AN ORANGE A DAY KEEPS THE DOCTOR AWAY

We have all heard of the saying that an apple a day keeps the doctors away. There is some truth in this statement of old. Orange is slightly better than apple.
The Feb 23rd edition of STROKE on-line, carries a study by Dr Aedin cassidy of east Anglia University, UK. She was reporting on the follow-up of the Nurses' Health Study. The Nurses' Health Study is a very big study, started in 1990, to follow-up nurses and see their health profile over the many years. One of the items under study was food. From 1990, the Nurses in the study were asked to fill in a "Food Frequency Questionaire ( FFQ )". Every 4 years, they were asked to fill in new ones, as a follow up. Over the years of follow up, all hospital admissions and deaths were recorded from hospital records. 69,622 nurses met the criteria from their baseline FFQ. After 30 years, there were 1803 strokes, of which 943 were ischemic strokes, 253 hemorraghic strokes and 607 strokes could not be accurately determined. When they match the strokes to their fruit intake, they found that consuming citrus fruits, especially fresh orange and apples, had a 19% reduction in the number of ischemic strokes over the 30 years. Even fresh fruit juices were good. Although blueberries, teas and dark chocolates were good, but they were not as good as fresh citrus fruits. It was quite surprising that dark chocolates did not make much of a difference in stroke prevention, as oppose to some other studies.
It could be that fresh citrus fruits are rich in anti-inflammatory substances, which may reduce the risk of atherosclerosis. there was no difference in the number of hemorraghic strokes. It may be that fresh citrus fruits contain significant amount of potassium, and so their BP control was better.
It is important to note that canned and package fruit juices do not confer the same benefit. The sugar added raises the incidence of diabetes which seem to negate the benefit of the fresh citrus fruits.
Yes, there is some truth that an orange or apple a day, or a cup of fresk citrus fruit juice a day keeps the doctor / neurologist away.

MORE NEWS FOR THE FEMALE GENDER: HEART ATTACKS IN FEMALES

As I was reading, I cam across this article, on females and heart attacks. Dr canto, from the Watson Clinic and Lakeland Regional medical Center, published their findings in the Journal of the American Medical association, 22nd Feb 2012. They examined the National registry of Myocardial Infarction from 1994 -2006. All in all, in the registry, there were 1,143,513 heart attacks. They compiled the numbers and this is how it turned out.

Results ( tabulated summary ) from Dr Canto’s study

	Females	Males
Age at presentation	74yrs	67yrs
Presenting without chest pains	42%	30%
In hospital mortality	14.6%	10.3%

What this would mean would be that, females tend to present later. Maybe they do not have the typical chest pains symptoms. More of them do not have typical chest pains and that more of them die, maybe because their presentation was missed upon admission, so that the diagnosis is delayed, or that they are more sick, by the time they present. It is certainly interesting to postulate on the reasons why. Is Heart attack a sexist disease. If not the disease itself, the caregiver bias?

I suppose this article teaches me that I must have a high index of suspicions when females with important risk factors present to me, and I must make sure that I take a good history and do an ECG, if not also the cardiac enzymes.

NEW CORONARY RISK FACTORS FOR WOMEN

In our attempt to prevent heart disease, more and more emphasis have rightly been placed on identifying coronary risk factors, since we cannot cure the disease. Women have traditionally been thought to be somewhat protected from premature CAD by the estrogen in their system. At least until menopause that is.
Well, there is this study, by Dr Abigail Fraser, in the 12th Feb issue of Circulation, which reported his observations that gestational diabetes and pre-eclampsia are also coronary risk factors. Dr Fraser and colleagues from the University of Bristol, UK, followed up for 18 years, 3,416 ladies ( they were part of the Avon Longitudinal Study of Parents and Children, ALSPAC cohort ) , who had gestational diabetes, and pre-eclampsia and found that after 18 years they had a 30% increas incidence of CAD compared to those who did not. Mind you, these ladies were mean age 48 years old at the end of follow-up. Those who had small for age babies were found to have a 10% increase risk after 18 years.
Gestational diabetes, increases coronary risk mainly due to diabetes mellitus per se, whereas those who had pre-eclampsia, seem to have more complicated relationship to CAD, from hypertension, obesity, metabolic syndrome, etc..
The message would be that those who have gestational diabetes, pre-eclampsia, and small for age babies, should let their doctors know, as part of their history taking and doctors must learn to look for these factors, as it should be factored in, in their risk profile assessment.
So ladies, stay healthy please.

OVER THE WEEKEND

I spend my weekend conducting the " Weekend seminar in Cardiology for GPs 2012" It went very well. We had 800 pre-registered. On Saturday afternoon, at the peak, we had about 600 in the room, and on Sunday, about 300. the numbers were a little down from last year, maybe 5%. The use of the interactive pads was very well received. We work hard and executed it smoothly. The delegates like it. Now they can test themselves without anonymously. All the speakers arrived on time. Some of them spoke too long, but overall time keeping was reasonable. The sponsors were happy. I could see that some were doing brisk business selling digital BP sets.

I left at about 1PM to drive down to Ipoh to speak at the 1Care Public forum there. It was held in Rayan Hall, Jln Tun Perak. About 150-200 people came. there were 3 MPs there from PKR, Socialist Party and also PAS. So they heard all the information. What was disappointing was that MOH again failed to show, and the organisers said that although the letter of invitation was send, they did not receive any reply. At least in Selangor / KL, they replied that they are not able to send a representative. In Ipoh, no reply. I wonder what they mean by saying that they will engage with the people.
The road-show next goes to Kuantan. We are preparing for the 1Care public forum in Kuantan I think on the 4th March. I will post the flyer, once we I receive it. Again MOH is invited. Let us see if they will show up?

IPOH HEALTHCARE FORUM ON 1CARE

PLEASE INVITE ALL YOUR FRIENDS IN THE IPOH AREA AND KINTA VALLEY TO ATTEND.
WE NEED TO SPREAD THE WORD.
ALL MALAYSIANS MUST KNOW ABOUT 1CARE

WEEKEND SEMINAR IN CARDIOLOGY FOR GPs 2012

Just a reminder that this weekend is the " Weekend Seminar in cardiology for GPs 2012" at the Sime Darby Convention Center, 18th-19th Feb 2012. The meeting starts with a Lunch Symposium at 12.45pm on 18th Feb. Admission is free. This meeting is for registered medical practitioners only. Not for the lay public.
After the seminar on 19th Feb, I will go to Ipoh to speak at the Ipoh Healthcare Forum.

HEALING THE INFARCTED HEART. THE CADUCEUS TRIAL

The latest Lancet online 14th Feb 2012, carries an important paper. The Cedar Sinai group, under Prof Eduardo Marban, undertook a study to see the safety of infusing stem cells into an infarcted area. It is a small study, about 25 patients who had an acute heart attack. The study involves harvested autologous cardiosphere derived stem cells from endomyocardial biosy, and infusing the stem cells into the infarct related artery after about 1.5-3 months of the index heart attacks. Their objective was not efficacy and recovery ( the sample size is too small for that ), it was to see if it is safe, as previous studies have shown that infusing stem cells could be hazardous as some have developed sudden cardiac death and also other forms of malignant arrhythmia s.
After 6 months of follow-up, the researchers found that it was safe. No patients died. The MACE in both groups were identical. There were no cardiac tumours detected. 4 patients in the treatment arm had some serious adverse. The authors did not say what events. The cardiac MRI done at 6 months seemed to suggest that the infarcted regional wall motion abnormality was improved, and also the infarcted segment seemed smaller. With such a small size, these findings must be seen to be preliminary and much more work with larger numbers needed to be done , before we can know for sure that Stem Cells helps to heal the infarcted heart.
In fact such studies are on the way, and we await the results.
Another small but important step towards healing the infarcted heart.

SELANGOR / KL HEALTHCARE PUBLIC FORUM 12th Feb 2012

The forum went well. we started about 15 mins late, as the large crowd arrived and registered slightly slow. At peak, the attendance was about 550 in the main hall and about 100-150 in the hall below ( connected by in house live transmission ), so around 650-700 attendance.

The MB opening address was long but entertaining. The lesson learn was that if given to the BN government, 1Care may go the way of Corporatisation of Water ( Puas, Syabas ). He said that the syabas CEO was drawing RM700,000 a month. You can imagine the 1Care CEO drawing RM 1M a month.
Dr Xavier spoke, then me and then Dr Jayabalan. Giving the facts ( me ), and how the politicians ( Dr Xavier ) sees it and how the consumer ( Dr Jayabalan ) see it.
Many in the room were wondering what we should do next? We were under pressure of time, so question time had to be somewhat curtailed. We finished at about 6.45pm.

As for us the campaign goes to Ipoh next sunday.
We want the whole country to know about the 1Care 1 Malaysia Healthcare Transformation. Let the rakyat know and let the rakyat decide.

SELNGOR / KL HEALTHCARE PUBLIC FORUM. 12th Feb 2012, 4-6pm, GLOBAL BUSINESS AND CONVENTION CENTER, PJ sec 19/1

COME ONE COME ALL.

Malaysia - 1 Care a ‘done deal’ despite ministry assurances, source says @ Fri Feb 10 2012

www.themalaysianinsider.com

THE ROLE OF IMMUNITY IN CORONARY ARTERY DISEASE.

The 9th Feb issue of the Lancet online, carries an interesting article on immunity and CAD. Led by Dr Maceij Tomaszewski from University of Leicester, the researches looked into the chromosomal types of patients who were under clinical study for CAD prevention. They examined the y chromosome ( the male chromosome ) of 3,233 individuals under study for other clinical trials, and found that 90% of them had haptogroup 1 or haptogroup R1b1b2 on their Y chromosomes. Amongst those with haptogroup 1, there was a 50% increase incidence of CAD. It is likely that these haptogroup 1 gene acts through the immune sustem, to increase our susceptibility for CAD
This findings is very interesting from 3 points of view.
1. We know that there are haptogroup 1 in the Y chromosomes that may increase our incidence of CAD. Therefore, we can then produced targetted therapy, using genomics.
2. We also know now that deranged immunity may play a role in CAD pathogenesis. We have always suspected this for a long time. This also opens another therapeutic frontier.
3. We can now identify people at risk of CAD and profile them together with the usual CAD risk factors of hypertension, diabetes, cigarette smoking and dyslipidemia.
Of course there is much more work that needs be done, before we can use these facts to our patients benefit.
Dr Maceij and colleagues have begun the first step.