate significant association between low vitamin D status and CVD risk factors in a nationally representative International Health News November 2007 Page 7 sample.

In addition, they pointed out that favorable trends for the risk factors for obesity, diabetes and hypertension may well continue to increase at levels greater than 92 nmol/L conferring additional health benefits. In addition, their results were regarded as consistent with the established literature that suggests a role for vitamin D in promoting insulin sensitivity and preventing diabetes. They also present plausible biological mechanisms for some of the observed dependencies on vitamin D.

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Monday 10 March 2008

Penyakit kulit karena jamur


Banyak orang beranggapan bahwa penyakit panu atau kurap sekadar masalah kosmetik. Pernah menikmati tempe atau tapai? Di masyarakat Indonesia kedua makanan ini sangat akrab sebagai hidangan di atas meja. Makanan dari kedua jenis bahan itu cukup lunak dan nikmat ketika dimakan. Ini tentu berbeda bila kita menyantap bahan bakunya. Tidak lunak, bukan?

Kenikmatan rasa tempe, tapai, roti, oncom, dan masih banyak jenis makanan yang lainnya itu dihasilkan dari proses fermentasi jamur. Kehadiran jamur dimanfaatkan untuk hal lain, seperti untuk melengkapi sayuran dan lauk-pauk bagi keluarga, dan untuk menghasilkan obat antibiotik.

Di dunia diperkirakan terdapat 100 ribuan jenis jamur. Tergolong ke dalam kelompok fungi, jamur bisa saja terdiri atas satu sel yang besarnya beberapa mikrometer, atau dapat juga membentuk tubuh buah yang besarnya mencapai satu meter. Sel-selnya tersusun berderet satu per satu dan membentuk hifa atau benang-benang (filamen). Alat perkembangbiakannya berupa spora.

Karena tak punya hijau daun, jamur menjadi makhluk konsumen dan sangat bergantung pada medium yang menyediakan karbohidrat, protein, vitamin, dan persenyawaan kimia lainnya. Semua itu didapatkannya dengan cara menyerap unsur yang dibutuhkan dari lingkungan hidupnya melalui sistem hifa.

Selain bisa melakukan fermentasi medium karbohidrat menjadi gula, jamur pun juga sangat penting dalam kehidupan manusia. Dengan jamur, sampah dan bangkai makhluk hidup lainnya bisa terurai. Namun, seringkali jamur juga dapat menguraikan bahan yang diperlukan manusia sehingga bisa mendatangkan kerugian. Pembusukan pada makanan dan pelapukan pada kayu cukup merepotkan manusia. Tak hanya itu, jamur bisa beracun dan menyebabkan penyakit tertentu.

Jamur pada manusia
Jamur memang sangat erat hubungannya dengan kehidupan manusia. Sedemikian eratnya sehingga manusia tak terlepas dari jamur. Jenis fungi-fungian ini bisa hidup dan tumbuh di mana saja, baik di udara, tanah, air, pakaian, bahkan di tubuh manusia sendiri.

''Jelasnya, di mana pun jamur bisa hidup, terutama di lingkungan yang cocok baginya berkembang biak. Manusia itu termasuk salah satu tempat bagi jamur untuk tumbuh, di samping bakteri dan virus,'' jelas pakar kesehatan kulit dan kelamin, Dr Kusmarinah Bramono dari FKUI (RSUPN-Cipto Mangunkusumo) dalam pemaparan tentang jamur di Jakarta, beberapa waktu lalu.

Jamur bisa menyebabkan penyakit yang cukup parah bagi manusia. Penyakit tersebut antara lain mikosis yang menyerang langsung pada kulit, mikotoksitosis akibat mengonsumsi toksin dari jamur yang ada dalam produk makanan, dan misetismus yang disebabkan oleh konsumsi jamur beracun.

Pada manusia jamur hidup pada lapisan tanduk. Jamur itu kemudian melepaskan toksin yang bisa menimbulkan peradangan dan iritasi berwarna merah dan gatal. Infeksinya bisa berupa bercak-bercak warna putih, merah, atau hitam di kulit dengan bentuk simetris. Ada pula infeksi yang berbentuk lapisan-lapisan sisik pada kulit. Itu tergantung pada jenis jamur yang menyerang.

Menurut Jimmy Sutomo dari perusahaan Janssen-Cilag, sebagai negara tropis Indonesia menjadi lahan subur tumbuhnya jamur. Karena itu, penyakit-penyakit akibat jamur sering kali menjangkiti masyarakat.

''Kita lihat, banyak masyarakat tak menyadari bahwa dirinya terinfeksi oleh jamur. Bahkan, jamur bisa mengenai manusia dari kepala hingga ujung kaki, dari bayi hingga orang dewasa dan orang lanjut usia,'' ujar Jimmy. Janssen-Cilag merupakan perusahaan farmasi yang memimpin pasaran dengan obat antijamur yang mengandung miconazole nitrate dua persen.

Jimmy menjelaskan, banyak orang meremehkan penyakit karena jamur, seperti panu atau kurap. Padahal, penyakit ini bisa menular lewat persentuhan kulit, atau juga dari pakaian yang terkontaminasi spora jamur. Banyak anggapan, katanya, penyakit panu atau kurap sekadar masalah kosmetik.

Anggapan ini dibenarkan Kusmarinah. ''Kami sering menangani pasien karena jamur. Mereka baru datang ke dokter kalau sudah merasakan gangguan kosmetik yang parah akibat infeksi jamur. Sebelumnya, mereka tak begitu memperhatikan penyakit ini.''

Pengobatan
Seharusnya, lanjut ahli kulit dari FKUI itu, masyarakat perlu memperhatikan kebersihan diri dan menjaga kekebalan tubuhnya bila ingin terhindar dari infeksi jamur. Bahaya infeksi jamur tak sekadar menyebabkan panu atau kurap saja, tapi juga bisa menyebakan kematian bila infeksinya meluas dan bahkan masuk ke organ dalam tubuh.

Karena itu, bila mendapati dirinya terkena infeksi jamur maka seseorang itu perlu segera diobati. Pengobatan yang dilakukan biasanya dengan antijamur. Lamanya pengobatan tergantung pada tingkat infeksi yang terjadi. ''Pengobatan diusahakan dilakukan sampai penyakit hilang dan sembuh benar. Kami pun harus memilih jenis obat antijamur yang efektif membasmi jamur dengan efek samping yang minimal,'' sambung Kusmarinah.

Dia mengemukakan, ada jenis obat yang bersifat iritan. Maksudnya, cara kerja obat tersebut memapas jamur dengan mengikis permukaan yang terkena jamur tiap lapisan. Biasanya obat ini memerlukan waktu 1-4 minggu untuk jenis panu atau kurap. Tapi, kondisi inipun tergantung pada tingkat keparahannya. Jenis obat lainnya bersifat fungisida. Ini lebih mengarahkan sasaran pada jamur itu sendiri tanpa mengiritasi kulit.

Kusmarinah dan Jimmy mengakui, banyak produk farmasi khusus untuk obat jamur kulit yang dijual bebas di pasaran. Umumnya masyarakat pun melakukan self medication atau pengobatan sendiri dengan membeli obat antijamur yang bebas itu. ''Bisa-bisa saja penderita melakukannya. Hanya saja, asal tahu jelas jenis infeksi jamur yang dideritanya. Namun, saya sering menemukan, masyarakat salah menggunakannya. Mereka biasanya berlebihan dalam menggunakan obat. Akibatnya, ketika kami diagnosis sulit bagi kami untuk melihat gejalanya,'' demikian Kusmarinah merincinya.

Itu juga karena persoalan informasi yang tak sampai pada masyarakat pengguna produk. ''Untuk informasi produk seharusnya disampaikan oleh ahli farmasi. Di negara kita, fungsi ini tak berjalan,'' cetus Jimmy.

Maka, masyarakat diharapkan berhati-hati dalam menggunakan obat. Sebab, infeksi jamur tak bisa dianggap enteng dan tak selalu bisa diatasi dengan pengobatan sendiri. Apalagi, dari seluruh penyakit kulit yang ditemui, masalah infeksi jamur ternyata tergolong cukup tinggi. Dengan demikian, masyarakat diharapkan meminta saran pengobatan kepada dokter dan melakukan pencegahan terhadap infeksi jamur.

Kenali Jenis Infeksi Jamur Kulit
* Panu (pitiriasis versikolor): menyerang kulit, bercak putih, merah, atau hitam.
* Kurap (dermatofitosis) yang terdiri atas Tinea Apitis menyerang kulit kepala, Tinea Korporis pada permukaan kulit, Tinea Kruris pada lipatan kulit, Tinea Pedis pada sela jari kaki (athlete's foot), Tinea Manus pada kulit telapak tangan, Tinea Imbrikata berupa sisik pada kulit di daerah tertentu, dan Tinea Ungium (pada kuku). Umumnya berbentuk sisik kemerahan pada kulit atau sisik putih. Pada kuku, terjadi peradangan di sekitar kuku, dan bisa menyebabkan bentuk kuku tak rata permukaannya, berwarna kusam, atau membiru.

* Ketombe (Pitiriasis Sika).
* Infeksi Kandida (kandidosis) pada lipatan kulit, sela jari, sela paha, ketiak, bawah payudara, mulut (sariawan), genetalia (keputihan), dan ruam popok.

Faktor-faktor Pencetus Infeksi
- Lembab dan panas dari lingkungan, dari pakaian ketat, dan pakaian tak menyerap keringat.
- Keringat berlebihan karena berolahraga atau karena kegemukan.
- Friksi atau trauma minor, misalnya gesekan pada paha orang gemuk.
- Keseimbangan flora tubuh normal terganggu, antara lain karena pemakaian antibiotik, atau hormonal dalam jangka panjang.
- Penyakit tertentu, misalnya HIV/AIDS, dan diabetes.
- Kehamilan dan menstruasi. Kedua kondisi ini terjadi karena ketidakseimbangan hormon dalam tubuh sehingga rentan terhadap jamur.

Cara Memastikan Penyakit Jamur
- Pemeriksaan tampilan secara klinis.
- Pemeriksaan dengan bantuan sinar lampu Wood (UV), kerokan kulit, mukosa, kuku untuk pemeriksaan mikroskopik, dan pemeriksaan biakan untuk mengetahui jenis jamurnya.wed

Sumber : Republika Online - Selasa, 25 Mei 2004 - Penulis : wed

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