Yo Yo Ma plays Ennio Morricone

Mitral Regurgitation (MR)

Mitral regurgitation refers to the leakage of mitral valve, which is a heart valve that controls blood flow between left atrium and left ventricle (see picture).




The main causes of mitral regurgitation (MR) are mitral valve prolapse and rheumatic heart disease. Dilated heart chambers resulting from heart attacks also cause MR.

In principle, corrective surgery should be performed before left ventricular (LV) chamber becomes dysfunctional and fails. Patients usually do not recover well after surgery if the contractile power of left chamber (LVEF) is < 40 percent before surgery. Therefore, doctors may recommend periodical echocardiography to assess left ventricular chamber and determine the need and timing of surgery.

If surgery is not indicated, many patients may benefits from several heart medications, especially hydralazine.

MR is often associated with atrial fibrillation, an irregularly irregular hear rhythm, which can result in formation of blood clots. Doctors may recommend conversion to normal heart rhythm or blood thinners to prevent risk of stroke.

According to 2007 guidelines by American Heart Association, patients with MR may not need antibiotic prophylaxis before dental or surgical procedures. However, those patients with artificial mitral valve still need antibiotic prophylaxis.

Spring by Vivaldi

Mitral Valve Prolapse Syndrome

Mitral valve prolapse syndrome (MVPS) refers to a group of symptoms:

• Palpitations



• Anxiety



• Hyperventilation, i.e. rapid breathing



• Chest pain



• Easy fatigue



• Numbness



• Dizziness
  

It is interesting to know that these symptoms may occur both in patients with MVP and in those without it.

To alleviate these symptoms, you should:

• avoid stimulants such as caffeine, alcohol



• avoid fatigue



• reduce stress



• do aerobic exercise 3 times a week for 12 weeks

It is important that you change your lifestyle little by little and consistenly. Give yourself several weeks. Get positive feedbacks and encouragement from spouses, friends, or support groups.

Taking appropriate supplements or medications can help. MVP patients with low serum magnesium may benefit from taking magnesium supplements for 5 weeks. Those with anxiety, panic attack, or depression should consult their physicians for appropriate treatments.

The Storm by Yanni & Multinational Musicians

Mitral Valve Prolapse (MVP)

An old classmate was recently inflicted with cardiovascular conditions. Valentine's Day is also coming up. So, I've decided to post updated information about some common heart diseases.


Mitral valve prolapse (MVP) refers to an abnormal anatomy of one of heart valves: the mitral valve. In MVP, one or both mitral valve leaflets billow into the left atrium of the heart.

Prevalence of MVP is 2.4 percent in both men and women, and is evenly distributed among age groups[N Engl J Med 1999 Jul 1;341(1):1-7].

Although MVP is usually benign, it can cause more serious problems such as mitral regurgitation, infective endocarditis, and arrhythmias. Mitral regurgitation (MR) requires more medical attention.

It's always a good idea to see a doctor to make sure mitral valve prolapse does not evolve into mitral regurgitation.

Chuc Mung Nam Moi

Old Drug, New Trick

Sometimes old drug, like the case of aspirin, may be rejuvenated to help prevent another illness. Steven Shoelson, a Harvard researcher, postulates that inflammation contributes to the formation of diabetes mellitus. He also found in the basement of Harvard library a German medical article, published in 1876, that suggested salsalate, a medication similar to aspirin, might improve diabetics' ability to control blood sugar. He has since then worked with his colleagues on several studies that showed promising therapeutic effect of salsalate on diabetes mellitus. Now the National Institutes of Health is funding an ongoing large study to validate earlier results.



If Steven Shoelson is right, then diabetics would have a cheap ammunition to fight this costly disease.

Bach's Suite No.1 by Yo Yo Ma

Cigarettes & Your Health

There are still about 1.3 billion people smoking cigarette worldwide. Cigarette smoking is known to increase risks of chronic obstructive lung disease (COPD), lung cancer, and heart attack.

It is interesting that many smokers do not believe smoking is harmful. A study by the Department of Medicine, Harvard Medical School discovered even those who smoked more than 40 cigarettes a day did not believe that cigarettes increased risk for heart attack and cancer. Non-believers tend to be older (65 year or older), less educated (not a high school graduate), and smoking lighter (less than 20 cigarettes a day).

Adagio by Secret Garden

Drugs and Liver

Drug-induced liver injury (DILI) is a common liver disease. DILI is the cause of acute jaundice, which is yellow discoloration of eyes or skin, in up to 50 percent of patients. DILI accounts for up to 30 percent of acute hepatitis. Even in the U.S., where the use and distribution of prescription drugs are highly regulated, DILI is still the most common cause of acute liver failure. It is perceivable that the incidence of DILI may be much higher in countries where drugs can be purchased from pharmacies without doctors' approval.

Chinese herbal remedies are widely used in many countries. Many herbs have beneficial effects. However, DILI has been reported with at least 10 herbal species. Jin Bu Huan and Sy0-saiko-to are the most notorious products. It is ironic that Syo-saiko-to is used to supposedly treat hepatitis C virus infection; but there have been reports of DILI associated with this product [Dig Dis Sci 1995 Aug;40(8):1845-8].

Liver damage seen in a 24 year-old woman who took Jin Bu Huan for 2 months

The main treatment of DILI is withdrawal of offending drugs.

Only two specific therapies are proven beneficial in treating two specific DILI. These two therapies are:

1. N-acetylcysteine for acetaminophen toxicity
   
2. L-carnitine for valproic acide toxicity

Aqua by Kitaro

Alcohol & Hepatitis C

Chronic hepatitis C and alcohol are the two common causes of liver diseases worldwide. There is good evidence that they work together to speed up the progression of chronic liver disease. It is reported that the prevalence of hepatitis C is higher in alcoholics than in general population. The reason for this higher prevalence is not completely understood.

Several studies have observed that heavy alcohol use in patients with hepatitis C:

• decreases the efficacy of treatment of hepatitis C


• increases the risk of hepatocellular carcinoma, i.e. liver cancer


• increases the rate of deaths

Microscopic picture of a liver infected by hepatitis C viruses

A safe amount of alcohol consumption in patients with hepatitis C is not known. Therefore, those who are inflicted with hepatitis C should completely abstain from alcohol.

Nocturne by Secret Garden

Colon Cancer & Diet

At this time, it is still unclear whether high-fiber diet reduces rate of colon cancer. Some observational studies found a reduced risk; however, two recent randomized studies did not find any reduction in colon cancer [N Engl J Med 2000 Apr 20;342(16):1149-55]. A systemic review of five studies involving 4349 patients did not find definitive evidence of reduction either [Cochrane Database Syst Rev 2002;(2):CD003430].

Contrary to a common hypothesis that antioxidant vitamins (vitamins A,C,E) can prevent cancer, randomized controlled trials have shown that these vitamins do not reduce the risk of colon cancer [N Engl Med 1994 Apr 14;330(15):1029-35]. High-dose of vitamin E (>400IU/day) may actually cause harm.

Calcium may protect the epithelium, i.e. inner lining, of colon. Calcium, taken at high dose of 1000mg or more a day, may reduce risk of colon cancer [Cancer Epidemiol Biomarkers Prev. 1998 Feb;7(2):163-8]. It appears that calcium should be taken for a long time to reduce the risk.

In short, calcium of high dose is better than fiber and antioxidant vitamins in reducing the risk of colon cancer.

Sogno by Andrea Bocelli

Aspirin and Colorectal Cancer

Increasing incidence of colorectal cancer with advancing age

"Does low-dose aspirin I am taking to prevent heart attack also helps prevent colon cancer?" you may ask.

Well, many clinical trials and meta-analysis studies were conducted to evaluate risks and benefits of aspirin in prevention of colorectal cancer. Several studies concluded that aspirin was associated with a 20-40 percent reduction in the risk of colorectal cancer in people who had average risks. However, this benefit was observed only in patients who consistently took high dose of aspirin for 10 to 14 years. Taking high dose of aspirin is associated with adverse effects such as gastritis, duodenitis, gastroduodenal ulcers, bleeding, hepatitis, renal failure.

There is evidence that low-dose aspirin, 81-162mg, which is used in prevention of coronary heart disease, is not associated with a reduction in the risk of colon cancer.

For people with high risk of cancer such as those with familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer or personal history of colon cancer, more studies are needed to elucidate the net benefits and risks of aspirin use.

At this time, the United States Preventive Services Task Force does not recommend use of aspirin for prevention of colorectal cancer because risks outweigh benefits.

Evening Falls by Enya

When the evening falls, and the daylight is fading

From within me calls; could it be I am sleeping?

For a moment I stray, then it holds me completely

Close to home, I cannot say

Close to home, feeling so far away

As I walk the road, there before me a shadow

From another world, where no other can follow

Carry me to my own, to where I can cross over

Close to home, I cannot say

Close to home, feeling so far away

Forever searching, never right

I am lost in oceans of night

Forever hoping I can find memories

Those memories I left behind

Even though I leave, will I go on believing

That this time is real; am I lost in this feeling?

Like a child passing through, never knowing the reason

I am home; I know the way

I am home, feeling, oh, so far away.

Colon Cancer & Diagnosis

Colon cancer seen by colonoscope

Colo-rectal cancer is a common and lethal disease in North America, Australia, and Europe. 90 percent of the disease occur after age 50. In the U.S., deaths from colon cancer account for about 9 percent of all cancer deaths every year.

Most of colon cancer arise from the mucosa, the inner lining of colon. At present time, colonoscopy is the best diagnostic test by which doctors perform biopsy. Another test, called barium enema (BE), is also used in 5 percent of patients in whom the colonoscope is not able to reach tumors because of obstruction cancer, tortuous colon. It is important that the whole colon be examined, so that other co-existing tumors are not missed.

A blood test, called carcinoembryonic antigen (CEA), is not recommended as a screening test for colon cancer. However, the blood level of CEA has prognostic utility; meaning it can predict if a patient with colon cancer will do well in the future.

CT scan is commonly used in detecting metastases. Its greatest benefit is to help avoid unnecessary surgery in patients who have distant metastases but do not have symptoms such as bleeding, obstruction.

PET scan is most helpful in detecting recurrence of colon cancer in patients who have high CEA level but in whom cancer is not found by CT, BE, colonoscopy.

Ennio Morricone & Once upon a Time in the West

Restless Leg Syndrome

Wall leg stretching: Stand facing a wall, feet together, 0.5 meter from the wall. Hold heels firmly on the wall. Keep hips and knees straight. Lean forward to the wall, stretching both legs. Hold this position for 15-30 seconds. Repeat five times per session. Do three sessions a day.

Muscle cramping of legs, also known as "vop be" in Vietnamese, is a common complaint for various illness. Common causes are prolonged sitting, arthritis, dehydration, low blood potassium or magnesium, iron deficiency, muscle cramping from vigorous excercise, diabetic or alcoholic peripheral neuropathy, Parkinson disease. In many cases, patients notice that cramping is worse in the evening and immediately relieved by walking. These patients may well have restless leg syndrome (RLS).

The International Restless Legs Study Group proposed the following four symptoms as essential criteria for the diagnosis of RLS:

• An urge to move both legs



• The urge to move begins during periods of rest such as lying or sitting



• The urge is relieved by walking or stretching



• The urge is worse in the evening or at night

In some cases, polysomnography, which is a sleep study, is needed for the diagnosis.

As far as treatment is concerned, leg stretching (see picture) before sleep is a good start and not costly at all. Avoidance of caffeine, nicotine, and alcohol helps many patients. Pharmacological treatment is available. Levodopa, pramipexole, ropinirole, benzodiazepines, or gabapentin are usually recommended.

Trinh Cong Son & Khanh Ly

Treatment and prognosis of small-cell lung cancer

Chest CT scan shows a central mass with adenopathy confirmed as small cell carcinoma.



Small cell lung cancer (SCLC) occurs almost exclusively in cigarette smokers. Although SCLC is highly responsive to chemotherapy and radiation therapy, it usually relapses within months depite treatment.

Choice of treatment, prognosis depend on disease staging at the time of diagnosis. Veterans' Affairs Lung Study Group has recommended a simple and clinically useful staging system:

• Limited-stage SCLC is defined as disease confined to ipsilateral hemithorax, meaning to the same side of the chest


• Extensive-stage SCLC is defined as disease extending outside the ipsilateral hemithorax

Without treatment, patients with SCLC survive only a few months. With chemotherapy or radiotherapy, survival is significantly prolonged.

• 80-90 percent of patients with limited-stage disease respond to chemotherapy plus radiation therapy


• 60-80 percent with extensive-stage disease respond to chemotherapy


• chest radiotherapy is usually for those with limited-stage disease


• median duration of responses is 6-8 months


• median survival for limited-stage disease is 14-20 months, extensive-stage disease 8-13 months

Winter by Vivaldi

Glucosamine and Chondroitin

Osteoarthritis (OA) is common in the elderly. It is important to know that osteoarthritis (OA) is different from rheumatoid arthritis (RA) and osteoporosis, since RA and osteoporosis require different treatment.

Available therapeutic options for osteoarthritis (OA) are exercise, weight loss, medications, surgery. Many people nowadays take supplements such as glucosamine and chondroitin, hoping to relieve pain and improve function. However, these supplements are often incompletely effective.

A 2005 meta-analysis study of glucosamine showed a significant improvement for pain relief. However, the largest randomized placebo-controlled study did not show significant differences in pain after 24 weeks of treatment with glucosamine, chondroitin, or the combination of both supplements [N Engl J Med. 2006 Feb 23; 354(8): 795-808]. Further clinical research studies are needed.

Adverse effects of these supplements are minimal. Most common symptoms are abdominal bloating, diarrhea.

Scent of Yesteryears

Prevention of malaria for world travelers

Arrows pinpoint a red blood cell infected by malaria parasite

Some of my friends once had spirited debate as to properly prevent malaria before they departed for overseas travel. It is interesting to know that malaria is transmitted by the bite of female Anopheline mosquitoes (how do we tell apart male and female mosquitoes may require an insect biologist's expertise, I guess) And malaria-transmitting mosquitoes feed at night; therefore, it makes sense to limit exposure between dusk and dawn. Effective preventive measures are:

• Using mosquito nets


• Covering skin with clothing


• Applying insect repellent

Travel to malarious regions, no matter how transient it is, requires the use of chemoprophylaxis, i.e. prophylactic medicines. Choices of medicines vary depending on geographic locations.

Travelers to Africa, South America, Indian subcontinent that consists of India, Pakistan, Bangladesh should take either mefloquine, or atovaquone-proguanil (Malarone), or doxycycline.

Travelers to most parts of China and southeast Asia should know that they may not have to take prophylactic medicines if they visit only urban areas. It is also important to know that resistant strains of Plasmodicum falciparum are prevalent in this part of the world. Therefore, only doxycycline or Malarone are recommended.

If you wish to know more details of malaria as reported by country, I recommend CDC (Center for Disease Control) website: http://www.cdc.gov/.

The Ecstasy of Gold

Medical Breakthrough of the year 2008

Malaria is a common disease in Africa and South East Asia. Malaria kills almost 1 million people a year. There are 4 species of Plasmodia that cause human malaria. Plasmodia falciparum is the species capable of causing deadly infections. Therefore, prevention of falciparum malaria is of the utmost importance.

Many vaccines are under development, but one new vaccine called RTS,S is the most promising, according to a New England Journal of Medicine publication on Dec. 8. Philip Bejon, of the KEMRI and the Centre for Tropical Medicine at the University of Oxford, said that an application for a license for RTS,S as a malaria vaccine would be expected.

The vaccine study was funded by a grant from Melinda Gates Foundation and drug maker GlaxoSmithKline.