New tool helps predict mortality risk in dementia patients

Researchers have developed a A new tool that predicts risk of death and admission to a long-term care facility for patients with dementia may help conversations between health care providers, patients and their families. The research has been published in the CMAJ - Canadian Medical Association Journal.

The recent tragic outbreaks of COVID-19 in long-term care homes highlight the need to have care discussions with residents and their caregivers.

"The majority of residents in long-term care homes have been diagnosed with dementia. Our study shows that the survival of many people with dementia is poor. It may be that many would choose care that focuses on comfort care and quality of life should they become acutely ill," says Dr. Peter Tanuseputro, a family physician and researcher with the Bruyère Research Institute, the Ottawa Hospital Research Institute and ICES, Ottawa, Ontario.

 

We have developed a tool that asks simple questions about a person at the time of dementia diagnosis and translates it to the chance of dying and of entering a nursing home over the next 5 years. This information can be used in conversations about what to expect," says Dr. Tanuseputro. "For newly diagnosed dementia patients and their families, personalized information about their trajectory may be helpful to plan for the future, including advance care planning and planning for additional supports."

The study used linked data from ICES on more than 108 000 people living in the community in Ontario who were newly diagnosed with dementia from 2010 through 2012.

 Researchers found that more than half of individuals (55%) died within 5 years -- comparable to many cancers -- and almost half of those who died (28%) lived in institutions. Only 1 in 4 people were still alive and living in the community 5 years after diagnosis.

Older age, male sex and presence of chronic obstructive pulmonary disease (COPD), congestive heart failure and kidney failure at the time of diagnosis of dementia were the most important factors that predicted death and admission to long-term care. The impact of organ failure on prognosis in people with dementia has not been well documented in other studies.  

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Eating Disorders - How To Get Rid Of Them?

While eating is one of the most important methods to survive, as it the fuel for the body, there are people who have issues related to eating. While some tend to avoid food, others tend to overeat and some tend to binge on certain types of foods. The two extremes of avoiding food and overeating,   known as anorexia nervosa and bulimia nervosa respectively are the most common types of eating disorders. In both cases, it is not just about food.
In each of the individual with an eating disorder, there is always an underlying psychological problem, depression, anxiety or substance abuse. As the eating disorder is just one of the manifestations, the underlying problem needs to be addressed for the eating disorder to completely disappear. Else, there are chances that it may resurface again in a while. Treating an eating disorder requires various approaches in addition to just managing the eating pattern. Read on to know the most common five methods.

1. Nutritional counselling: In people with eating disorders, the person begins to believe that he/she is eating a healthy diet. The counsellor tries to break this belief and instil healthy eating habits. This helps in complete recovery and is essential for the long-term success of treating the disorder. In some severe cases, even the family members may be involved in this counselling.
2. Psychotherapy: This again helps the affected individual understand the reason behind the altered eating patterns. Exploring the causes and understanding the disorder helps prevent relapse after initial treatment. Additionally, strained relationships, anxiety, depression, and stress management are also addressed through psychotherapy. Success of treating an eating disorder often lies in managing the coexisting mental conditions.
3. Cognitive behavioral therapy: This is one of the main modalities of treating an eating disorder and it is a very structured program. It might sometimes involve the close family members also and addresses unhealthy thought patterns that lead to the disorder. The person becomes aware of why he/she is eating abnormally and tries to make a conscious change to it.
4. Co-Medical conditions: In patients with anorexia, the consciously reduced food intake can have severe effects on the other body organs including anaemia, low blood pressure, fatigue, vital organ failure, and overall low energy levels. A thorough evaluation and treatment to manage these conditions are essential before putting the person on a course correction of the eating disorder.
5. Medications: Medications are essential to not treat the eating disorder per se, but to manage the other conditions. Whether it is medical conditions like anaemia and low blood pressure or psychological conditions like anxiety or depression, medications are used to manage these.

In more severe cases, the person may be required to undergo a residential program to overcome abnormal eating tendencies.

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Malaria - Know Symptoms Of It!

Mosquitoes might be tiny creatures but are responsible for some of the most dreadful diseases, one of them is malaria. Malaria is caused by a parasite that is transmitted through mosquito bites directly or from mother to unborn baby and through blood transfusions. Very widely spread in the Asian and African continents, people travelling here are very cautious of this disease. In areas that are notorious for mosquito infestations, the local people also take preventive measures to ensure mosquito breeding is prevented or at least minimised.

Spread of the disease: When a mosquito bites an infected person, it picks up the parasite from the person and when it next bites another person, the infection is also transmitted. From there, the parasite travels to the liver and into the bloodstream before reaching another individual. While all people are prone to getting the infection, elderly people, children, pregnant women, and immunocompromised people are at greater risk. Also, new travellers are at greater risk than local people, who are to some extent immune to mosquito bites.

Symptoms: The disease is characterised by moderate to severe shaking chills which are more common in the evening, high fever, profuse sweating, headache, vomiting , and diarrhea. Quite often, there is about a 4-week gap between the time of the mosquito bite and the onset of symptoms. 

However, in many people, the disease could lie dormant and symptoms manifest when the immunity is severely lowered.

With the gradual progression of the disease, more severe symptoms could evolve as below, and that is when malaria becomes life-threatening.

1. Cerebral malaria: Once the parasites enter the bloodstream, they can block the minor blood vessels in the brain leading to cerebral oedema and even brain damage. It could eventually result in coma.
2. Anaemia: There is large-scale destruction of red blood cells, leading to severe anaemia and weakness and fatigue.
3. Breathing problems: Similarly, accumulation of fluid in the lung spaces can lead to pulmonary edema which causes difficulty breathing and lung failure.
4. Organ failure: Blood flow blockage to other vital organs like kidneys, liver, and spleen are also possible. The spleen may rupture leading to severe hemorrhage.
5. Low blood sugar: The malarial parasite per se and the most commonly used medicine (quinine) are both known to cause low blood sugar levels. This can result in coma and even death.

Once the diagnosis is confirmed, treatment usually consists of chloroquine, Metfloquine, quinine sulfate, or hydroxychloroquine. There are various drug-resistant forms of malaria, and they may require combination therapy.

Prevention assumes greater significance with travellers going for vaccines prior to visiting these areas. Even the local people should find ways to avoid breeding of mosquitoes, use mosquito repellents and nets to avoid the infection.

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Low-fibre, high-fat diet may up severe sepsis risk

Consuming a Western diet, low in fibre and high in fat and sugar, can put you at increased risk of developing severe sepsis, researchers say.

The study, found mice that were fed the Western diet showed an increase in chronic inflammation, sepsis severity and higher mortality rates than mice that were fed a normal diet.

Sepsis is a potentially life-threatening condition caused by the body’s response to an infection. It can lead to shock and organ failure. It is one of the most common cause of death worldwide.

According to the researchers, the mice had more severe sepsis and were dying faster because of something in their diet, not because of the weight gain or microbiome, the body’s community of bacteria.

“The mice’s immune system on the Western diet looked and functioned differently. It looks like the diet is manipulating immune cell function so that you are more susceptible to sepsis, and then when you get sepsis, you die quicker,” Napier said.

The researcher said the findings can help hospitals better monitor the diets of patients in the intensive care unit (ICU) since they are already the ones most likely to develop sepsis.

“If you know that a diet high in fat and sugar correlates with increased susceptibility to sepsis and increased mortality when those patients are in the ICU, you can make sure they’re eating the right fats and the right ratio of fats,” she said.

“If you could introduce a dietary intervention while they are in the ICU to decrease their chances of manipulating their immune system in that way, you can somehow influence the outcome,” she added.
The team also identified molecular markers in Western diet-fed mice that could be used as predictors or biomarkers for patients that are at high risk for severe sepsis or patients that may need more aggressive treatment.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                    PS- THOSE INTERESTED IN RECIPES ARE FREE TO  VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/       

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Be Aware of the Symptoms of a Heat Stroke

Summer is the favorite season for many. Most people spend most of their days lazing at the beach and tend to adopt more of a relaxed lifestyle. One thing most do miss though are their long runs and weekend hikes. But, at this time of year, when temperatures and humidity levels soar, our risk of heat exhaustion, or worse, heat stroke, increases. And while this is a likely concern for the elderly, the heat can take its toll on the young too. 

Heat stroke is a life-threatening issue if you suffer from conditions like high blood pressure, thyroid disease or diabetes. It also means that you're more susceptible to a heat stroke, as well as other issues like eating disorders or a high BMI. Taking medications with stimulants may also put you at risk of heat stroke.

As such, scorching summer temperatures do not guarantee that you will have a heat stroke, however, the closer the outside temperature gets to your body temperature, the higher your risk is. At this time of year, it is therefore better to exercise with the air-conditioner on, particularly when heat levels soar to the 90s or 100s. Nevertheless, it is always useful to know how to prevent an emergency such as this, as typically, someone doesn't just have a heat stroke out of the blue in a matter of minutes. 

These warning signs will tell you to slow down:

 

1. Your body temperature soars

You may be familiar with heat exhaustion, which is worrisome, but less extreme when compared to heat stroke. Whereas the latter body temperature usually maxes out at 102°F, someone suffering from a heat stroke will likely have their body temperature at 105°F or higher! As your temperature rises, your skin may flush red and your heart could start racing as it tries to cool your body down. 

2. Your organs start to fail

Once your body temperature soars to 105 and over, your organs can shut down. The kidneys, the liver, the heart and the brain can be affected. If your kidneys start to fail you may spot red urine. 

3. You feel nauseated

One of the most common symptoms of heat exhaustion is feeling queasy, accompanied by other signs such as fatigue and vomiting. If recognized early, head to a cool place and replenish lost fluids and electrolytes by having a sports drink. 

4. You are confused

Another marker of a heat stroke are changes in mental status, confusion and delirium. The changes also indicate that you have moved from heat exhaustion to a life-threatening heat stroke. 70% of people who get to this stage can die from it. By this point, you won't be able to converse or think clearly enough to step away from the heat and get the help you need. If you ever feel slightly woozy, move indoors as soon as possible.

Other symptoms may include:
Throbbing headache
dizziness and light-headedness
hardly sweating despite the heat
Red, hot, and dry skin
Muscle weakness or cramps
Rapid heartbeat, which may be either strong or weak
Rapid, shallow breathing
Behavioral changes such as confusion, disorientation, or staggering
Seizures
Unconsciousness

First Aid

If you suspect that someone has a heat stroke, immediately call 911 or transport the person to a hospital. Any delay seeking medical help can be fatal.
While waiting for the paramedics to arrive, initiate first aid. Move the person to an air-conditioned environment -- or at least a cool, shady area -- and remove any unnecessary clothing.
If possible, take the person's core body temperature and initiate first aid to cool it to 101 to 102 degrees Fahrenheit. (If no thermometers are available, don't hesitate to initiate first 
aid.)
Try these cooling strategies:
Fan air over the patient while wetting his or her skin with water from a sponge or garden hose.
Apply ice packs to the patient's armpits, groin, neck, and back. Because these areas are rich with blood vessels close to the skin, cooling them may reduce body temperature.
Immerse the patient in a shower or tub of cool water.
If the person is young and healthy and suffered heat stroke while exercising vigorously -- what’s known as exertional heat stroke -- you can use an ice bath to help cool the body.

Do not use ice for older patients, young children, patients with chronic illness, or anyone whose heat stroke occurred without vigorous exercise. Doing so can be dangerous.
If emergency response is delayed, call the hospital emergency room for additional instructions.

Risk Factors for Heat Stroke

Heat stroke is most likely to affect older people who live in apartments or homes lacking air conditioning or good airflow. Other high-risk groups include people of any age who don't drink enough water, have chronic diseases, or who drink excessive amounts of alcohol.

Heat stroke is strongly related to the heat index, which is a measurement of how hot you feel when the effects of relative humidity and air temperature are combined. A relative humidity of 60% or more hampers sweat evaporation, which hinders your body's ability to cool itself.

The risk of heat-related illness dramatically increases when the heat index climbs to 90 degrees or more. So it's important -- especially during heat waves -- to pay attention to the reported heat index, and also to remember that exposure to full sunshine can increase the reported heat index by 15 degrees.

Other risk factors associated with heat-related illness include:
Age. Infants and children up to age 4, and adults over age 65, are particularly vulnerable because they adjust to heat more slowly than other people.
Health conditions. These include heart, lung, or kidney disease, obesity or underweight, high blood pressure, diabetes, mental illness, sickle cell trait, sunburn, and any conditions that cause fever.

Medications-It includes antihistamines, diet pills, diuretics, sedatives, tranquilisers, stimulants, seizure medications (anticonvulsants), heart and blood pressure medications such as beta-blockers and vasoconstrictors, and medications for psychiatric illnesses such as antidepressants and anti-psychotics. Illegal drugs such as cocaine and methamphetamine also are associated with increased risk of heat stroke.

People with diabetes -- who are at increased risk of emergency room visits, hospitalization, and death from heat-related illness -- may be especially likely to underestimate their risk during heat waves, according to a recent study.

Check with your doctor to see if your health conditions and medications are likely to affect your ability to cope with extreme heat and humidity.

Prevention-
When the temperature is high, it's best to stay in an air-conditioned environment. If you must go outdoors, you can prevent heat stroke by taking these steps:
Wear lightweight, light-colored, loose-fitting clothing, and a wide-brimmed hat, or carry an umbrella.

Use a sunscreen with a sun protection factor (SPF) of 30 or more.

Drink more fluids. To prevent dehydration, it's generally recommended to drink at least eight glasses of water, fruit juice, or vegetable juice per day. As heat-related illness also can result from salt depletion, it may be advisable to substitute an electrolyte-rich sports drink for water during periods of extreme heat and humidity.

Take additional precautions when exercising or working outdoors.The general recommendation is to drink 24 ounces of fluid two hours before exercise, and consider adding another 8 ounces of water or sports drink right before exercise. During exercise, you should consume another 8 ounces of water every 20 minutes, even if you don't feel thirsty. Best is to exercise early morning, when the temperature will not be so high.

Symptoms and Treatment

Monitoring the color of your urine. Darker urine is a sign of dehydration. Be sure to drink enough fluids to maintain very light-colored urine. 

Measuring your weight before and after physical activity. Monitoring lost water weight can help you determine how much fluid you need to drink.

Avoid fluids containing caffeine or alcohol, because both substances can make you lose more fluids and worsen heat-related illness. Also, do not take salt tablets unless your doctor has told you to do so. The easiest and safest way to replace salt and other electrolytes during heat waves is to drink sports beverages or fruit juice.

Check with your doctor before increasing liquid intake if you have epilepsy or heart, kidney, or liver disease; are on fluid-restricted diets; or have a problem with fluid retention.

If you live in an apartment or house without fans or air conditioning, try to spend at least two hours each day -- preferably during the hottest part of the day -- in an air-conditioned environment. At home, draw your curtains, shades, or blinds during the hottest part of the day, and open windows at night on two sides of your building to create cross-ventilation.

After you've recovered from heat stroke, you'll probably be more sensitive to high temperatures during the following week. So it's best to avoid hot weather and heavy exercise until your doctor tells you that it's safe to resume your normal activities. 

HIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                                                                                                                                                                                                                            PS- THOSE INTERESTED IN RECIPES ARE FREE TO  VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/   

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