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From The Editors Health

New Study Reveals Exciting Breakthrough in Leukaemia Treatment

24 patients suffering from chronic lymphocytic leukemia (CLL), who had failed to respond to conventional treatment with ibrutinib for the terminal illness, were given anti-CD19 CAR-T cell therapy in a clinical trial of the new line of treatment being researched. The findings, published in the “Journal of Clinical Oncology,” were very encouraging with 71% of the patients experiencing partial or total remission.

The procedure on the patients, ranging in age from 40 to 73 years, involved extracting the patients’ own T-cells from their blood and modifying them to recognize the offending CD-19 on the surface of the leukemia cells. The patients were then infused with their tweaked T-cells which began a seek-and-destroy mission against the CD-19 antigen. Six months into the therapy and 17 of the 24 patients found that their tumors had shrunk or disappeared altogether.

The report concluded that “CD19 CAR-T cells are highly effective in high-risk patients with CLL after they experience treatment failure with ibrutinib therapy.”

“It was not known whether CAR T-cells could be used to treat these high-risk CLL patients,” said Dr. Cameron Turtle, an immunotherapy researcher at Fred Hutchinson, in a statement. “Our study shows that CD19 CAR T-cells are a highly promising treatment for CLL patients who have failed ibrutinib.”

Chronic lymphocytic leukemia or CLL, in simple terms, is a cancer of the white blood cells in adults and is the most common type of leukemia. B-cell lymphocytes found in the bone marrow are responsible for the body’s defense mechanism against infection but CLL takes a heavy toll on these lymphocytes.

What really happens in patients with CLL is that B-cells grow uncontrollably accumulating in the blood and bone marrow where they overwhelm the healthy blood cells.

Statistics show that CLL is predominantly a disease of the elderly but, in rare cases, has known to affect teenagers and children as well, which, in most cases is hereditary. Data also shows that CLL affects men more than women with more than 60% of new cases occurring in men.

As early symptoms are not severe, most cases are diagnosed during routine blood tests that show an increased white blood cell count resulting in swollen liver, spleen, and lymph nodes with anemia and infections setting in as the disease advances.

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From The Editors Health

11 Vaccines to be Made Mandatory in France from 2018 as Opposed to 2 that are Currently Compulsory

Effective 2018, French parents will be legally responsible for ensuring that their young children are vaccinated against 11 specified illnesses, unanimously recommended by health authorities including WHO.

Eight new vaccines have been added to the three existing ones – measles, hepatitis B, and influenza vaccines – that are compulsory under the current law. The new additions are whooping cough, mumps, rubella, pneumonia, and meningitis C vaccines.

While addressing the Parliament on Tuesday, Édouard Philippe, France’s new prime minister, referred to the pioneering French chemist Louis Pasteur who developed first rabies and anthrax vaccines in the 19th century.

The prime minister said that “diseases that we believed to be eradicated are developing once again, children are dying of the measles in France and in the country of Pasteur, that is unacceptable.”

Speaking to the French newspaper Le Parsien in June, new health minister Agnes Buzyn had hinted that the prevailing system was inadequate – “a real public health problem” is what she called it adding that the eleven vaccines were being made mandatory in light of the recent measles outbreak in the country.

“Today, only three infant vaccines are compulsory (diphtheria, tetanus, and polio). This poses a real public health problem,” Buzyn said.

“Today, in France, measles reappears. It is not tolerable that children die from it: 10 have died since 2008. Since this vaccine is only recommended and not mandatory, the coverage rate is 75 percent, whereas it should be 95 percent to prevent this epidemic.”

“We have the same problem with meningitis. It’s not acceptable that a 15-year-old teenager could die just because they have not been vaccinated,” the minister added.

A similar policy adopted by Italy in May has made non-vaccinated children ineligible for state schools.

24,000 cases of measles with 1500 serious complications and 10 related deaths were reported in France between 2008 and 2016 notwithstanding the easy availability of the vaccine. It is the French people’s distrust of vaccination – fuelled by anti-vaccine movements – that have contributed to the low immunity against communicable diseases in the country.

Findings of a survey conducted on 65,819 individuals across 67 countries revealed that 41% of the French people surveyed did not agree that “vaccines are safe” while the global average is just 13%.

“We are astonished to see that 41 percent of the French say they are wary of vaccinations,” remarked Dr. François Chast, head of pharmacology at Paris hospitals.

“It is urgent to fight the speeches of anti-science and anti-vaccination lobbies that play on fear, they show nothing and rely on a few very rare side effects to discredit vaccines that save millions of lives,” he added.

“As soon as we talk about a vaccination obligation, it triggers a row,” said Professor Alain Fischer, president of a body that advises on vaccinations.

“Unfortunately there are no other solutions to combat the upsurge in childhood diseases. It is a short term evil for a long-term good.”

Another major contributor to the apprehensions about vaccine safety has been the fake study by the disgraced doctor Andrew Wakefield who has been barred from practicing medicine in the UK.

His study linking the MMR (measles, mumps, and rubella) vaccine to autism and bowel disease published in the journal “The Lancet” (1998) was officially struck off the journal in light of a “fatal conflict of interest.” Subsequent scientific studies were successful in disproving the mythical theory of Wakefield the quack.

The January and February records of 2017 show 79 cases of measles reported in France mainly because of the outbreak of 50 cases reported in the north-eastern region of Lorraine, as confirmed by the European Centre for Disease Prevention and Control.

Italian expert on infectious diseases Alberto Giubilini believes that there is justification in holding the parents liable for not vaccinating their children.

“The benefits of vaccination in terms of protection from infectious disease outweigh the costs and risks of vaccination,” he observed. “For instance, the World Health Organisation estimates that between 2000 and 2015, measles vaccination prevented more than 20 million deaths.

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From The Editors Health

InVivo Announces Encouraging Motor Recovery in SCI Patients

InVivo Therapeutics Holdingsss Corp (NVIV) announced Wednesday that two patients with Spinal Cord Injury or SCI, who were enrolled in the INSPIRE experiment of its Neuro-Spinal Scaffold, have shown encouraging improvement in the most recent assessments of the INSPIRE trials.

The patient who was enrolled in May last year with “Complete AIS A SCI” had shown progress in the first “three-month- INSPIRE-assessment” in August 2016 converting to “Incomplete AIS B SCI.”

In the next INSPIRE assessment which was after 12 months since enrollment the patient was found to have “regained motor function associated with the most sacral segments of the spinal cord” – meaning the patient had further improved to “Incomplete AIS C SCI.”

M.D. Stuart Lee, the Principal Investigator at Vidant Medical Center in Greenville, North Carolina, where this patient was implanted with the Neuro-Spinal Scaffold had this to say in regards to the INSPIRE assessment:

“The patient’s continued improvement at the one-year exam is encouraging. Return of sacral motor function may be related to improvements in bowel and bladder function that can have an appreciable impact on a patient’s quality of life. We look forward to monitoring this patient’s recovery and hope for continued progress.”

The second patient had joined the INSPIRE trials in June 2015 with “Complete AIS A SCI” and converted to “Incomplete AIS B SCI” at the one-month-assessment in July that year. At the 24-month ISNCSCI test the patient was assessed to be “AIS C” showing the ability to contract two muscles of one leg.

Dr. William Bockenek of Carolinas Rehabilitation who, along with Domagoj Coric, M.D., of Carolina Neurosurgery and Spine Associates, is the co-investigator at the facility where the implantation of the Neuro-Spinal Scaffold was carried out on this patient said:

“This patient moved from AIS A to AIS B shortly after the initial injury and implantation with the Neuro-Spinal Scaffold two years ago, and now is noted on the ISNCSCI exam to have moved to an AIS C based on trace movements in one leg. Though the clinical significance of this change is unknown at this time, we remain cautiously optimistic that there may be a possibility for additional changes.”

These two SCI sufferers bring the total number to three patients who have reached AIS C motor incomplete classification with the Neuro-Spinal Scaffold implant under the INSPIRE experiment.

This is what the CEO and Chairman of InVivo, Mark Perrin, said in regards to the assessments:

“We are excited that these two patients have continued to progress beyond the period of early improvement. Three of the five patients with an AIS conversion in INSPIRE have demonstrated motor recovery and are now classified as AIS C conversions. Having assessments of motor improvements occurring one or two years post-implantation is uncommon and may be indicative of prolonged neural repair.”

About InVivo

Headquartered in Cambridge – MA, InVivo Therapeutics Holdings Corp is a research and clinical-stage biomaterials and biotechnology company primarily involved in the treatment of spinal cord injuries.

Established in 2005 the company has received the following awards for its outstanding and praiseworthy contribution to spinal cord injury treatment and research.

In 2011, the company won the David S. Apple Award from the “American Spinal Injury Association” for its outstanding contribution to spinal cord injury medicine.

In 2015, the company’s investigational Neuro-Spinal Scaffold received the 2015 Becker’s Healthcare Spine Device Award.

InVivo was founded with the proprietary technology co-invented by Robert Langer, Sc.D., Professor at Massachusetts Institute of Technology, and Joseph P. Vacanti, M.D., who at the time was at Boston Children’s Hospital and is now affiliated with Massachusetts General Hospital.

Neuro-Spinal Scaffold

What exactly is the Neuro-Spinal Scaffold implant and how is it done? Here’s how InVivo answers that question.

“Following acute spinal cord injury, surgical implantation of the biodegradable Neuro-Spinal Scaffold within the decompressed and debrided injury epicenter is intended to support appositional healing, thereby reducing post-traumatic cavity formation, sparing white matter, and allowing neural repair within and around the healed wound epicenter. The Neuro-Spinal Scaffold, an investigational device, has received a Humanitarian Use Device (HUD) designation and currently is being evaluated in The INSPIRE Study for the treatment of patients with acute, complete (AIS A), thoracic traumatic spinal cord injury and a pilot study for acute, complete (AIS A), cervical (C5-T1) traumatic spinal cord injury.”

ISNCSCI

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is an all-encompassing neurological test conducted to determine sensory and motor impairments in SCI patients. The ISNCSCI is published by the American Spinal Injury Association (ASIA) formed in 1973.

It is on the ISNCSCI findings that the American Spinal Injury Association Impairment Scale (AIS) grade classification is based.

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From The Editors Health

Obese or Not – Study Says Extra Weight Can Cause Death

A paper on the findings of a Study has been published in the New England Journal of Medicine which basically says that being overweight and not obese, does not lessen the risk of weight-related death – anyone carrying extra weight is at risk of dying from the additional burden.

40 % of the 4 million weight-related deaths in 2015 were not the result of clinical obesity – just being overweight did them in.

The Study has also revealed that over 2 billion people, including children, suffered from heart diseases, Type 2 diabetes, and even some types of cancer – all due to being overweight.

“People who shrug off weight gain do so at their own risk – risk of cardiovascular disease, diabetes, cancer and other life-threatening conditions,” said Dr. Christopher Murray, author of the study and director of the Institute for Health Metrics and Evaluation at the University of Washington.

“Those half-serious New Year’s resolutions to lose weight should become year-round commitments to lose weight and prevent future weight gain,” he added.

The protracted research of 35 years (1980 – 2015) took into consideration 195 countries and the conclusion is that 2.2 billion children and adults who make up 30% of the world’s population are victims of overweight.

Out of the 2.2 billion affected people, over 600 million adults and 108 million children have a body mass index (BMI) higher than the threshold of 30 which makes them clinically/medically obese.

By the way, BMI of an individual is calculated by dividing his/her weight (in kilograms) by his/her height squared (in centimeters). Anyone with a BMI of 30+ is considered clinically/medically obese.

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The Study observes that obesity has been steadily on the rise since 1980, having doubled in more than 70 of the 195 countries surveyed. What is alarming is that 13% of American children and adults are over the BMI threshold – simply put, they are obese.

Egypt, however, was at the top of the list at 35% in so far as adult obesity is concerned.

Last year, in an interview with Ruth Michaelson of the Guardian on the issue of obesity in Egypt, Dr. Randa Abou el Naga of the World Health Organization, held the lack of “vigorous physical exercise” responsible for the state of affairs.

What’s more worrying about the Study findings is that children are getting obese at a faster rate than adults with 15.3 million obese children in China and 14.4 million in India. The numbers make sense largely for two reasons:

a. China and India are the two most populated countries in the world, in that order. A higher number of obese children in the two countries with such large populations should be expected.

What is not right, though, are the number of obese children in the two countries and what steps the two governments and, indeed, the world should take to check the alarming rate with which it is happening.

b. Both countries have experienced tremendous growth and a surge in their respective economies in the last couple of decades. Prosperity has brought about “increased availability, accessibility, and affordability of energy-dense foods, along with intense marketing” which “could explain the weight gain in different populations,” says the Study.

The lowest on the obesity list of the Study are Bangladesh and Vietnam at a healthy 1% – at least, as far as obesity is concerned.

“Governments throughout the world caught like rabbits in car headlights, become petrified in the face of escalating obesity. Year after year, mega-statistics like these are published confirming that administrations appear powerless to avoid being crushed by them,” Tam Fry, chairman of the National Obesity Forum, has remarked.

Dr. Ashkan Afshin, lead author of the study and an assistant professor of Global Health at IHME observed that “Excess body weight is one of the most challenging public health problems of our time, affecting one in every three people.”

It is imperative that the world governments sit up and take notice, and intervene, and work on a war footing to counter the menace of obesity.

The authors stressed the need for intervention to reduce the pervasiveness of high BMI among populations in order to fight overweight and obesity and their consequences.

Dr. Alison Tedstone, chief nutritionist at Public Health England, said “Our work to tackle obesity in England is world leading and we want to see other countries following our example.

“We have set clear guidelines for the food industry to reduce sugar in the foods children eat the most of and will openly and transparently monitor and report on their progress.”

To give you an idea of the seriousness and enormity of the situation here’s an extract from the article, “Health Effects of Overweight and Obesity in 195 Countries over 25 Years,” published in the New England Journal of Medicine.

“The prevalence of overweight and obesity is increasing worldwide. Epidemiologic studies have identified high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) as a risk factor for an expanding set of chronic diseases, including cardiovascular disease, diabetes mellitus, chronic kidney disease, many cancers, and an array of musculoskeletal disorders. As the global health community works to develop treatments and prevention policies to address obesity, timely information about levels of high BMI and health effects at the population level is needed.”

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From The Editors Politics

‪‪Donald Trump‬, ‪Paul Ryan‬, ‪Jeanine Pirro‬‬ Health Care Bill Failure

Not long after Leader Donald Trump informed his Facebook fans Sunday night to see the display of Fox News sponsor Judge Pirro, the Trump and his sponsor friend required to the display to give a severe rebuke of Residence Presenter John Ryan.

“The cause? He neglected to give the ballots for his medical expenses. The one which he’d to work with. The one he concealed in the cellar of Congress under lock and key. The one who needed to be taken to avoid the humiliation of not having enough votes to move.”

“He does not attribute John Ryan,” Priebus stated. “In truth, he believed John Ryan worked very hard.

Ryan spokesperson Doug Andres told CNN.com that Trump discussed with Ryan on Saturday morning and “the Leader was obvious his Charlene Keys had nothing related to the loudspeaker. They can be equally keen to reunite to work with the program.”

That dialogue adopted an hour long call Sunday, in which loudspeaker and the President mentioned about the best way to progress on their plan aims that were common, Ryan spokeswoman Powerful mentioned.

“Their relationship is more powerful than ever before right today,” Powerful, informed CNN.com.

The workplace of Administration and Budget Overseer Mick Mulvaney also double-D down Saturday morning on NBC’s “Fulfill the Media,” stating, “Never once have I saw (Trump) attribute, John Ryan.”

Both behind-the-scenes, Trump’s heaviest and openly irritations look like aimed maybe not the traditional associates of the Residence Liberty Caucus, whom he invested the other day wanting to negotiate with, yet although at Ryan.

The White House had provided the Flexibility Caucus an eleventh-hour offer to repeal an Obamacare condition that insurance companies cover important health treatment advantages, like prescription medicines and clinic remains, to get them up to speed.

But associates of the team claimed that that might do enough to lessen rates. A lot more was needed by the Independence Caucus, for example, fighting Obamacare conditions that were well-known, including allowing kids to remain on their parents’ insurance till they’re 26 and requiring insurance companies to cover pre-existing illnesses, both that Trump had promised through the strategy which he might contact.

As the discussions progressed, the White Residence became conscious of the schisms inside the GOP positions, which light emitting diode Residence Presenter David Boehner, Ryan’s forerunner, to step down and festered for years.

Nevertheless, the White House believed points might be different today, having a real chance to present on a seven as well as a Republican Leader office campaign guarantee.

“We under-estimated the acrimony in the caucus” a senior White House established informed CNN including that they’d mistakenly presumed the Independence Caucus might behave otherwise than it had before offered Trump’s recognition in people’ areas.

“It was not about the plan,” the state mentioned. “It did not issue what coverage we created because they did not need an offer. We were prisoners within a Residence caucus combat that are an interior. The Flexibility Caucus also had much curiosity in eliminating this to deliver an email to Loudspeaker Ryan: ‘you’ve got an excessive amount of power.'”

For the present time, Trump’s connection and Ryan seems complete, which is crucial to ensuring the Residence, handed tax-reform, another legal airlift.

But on how points are heading one inform may be how significantly the White House outsources Slope the next time around and the legal procedure to Ryan.

Source: http://edition.cnn.com/2017/03/26/politics/ryan-trump-relationship-health-care/

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From The Editors Top 5

Top 5 Tummy Tightening Foods

A toned, flat tummy is a goal many of us. You can drop belly fat with a well-planned diet which is the key to losing weight and tightening up, particularly in your tummy. Here are a few Tummy Tightening Foods to help get you on the right track;

1. GrapeFruit

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Grapefruit helps lower insulin levels, which promotes weight loss and a fast metabolism.

2. Almonds

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Almonds are an excellent source of protein and help keep you full and your metabolism kicking.

3. Green Tea

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Natural caffeine can help speed up your metabolism and keep you energized to burn more calories throughout the day. Plus green tea contains antioxidants to help you rid your body of toxins.

4. Greek Yogurt

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Filled with Probiotics, Non-fat Greek yogurt is a great snack to set you on the path to a flat belly. It will keep you full until your next meal. if you chose the right flavor, might help out with the sweet tooth.

5. Cranberries

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You might think Cranberries against the weapon against urinary tract infections, and that is definitely true. They also serve important purposes in our body. These little berries are high in manganese, which plays a large part in your metabolism.

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From The Editors Health

Here’s What Smokers Should Eat

Smoking

Tobacco smoking dates back to between 3000 and 5000 BC which spread to Europe and Asia in the 17th century through trade routes of the time. Initially restricted to certain segments of a number of societies it became pervasive, to a large extent, with the automation of the cigarette rolling process.

It was German scientists, in the 1920s, who first established that cancer was related to smoking. The findings heralded the first anti-smoking campaign known in modern times, to be cut short with the fall of Nazi Germany at the end of the Second World War.

A clear connection between cancer and smoking was demonstrated by British scientists in the 1950s and, ever since, evidence to that effect has been growing.

A high percentage of smokers get hooked at an early age because of imagined pleasures of smoking and to be in with the rest. As time passes, the motivation to continue emanates from the fear or avoidance of withdrawal symptoms.

A study has revealed that young smokers are mostly victims of advertising campaigns that glorify cigarette smoking. The habit can also be picked up from parents, siblings, and friends.

Passive Smoking

The unintentional consumption of tobacco smoke is called passive smoking and can be of two types, second-hand smoke (SHS) and environmental tobacco smoke (ETS), also called third-hand smoke. Second-hand involuntary consumption takes place when the tobacco is still burning while ETS is the result of smoke left in the air even after the cigarette has been put out.

Reasons for smoking

The most commonly heard reasons for puffing away are:

* Addiction to tobacco smoke. Abstinence will induce withdrawal symptoms and mild cold turkey

* Pleasure derived from tobacco smoke

* Relaxation – cigarette is considered by most smokers as a stress buster.

* Social smoking which may or may not involves inhaling smoke into the lungs.

* Stimulation

* Habit

* Smoking exclusively for losing and maintaining body weight

While the reasons are not gender-specific, it may differ in certain cases in that women can be more inclined toward social smoking and smoking for the release of tension.

Smoking and health

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One of the major public health concerns, smoking is decidedly harmful to the extent of being the primary cause of preventable mortality. Diseases that can result from smoking are:

* Chronic obstructive pulmonary disease (COPD)
* Heart attacks
* Strokes
* Emphysema
* Cancers of the lungs, larynx, mouth, esophagus, pancreas, and bladder

While quitting is the best suggestion anyone can give, it is not always easy, and then, there are those who just don’t want to give up the so-called pleasures of smoking. Well, if you can’t give the butt a kick in the butt, the best you can do is adopt eating habits that can somewhat slow down the harmful effects of tobacco smoke on the body.

Recommended foods for smokers

1. Flavonoid-rich foods

Certain flavonoid compounds like Epicatechin, Catechin, Quercetin and Kaempferol help prevent lung cancer in tobacco smokers according to a research published in the journal Cancer.

Flavonoids are plant pigments that have antioxidant and anti-inflammatory properties and may have the potential to protect lung cancer by checking the growth of cancer cells, not letting tumors to develop blood vessels that feed them, and fighting DNA damaging effects that result from smoking.

Foods that contain flavonoid compounds can be found in:

* Green tea, black tea, blackberries, raspberries, cherries, cocoa, and strawberries contain Catechin.

* Apples, peppers, red wine, blueberries, bilberries, blackberries, beans, broccoli, cabbage, sprouts, tomatoes, spinach, kale, onions and citrus fruits are good sources of Quercetin

* Apples, grapes, tomatoes, green tea, potatoes, onions, broccoli, Brussels sprouts, squash, cucumbers, lettuce, green beans, peaches, blackberries, raspberries, and spinach have Kaempferol.

2. Foods containing Phytoestrogens

A study published in the Journal of the American Medical Association shows that Phytoestrogens can lower the risk of lung cancer in smokers as well as non-smokers.

There are three basic types of Phytoestrogens (Isoflavones, Coumesterol, and Lignans) found in foods that should be consumed regularly by smokers to reduce smoking-related vulnerability to lung cancer.

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* Chickpeas, soybeans (unprocessed), peanuts, red clover, alfalfa, fava, beans, and kudzu contain good amounts of Isoflavones.

* Fatty meat and meat products such as sausages, butter, full-fat cheese, milk, cream and yogurt, butter, hard margarine, coconut and palm oils and coconut cream, bean, peas, clover, spinach, and sprouts are good sources of Coumesterol

* Flax seeds are the best source of Lignans. Other good sources include foods such as whole grains, sesame seeds, sunflower seeds, cashews, kale, broccoli, berries, rye grains, linseeds, carrots, spinach, and other vegetables.

3. Beta-cryptoxanthin rich foods

Beta-cryptoxanthin rich foods have been known to minimize the risk of lung cancer and can be found in:

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* Red bell pepper – without salt, cooked, boiled and drained

* Pumpkin – without salt, cooked, boiled and drained

* Papaya – raw

* Tangerines – canned with light syrup

4. Vitamin-enriched foods

* Papaya, cantaloupe and collard greens may reduce the risk of emphysema in smokers.

5. Foods rich in Zinc

Zinc plays an important role in preventing and reversing respiratory ailments such as colds which smokers are highly vulnerable to. Food sources are:

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* Beef, by far, is the best source of high levels of zinc

* Shrimp, kidney beans, oysters, pumpkin seeds, flax seeds, and watermelon seeds are other good sources of the mineral.

6. Nutritional Supplements

* Vitamin C supplements – Smoking causes depletion of antioxidant Vitamin C to an extent which cannot be replaced by foods alone and, therefore, supplements are highly recommended for smokers and ex-smokers.

* Multivitamin and Multimineral supplements – Alongside high potency Vitamin C, multivitamin and multimineral supplements should be taken to reduce smoking-related risks.

7. Physical Activity

Physical activity helps in minimizing smoking-related risks and can even help smokers quit. Here are some benefits of quitting that may motivate smokers to exercise and kick the ‘butt.’

* 20 minutes after quitting, the heart rate drops.

* 12 hours after quitting, carbon monoxide levels in the blood drops to normal.

* 2 weeks to 3 months after quitting, lung function begins to improve.

* 1 to 9 months after quitting, coughing and shortness of breath decrease.

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From The Editors Health

Are Doctors Responsible For Opioid Dependency by Over-Prescribing It?

Opioid prescribing, opioid dependence and opioid overdose deaths have been in the ascendancy and have increased four times in the United States in the last three decades. Medicare insured senior citizens are the most affected by this opioid over indulgence which is taking epidemic proportions.

The elderly are more susceptible to the risks involved not only in the protracted use of opioids and opioid overdose but also when low-intensity opioids are administered over shorter periods of time. This is because of their vulnerability to the sleep-inducing side effects of the drug. Most of the Medicare seniors have a history of falls, fractures and broken bones and, not to forget, the potentially fatal, opioid dependence and addiction.

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Dr. Michael L. Barnett (Assistant Professor, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health) and his team have conducted a study based on exactly those concerns.

Growing overuse and the resultant addiction or dependency and whether it could be partly because of trigger-happy physicians who prescribed the addictive drug a little more frequently than others, were the areas the research team, led by Dr. Barnett, intended to probe.

Furthermore, among the opioid prescribers, there are those physicians who prescribe low-intensity opioids and others who write out high-intensity opioid prescriptions and the study proposed to look at this angle as well.

The methodology of the research team involved identifying Medicare claims recipients, mostly sixty-five and above, who had visited the emergency department of the same hospital and had not been prescribed any opioids in the last six months before the visit. The purpose behind the six-month-condition was to check the resulting effects of exposure on opiate-free patients.

The next step included identifying prescribers of low and high-intensity opioid in each of the hospitals surveyed. Subsequently, patients treated under these two categories of prescribers were examined in order to determine rates of prolonged use and subsequent hospitalizations.

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The research was conducted on 215,678 patients treated by prescribers of low-intensity opioids and 161,951 patients treated by high-intensity opioid prescribers during an emergency department visit and the outcome was worse than what was being expected.

The findings revealed that, in a given hospital, the rate of low-intensity opioid prescribers was 7.3% in comparison to 24.1% high-intensity prescribers in the emergency department of that hospital – a variation too wide for anybody’s comfort.

The results also showed that prolonged opioid use was higher among patients treated by higher-power-opioid prescribers than those treated by prescribers of low-intensity opioids.

“The whole medical community has a responsibility for this,” says Dr. Barnett.

“I think it’s a warning shot to doctors about understanding the risks of these medications and communicating them much more clearly — both to each other during training, as well as the patients,” he said.

Source: The New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NEJMsa1610524#t=abstract

How do opioids differ from opiates?

Drugs manufactured with opium from the poppy plant are called opiates like morphine, codeine, and thebaine.

The term opioid, on the other hand, was previously used only to describe drugs that were synthetically made to mimic the effects of opiates; however, nowadays, the term is used broadly to include all opiates, semi-synthetic opioids like heroin, hydrocodone, hydromorphone, oxycodone, and oxymorphone, and synthetic opioids that induce the effects of opiates but are not its derivatives such as methadone and fentanyl.

Medical uses of opioids

In addition to being used for pain relief and anesthesia, opioids are also used for:

* Relief from a cough and diarrhea
* Addiction treatment
* Reversal of opioid overdose
* Suppression of opioid-induced constipation

Side effects of opioids

While opioids are known to be safe when used correctly, older adults are vulnerable to side-effects like constipation, nausea and vomiting, urinary retention, sedation and falls, dependency, and addiction.

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From The Editors Health

The Hard Facts of Spinal Cord Injury (SCI)

Spinal cord injury (SCI), as the name suggests, is an injury to the spinal cord which can be traumatic or non-traumatic. Most cases are the result of physical trauma or injury to the spinal cord while non-traumatic SCI can be toxic or result from lack of blood flow, a condition known as ischemia in medical terminology. Compression of the cord from tumors and infection can also cause non-traumatic spinal cord injury.

Spinal cord injury can be complete where there is minimal or no sensation and muscle function below the injury level or incomplete with partial sensation as some nervous signals from the brain can pass through the injured part of the spinal cord.

The location or level of injury is the basis on which prognosis is possible, which can be anything from total recovery – a remote possibility – to partial or total loss of sensory and motor functionality of the torso and all four limbs medically known as tetraplegia or quadriplegia. However, in quadriplegia the arms are spared – only the legs and torso are affected.

Now, having got a general idea of spinal cord injury let’s take this a step at a time to give it some chronology.

Spinal Cord – The spinal cord is a tubular shaped, long, thin and compact bundle of nerves and cells starting at the base of the brain called the medulla oblongata and extending down the vertebral column – the backbone or spine, as we know it. It does not, however, span the entire length of the vertebral column but ends at the lumbar region of the spine. The length of the cord varies according to sex, 18 inches (45 cm) long in adult males and 17 inches (43 cm) in women.

The spinal cord runs down the protective cavity of the comparatively longer vertebral column which is made up of thirty-three segmented bones called vertebrae. While the lower nine are fused together the upper twenty-four are separated by intervertebral discs that allow marginal movement of the vertebrae.

The spinal cord combined with the brain forms the central nervous system of the body. It is the lifeline that allows sensory and nervous information from the command center of the nervous system – the brain – to travel through it to the peripheral nervous system enabling normal bodily functions.

The peripheral nervous system is a network of nerves coming out from either side of the spinal cord and spreading through the entire body to carry commands from and to the brain through the main line, the spinal cord.

The peripheral nervous system together with the central nervous system allows the brain to control our bodily functions which can be classified into three categories:

Motor Function – allows the voluntary movement of the body muscles like the movement of limbs, walking, running, talking, use of hands etc.

Sensory Function – This function controls the sense of feeling – like touch, pressure, pain and temperature.

Autonomic Functions – are those functions that do not require conscious intervention in that they are the involuntary 24/7 functions of the body like digestion, respiration, heartbeat, urination, body temperature, blood pressure, etc. that are going on even while we are asleep.

Injury to the spinal cord can wholly or partially affect either or all of these three functions.

Spinal Cord Injury – Spinal cord injury can be broadly classified into three main categories: mechanical, toxic and ischemic as discussed depending on whether the SCI is traumatic or non-traumatic.

Mechanical SCI – is a traumatic spinal cord injury as a result of physical trauma to the spinal cord from a car crash, sports accident, gunshot, a fall, or any other accidental damage to the spine.

Toxic and Ischemic SCI – are non-traumatic and result from damage to the spinal cord from toxins or lack of proper blood flow respectively.

Levels of Spinal Cord Injury – As mentioned earlier, the purpose of the vertebral column comprising 33 vertebrae is to provide protection to the spinal cord. The spinal cord is housed within a cavity in the vertebral column known as the spinal canal.

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Now, the 33 vertebrae in the vertebral column are divided into five sections in relation to the curves in the column. The first seven vertebrae, starting at the top, are in the cervical curve and are called cervical vertebrae (C1 – C5); the next twelve are called thoracic vertebrae (T1 – T12) as they are in the thoracic curve region; The lumbar curve has five lumbar vertebrae (L1 – L5).

The last nine vertebrae which are fused together are divided into two sections; the upper five are the sacrum vertebrae (S1 – S5) and the lower four are the coccygeal vertebrae (tailbone) and together they form the sacral curve of the spine. The last four are not assigned numbers, though.

As nerves branch out from the spinal cord to different parts of the body through gaps in the vertebrae, the higher the level of injury in the vertebral column the more severe is the resultant damage. The following table will give us a better understanding of the different levels of injury and their severity.

C1 – C4 – High Cervical Nerves

* Damage to the spinal cord at this level is the most severe and can cause paralysis in the arms, hands, legs and torso.

* Unaided breathing may not be possible and the patient is likely to lose bladder and bowel control.

* Impaired or reduced speech is another possibility with spinal cord injury at this level.

* Renders the patient incapable of daily activities like eating, bathing, dressing and getting in and out of bed and requires a dedicated caregiver 24/7.

C5 – C8 – Low Cervical Nerves

Nerves at this level control the arms and hands and the severity of the damage depends on which particular vertebrae level the nerves have been damaged.

C5 level injury

* The patient is able to raise the arms and bend the elbows with the likelihood of total or partial paralysis of the wrists, hands, torso and legs.

* Speech and use of diaphragm will remain unaffected; however, respiration will get affected resulting in breathing issues.

* Will need assistance with most day to day living activities but will be able to move unaided in a powered wheelchair.

C6 level injury

* Paralysis in hands, legs, and torso with affected wrist extension. However, the patient should be able to bend the wrists backward.

* Speech and use of diaphragm will remain unaffected; however, respiration will get affected resulting in breathing issues.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* Assistive equipment will be needed for moving in and out of bed and wheelchair and may also be able to drive a customized vehicle specific to the limitations of the patient.

C7 level injury

* At this level, nerves control elbow extension and some finger extension are likely, as well.

* Straightening of arms and normal shoulder movement is possible with most C7 level spinal cord injury.

* Most day-to-day activities are possible independently but assistance with more difficult tasks will be necessary.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* Assistive equipment will be needed for moving in and out of bed and wheelchair and may also be able to drive a customized vehicle specific to the limitations of the patient.
C8 level injury

* Nerves will control limited hand movement and patient should be able to hold and release objects.

* Most day-to-day activities are possible independently but assistance with more difficult tasks will be necessary.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* May also be able to drive a customized vehicle specific to the limitations of the patient.

Thoracic level injuries (mid-back region)

T1 – T5 level injury

* Injury at this level generally affects the torso and legs as the corresponding nerves affect the muscles, upper chest, abdominal muscles, and mid-back. The condition is called paraplegia and the sufferer is referred to as paraplegic.

* Use of manual wheelchair possible.

* May also be able to drive a customized vehicle specific to the limitations of the patient.

* Most can stand with the help of a standing frame while others may be able to walk using braces.

T6 – T12 level injury

* Abdominal and back muscles are likely to be affected depending on which particular T level the injury is at with resultant paraplegia being a distinct possibility.

* Normal upper body movement with relatively good torso control and balance when seated.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* Use of manual wheelchair possible.

* May also be able to drive a customized vehicle specific to the limitations of the patient.

* Most can stand with the help of a standing frame while others may be able to walk using braces

Lumbar level injuries (L1 – L5)

* Injury at this level results in some loss of functionality of the hips and legs.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* May be able to walk with braces.

Sacral level injuries (S1 – S4)

* Injury at this level results in some loss of functionality of the hips and legs.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* High likelihood of being able to walk

Steps followed for diagnosis of spinal cord injury

* The attending doctor will collect as much information as possible with the emphasis on the medical history of the patient, the circumstances and time of the injury. The amount of time elapsed since the injury is important to know as a spinal cord injury is a medical emergency that requires immediate attention to limit the damage and enhance the chances of recovery.

* Details of previous injuries or surgeries to the head, neck or spine will be asked for.

* Pain in the back or neck areas, weakness in the limbs, loss of bladder or bowel control, loss of sensation in the limbs, details of other previous medical conditions suffered by the patient will have to be provided to the physician.

* The diagnostic procedure will include a thorough physical examination to check and gauge sensation to touch, muscle strength and reflexes in the limbs.

* The next logical step in the diagnosis is x-rays of the neck or back or both to identify the level and nature of the injury such as vertebrae fracture.

It must be noted that fracture or dislocation of the vertebrae may occur in traumatic SCI but if the spinal cord injury is the result of non-traumatic causes, ischemic or toxic, the x-rays will not show any crack or dislocation of the vertebrae. However, x-rays can help identify the presence of these non-traumatic causes, as well, such as a tumor or infection or even chronic and severe arthritis which can cause SCI.

The more advanced and sophisticated computer tomography, popularly known as CT scan, is a better alternative to x-rays in that it provides a better and enhanced view of the vertebrae to the doctor and has the ability to show injuries that are not visible on regular x-rays.

The magnetic resonance imaging or MRI scan is an even better option than the previous two because of its ability to evaluate soft tissue like nerves, ligaments, intervertebral discs and the spinal cord itself.

Treatment of spinal cord injury

* The first step involves checking if the patient is able to breathe and whether the heart is beating and accordingly the physician decides whether a breathing tube and ventilator are needed or not.

* Immobilization is the next step in treating SCI. This should be done at the paramedic level before the patient is transferred to the hospital. The idea is to ensure minimal or no movement, if possible, to avoid chances of further aggravating the injury. For this purpose, the patient may be put in a cervical collar or on a backboard.

* Once the diagnosis is complete and if spinal cord injury is detected the patient might be put on high potency steroids to reduce inflammation which can further damage the spinal cord. As steroids have a risk factor attached to their use in spinal cord injury patients the final decision lies with the physician. Steroids can make some difference only if administered within eight hours of the trauma.

* The patient is then placed in traction or a halo-like device around the head in order to provide stability to the spine and prevent further injury.

* Some cases may require surgery for two main purposes, basically. The first and foremost goal of surgery in SCI is to remove the presence of any pressure on the spinal cord. For example, broken vertebrae may be pressing against the spinal cord and need to be removed.

The second and main purpose of surgery is stabilizing the vertebral column itself if weakened by broken vertebrae or by disease. It is the major goal because stability and strength in the vertebral column are integral to the health of the spinal cord. Screws, plates, and rods may be necessary to repair the damage to the vertebral column.

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After the first up treatment, which is basically to save the life of the patient or minimize further damage to the spinal cord, the patient needs to go through a long drawn rehabilitation program to help the patient enhance bodily functions through various therapies and assistive devices.

Cure

There is no known or definite cure for spinal cord injuries, yet. However, constant work is going on in this regard by dedicated and devoted physicians and medical scientists whose research include treatment through stem cell implants, engineered materials for tissue support which involves the potential use of silk-fiber matrix material for tissue engineering anterior cruciate ligaments (ACL), and robotic exoskeletons which can be worn by an SCI patient for a better quality of life.

A lot of advancement has been witnessed in the treatment of spinal cord injuries over the years and considering the kind of work being put in by researchers and scientists towards finding a cure for SCI, it’s a distinct possibility that we may soon have a cure for this debilitating affliction.

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From The Editors Health

Life in a Wheelchair – Truths & Myths

There are certain myths about wheelchair users that have been around for some time now. They emanate from ignorance which in turn is the outcome of the absence of interaction with someone who has mobility issues and is wheelchair bound. This leads to myths about and negative approach towards wheelchair users that they have to contend with on a daily basis

Here are a few of the myths about wheelchair users that have been doing the rounds for a long time now and need to be communicated, not that this is the first ever attempt towards creating awareness:

Users are bound to their wheelchairs

The term “wheelchair bound” has been taken literally by some people who are of the view that wheelchair users are bound or strapped to their mobile chairs. It’s the equivalent of saying that someone riding a cycle is bound to it. A wheelchair is just a specialized mode of transport for a person lacking mobility in the lower body meant to take him or her from one point to another.

Companies employ wheelchair users out of sympathy

The Americans with Disabilities Act of 1990 is meant to protect Americans with disabilities against discrimination. The Act does not bind employers, in any way, to hire disable people even if they do not meet the job requirements. So, the supposition by able people that the disabled on wheelchairs are hired out of sympathy or legal binding is really a myth and nothing more.

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Wheelchair users enjoy job immunity and can’t get fired 

This again is a misconception that needs a nip in the bud. Employers certainly have the freedom to fire a disabled employee provided they meet the following conditions attached to such terminations:

* The employee fails to meet the valid job requirements
* The reason for termination of service is not related to the employee’s disability
* The disability is a direct threat to safety or health at the place of work.

Wheelchair users are not dependable

On the contrary, most wheelchair users are known for their punctuality, excellent attendance record, and diligence at the workplace. Don’t forget; they have a point to prove that they are in no way inferior to an able bodied employee, in spite of their disabilities.

People in wheelchairs need help and assistance all the time

We often get to see strangers in public places going overboard in their attempt to help wheelchair users. This stems from the assumption that wheelchair users are always seeking help which is totally untrue. Most wheelchair users are quite adept at their day to day activities and could well do without our sympathy or help. However, if someone is visibly struggling, offering assistance in such a scenario would be the polite thing to do.

Disabled people on wheelchairs prefer the company of people like them and live differently from others

This is an entirely warped conception that is fuelled early at public schools where children with disabilities are segregated from normal students. This gives rise to the misconception, very early in life, that disabled people are different and do not like to mix with able-bodied people.

People with disabilities are no different than able-bodied people in that they lead the same lives as most of us do. They too go to school, grow up, get jobs, have a family of their own, laugh, cry, joke, and most importantly pay their taxes among other things that are part of anybody’s life whether disabled or able-bodied.

Disabled people are victims of depression and are always sad

Depression is something that anyone can fall victim to, able-bodied or disabled. A disabled person can be sad or depressed like, any other individual, which may not necessarily be related to the person’s disability.

Wheelchair users lack decision-making abilities

This is a weird assumption considering the fact that there are numerous examples of successful wheelchair users all over the world who are excellent decision makers and excel in what they do in their individual capacities.

Wheelchair users cannot have sexual relationships

This is another ridiculous myth that people have about disabled people on wheelchairs. Don’t forget that nature has blessed us with adaptability and sex is not the domain of able-bodied people only.

Wheelchair users are often asked some of the most shocking questions and often hear and experience things that are pretty much absurd and twisted. Almost daily they get to hear some of the most appalling comments about themselves. It is generally offensive, but many have been exposed to such comments and behavior for so long that they have learned to laugh at them.

Some of the most awkward and outrageous questions wheelchair users are asked are:

“How do you have sex?”

Well, it’s none of the anybody’s goddamned business! Ridiculous! It’s the most personal and inexcusable question one can ask of another person and, trust me, nobody walks up to an able-bodied person and asks him or her “How do you have sex?” unless the person is looking for a black eye.

“Are you Lonely?”

This question is not only preposterous but rude as well. It is pregnant with the implication that wheelchair users are not capable of having relationships. Let me tell you nothing can be farther from the truth because wheelchair users are as much human as anybody else. Happiness, family life, marital bliss, children are not the birthrights of able-bodied people only.

“Is your partner disabled too?”

This is another presumption that some people make when they ask the question. It’s as if they know the answer will be a certain “Yes.” Relationships and mutual attraction are matters of the heart and don’t really matter whether an able-bodied person is attracted to or in a relationship with a wheelchair user or vice versa.

“Have you ever had a flat tire?”

Now, this sounds like a smart Alec question but can be an innocent query, as well, because some wheelchairs have air filled tires too.

“Hope you get out of that thing soon.”

This comment to a wheelchair user whose disability is permanent sounds inappropriate and rude. Unless one is sure that the wheelchair is a temporary requirement one must refrain from making such a comment.

Having discussed the myths and the outlandish questions and comments wheelchair users are subjected to, let’s now talk about some absolute realities in a wheelchair user’s life.

Difficult days

Most wheelchair users are bound to have their difficult days when they are prone to bouts of depression and disbelief that their lives have been restricted to a wheelchair. However, it’s but natural for this to happen and one has to be strong in these moments which will eventually pass. And please remember that able-bodied people are also susceptible to depression. After all, disabled or able-bodied, we are equal humans.

Damage to wheelchair when flying

This is another universal truth that wheelchair users who travel frequently have to live with. Luggage handlers at airports are known for their inconsiderate handling of luggage including wheelchairs which is just another piece of luggage for them.

Wheelchairs are not inexpensive and may cost a minimum of US$ 5000. It is, therefore, imperative that one ensures proper packing of the wheelchair with the “Fragile – Handle with care” marking on it. Although it’s not a guarantee against damage, it minimizes the likelihood.

Comfortable seating

When you are sitting all day, you are exerting pressure on your seat and back which can lead to aching muscles and stiffness. Proper seating is of utmost importance, and it is recommended that a wheelchair user gets a customized seat available at most rehab centers.

Murphy’s Law

While it may sound ridiculous, wheelchairs are bound to break and get damaged when the user needs it the most, like on the weekend or a holiday. If it’s not Murphy’s Law, what is it?

Joints and muscles

As wheelchair users depend on their upper body for most functions, there is a tendency to overuse their shoulders, neck, elbows and wrists which can be painful and render them incapable of doing much. Massage, hot packs or a hot soak-up in the tub can alleviate the pain to a great extent.

To avoid muscle stiffness, which is the result of long hours of inactivity, stretching is highly recommended even if it requires seeking help from a caregiver or a family member.

There are numerous myths surrounding disability and wheelchair users that are blatant untruths or misrepresented facts. We should learn to treat people in wheelchairs no differently than other people. We ought to treat them with the same courtesy and respect that we would accord to an able bodied person.