“Early diagnosis of epilepsy is of the utmost importance because epileptic seizures can lead to injury and even death,” said study author Jacqueline French, MD, of NYU Grossman School of Medicine in New York City and a Fellow of the American Academy of Neurology. “Medications can reduce these risks, but our study found that a history of nonmotor seizures was being missed when children and teens were seen in emergency care.”

Subtle, nonmotor seizures have no noticeable movement. Symptoms affect the senses and may include nausea, visual distortions, feelings of déjà vu, or smelling odd odors. Motor seizures involve uncontrolled movements of the arms and legs and include more severe tonic-clonic seizures with full body convulsions.

The study involved 83 children and teens 12 to 18 years old. All were within four months of starting treatment for focal epilepsy, which accounts for more than half of all epilepsy cases and involves recurring seizures that begin in a localized area of the brain. Researchers reviewed participants’ medical records. There were 39 participants whose first seizure was a motor seizure, and 44 whose first seizure was a nonmotor seizure.

Before diagnosis, 58 went to emergency care for seizures. Looking back at medical records, researchers determined for 32, their first seizure was a motor seizure, and for 26, a nonmotor seizure. But when seeking this emergency care, 90% were seen for motor seizures, with 38% of that group having an unidentified history of nonmotor seizures.

There were 17 participants who were seen for their first motor seizure who had a history of nonmotor seizures, but none were recognized at the time as having had prior nonmotor seizures. As a result, they received similar treatment as those experiencing their first seizure, even though they were more advanced in the disease. French noted nonmotor seizures often worsen over time and progress to tonic-clonic seizures when left untreated.

Researchers found those with initial nonmotor seizures were less likely to seek emergency care with only 59% seeking care compared to 82% of those with initial motor seizures.

In emergency care, researchers also found just 33% of nonmotor seizures were correctly identified compared to 81% of motor seizures.

“Participants with nonmotor seizures described symptoms of hearing repeated phrases or jumbled noises, zoning out and episodes of dizziness, yet for many, this history was not collected until they had a tonic-clonic seizure and were referred to a neurologist,” said French. “This highlights a critical need for doctors to ask about these symptoms when someone seeks care for a motor seizure to ensure they get the best care.”

A limitation of the study was that nonmotor seizures may have been underreported, particularly in children who may have had difficulty identifying and communicating the symptoms of those seizures.

Reference:

Nora Jandhyala, Monica Ferrer, Jacob Pellinen, Hadley T. Greenwood, Dennis J. Dlugos, MSCE, Kristen L. Park,  Liu Lin Thio, and Jacqueline French, Unrecognized Focal Nonmotor Seizures in Adolescents Presenting to Emergency Departments, Neurology, https://doi.org/10.1212/WNL.0000000000209389.

MD Anderson and Pan American Health Organization join forces to support cancer prevention and control in the Americas

Cristina Mitchell

1 May 2024

Does consuming grains help improve type 2 diabetes?In a recent review and meta-analysis published in the journal Nutrition, Metabolism and Cardiovascular Diseases, researchers reviewed and examined available literature investigating the health outcomes of 'ancient' grains, including oats, brown rice, buckwheat, chia, and others.Diabetes mellitus, characterized by high blood sugar levels, has seen a dramatic global prevalence increase, projected to exceed 700 million by 2045. Alongside medical treatments, dietary changes are key in managing the condition. Ancient cereals, untouched by human genetic modification, offer promising benefits against diabetes mellitus. These grains contain higher levels of phytochemicals and fibers known to lower blood sugar compared to modern varieties.In the present review, researchers aimed to discuss evidence from the literature investigating ancient grain consumption outcomes on DM patients. Specifically, the review provided an overview of the glycemic control impacts of ancient grains on T1DM and T2DM; the ancient grains most often studied using randomized controlled trial methodologies, and the effectiveness of ancient-grain-based diets in managing DM as conventional therapeutic enhancers. Meta-analysis results highlighted that while the consumption of ancient grains does produce generally positive outcomes in T2DM patients (especially in the case of oats, brown rice, and millets), inter-study heterogeneity makes these results lacking in reliability, preventing their current recommendations as anti-DM interventions.The study suggested that ancient grains may help in managing type 2 diabetes mellitus (T2DM) due to their higher fiber content, lower glycemic index, and rich array of phytochemicals. These grains, untouched by modern genetic modification, can help stabilize blood sugar levels, improve insulin sensitivity, and reduce inflammation associated with T2DM. Additionally, their balanced nutrient profile and potential prebiotic effects on gut health contribute to overall well-being in individuals with diabetes. Incorporating ancient grains into the diet presents a promising dietary strategy for T2DM management and improved health outcomes."Further emphasis should be placed in designing future RCTs with better definition of dietary interventions, adequate sample sizes for relevant clinical outcomes, and sufficient duration of treatment. Furthermore, studies specifically designed for patients with Diabetes mellitus should be implemented," said the study authors. Reference: Magi, C. E., Rasero, L., Mannucci, E., Bonaccorsi, G., Ranaldi, F., Pazzagli, L., Faraoni, P., Mulinacci, N., Bambi, S., Longobucco, Y., Dicembrini, I., & Iovino, P. (2024). Use of ancient grains for the management of diabetes mellitus: A systematic review and meta-analysis. Nutrition, Metabolism and Cardiovascular Diseases, 34(5), 1110-1128, DOI – 10.1016/j.numecd.2024.03.005, https://www.sciencedirect.com/science/article/pii/S0939475324000929Inhaling Fentanyl may cause irreversible brain damage, finds studyAccording to a report in the journal BMJ Case Reports, Inhaling the synthetic opioid fentanyl may cause potentially irreversible brain damage (toxic leukoencephalopathy). The doctors warned after treating a middle-aged man found unresponsive in his hotel room after snorting the drug.Leukoencephalopathy refers to inflammation and damage to the brain’s white matter—the network of nerve fibres that enable the exchange of information and communication between different areas of the brain’s grey matter. Toxic leukoencephalopathy is a sudden or longstanding neurological syndrome, which has been reported after heroin inhalation. The condition manifests in various signs and symptoms, the most obvious of which are neurological and behavioural changes, ranging from mild confusion to stupor, coma, and death.In this case, a previously healthy man was discovered unconscious in his hotel room with unidentified crushed pills nearby. Upon admission to the hospital, he exhibited neurological deficits, including an inability to respond to questions or commands, and only responding to pain stimuli in his legs. Brain imaging revealed inflammation and swelling in the white matter and cerebellar injury, affecting his gait and balance. Despite testing negative for epilepsy, a urine test indicated exceptionally high levels of fentanyl, leading to a diagnosis of toxic leukoencephalopathy induced by fentanyl inhalation. Over the following weeks, he remained bedbound and required various medical interventions for urinary incontinence, kidney injury, cognitive impairment, suspected opioid withdrawal, pain, agitation, and pneumonia. After 26 days, he was discharged to a rehabilitation facility and later returned home with outpatient physiotherapy and occupational therapy support. Remarkably, within a year of his hospitalization, he fully recovered and resumed full-time work.“This is the first reported case associated with fentanyl. This case illustrates the need for the inclusion of fentanyl in routine urine drug screens for earlier identification and appropriate management,” said the report authors.Reference: Eden CO, Alkhalaileh DS, Pettersson DR, et alClinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathyBMJ Case Reports CP 2024;17:e258395.Study finds vaping association with risk of heart failureAccording to a new study presented at the American College of Cardiology annual scientific session, people who use e-cigarettes have a much higher risk of developing heart failure compared to those who have never vaped.More than 64 million people globally are affected by heart failure — a cardiovascular condition where the heart muscle is not able to pump enough blood for the body. Heart failure can occur if the heart muscle is damaged by infection, illegal drug use, high blood pressure, a congenital heart defect, heart attack, irregular heart rhythm, certain diseases including diabetes and coronary artery disease, and cigarette smoking.For this study, Yakubu Bene-Alhasan, a resident physician at MedStar Health in Baltimore and lead author of this study, along with his team reviewed data from electronic health records and surveys of more than 175,000 adults from the All of Us study, run by the National Institutes of Health. Upon analysis, researchers found that people who used e-cigarettes at any point in their lives were 19% more likely to develop heart failure than those who had never used e-cigarettes. They also found e-cigarette use had the biggest impact on a certain type of heart failure. The researchers reported that the increased heart failure risk linked to e-cigarette use was statistically significant for heart failure with preserved ejection fraction- also known as diastolic heart failure – which occurs when the heart can pump normally, but the muscle is too stiff to allow it to properly fill with blood.“A recent meta-analysis in NEJM found that vaping increased (the) risk of cardiovascular disease among others. Animal studies have also found changes in the heart leading to reduced contractility and relaxation after exposure to e-cigarettes. These are the same changes seen in heart failure,” said Bene-Alhasan.“Heart failure with preserved ejection fraction is relatively less understood but is gaining more recognition. The traditional medicines used to treat heart failure have less mortality benefits in this type of heart failure. As such, its management should include strategies to prevent it from developing in the first place. Knowing that e-cigarettes could potentially lead to this type of heart failure is important (in) drawing up preventive interventions,” he concluded. Reference: bene-alhasan, y, Mensah, S, Almaadawy, O. et al. ELECTRONIC NICOTINE PRODUCT USE IS ASSOCIATED WITH INCIDENT HEART FAILURE - THE ALL OF US RESEARCH PROGRAM. J Am Coll Cardiol. 2024 Apr, 83 (13_Supplement) 695; https://doi.org/10.1016/S0735-1097(24)02685-8

Motivada por graves errores durante la pandemia, la OMS convocó a unos 50 expertos en virología, epidemiología, ciencia de aerosoles e ingeniería biológica, entre otras especialidades, que pasaron dos años revisando evidencia sobre cómo se propagan los virus y bacterias por el aire.

El informe de la OMS no recomienda acciones a los gobiernos, hospitales o al público en general. Queda por ver si los Centros para el Control y Prevención de Enfermedades (CDC) utilizarán esta información en su propia orientación sobre el control de infecciones en entornos de atención médica.

La OMS concluyó que la transmisión aérea ocurre cuando las personas enfermas exhalan patógenos que quedan suspendidos en el aire, contenidos en pequeñas partículas de saliva y moco que, a su vez, son inhaladas por otros.

Aunque pueda parecer obvio, y algunos investigadores han abogado por este reconocimiento durante más de una década, el que perduró es un dogma alternativo que impidió a las autoridades sanitarias decir que el covid se transmitía por vía aérea hasta muchos meses entrada la pandemia.

Específicamente, se basaron en la noción tradicional de que los virus respiratorios se propagan principalmente a través de gotas expulsadas por la nariz o la boca de una persona infectada. Estas gotas infectan a otros al caer directamente en su boca, nariz u ojos, o entran en estos orificios por los dedos contaminados con estas gotas.

Aunque estas vías de transmisión siguen ocurriendo, especialmente entre niños pequeños, expertos han concluido que muchas infecciones respiratorias se propagan simplemente al inhalar aire contaminado con virus.

“Esto es un cambio radical”, dijo Julian Tang, virólogo clínico de la Universidad de Leicester en el Reino Unido, quien asesoró a la OMS para el informe. También ayudó a la agencia a crear una herramienta en línea para evaluar el riesgo de transmisión aérea en interiores.

Peg Seminario, especialista en salud y seguridad ocupacional en Bethesda, Maryland, aplaudió el cambio después que las autoridades sanitarias se resistieran por años. “El dogma de que las gotas son una forma principal de transmisión es ahora la posición de la ‘Tierra plana'”, dijo. “¡Viva! Finalmente estamos reconociendo que la Tierra es redonda”.

El cambio pone un nuevo énfasis en la necesidad de mejorar la ventilación en interiores y almacenar máscaras de calidad antes que se desate la próxima enfermedad transmitida por vía aérea. Lejos de ser una posibilidad remota, el sarampión está en aumento este año y la gripe aviar H5N1 se está propagando entre el ganado en varios estados.

Los científicos temen que a medida que el virus H5N1 pase más tiempo en mamíferos, podría evolucionar para infectar más fácilmente a las personas y propagarse entre ellas por el aire.

Las creencias tradicionales sobre la transmisión por gotas ayudan a explicar por qué la OMS y los CDC se centraron tanto en lavarse las manos y en limpiar las superficies al comienzo de la pandemia. Estos consejos eclipsaron las recomendaciones para el uso de máscaras N95 que filtran la mayoría de las partículas de virus suspendidas en el aire.

Los empleadores negaron a muchos trabajadores de salud el acceso a las N95, insistiendo en que solo aquellos que trabajaban rutinariamente a pocos metros de pacientes con covid las necesitaban. Más de 3,600 trabajadores de salud murieron en el primer año de la pandemia, muchos debido a la falta de protección.

Sin embargo, un comité asesor de los CDC parecen estar dispuesto a ignorar la actualización científica cuando se trata de su propia orientación pendiente sobre las instalaciones de atención médica.

Lisa Brosseau, experta en aerosoles y consultora del Centro de Investigación y Política de Enfermedades Infecciosas en Minnesota, advierte sobre volver a vivir el 2020 si eso sucede.

“El momento de la verdad llega cuando se toman decisiones sobre cómo proteger a las personas”, dijo Brosseau. “Los científicos de aerosoles pueden ver este informe como una gran victoria porque piensan que a partir de ahora todo seguirá a la ciencia. Pero esto no funciona así y todavía hay barreras importantes”.

El dinero es una de ellas.

Si una enfermedad respiratoria se propaga por inhalación, significa que las personas pueden reducir su riesgo de infección en interiores a través de métodos a veces costosos para limpiar el aire, como la ventilación mecánica o los purificadores de aire, y usando una máscara N95.

Hasta ahora, los CDC han sido reacios a presionar por tales acciones, mientras actualiza las directrices fundamentales para frenar las infecciones transmitidas por el aire en hospitales, hogares de adultos mayores, prisiones y otras instalaciones que brindan atención médica.

Este año, un comité asesor de los CDC publicó el borrador de una guía que difiere significativamente del informe de la OMS. Mientras que el informe de la OMS no caracteriza a los virus y bacterias transmitidos por vía aérea como “viajeros” de distancias cortas o largas, el borrador de los CDC mantiene esas categorías tradicionales. Recomienda máscaras quirúrgicas menos ajustadas, en lugar de las N95 para patógenos que “se propagan predominantemente por distancias cortas”.

Las máscaras quirúrgicas bloquean muchas menos partículas de virus en el aire que las N95, que cuestan aproximadamente 10 veces más.

Los investigadores y trabajadores de salud han reaccionado con indignación al borrador del comité, y han enviado cartas y peticiones a los CDC. Dicen que tergiversa la ciencia y que pone en peligro la salud. “Una separación entre distancias cortas y largas es totalmente artificial”, dijo Tang.

Los virus transmitidos por aire viajan de manera similar al humo del cigarrillo, explicó. El olor será más fuerte junto a un fumador, pero los que están más lejos inhalarán más y más humo si permanecen en la habitación, especialmente cuando no hay ventilación.

De la misma manera, las personas abren ventanas cuando queman tostadas para que el humo se disipe antes de llenar la cocina y activar una alarma. “¿Creen que los virus se detienen después de 3 pies y caen al suelo?”, dijo Tang sobre la noción clásica de distancia. “Eso es absurdo”.

El comité asesor de los CDC está compuesto principalmente por investigadores de control de infecciones en grandes sistemas hospitalarios, mientras que la OMS consultó a un grupo diverso de científicos que examinaron muchos tipos diferentes de estudios.

Por ejemplo, uno de los análisis de la OMS examinó las nubes de vapor expulsadas por cantantes y músicos que tocaban clarinetes, trombones, saxofones y trompetas. Otro revisó 16 investigaciones sobre brotes de covid en restaurantes, un gimnasio, una fábrica de procesamiento de alimentos y otros lugares, encontrando que una ventilación insuficiente probablemente empeoró el problema sanitario.

En respuesta a la protesta, los CDC devolvieron el borrador a su comité para su revisión, pidiéndole que reconsiderara sus consejos. Desde entonces, se han realizado reuniones privadas con un grupo de trabajo ampliado. Pero el sindicato National Nurses United obtuvo notas de las conversaciones a través de una solicitud de registros públicos a la agencia.

Los registros sugieren una presión para una protección más relajada. “Puede ser difícil en cuanto a la conformidad no tener las mascarillas quirúrgicas como una opción”, dijo un miembro no identificado, según las notas de la discusión del comité del 14 de marzo. Otro advirtió que “el suministro y el cumplimiento serían difíciles”.

El sindicato de enfermeras escribió en su sitio web: “El Grupo de Trabajo ha priorizado los costos y ganancias del empleador (a menudo bajo el paraguas de ‘viabilidad’ y ‘flexibilidad’) por sobre las protecciones sólidas”.

Jane Thomason, higienista industrial principal del sindicato, dijo que los registros de la reunión sugieren que el grupo de los CDC está trabajando al revés: moldeando sus definiciones de transmisión aérea para que se ajusten al resultado que prefiere.

Tang espera resistencia al informe de la OMS. “Las personas de control de infecciones que han construido sus carreras en esto se opondrán”, dijo. “Se necesita mucho tiempo para cambiar la forma de pensar de las personas”.

Los CDC se negaron a hacer comentarios sobre cómo el cambio de la OMS podría influir en sus políticas finales sobre el control de infecciones en instalaciones de salud, normas que podrían no completarse este año.

Formular políticas para proteger a las personas de inhalar virus transmitidos por el aire es algo complejo por la cantidad de factores que influyen en cómo se propagan en interiores, como la ventilación, la temperatura y el tamaño del espacio.

Agrega complejidad que los responsables de formularlas deben sopesar el costo de varias dolencias, desde el covid hasta los resfriados y la tuberculosis, contra la carga de la protección. Y los costos a menudo dependen del contexto: si un brote ocurre en una escuela o en una sala oncológica.

“¿Cuál es el nivel de mortalidad que las personas aceptarán sin precauciones?”, dijo Tang. “Esa es otra pregunta”.

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CERVICAL CANCER is considered a preventable disease. However, in the Caribbean, it is still one of the fourth most common causes of death in women. Efforts to overcome obstacles to the treatment and control of this preventable disease are being...

The study utilized accelerometry data to monitor physical activity, suggests that performing aerobic moderate to vigorous physical activity (MVPA) in the evening could be particularly beneficial.

The study utilized data from the UK biobank and encompassed a large group of a total of 29,836 adults who were classified as obese with a body mass index (BMI) of 30 kg/m2 or higher. The participants were monitored over an average period of nearly eight years. During this time, the study recorded 1,425 deaths, 3,980 cardiovascular disease (CVD) events and 2,162 microvascular disease (MVD) events among the group.

The participants were divided into categories based on the timing of their exercise routines which were at morning, afternoon and evening. The reference group consisted of the individuals who averaged less than one bout of aerobic MVPA per day. The data revealed that engaging in exercise during the evening was associated with the lowest risk of all-cause mortality with a hazard ratio (HR) of 0.39. Morning and afternoon activities also showed beneficial effects but were less pronounced when compared to evening exercises.

The risk of developing cardiovascular and microvascular diseases were significantly lower among the evening exercisers. The findings showed that evening activity was associated with a 36% lower risk of CVD and a 24% reduction in MVD risk. The benefits extended to the individuals with obesity and T2D that suggests a potentially vital strategy for managing both conditions.

The study adjusted for a variety of potential confounders by ensuring that the results robustly support the conclusion that not just the quantity, but the timing of physical activity is critical for health outcomes in obese adults. These findings could be transformative for the management strategies of obesity and type 2 diabetes that emphasizes the importance of regular physical activity and also its timing. Further research may explore the physiological mechanisms that support why evening exercise offers these health benefits.

Reference:

Sabag, A., Ahmadi, M. N., Francois, M. E., Postnova, S., Cistulli, P. A., Fontana, L., & Stamatakis, E. (2024). Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity. In Diabetes Care (Vol. 47, Issue 5, pp. 890–897). American Diabetes Association. https://doi.org/10.2337/dc23-2448

“Different parts of the pumpkin can be used to secure different vitamins and phytonutrients the body needs”

View the full post The benefits of eating pumpkin on NOW Grenada.

Santo Domingo.- The director of SeNaSa emphasized that during his tenure alone, 1,549 codes have been granted to healthcare professionals. Additionally, he mentioned that he continued processing the 132 cases inherited upon assuming office, ensuring compliance with regulations set by the Superintendency of Health and Occupational Risks (Sisalril).

The executive director of SeNaSa stated that the Dominican ARS is currently handling 28 applications, with completion imminent, and only fourteen are awaiting evaluation. “Upon completion of this process, a total of 1,591 professionals from various healthcare fields will have their codes under our administration.”

He specified that these health professionals meeting supervisory body requirements are spread across the country and represent various specialties including family medicine, urology, cardiology, pediatrics, anesthesiology, psychology, proctology, perinatology, rheumatology, neurology, internal medicine, nephrology, hematology, and obstetrics-gynecology, among others.

“We are dedicated to fostering dialogue and collaborating on solutions that benefit our members the most. Our commitment remains ensuring access to quality services that comply with current standards,” stated Dr. Hazim.

He recalled the agreement reached last year with the Dominican Medical College and Sislaril, establishing the requirements for obtaining these codes through various meetings.

Dr. Hazim concluded by affirming SeNaSa’s ongoing commitment to open dialogue in pursuit of continual enhancements in member services.