Total Health Care and Safety Guidlines and tips

Blood Clots / Stroke- they now have a 4th indicator, the TONGUE

2010-03-27T05:45:00.000-07:00

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE:

Thank God for the sense to remember the '3' steps, STR . Read and Learn!

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.

Now doctors say a bystander can recognize a stroke by asking three simple questions:

S *Ask the individual to SMILE.

T *Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently)(I.e. It is sunny out today)

R *Ask him or her to RAISE BOTH ARMS.

If he or she has trouble with ANY ONE of these tasks, call emergency number immediately and describe the symptoms to the dispatcher.

New Sign of a Stroke -------- Stick out Your Tongue

NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out his tongue.. If the tongue is 'crooked', if it goes to one side or the other, that is also an indication of a stroke.

Food Dyes should be banned

2008-11-15T02:34:00.000-08:00

The British Food Standard Agency deserves credit for encouraging manufactures and restaurants to switch to safer, natural colorings.As a result of government pressure, Kelloge, McDolands , Craft, Mars, and other multinational companies now market foods without dyes in Britain, but market the same foods with dyes in the United States. The U.S food and drug administration maintains flatly that well conducted controlled studies have produced no evidence that food additives cause hyperactivity or learning disabilities in children.

Tomato Food products protects against prostate cancer and DNA damage

2008-11-15T02:21:00.000-08:00

New research reveals additional clues to the mechanism behind tomatoes known protective effect against prostate cancer.

Investigators at all university of Missouri-Columbia, and colleagues demonstrated that FruHis, a carbohydrate derivative present in dehydrated tomato products, exerts this effect.

Laboratory studies showed that FruHis Protected against DNA damage. A combination of lycopene, an antioxidant in tomatoes that also protects against DNA damage, and FruHis caused a greater than 98% inhabitation of prostate cancer cell growth in vitro compared with single agents.

Sunshine Vitamin D Deficiency

2008-11-15T02:05:00.000-08:00

Fortification of foods and advice on sensible sun exposure are urgently needed.

Rickets became extremely rare in the United Kingdom, Europe and United States after it was realized that exposure to ultraviolet light was the major of vitamin D, and after the fortification of milk and other foods with vitamin D.
At least a billion people world wide are estimated to be vitamin D Deficient, mainly because of inadequate exposure to sunlight and inadequate fortification of food with vitamin D.

Human breast milk contains very little vitamin D and women with vitamin D Deficiency provide no vitamin D for their infant.

Vitamin D deficiency causes Secondary Hyperparathyroidism and increases destruction of the skeleton by precipitating on exacerbation osteropenia and osteoporosis. Raised parathyroid hormone concentration include phosphaturia and hypophospatemia, this causes a mineralization defect of the osteoid (osteomalacia). Unlike osteoporosis, which is painless disease, rickets and the adult counterpart osteomalacia can cause non-specific aches and pains in bones and muscles, and severe muscle weakness.

Vitamin D deficiency, or lack exposure to the sun have an increased risk of many risk of many cancers. Increasing the intake of vitamin D to 1000 IU a day reduces the risk of colorectal cancer and other deadly cancers by 30-50%. Vitamin D deficiency is also linked to cardiovascular disease.

One study found that the risk for the first cardiovascular event was 62% higher in people with Vitamin D deficiency.
Vitamin Deficiency has also been associated with autoimmune disease, infectious disease, and schizophrenia.

Serum calcium concentrations are usually normal in people with vitamin D deficiency and 1,25-dihydroxyvitamin D values are normal or raised.

The only way to know a person's vitamin D status to measure serum 25-hydroxyvitamin D concentrations. Aggressive treatment of vitamin D deficiency with 300 000 IU of intramuscular vitamin D daily. Vitamin D (50,000 IU) once a week for eight weeks will correct vitamin D deficiency. To maintain vitamin D sufficiency, 500,000 IU of vitamin D twice a month or 1000-2000 IU of vitamin D a day is usually sufficient. Vitamin D intoxication is an extremely rare.
Although the health benefits of vitamin D sufficiency are clear, awareness of dangers of vitamin D deficiency is lacking. People with vitamin D deficiency have no obvious symptoms until it is so severe that they develop osteomalacia; this is often misdiagnosed as fibromyalgia.

Whiplash injuries, symptoms, causes and prevention

2008-11-13T00:45:00.000-08:00

Definition:
Whiplash is an acute injury of at least moderate intensity which causes a strain to the bones, muscles, nerves, tendons, and vertebral discs of the neck region. It is caused by a sudden, unexpected impact which jerks the head back and then forward causing the neck to snap out of alignment.

Where could it happen?
1. Traffic/stop light (‘traffic light disease’)

2. End of traffic jam/queue

3. Sport (Boxing, Karate, Judo……)

4. Roller coaster

What are the symptoms?
Symptoms are:
Headaches/migraines, stiffness, neck pain, dizziness (nausea/vomiting), problems thinking or remembering, numbness and tingling (arms, face, shoulders), jaw pain, low back pain, hip pain, impaired vision.

What is a potential outcome?

before after

Note misalignment of vertebral discs after suffering from a whiplash injury.

What happens to the driver during a rear end collision if
- head restraint
- seat position
- seat belt height
are not adjusted correctly?

1) Body moves up – depending on angle of backrest and position of seat belt adjustor,..
2)... head jerks back…..
3) …pushing the head restraint down

What are the facts?

Facts:

- even low speed accidents can cause significant injuries depending on where and how hard your car got hit, your position in the car, the position of your head, type of seat, position of the headrest, your pre-accident medical condition, and other things

- only 12% of persons who suffer from whiplash are symptom-free after 10 years

- Saab was the first to introduce an active protection system (SAHR); Volvo’s “Whiplash Protection Seating System” reduces acceleration forces on the neck by up to 50 %

- A study by Young et al. (2005) showed that 93% of all head restraints observed were sub-optimally positioned A L Young, B T Ragel, E Su, C N Mann, E H Frank: Assessing automobile head restraint positioning in Portland, Oregon; Injury Prevention 2005; 11: 97-101.

How can it be prevented?

Adjust your head restraint

1) Ensure that the top of the head restraint is as high as the top of your head.

2) Position the head restraint as close to the rear of your head as possible.

Adjust your seat position

First, the driver's back should be flat against the back of the seat with the buttocks squarely tucked into the corner created at the intersection of the seat back and bottom. The underside of the legs should be in contact with the seat bottom. The purpose of this position is to provide as much surface contact between the driver's body and the seat. This has safety benefits as well as providing the driver with the most tactile feedback as possible

Second is the arm position. The arms when fully extended should allow the wrists to rest at the top of the steering wheel. This allows the arms to be slightly bent at the elbow when fully extended for a turn. The purpose of this position is to prevent the arms from being overextended during turns (the shoulders should not need to lift from the seat back even to do a full arm crossover). Overextending the arms will cause them to tire quickly, and will cause the driver to lose sensitivity to the vibrations in the steering wheel

Third is the leg position. When any of the pedals are fully depressed with the ball of the foot on the pedal (not the toes), the leg should still be bent at the knee. This is to prevent overextension as described for the arms. Be sure that the knees are not against the underdash or steering column. In fact, there should be several inches room to prevent injury in event of a collision.

Finally, whiplash injuries can be prevented by following guidelines:

Adjust head restraint – not only in your own car!

Adjust seat position.

Check seat belt adjustor position.
Leave plenty of space (escape route) if you are the last car in a traffic jam – closely observe oncoming traffic in rear view mirror.
Look up safety ratings before buying your next new or used car .

Sources: http://www.iihs.org/ratings/head_restraints/head_restraint_info.html
http://www.rospa.co.uk/roadsafety/info/adjust_head_restraints.pdf

Tips to Healthy Teeth and brushing your teeth

2008-11-08T01:39:00.001-08:00

If you want a healthy teeth, here are some tips and guidelines:

Brush at least twice a day using fluouride containing tooth paste (two minutes each time) and floss every night.
Use a soft-bristled toothbrush (teeth cleaning and brushing techniques are highlighted below).
Brush your tongue to clear all odours.
Avoid vigorous or harsh scrubbing.
Massage your gums with your fingertips for two minutes once a day for two minutes to improve circulation.
See a dentist’s recommendation for mouthwash, especially for children.
Replace your tooth brush every three months.
Consider using an electric toothbrush, especially if you have joint pains or arthritis that makes brushing difficult.
Rinse your mouth after each meal.
Avoid snacks in between meals.
Your diet should contain a lot of calcium like milk or cheese and lots of fruits and vegetables.
Vitamin C found in citrus fruits, guavas etc. is essential for healthy gums.
Apples are an excellent cleanser of teeth.
Maintain a balanced diet and reduce the consumption of foods containing sugars or starch (such as snacks or potato chips) as they accelerate tooth decay.
Cola drinks damage teeth.
Smoking stains teeth and damages gums by reducing blood supply.
Chewing sugar-free gum prevents bad breath and fights tooth decay.
Don’t chew on hard objects that can crack your teeth.

Teeth Cleaning and brushing techniques are as follows:
1. Apply the paste or Gel on to your brush.
2. Hold the brush at an angle of 45 degree and brush the outer surfaces in a circular or up and down motion.
3. Using the same circular motion, brush the inside of the back teeth.
4. Use the tips of the brush to clean the inner surfaces of the front teeth.
5. Using a scrubbing motion, clean the chewing surfaces. Also brush your tongue gently and rinse well with water.

A chat with leading Indian cardiologist Dr. Devi Shetty

2008-10-15T02:35:00.000-07:00

Given below is a chat, arranged by WIPRO for its employees, with Dr. Devi Shetty, Narayana Hrudayalaya (Heart Specialist) Bangalore.

Qn: What are the five thumb rules for a layman to take care of his
heart?
Ans: 1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour’s walk at least five days a week; avoid lifts and avoid sitting for a longtime.
3. Quit smoking
4. Control weight
5. Control blood pressure and sugar

Qn: Is eating non-Veg food (fish) good for the heart?

Ans: No

Qn: It's still a grave shock to hear that some apparently healthy person gets a cardiac arrest. How do we understand it in perspective?
Ans: This is called silent attack; that is why we recommend everyone past the age of 30 to undergo routine health checkups.

Qn: Are heart diseases hereditary?

Ans: Yes

Qn: What are the ways in which the heart is stressed? What practices do you suggest de-stressing?

Ans: Change your attitude towards life. Do not look for perfection in everything in life.

Qn: Is walking better than jogging or is more intensive exercise required to keep a healthy heart?

Ans: Walking is better than jogging since jogging leads to early fatigue and injury to joints.

Qn: You have done so much for the poor and needy. What has inspired you to do so?

Ans: Mother Theresa, who was my patient.

Qn: Can people with low blood pressure suffer heart diseases?

Ans: Extremely rare

Qn: Does cholesterol accumulates right from an early age (I'm currently only 22) or do you have to worry bout it only after you are above 30 years of age?

Ans: Cholesterol accumulates from childhood.

Qn: How do irregular eating habits affect the heart?

Ans: You tend to eat junk food when the habits are irregular and your body's enzyme release for digestion gets confused.

Qn: How can I control cholesterol content without using medicines?

Ans: Control diet, walk and eat walnut.

Qn: Can yoga prevent heart ailments?

Ans: Yoga helps.

Qn: Which is the best and worst food for the heart?

Ans: Best food is fruits worst are oil.

Qn: Which oil is better - gingili, groundnut, sunflower, saffola, olive?

Ans: All oils are bad; the so-called best oil company has the largest marketing budget.

Qn: What is the routine checkup one should go through? Is there any specific test?

Ans: Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.

Qn: What are the first aid steps to be taken on a heart attack?

Ans: Help the person into a sleeping position, put an aspirin tablet under the tongue with a sorbitrate tablet if available, and rush him to a coronary care unit since the maximum casualty takes place within the first hour.

Qn: How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?

Ans: Extremely difficult without ECG.

Qn: What is the main cause of a steep increase in heart problems amongst youngsters? I see people of about 30-40 yrs of age having heart attacks and serious heart problems.

Ans: Increased awareness has increased incidents. Also, sedentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.

Qn: Is it possible for a person to have BP outside the normal range of 120/80 and yet be perfectly healthy?

Ans: Yes.

Qn: Marriages within close relatives can lead to heart problems for
the child. Is it true?

Ans: Yes, co-sanguinity leads to congenital abnormalities and you may not have a software engineer as a child

Qn: Many of us have an irregular daily routine and many a times we have to stay late nights in office. Does this affect our heart? What precautions would you recommend?

Ans: When you are young, nature protects you against all these irregularities. However, as you grow older, respect the biological clock.

Qn: Will taking anti-hypertensive drugs cause some other complications (short / long term)?

Ans: Yes, most drugs have some side effects. However, modern anti- hypertensive drugs are extremely safe.

Qn: Will consuming more coffee/tea lead to heart attacks?

Ans: No.

Qn: Are asthma patients more prone to heart disease?

Ans: No.

Qn: How would you define junk food?

Ans: Fried food like Kentucky, McDonalds, samosas, and even masala dosas.

Qn: You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food?

Ans: Every race is vulnerable to some disease and unfortunately, Indians are vulnerable for the most expensive disease. Qn: Does consuming bananas help reduce hypertension?

Ans: No.

Qn: Can a person help himself during a heart attack (Because we see a lot of forwarded emails on this)?

Ans: Yes. Lie down comfortably and put an aspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary care unit without any delay and do not wait for
the ambulance since most of the time, the ambulance does not turn up.

Qn: Do, in any way, low white blood cells and low hemoglobin count lead to heart problems?

Ans: No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.

Qn: Sometimes, due to the hectic schedule we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?

Ans: Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.

Qn: Is there a relation between heart problems and blood sugar?

Ans: Yes. A strong relationship since diabetics is more vulnerable to heart attacks than non-diabetics.

Qn: What are the things one needs to take care of after a heart operation?

Ans: Diet, exercise, drugs on time. Control cholesterol, BP, weight.

Qn: Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?

Ans: No.

Qn: What are the modern anti-hypertensive drugs?

Ans: There are hundreds of drugs and your doctor will chose the right combination for your problem, but my suggestion is to avoid the drugs and go for natural ways of controlling blood pressure by
walk, diet to reduce weight and changing attitudes towards lifestyles.

Qn: Does dispirin or similar headache pills increase the risk of heart attacks?
Ans: No.

Qn: Why is the rate of heart attacks more in men than in women?
Ans: Nature protects women till the age of 45.

Qn: How can one keep the heart in a good condition?

Ans: Eat a healthy diet, avoid junk food, exercise everyday, do not smoke and, go for a health checkup if you are past the age of 30 for at least once in two yrs. And work very hard and enjoy your Life...

Tips to feel satisfied with less Food

2008-09-21T03:57:00.000-07:00

Did you know that simply changing the way you eat could help you to feel more satisfied after eating?

Notice the word satisfied is use not full. There's a big difference. Full means, "I'm really stuffed." Satisfied is simply, "I'm no longer hungry."

Satisfaction is actually a learned feeling. Many of us in fact feel satisfied after eating only half of a meal, but we don't recognize that feeling because, instead of pausing, we go on and eat to fullness. I am still part of the clean-plate generation — that's just how we were brought up.

But now we need to change our thinking and learn to recognize what it feels like to be satisfied during a meal. If you stop when you are satisfied, you will eat less food.

Try some of these tips to help you feel more satisfied at meals:

Use smaller plates and bowls: This trick actually fools your mind into thinking that you're getting more food. When you see a plate (no matter what size) brimming with food, you're already thinking, I am going to be satisfied after this meal! Smaller plates mean that your portion sizes will be smaller and you'll eat less food.
Eat your meal slowly: It takes about 20 minutes for your brain to get the message that you have eaten enough and to then communicate that feeling of satisfaction (or fullness!) to your stomach. Put your fork or spoon down between bites of food, talk with others at the table, chew your food thoroughly, and drink liquids during meals to slow your rate of eating.
Drink plenty of non-calorie beverages each day. Interestingly, the feeling of thirst can sometimes impersonate that of hunger, so make sure you are drinking enough fluids every day.
Change your eating schedule, or create one that works. Skipping or delaying meals can result in overeating. If you skip meals often, try to eat on more of a schedule. You will then feel more satisfied with what you do eat.
Enjoy your food. Take the time at meals to simply enjoy what you are eating. Taking pleasure in what you eat will help you feel more satisfied.

Source: John Hopkins University

Tips for Spotting Risky Exercises

2008-09-21T03:33:00.000-07:00

Today's fitness professionals are becoming much more sophisticated about exercise recommendations and safety issues. We assess the safety of any exercise in terms of risk. There isn't the same long list of "bad" exercises; only exercises with a higher degree of risk of injury to an individual. It's also important to remember that what is safe for one athlete may cause an injury in another. In general high risk exercises require more fitness and skill to be done safely. Plyometrics, for example, are great for building explosive power, but only in a highly trained and fit athlete using perfect form. When performed by a beginner with limited skill or fitness, plyometrics may result in injury.

Tips for Recognizing Unsafe Exercises

It's best to learn about exercise safety from a pro, but you should also use common sense and avoid exercises that aren't right for your fitness level. Listen to your body and when in doubt, back off.

You can always increase your intensity during your next workout.

Unsafe or Dangerous Exercise Habits

Working Through Pain: Pain is your body's way of telling you something is wrong. Ignoring this message and pushing on is the fastest way to get a serious or chronic injury. Although it seems obvious to stop if you feel pain, many athletes exercise with pain. Don't. If you feel pain, stop what you are doing and rest.
Not Resting : Any exercise routine that lacks rest days is potentially unsafe. A large number of sports injuries are the result of overuse. These injuries occur from simply doing too much exercise. To avoid overuse injuries, balance rest days with exercise to allow the body to recover from the stress of training.
Doing Only One Type of Exercise : Doing the same exercise day after day may help you become very skilled at a sport, but it is another way to end up with an overuse injury. Stressing the same muscle groups and performing the same movement patterns repeatedly can put a tremendous amount of strain on muscles, tendons and ligaments, causing irritation, inflammation and even stress fractures. Even if you successfully avoid an overuse injury, you may end up with muscle imbalance, weakness, tightness and alignment problems. To avoid these problems, vary your exercise training routine. Do a variety of different types of exercise and cross train.
Performing Uncontrolled or Sloppy Movements: Sloppy or uncontrolled movements occur for a variety of reasons, including fatigue, lack of appropriate skill, going too fast, and a lack of attention. When you are exercising, it's essential to be in control of your body. Sloppy execution or poor control a set-up for injury. Even the safest exercise can become unsafe when done in an uncontrolled manner.
Forcing Unnatural Joint Movement : Any unnatural joint movements put you at high risk for an injury. Unnatural movements are typically caused by using a machine that isn't designed for your specific body shape or size and forces your joints to move in a way that doesn't follow your normal range of motion. One exercise that forces an unnatural joint movement is the behind the neck lat pulldown. This exercise works against the structural design of the shoulder joint. It puts unnecessary stress on the rotator cuff muscles and forces the shoulders to rotate externally, a position vulnerable to dislocation. Additionally, you are forced to drop the head forward to the chest during the movement, which causes additional neck strain. Instead of this unnatural and dangerous exercise, consider lat pulldowns to the front, which work with the body's natural range of motion.
Doing Too Much Too Soon : Gradually increasing both the time and intensity of exercise is the ideal way to allow the body to adapt, grow stronger and become more fit. However, pushing your body beyond its ability to adapt will result in illness or injury. Many beginners find this out the hard way. They go out too hard, too fast and too furious and end up sore, injured and hating exercise. Even elite athletes can fall into this trap by thinking that if they are extremely fit in one sport, they can do anything. Not so. No matter what level of ability they have in another sport, athletes can get injured if they attempt to perform an exercise that is beyond their fitness level for that particular exercise. Remember to be realistic when assessing your ability and skill level.
Using Poor Form or Technique: When you are new to exercise or learning a new routine, it's important to learn how to do the movements properly. Most people should get some professional coaching at the beginning of a new sport to learn the fundamentals and develop good habits. If meeting with a professional coach, trainer or instructor is not possible, at least take a look at some books or videos about sports technique and exercise form. Keep in mind that we are all unique and some movements may be better-suited to your abilities or biomechanics. An instructor can help you modify exercises to fit your unique needs.
Lifting Too Much: Any weight training exercise that is done with weights that are too heavy for you is risky. It's that simple. If you can't maintain proper form while lifting, the weights are too heavy for you.
Source
ACSM's Guidelines for Exercise Testing and Prescription, 7th Edition 2005. 2008 American Council on Exercise, Exercise Safety Guidelines

Hyperthyroidism and Pregnancy

2008-09-21T03:25:00.000-07:00

How common is hyperthyroidism in pregnancy?

Hyperthyroidism occurs in 2/1000 pregnancies in the United Kingdom. Graves hyperthyroidism (defined as hyperthyroidism that is the result of stimulation of the thyroid by thyrothrophin receptor stimulating antibodies (TRAb) is the commonest cause of hyperthyroidism in young women (about 85% of cases0 in the United Kingdom. The prevalence of undiagnosed hyperthyroidism in women is about 4.7/ 1000, and 0.2% of UK women have been previously diagnosed and treated.

In addition to true hyperthyroidism, the more common clinical entity of transient gestational hyperthyroidism may be seen particularly in the first trimester, with a prevalence in Europeans of 2-3% but a much higher prevalence in South Asian populations.

How does hyperthyroidism affect pregnancy?

Pre-eclampsia, heart failure, fetal loss, premature labour, and having a low birth weight baby are more likely to occur in untreated or poorly controlled thyro-toxic women.

Pre-term delivery, prenatal mortality, and maternal heart failure were more common in women who remained thyr-otoxic despite treatment or whose hyperthyroidism was first diagnosed during pregnancy.

Women with thyroid hormone resistance (where thyroid hormone and thyrotrophin concentrations are inappropriately high – that is, not due to auto-immunity) also have a high miscarriage rate.

Fetal and neonatal thyroid dysfunction.

If antibodies do not decline they will cross the placenta an stimulate the fetal thyroid, evidenced by signs of fetal hyperthyroidism such as tachycardia, intrauterine growth retardation, cardiac failure, and the development of fetal goiter.

Maternal euthyroidism is particularly important in the later stages of pregnancy, as poorly controlled hyperthyroidism can lead to suppression of the fetal pituitary thryroid axis resulting from placental transfer of thyroxine.

How does pregnancy affect hyperthyroidism?

A deterioration in previously diagnosed thyroid disease is not uncommon during the first trimester of pregnancy and may be due to an increase in the titre of TRAb concentrations or high levels of human chronic gonadotrophin acting as a thyroid stimulator.

Hyperthyroidism before pregnancy may remit during pregnancy but will recur in the postpartum period as the immune status reverts to a ThI state.

How is hyperthyroidism treated in pregnancy?

Prepregnancy planning and counseling

A women who knows she has hyperthyroid should seek prepregnancy advice.

Patients already treated for hyperthyroidism caused by Graves’ disease.

TRAb concentration should be measured early in pregnancy in a euthyroid pregnant women who has previously had surgery or radioiodine therapy. If the concentration is high at this time, the fetus should be evaluated carefully during gestation (with serial ultrasonography) and the antibodies measured again in the third trimester. If the TRAb concentration is high at 36 weeks, the neonate needs to be checked for hyperthyroidism after delivery.

Treatment of hyperthyroidism in pregnancy

At all stages of pregnancy antithyroid drugs are the preferred treatment. Radioiodine is contraindicated and surgery requires pretreatment with antithyroid drugs to render he patient euthyroid.

The thionamides Carbimazole, methimazole (the metabolite of Carbimazole, and propylthiouracil are all effective in inhibiting thyroidal biosynthesis of thyroxine during pregnancy. Propylthiouracil is the preferred drug in pregnancy as Carbimazole and methimazole are (albeit rarely) associated with teratogenic effects.

The starting dose of propylthiouracil is relatively high, 300-450 mg a day, up to 600mg daily if necessary, given in two to three divided doses. Some improvement is usually seen after one week of treatment with antithyroid drugs, but four to six weeks may be needed for a full effect.

B-adrenergic blocking agents such as propranolol may be used for a few to ameliorate the peripheral sympathomimetic actions of excess thyroid hormone, but prolonged use can result in restricted fetal growth, impaired response to hypoxic stress, postnatal bradycardia, and hypoglycemia.

Postpartum period
Breast feeding
As long as the doses of methimazole or propylthiouracil can be kept moderate (propylthiouracil < 250-300mg a day, methimazole <20mg a day) the risk for the infant is negligible, and no evidence based argument exists to advise mothers against feeding when they take an antithyroid drug.

Maternal and neonatal follow-up

The mother has a significant risk of exacerbation of hyperthyroidism postpartum, and thyroid function should be checked at 6 weeks and 3 months post delivery.

If a high TRAb concentration has been noted at 30 weeks, the neonate should be tested for hyperthyroidism after six hours and, if the mother has been taking an antithyroid drug up until delivery, the baby should be screened again several days later as he or she may well be euthyroid at birth but develop hyperthyroidism as the antithyroid drug is metabolized.

Mobile phones more dangerous than smoking

2008-09-12T01:28:00.000-07:00

Mobile phones could kill far more people than smoking or asbestos, a study by an award-winning cancer expert has concluded. He says people should avoid using them wherever possible and that governments and the mobile phone industry must take 'immediate steps' to reduce exposure to their radiation. The study, by Dr Vini Khurana, is the most devastating indictment yet published of the health risks. It draws on growing evidence – exclusively reported in the IoS in October – that using handsets for 10 years or more can double the risk of brain cancer. Cancers take at least a decade to develop, invalidating official safety assurances based on earlier studies which included few, if any, people who had used the phones for that long. Earlier this year, the French government warned against the use of mobile phones, especially by children. Germany also advises its people to minimise handset use, and the European Environment Agency has called for exposures to be reduced. Professor Khurana – a top neurosurgeon who has received 14 awards over the past 16 years, has published more than three dozen scientific papers – reviewed more than 100 studies on the effects of mobile phones. He has put the results on a brain surgery website, and a paper based on the research is currently being peer-reviewed for publication in a scientific journal. He admits that mobiles can save lives in emergencies, but concludes that 'there is a significant and increasing body of evidence for a link between mobile phone usage and certain brain tumours'. He believes this will be 'definitively proven' in the next decade. Noting that malignant brain tumours represent 'a life-ending diagnosis', he adds: 'We are currently experiencing a reactively unchecked and dangerous situation.' He fears that 'unless the industry and governments take immediate and decisive steps', the incidence of malignant brain tumours and associated death rate will be observed to rise globally within a decade from now, by which time it may be far too late to intervene medically. 'It is anticipated that this danger has far broader public health ramifications than asbestos and smoking,' says Professor Khurana, who told the IoS his assessment is partly based on the fact that three billion people now use the phones worldwide, three times as many as smoke. Smoking kills some five million worldwide each year, and exposure to asbestos is responsible for as many deaths in Britain as road accidents.