RedScrubs
The Resource for Medical Professionals

Chronic pain involving muscles, bones and/or joints is the leading complaint that drives patients to their doctors seeking relief. Now, according to peer-reviewed clinical research looking at adult patients of all ages, inadequacies of vitamin D might be linked to pain of all types including fibromyalgia, chronic fatigue syndrome, seasonal affective disorder, rheumatic disorders, osteoarthritis, migraine headaches and other somatic complaints.

Vitamin D has long been known to be involved in other metabolic processes other than building strong bones. The process that links vitamin D to musculoskeletal pain is presumed to begin with a lack of circulating calcium due to an inadequacy of vitamin D. This calcium deficiency stimulates increased parathyroid secretion and precipitates a cascade of events that leads to chronic pain.

Vitamin D receptors have been found in various brain structures, the spinal cord, and the sensory ganglia. Results of some studies suggest that benefits of vitamin D supplementation might also help with neuropathies, another pain syndrome frequently found in people with diabetes.

As a healthcare recruiter, my job is to find qualified and quality persons to place as candidates in the jobs we have been requested to fill. The goal of all recruiters, in all agencies and facilities, is to complete these tasks in a timely and responsible manner.
We, as recruiters, frequently fail to consider the older persons in our professions. Nursing is an area in which the older persons need to be considered, not only for new hires, but also in retention of qualified personnel. Age should not be a factor if the candidate is both mentally and physically capable of performing the job as outlined in the job descriptions.

This study demonstrated that derangements of blood glucose control occur in patients with and without diabetes who undergo cardiac surgery. The study analyzed 8,727 adults placing them in a variety of blood glucose control categories (good= < 200 mg/dl), (moderate = 200-250 mg/dl)or (poor = >250 mg/dl). They determined that the percentage that fell in the inadequate blood glucose control categories were more likely to have heart failure, hypertension, renal dysfunction and ejection fraction < 50%. The study found that 52% of patients had poor control, 31% had moderate control and 8% with good control had diabetes as a diagnosis. Inadequate blood glucose control, but not diabetes, was associated with in-hospital mortality and morbidity. Inadequate control was also associated with post-operative heart attacks, and with pulmonary and renal complications in people without the diagnosis of diabetes.

There has been a lot of talk about prions on redscrubs.com since the inception of the website. The articles have been about downer cows, mad cow disease, vCreutzfeldt-Jakob disease and those illnesses caused by prions generally termed transmissible spongiform encephalopathies (TSEs). This recent study published in the July 1 issue of Environmental Science and Technology highlights how prions survive in the environment.

Prions are difficult to inactivate surviving even autoclaving in a hospital setting unless the autoclaving is set for at least 18 minutes. They are resistant to extreme heat, chemical disinfectants and irradiation. Until now, scientists have never really looked to see if they survived wastewater treatment because the tests were not sensitive enough. Now the concern is that they are surviving as they come out of the sewers and septic tanks from slaughterhouses, meatpacking facilities and private game dressing businesses.

Scientists used lab experiments with simulated wastewater treatment to show that prions can be recovered from wastewater sludge after 20 days remaining in the “biosolids”, a by-product of sewage treatment sometimes used to fertilize fields.

Although the scientists clarified that prions have never been reported in wastewater treatment, they also noted that no one is testing for them.

Should diabetes drugs face tougher standards? With nearly 24 million Americans with Type II Diabetes who are already at risk for heart disease, should we be medicating them with drugs that aggravate or increase the risk for heart disease?

In a Fox News report it was brought to our attention that advisors to the Food Drug Administration (FDA) had voted 14-2 on tougher studies to assure that diabetes drugs don’t increase the risk of heart disease. This comes on the heels of the news release that the FDA will be adding new information on heart disease risk to the existing boxed warning about the potential for increased risk for heart attacks with the use of Avandia, a popular anti-Diabetes drug.

The FDA stated that at this time there isn’t enough evidence to indicate that the risks of heart attacks or death are different between Avandia and some other type 2 diabetes treatments. Therefore, the FDA has requested the Glaxo—Smith Kline (GSK) conduct a new long-term study to evaluate these proposed cardiovascular risks with Avandia. GSK, who currently manufactures Advandia, has agreed to the study with FDA oversight authority.

Things have been absolutely hectic this week for us here, and I would imagine for many of you, as well, after last week’s Holiday. One of the most mind-numbing tasks has been choosing a winner for this week’s Scrubby Awards. Why, you ask? Two reasons…

First, the quality of medical blogging seems to be improving week after week in my opinion; more physicians, healthcare professionals, and students are wearing their keyboards out even faster than normal by jumping headfirst into the blogosphere.

Secondly, because of last week’s Holiday, I personally had over 1100 blog posts to go through for the last two weeks to choose the winners! That’s a LOT of reading. Oh, and I know I say this often, but if your not using MedReader, you are really missing out on a massive daily supply of some of the best information out there - seriously. It is just so much easier to get my medical news and blogs all in one place, rather than checking dozens of sources for daily updates.

Anyway, those mentioned in this weeks wrap-up should feel extra special to be chosen out of all of those posts and submissions. Also, if you didn’t know, the Scrubby Award winner receives a free pair of scrubs courtesy of NW Scrubs. Good work everybody!

— Dr. Incognito

In a study published in the June, 2008 issue of The American Journal of Medicine the cut-off level for determining diabetes was again challenged. After looking at 46, 578 members of Kaiser Permanente it was found that subjects developed diabetes at a rate of 1% per year. Subjects were assigned to 1 of 4 categories of blood sugar levels (<85, 85-89, 90-94, or 95-99 mg/dl). They were followed for 81 months.

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors (i.e. body mass index, blood pressure, lipids, smoking, cardiovascular disease and hypertension) suggests that diabetes risk increases as fasting plasma glucose increases, even within the currently accepted normal range. For example, for each mg. per deciliter of fasting plasma glucose diabetes risk was increased by 6%. Subjects with glucose levels of 95-99 were 2.33 times more likely to develop diabetes. Subjects in the 90-94 mg/dl group were 49% more likely to progress to diabetes.

Food diaries are records of everything that you eat in a day and can be simple or complex. It is not unusual for an RD to ask you to bring in a three day food diary to your first appointment so the assessment can include an overall view of what the current diet looks like. Then, typically, the patient is asked to keep a record of the daily food intake with corresponding values for calories,protein, fat, carbohydrate and fiber so patients can learn how to balance their food intake to achieve the optimal intake of nutrients and decrease intake of nutrients that are too high. The record also is reviewed at follow-up appointments with the RD where suggestions are made on ways to improve intake so nutritional goals are achieved.

A recent study looked at the effect of keeping a food diary and the amount of weight loss relative to the record keeping. According to the Kaiser Permanente Study, keeping the food diary doubled weight loss over the course of the study and the more food records people kept, the more weight they lost. The study looked at 1,700 participants who were instructed to follow the DASH diet rich in fruits and vegetables and low in fat. Weekly group sessions and exercise for 30 minutes per day were encouraged.

The authors concluded that keeping a record of what you eat makes you more aware of what you are eating and where your bad habits are. Food journaling in conjunction with a good weight management program is a great combination of tools and support.

For more information see http://www.kpcmi.org/weight-management/index.html

Rimonabant (also known as Accomplia,Slimona, Zimulti) has been approved for use in the UK National Healthcare Service (NHS) for the treatment of obesity in those who have not had success with lifestyle changes, or the two other weight loss drugs, Orlistat and Sibutramine. Rimonabant has been withheld from the U.S. markets due to concerns over side-effects such as severe depression.

This approval comes after many concerns over Rimonabant’s possible side-effects. Last month the Medicines and Healthcare products Regulatory Agency (MHRA) said it had received 720 reports of adverse drug reactions (for a grand total of 2,123) in the UK since the drug launched in 2006.

Rimonabant is the first selective CB1 receptor blocker to be approved for use anywhere in the world. It is an inverse agonist for the cannabinoid receptor CB1. Its main avenue of effect is reduction in appetite although some companies have tried to push it through for smoking cessation indications.