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A type 2 diabetes drug taken orally and in widespread use for more than a decade has been found to have distinct advantages over nine other, mostly newer medications used to control the chronic disease, according to a study by researchers at Johns Hopkins.

In their report, published online July 16 in the journal Annals of Internal Medicine, the Hopkins team found that metformin, first approved by the U.S. Food and Drug Administration in 1995 (and sold as Glucophage, Riomet and Fortamet), not only controlled blood sugar levels but also was less likely to cause weight gain and more likely than others to lower bad cholesterol levels in the blood.

Researchers say these health benefits are important because they can potentially ward off heart disease and other life-threatening consequence from diabetes. More than 15 million Americans have type 2 diabetes.

“Sometimes newer is not necessarily better,” says lead study author Shari Bolen, M.D., an internist at Hopkins. “Issues like blood sugar levels, weight gain and cost could be significant factors to many patients struggling to stay in good health,” says Bolen, an instructor at The Johns Hopkins University School of Medicine.

In what is believed to be the largest drug comparison of its kind, the scientists showed that all of the commonly used oral medications worked much the same at lowering and controlling blood sugar levels, and were equally safe. But metformin stood out because it offered the same level of effectiveness without lowering glucose measurements too much, and it did so for a lower price.
Metformin was found to lower LDL or bad cholesterol by about 10 milligrams per deciliter of blood, while newer medications studied, such as pioglitazone (Actos) and rosiglitazone (Avandia), or so-called thiazolidinediones, were found to have the opposite effect, increasing levels of the artery-clogging fat by the same amount.

Researchers say the main drawbacks to metformin are digestive problems and diarrhea. Previous reports have found evidence that the medication leads to the buildup of lactic acid in the blood in people with moderate kidney or heart disease, and they note that it should not be prescribed to anyone with either of these conditions. The main advantages to both newer thiazolidinediones were a small increase in HDL or good cholesterol, and less too-low blood sugar levels than three other older, cheaper drugs studied — glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Micronase, DiabBeta, Glynase PresTab) — known as second-generation sulfonylureas.

Annual treatment with metformin or the sulfonylureas, they note, costs on average $100, roughly one-fourth the cost of oral diabetes medications FDA-approved since then, including the two newer thiazolidinediones, both approved in 1999. (Their price is expected to drop once generic versions become available.)

“When you are dealing with an epidemic like diabetes, it is important for people to weigh their treatment options with their physician and to make informed decisions about which medication best suits their needs,” says Bolen.

In the study, Bolen and her colleagues reviewed the scientific evidence from 216 previous studies and compared each drug for its clinical effectiveness, risks and costs. In addition to metformin, the thiazolidinediones and sulfonylureas, drugs included in their analysis were repaglinide (Prandin), miglitol (Glyset), acarbose (Precose), and nateglinide (Starlix).

Among the team’s other findings were that glimepiride, glipizide, and glyburide led more frequently to too-low blood sugar levels than the other drugs. The sulfonylureas and acarbose appeared to have no effect on bad cholesterol. And except for metformin and acarbose, drug treatment led to an increase in weight from 2 to 11 pounds.

Researchers also noted the increased risk of heart failure, albeit small (less than three people in a hundred), in people taking thiazolidinediones who did not have a history of heart disease. They also caution that despite recent reports about the potential for increased risk of heart attack from rosiglitazone, there is not yet sufficient information to verify the finding.

Researchers say further studies are needed to compare the long-term effectiveness of one treatment to another and to compare drug effects on quality of life and life expectancy. Additional research will also be needed to compare these findings with results for injectible medications for diabetes, most notably insulin, which was not included in the latest report.

The study, conducted solely at Hopkins, was supported with funding from the federal Agency for Health Care Research and Quality. The agency has posted the analysis, along with a question-and-answer document, on its Web site at And the consumer watchdog publication, Consumer Reports, has posted a related report at

Besides Bolen, other researchers involved in the study were Leonard Feldman, M.D.; Jason Vassy, M.D., M.P.H.; Lisa Wilson, B.S., Sc.M.; Hsin-Chieh Yeh, Ph.D.; Spyridon Marinopoulos, M.D., M.B.A.; Crystal Wiley, M.D., M.P.H.; Elizabeth Selvin, Ph.D.; Renee Wilson, M.S.; Eric Bass, M.D., M.P.H.; and Frederick Brancati, M.D., M.H.S.

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Although you may have heard or read a great deal about the environmental consequences of global warming, man will probably be affected through famine, or war long before the health of the population as a whole is harmed to a serious degree by the temperature change. However increasing extremes of temperature, as a result of climatic change, could result in increased mortality even in temperate climates.

Important issues concerning physical hazards include those relating to health effects of electromagnetic radiation and ionising radiation. If one excludes the occupational environment, then noise and other physical hazards may present a nuisance to many inhabitants, and impair general well being. Environmental noise does not usually contribute to deafness but notable exceptions may include noisy discotheques and “personal stereos”.

Electromagnetic radiation ranges from low frequency,relatively low energy, radiation such as radio and microwaves through to infra red, visible light, ultraviolet, X-rays and gamma rays. These last as well as other forms of radioactivity such as high energy subatomic particles (e.g. electrons – Beta rays) can cause intracellular ionization and are therefore called ionizing radiation. Exposure to ultraviolet (UV) radiation carries a increased risk of skin cancer such as melanoma, and of cataracts which are to an extent exposure related. Some pollutants such as chlorofluorocarbons (CFCs) used as refrigerants or in aerosol propellants or in the manufacture of certain plastics can damage the “ozone layer” in the higher atmosphere (stratosphere) and thus allow more UV light to reach us, and harm us directly. Ultraviolet light may also cause harm indirectly by contributing to an increase in ozone in the troposphere (the air we breathe) – see below under chemical hazards, or elsewhere in connection with air quality.

Radioactivity is associated with an exposure dependent risk of some cancers notably leukaemia. Contrary to popular belief however, most radiation to which the average person is exposed is natural in origin, and, of the man made sources, medical diagnosis and treatment is on average the largest source to the individual. A very important issue is the extent to which radon gas arising from certain rock types beneath dwellings can contribute to cancer risk. According to some estimates it could result in a few thousand cancer deaths per year in the U.K. (but still probably less than one twentieth of the cancer deaths alone caused by tobacco smoking).

Ionization radiation from the nuclear industry and from fallout from detonations contributes less than 1% of the annual average dose to inhabitants of the U.K. The explanation for leukemia clusters around nuclear power plants is not yet resolved. Similar clustering can occur in other parts of the country. The effect of viral infections associated with population shifts may be important but requires further study.

Non ionising electrical, magnetic or electromagnetic fields are an increasing focus of attention. The scientific evidence of adverse health effects from general environmental exposure to these fields is “not proven”. If there are adverse effects yet to be proven, the risk is probably likely to be very small.

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asthma01Asthma is a chronic disease of the respiratory system and may turn even fatal at times. It is therefore important for the asthma patients to take proper care and precautions regularly. Asthma patients suffer from attacks that enforce the system to breathe with difficulty. Wheezing, choking, gasping for breath and suffocation are the symptoms of asthmatic attack.

The attacks may last up to several minutes and leave a person thoroughly exhausted. There can be severe organ damage due to problem in respiration during the asthma attack. Also the system may suffer from lack of oxygen for a longer duration of time. It is therefore imperative to exercise proper caution and avoid the onset of an attack to the extent possible.

Some easily followed precautions everyday may keep an asthmatic without suffering an attack. These precautions are:

1. An asthmatic needs to follow routines. This is because it is generally seen that people do not suffer the agony of an asthmatic attack if they continue to live their life in a regular way. The problem arises mainly when the people go out of their way and break all the routines. The system thus gets unnecessarily pressured and reacts badly by manifesting the symptoms of the disease in the oddest of ways and without many warning signs. Sometimes the body does give the warning signs but the person may ignore them completely.

2. Daily morning walk does wonders to the system. But in the case of asthma patients the benefit from early morning exercise is enhanced manifold. This is because the early morning is the time when the air is pure and at its best. Exercising the lungs with the early morning air does wonders to the asthmatic lungs and respiratory tract.


3. Daily morning exercise schedule needs to be followed religiously in case of an asthma patient. Not only does this help in exercising the whole system but it also makes a person live a more disciplined and regularised life. This is because if a person gets into the habit of getting up early, in all probability he would try and sleep early too and his routine will automatically be set and fixed.

4. The daily diet of an asthma patient should be kept simple and nutritious. He should take care of not eating heavy meals as they would tax the system unnecessarily. Care should be taken to keep the meals small and frequent if need be, rather than consuming standard heavy meals at set hours. Also the food should be cooked with less oil and spices to keep it easily digestible. The diet should be mainly vegetarian with less of fats and carbohydrates. Sweets should best be avoided at night time. Dinner should be consumed at least two hours before sleeping so that the stomach is almost empty before sleeping. Dietary intake of fruits and vegetables should be enhanced. Snacks should be mainly in the form of fresh fruits and vegetables only and fatty, oily and salty or sweet snacks should be avoided completely.

5. Asthma patients should avoid smoking completely. Smoking fills the system with many toxins and the respiratory system gets flooded with them. These toxins are major irritants to the respiratory tract and create an undue pressure on the system that may be too much for an asthmatic to handle. An asthmatic may get more bronchial spasms and is more likely to be affected with respiratory infections if he continues to smoke.

6. An asthmatic person should also not indulge in drinking too much. This is because drinking causes a person to lose sense and become more prone to breaking disciplines of routine and diets. An asthmatic may become careless with his diet and may tend to overeat to counteract the influence of alcohol if he indulges in drinking too much.

7. Asthma patient’s surroundings should be kept neat and tidy. As far as possible clutter should be completely avoided to steer clear of dust induced allergies that may create an attack. Clutter in the surroundings inhabits several mites and allergy causing organisms. It is therefore necessary that the furniture and other stuff should be arranged in such a way, which allows proper dusting and cleaning on a daily basis.


8. Asthma patients may have difficulty with the atmospheric pollution also. It is very important to assess whether the patient may be allergic to any particular kind of allergen present in the atmosphere around his place of dwelling or occupation. Sometimes certain professions support the excessive usage of one kind of toxin or the other, in which case a change in profession or occupational conditions may remain to be the only option.

9. Asthmatics should also be very careful of not getting mentally excited too much. This is because the mental aggravation may lead to appearance of asthmatic symptoms in patients. On a daily basis it is better not to accumulate taking decisions, whether in the personal life or in the professional life. The work should also be handled as far as possible on a daily basis to avoid excess stress and anxiety.

10. In order to manage asthma it is very necessary to accept the disease and the limitations attached with it in one’s daily life. If proper discipline is maintained a patient can have a long and problem free life.

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Hives (urticaria), also known as welts, is a common skin condition with itchy, pink to red bumps that appear and disappear anywhere on the body. An individual lesion of hives typically lasts a few hours before fading away, and new hives can appear as older areas disappear.images5

Physicians arbitrarily divide hives into acute (new or periodic episodes lasting fewer than 6 weeks) and chronic (periodic episodes lasting more than 6 weeks). Though many people have a single episode of acute hives that goes away within a few days to weeks, some individuals may have chronic hives, periodic (recurrent) attacks of hives that come over periods of years.

Hives can be triggered by many things, including:

* Medications, especially aspirin, ibuprofen, naproxen, narcotic painkillers, or antibiotics
* Infections with viruses, bacteria, or fungi
* Environmental allergies such as insect bites, pollen, mold, or animal dander
* Physical exposures such as heat, cold, water, sunlight, or pressure
* A medical condition such as gland diseases, blood diseases, or cancer
* Food allergies, such as strawberries, eggs, nuts, or shellfish
* Stress
images4In up to 90% of outbreaks of hives, a trigger is never found despite extensive testing; these cases are referred to as idiopathic urticaria. In approximately 50% of idiopathic urticaria outbreaks, hives are most likely caused by a reaction from the person’s own immune system (autoimmune reaction).

Following are some facts on Scabies. This contagious skin disease can be a nightmare for you if you don’t take precautions. This piece of post is to lighten up the world to be healthy.

  • Scabies [SKAY-bees] is a skin disease caused by a parasitic mite.
  • Scabies is spread by prolonged person-to-person contact and is very contagious.
  • Anyone can get scabies.
  • Scabies is treatable with mite-killing skin lotions and creams.
  • To prevent scabies: 1) avoid contact with people with scabies, and 2) make sure that affected persons and their contacts are treated.


What is scabies?

Scabies is a contagious mite infection of the skin.

What is the infectious agent that causes scabies?

Scabies is caused by Sarcoptes scabiei, a parasite mite.

Where is scabies found?

Scabies occurs worldwide. Scabies mites live on human blood and need the warmth of the human body to survive. Away from the body, they die within 48 hours.

How do people get scabies?

Scabies is spread from person to person mainly by prolonged (several minutes) direct skin-to-skin contact, such as touching a person who has scabies. In rare cases, scabies can spread by contact with clothes, towels, bedding, and other personal items that were recently in contact with an infected person.

Burrowing of the mites causes the infection. Scabies mites tunnel under the skin, lay eggs, and produce substances that cause an allergic reaction. The path of a mite’s burrow looks like a line of tiny blisters on the skin. Larvae hatch from the eggs and live under the skin’s surface, where they develop into adult mites.

What are the signs and symptoms of scabies?

The earliest and most common symptom is intense itching, especially at night. An early scabies rash will show up on the skin as a line of tiny blisters or little red bumps. In more serious cases, the skin might be crusty or scaly.

In adults, signs of scabies will usually appear first in body folds — particularly between the fingers, on the elbows or wrists, on the buttocks or waistline, around the nipples for women, and on the penis for men. Scabies rarely affects the skin above the neck.

In infants and children, scabies can affect the entire body, including the palms, soles of the feet, and head and scalp. The child may be tired and cranky because of loss of sleep from itching.

How soon after exposure do symptoms appear?

It can take up to 2 to 6 weeks before a newly infected person will notice any itching or rash. Persons who have already had scabies and are re-exposed might show symptoms in 1 to 4 days.

How is scabies diagnosed?

Scabies is diagnosed by the characteristic rash. The diagnosis can be confirmed by finding mites or eggs in skin scrapings.

Who is at risk for scabies?

Anyone can get scabies. It can strike people of any age, race, or sex, regardless of personal cleanliness. Scabies is not a disease of poverty, neglect, or poor hygiene. However, it is more common among people living in crowded conditions and among those with close physical contact with others, such as children, mothers of infants, and persons in nursing homes.

What complications can result from scabies?

Scratching can cause infected sores. Some people become very sensitive to the mites and develop large areas of inflamed skin.

What is the treatment for scabies?

Treating scabies means killing the mites and their eggs. Prescription skin creams or lotions containing 5% permethrin, lindane, or crotamiton will kill the mites and eggs. Lotions must be applied according to the package directions. It can take 1 to 2 weeks after treatment for the itching to stop. A second treatment in 7 days is often recommended.

Scabies Mite

Scabies Mite

If you suspect scabies:

  • See a dermatologist (skin doctor) right away for diagnosis. Remember, scabies does not indicate anything about your personal cleanliness.
  • Wash and dry clothing, bed linens, and towels on the hot cycle, or have personal items professionally dry cleaned. Clothing that cannot be laundered or dry cleaned should be stored in plastic bags for several days to kill the mites.
  • Vacuum rugs and furniture, and discard the vacuum bag.
  • Treat all household members, personal contacts, and sexual contacts at the same time, whether or not they have symptoms.
  • Do not treat scabies with home remedies. These can make the condition worse. Do not use steroids or other creams unless prescribed by a doctor.

How common is scabies?

Scabies is a fairly common infectious disease that occurs sporadically and also sometimes in outbreaks. Most outbreaks occur in nursing homes, institutions, and child-care centers.

Is scabies an emerging infectious disease?

Yes. There has been a recent wave of infestation in the United States. Scabies in residents of nursing homes and extended care facilities has become a common problem.

How can scabies be prevented?

  • Avoid physical contact with infected persons and their belongings, especially clothing and bedding.
  • Treat all family and household members who had skin contact with an infected person, whether or not they are itching or have a rash.
  • Exclude persons with scabies from school or day care until 24 hours after treatment.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have any questions about the disease described above or think that you might have a parasitic infection, consult a health-care provider.

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Time and dates are just for convenience

August 2020

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