March 2007

It's Ten P.M. Do You Know Where Your Stroke Center Is?
It's late at night. An older person in your home suddenly has difficulty finding words or becomes weak or confused or has difficulty with balance or has sudden numbness on one side of the body or develops a severe headache. They may be suffering from the most common type of stroke, one caused by a clot (as opposed to a bleed). If you can quickly get the person to a hospital that has an emergency stroke unit that does rapid brain scanning, they may be given clot-busting treatment known as t-PA (tissue plasminogen activator). Given within three hours of a stroke, t-PA has been shown to significantly reduce disability. Since minutes count, it might be a good idea to call your local hospital in advance to find out the location of the stroke unit closest to you. Be sure that the unit does rapid brain scanning and uses t-PA as some units called stroke units consist only of a set of in-hospital beds for people recovering from a stroke.

Let's Hear it for the Mohels
A series of large studies have all shown that circumcision reduces the incidence of HIV by about 50%. Although the studies were carried out in the developing world, they have clear implications for the developed world as well. Those opposing circumcision on moral, esthetic, hedonistic, and/or heath grounds may want to reassess the benefit-risk balance of the procedure in view of these findings.

You Haven't You Taken Your Anti-oxidants Today? Good!!
It is generally agreed that oxidative stress may damage bodily functions. So why not take anti-oxidant supplements like beta-carotene, Vitamin A and vitamin E. Seems reasonable. (You can guess what's coming.) An analysis was carried out of the 47 best randomized studies done on more than 230,000 people, most of whom were healthy. It turns out that one reason not to take these supplements is that they cause a small but significant increase in mortality rate. Whoops. This was not true of those taking Vitamin C or selenium. But then again those supplements didn't seem provide any benefit either. On the positive side, the authors reassure us that it's still OK to eat fruits and vegetables that contain vitamins. That's a relief.

Quick. Where Is the Nearest Men's Room?
The most common treatments for Benign Enlargement of the Prostate (BPH) are surgery and medication. British investigators recently found that simple behavioral interventions had a prompt and lasting effect on BPH symptoms and reduced, deferred, or eliminated the need for these treatments. One hundred forty men (mean age 63) who were not taking BPH medicine were randomized to receive either "watchful waiting" or self-management training. Treatment failure was defined as marked rise in symptoms, acute urinary retention, or the use of medication or surgery. The failure rate for the usual care group at 3, 6 and 9 months was 42%, 61%, and 79%. That for the training group was only 10%, 19%, and 31%. Numerous strategies were taught including keeping daily fluid intake to 1500-2000 ml per day; double voiding; restricting fluids for 2 hours prior to retiring, during long journeys, or when out in public; avoiding caffeinated drinks; avoiding alcohol in the evening; avoiding large volume alcoholic drinks like beer; timing the use of BPH medications for when they're most needed; and others. Those suffering from BPH and their spouses can find details of the training program at www.bmj.com/cgi/data/bmj.39010.551319.AE/DC1/1

And Now, Introducing the New Diet Champion…
Four popular diets in the US are the Atkins (very low carb), the Zone (low carb), the Ornish (very high carb, very low fat), and the LEARN (planning what and when to eat). A study of the effects of these diets on 311 overweight, non-diabetic pre-menopausal women found that the diet that brought about the greatest weight loss in one year was…..the Atkins. It brought about an average weight loss of 10 pounds compared to 6 pounds with the Ornish, 5 pounds with the LEARN, and 3.5 pounds with the ZONE. Suprisingly. the Atkins, which allows you to eat a fair amount of meat, also brought about the greatest improvements in HDL cholesterol, triglyerides, and blood pressure, although these reductions were modest in size. The main finding of the study is the importance of eliminating from the diet, as much as possible, refined carbohydrates such as white bread, sugar, and soda. Several basic vitamins and minerals can be difficult to get in adequate amounts from a very-low-carbohydrate diet so you may need to take vitamin supplements.