BLOOD GLUCOSE TEST STRIPS - How do they work? PART I

1. Insert a disposable test strip into the meter, automatically turning the meter on.
2. Lance the skin with a fine sharp to produce a small blood droplet, about one mm in diameter (volume = 0.3 to 5 µl)
3. Sample the blood with the test strip, attached to the meter.
4. The meter interrogates the strip in order to measure the blood glucose concentration, typically requiring about 5-10 seconds.

The test strips described in the above procedure can be either optical, in which glucose-derived electrons effect a change in the color of an indicating dye molecule, or electrochemical, in which case the glucose-derived electrons are routed directly through the external meter, and counted. For various reasons, including accuracy and the ability to measure extremely small blood volumes, electrochemical strips have gained the advantage in recent years, and now comprise a growing majority of the test strip market.

Components of a test strip

Automatic coding

Generally, calibration codes, corresponding to a particular batch of strips, are entered into the meter by the user, either manually or through insertion of a calibration “chip,” that accompanies the strip vial. However, it is desirable to entirely bypass this process, since user error is always a possibility. Therefore, some EBGTS do not require calibration of any sort. This is generally accomplished by:

1. Precise manufacturing control of the sensitivity of the produced strips, such that their performance is highly reproducible from batch to batch. In this process, strips are rejected, and disposed of, if their performance does not meet very stringent performance criteria.
2. Adding an indicating mark to the strip that the meter can use to assign a calibration code.

Both systems are currently in use, and automatically coded strips make up an increasing share of EBGTS

Copied by permission from the "Electrochemistry Dictionary" (http://electrochem.cwru.edu/ed/dict.htm) on "04/09/12." The original material is subject to periodical changes and updates.


Tomorrow we will discuss about the Electrochemical blood glucose test strips (EBGTS) - The newest and commonest type of strips used today

Magnetic resonance imaging (MRI) - the basics

An MRI machine uses a powerful magnetic field to align the magnetization of some atomic nuclei in the body, and radio frequency fields to systematically alter the alignment of this magnetization. This causes the nuclei to produce a rotating magnetic field detectable by the scanner—and this information is recorded to construct an image of the scanned area of the body. 

Image Courtesy: http://www.magnet.fsu.edu

Magnetic field gradients cause nuclei at different locations to rotate at different speeds. By using gradients in different directions 2D images or 3D volumes can be obtained in any arbitrary orientation.

MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart, and cancers compared with other medical imaging techniques such as computed tomography (CT) or X-rays. 

Unlike CT scans or traditional X-rays, MRI does not use ionizing radiation.

White rice vs. Brown Rice

Check this article in Medscape: 

White Rice Intake May Promote Higher Risk for Type 2 Diabetes 

THIS PROMPTED ME TO WRITE ABOUT BROWN AND WHITE RICE!




Brown rice (or "hulled rice") unmilled or partly milled rice, is a kind of whole, natural grain. It has a mild nutty flavor, is chewier and more nutritious than white rice, but goes rancid more quickly because the germ—which is removed to make white rice—contains fats that can spoil. Any rice, including long-grain, short-grain, or sticky rice, may be eaten as brown rice.

Brown rice and white rice have similar number of calories and carbohydrates. The main differences between the two forms of rice lie in processing and nutritional content.

When only the outermost layer of a grain of rice (the husk) is removed, brown rice is produced. To produce white rice, the next layers underneath the husk (the bran layer and the germ) are removed, leaving mostly the starchy endosperm.

Several vitamins and dietary minerals are lost in this removal and the subsequent polishing process. A part of these missing nutrients, such as vitamin B₁, vitamin B₃, and iron are sometimes added back into the white rice making it "enriched", as food suppliers in the US are required.

One mineral not added back into white rice is magnesium; one cup (195 g) of cooked long grain brown rice contains 84 mg of magnesium while one cup of white rice contains 19 mg.

When the bran layer is removed to make white rice, the oil in the bran is also removed. Rice bran oil may help lower LDL cholesterol.

Among other key sources of nutrition lost are small amounts of fatty acids and fiber

A: Rice with chaff
B: Brown rice
C:Rice with germ
D: White rice with bran residue
E: Musenmai (Japanese:無洗米), "Polished and ready to boil rice", literally, non-wash rice
(1):Chaff
(2):Bran
(3):Bran residue
(4):Cereal germ
(5):Endosperm

Running away from Runny Nose - Rhinorrhea

Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucous fluid. The condition, commonly known as "runny nose", occurs relatively frequently and is not usually considered dangerous. 

Rhinorrhea is a common symptom of allergies or certain diseases, such as the common cold or hay fever. It can be a side effect of crying, exposure to cold temperatures, or withdrawal, such as from opioids like methadone.

Treatment for rhinorrhea is not usually necessary, but there are a number of medical treatments and preventative techniques available.

The term was coined in 1866 and is a combination of the Greek terms "rhin-" meaning "of the nose" and "-rhoia" meaning "discharge or flow".

In most cases treatment for rhinorrhea is not necessary and will clear up on its own - especially if it is the symptom of an infection. For general cases, one may simply blow his or her nose to get rid of the mucus buildup. Alternatively, salinenasal sprays and Vasoconstrictor nasal sprays may also be used, but may become counterproductive after several days of use, causing Rhinitis medicamentosa.

In recurring cases, such as those due to allergies, there are medicinal treatments available. For cases caused by histamine buildup, several types of antihistamines can be obtained relatively cheaply from drugstores.

People who prefer to keep clear nasal passages, such as singers, who need a clear nasal passage to perform, may use a technique called "nasal irrigation" to prevent rhinorrhea. Nasal irrigation involves rinsing the nasal cavity regularly with salty water or store bought saline solutions

We will talk about nasal irrigation soon

AB-Yogurt helps!! ....Treatment Options - H.Pylori eradication

Helicobacter pylori eradication protocols is a standard name for all treatment protocols for peptic ulcers and gastritis; the primary goal is not only temporary relief of symptoms, but total elimination of Helicobacter pylori infection.

Definition

A good, clinically useful H. pylori eradication protocol is a treatment protocol, which ensures at least 80% H. pylori eradication rate, is not longer than 14 days (preferably 7 or 10 days) and is not too toxic (side effects should occur in not more than 10–15% patients receiving treatment by this protocol, and should not be so severe to warrant treatment discontinuation).

The treatment regimen should also be easy to follow by the patient, both human and canine, to improve or maintain high rate of treatment compliance.

During last decades, several new eradication protocols have been developed. This allowed clinicians to target several goals:

• improved treatment compliance;
• sharpened dietary component
• no need to strictly follow a diet, due to new proton pump inhibitor efficacy;
• decreased duration of therapy: from 14 to 7–10 days;
• decreased number of different tablets to ingest, due to combined standard preparations;
• decreased number of daily tablets from 4 times a day to twice-daily schemes;
• lessened toxicity and probability of side effects;
• improved clinical efficacy in terms of H. pylori eradication ratios;
• overcoming the problem of antibiotic resistance;
• satisfied the need for alternative protocols for those patients who are allergic to one of the standard antibiotics used in standard protocols.

Molecular model of H. pylori urease enzyme 

The standard first-line therapy is a one week "triple therapy" consisting of proton pump inhibitors such as omeprazole,lansoprazole and the antibiotics clarithromycin and amoxicillin. 

Variations of the triple therapy have been developed over the years, such as using a different proton pump inhibitor, as with pantoprazole or rabeprazole, or replacing amoxicillin with metronidazole for people who are allergic to penicillin. 

Such a therapy has revolutionized the treatment of peptic ulcers, and has made a cure to the disease possible; previously, the only option was symptom control using antacids, H₂-antagonists or proton pump inhibitors alone.

An increasing number of infected individuals are found to harbour antibiotic-resistant bacteria. This results in initial treatment failure and requires additional rounds of antibiotic therapy or alternative strategies, such as a quadruple therapy, which adds a bismuth colloid, such as bismuth subsalicylate.

 For the treatment of clarithromycin-resistant strains of H. pylori, the use of levofloxacin as part of the therapy has been suggested

An article in the American Journal of Clinical Nutrition found evidence that "ingesting lactic acid bacteria exerts a suppressive effect on Helicobacter pylori infection in both animals and humans," noting that "supplementing with Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) was shown to improve the rates of eradication of H. pylori in humans

This bacteria that causes ulcers may also play a role in the development of diabetes

Immunohistochemical staining of H. pylori from a gastric biopsy 

Helicobacter pylori (English pronunciation: /ˌhɛlɨkɵˈbæktər paɪˈlɔraɪ/; H. pylori),  is a Gram-negative, found in the stomach. It was identified in 1982  present in patients with chronic gastritis and gastric ulcers, conditions that were not previously believed to have a microbial cause. 

It is also linked to the development of duodenal ulcers and stomach cancer. However, over 80 percent of individuals infected with the bacterium are asymptomatic and it has been postulated that it may play an important role in the natural stomach ecology.

More than 50% of the world's population harbor H. pylori in their upper gastrointestinal tract. Infection is more prevalent in developing countries, and incidence is decreasing in Western countries. H. pylori's helix shape (from which the generic name is derived) is thought to have evolved to penetrate the mucoid lining of the stomach.

Doctors Yu Chen, PhD, and Martin Blaser, MD, in two large cohorts, Helicobacter pyloricolonization was positively associated with levels of glycosylated hemoglobin (HbA1c) 

The combination of H. pylori colonization and elevated body mass index was associated with higher HbA1c levels than either factor alone.

The findings come from a cross-sectional analysis of two cohorts from the National Health and Nutrition Examination Surveys -- NHANES III, conducted from 1988 to 1994, and NHANES 1999-2000.

The surveys are the only two of the NHANES series in which lab data on H. pylori status were collected, the researchers noted. NHANES III also collected data on the presence or absence of the H. pylori virulence factor cytotoxin-associated gene A (cagA).

For this analysis, Chen and Blaser studied 7,417 participants in NHANES III (18 and older) and 6,072 in NHANES 1999-2000 (3 and older) who had data available on H. pylori, HbA1c, and sociodemographic and lifestyle variables.

The researchers found no association between H. pylori and history of self-reported diabetes.

However, after excluding people with a history of diabetes and controlling for potential confounders, colonization with H. pylori -- and especially a strain with the cagA gene -- was associated with HbA1c levels.

Specifically:

1. In NHANES 1990-2000, the 2,403 participants who were H. pylori-positive had a mean HbA1c level of 5.49%, compared with 5.40% among the 3,669 who were not colonized.
2. The difference was significant at P=0.02 and remained significant after self-reported diabetics and insulin users were excluded.
3. The association was significant among those 18 and older (at P<0.01) but lost significance among those under 18.
4. In NHANES III, the overall difference in HbA1c levels was non-significant, but became significant (at P<0.01) when diabetics and insulin users were excluded.
5. In both cohorts, there was also an interaction between H. pylori and body mass index of 25 or higher -- increased HbA1c associated with having both H. pylori and higher BMI was greater than the sum of their individual effects.
6. The interaction was significant at P=0.04 in NHANES III and P<0.01 in NHANES 1999-2000.

In NHANES IIII, which assessed levels ofcagA, there was a progressive increase in average HbA1c levels when participants without H. pylori were compared with those with the bacterium but not cagA and those with both, the researchers said.

The trend overall was significant at P=0.02 and at P<0.01 when diabetics and insulin users were excluded.

The researchers cautioned that the study is cross-sectional and therefore can't say anything about causality. But reverse causation is unlikely, they said, simply because H. pylori is usually acquired in childhood.

In an accompanying editorial they stated that, people with H. pylori colonization and a higher body mass index -- even if they have no symptoms -- may need treatment to prevent or control diabetes.

But, they cautioned, the findings need to be confirmed and more study is needed -- especially in the form of randomized trials -- to tease out the effect of H. pylori treatment on diabetes and HbA1c levels.

We will talk about treatment of Helicobacter pylori soon

Williams syndrome

 Children with syndrome have a distinctive, "elfin" facial appearance, along with a low nasal bridge, an unusually cheerful demeanor and ease with strangers; developmental delay coupled with strong language skills; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia.


Williams syndrome is caused by the deletion of genetic material from the region q11.23 of chromosome 7.

Image Courtesy: http://geneticsf.labanca.net/

1 in every 20,000 live births. Williams syndrome is considered an autosomal dominant condition
The diagnosis is confirmed using one of two possible genetic tests: micro-array analysis or the fluorescent in situ hybridization (FISH) test. The FISH test examines chromosome #7 and probes for the existence of two copies of the elastin gene. Since 98-99% of individuals with Williams syndrome lack half of the 7q11.23 region of chromosome #7, where the elastin gene is located, the presence of only one copy of the gene is a strong sign of the disorder.  


The American Academy of Pediatrics recommends annual cardiology evaluations for individuals with Williams syndrome. Other recommended assessments include: opthalmologic evaluations, an examination for inguinal hernia, objective hearing assessment, blood pressure measurement, developmental and growth evaluation, orthopedic assessments on joints, muscle tone, and ongoing feeding and dietary assessments to manage constipation and urinary problems.


Support Group: http://www.williams-syndrome.org/what-is-williams-syndrome AND http://www.wsf.org/

Internet addiction disorder (IAD)

Internet addiction disorder (IAD), or, more broadly, Internet overuse, problematic computer use or pathological computer use, is excessive computer use that interferes with daily life


Over the past decade, the concept of Internet addiction has grown in terms of acceptance as a legitimate clinical disorder often requiring treatment

Internet Addiction Test

The Internet Addiction Test (IAT) is the first validated instrument to assess Internet addiction. Studies have found that the IAT is a reliable measure that covers the key characteristics of pathological online use. The test measures the extent of a client’s involvement with the computer and classifies the addictive behavior in terms of milled, moderate, and severe impairment. 

The IAT can be utilized in outpatient and inpatient settings and adapted accordingly to fit the needs of the clinical setting. Furthermore, beyond validation in English, the IAT has also been validated in Italy (Ferraro, Caci, D' Amico, & Di Blasi, 2007 and France (Khazaal et al., 2008) making it the first global psychometric measure.

The test consists of twenty questions with the responses graded out of 5, which produces a score from 0 to 100.

Brain Imaging on Adolescence with Internet Addiction Disorder - courtesy: http://english.wipm.cas.cn/rh/rp/201201/t20120121_81009.html - Dr. Lei Hao and colleagues found structural abnormalities in both white matter and gray matter of IAD adolescents’ brain, and most of them appeared in the left hemisphere. These discoveries could help understanding IAD.

Griffiths criteria

Mark D Griffiths' six criteria of Internet addiction are:

1. Salience: Using the Internet dominates the person’s life, feelings and behaviour.
2. Mood modification: The person experiences changes in mood (e.g. a ‘buzz’) when using the Internet.
3. Tolerance: Increasing amounts of Internet use are needed to achieve the same effects on mood.
4. Withdrawal symptoms: If the person stops using the Internet, they experience unpleasant feelings or physical effects.
5. Conflict: Using the Internet causes conflicts with those close to the person, or with their everyday life (e.g. their job, social life or hobbies).
6. Relapse: The addict tends to relapse into earlier patterns of behaviour, even after years of abstinence or control.

We will talk about dealing with this soon.... No turn off the computer and go enjoy some physical activity!

How does a nebulizer work?

In medicine, a nebulizer is a device used to administer medication in the form of a mist inhaled into the lungs.
Nebulizers use oxygen, compressed air or ultrasonic power to break up medical solutions and suspensions into small aerosol droplets that can be directly inhaled from the mouthpiece of the device. 

http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/


The definition of an aerosol is a "mixture of gas and liquid particles," and the best example of a naturally-occurring aerosol is mist, formed when small vaporized water particles mixed with hot ambient air are cooled down and condense into a fine cloud of visible airborne water droplets. 
When using a nebulizer for inhalation therapy with medication to be administered directly to the lungs, it is important to note that inhaled aerosol droplets can only penetrate into the narrow branches of the lower airways if they have a small diameter of 1–5 micrometers. Otherwise they are only absorbed by the mouth cavity, where the effect is low

Recent evidence show that nebulizers are no more effective than metered-dose inhalers (MDIs) with spacers and that MDIs may offer advantages in children with acute asthma

Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma

In acute asthma attacks higher doses of inhaled β2-agonists (reliever inhalers) are used to overcome the narrowing of the passages in the lungs. The medication can be given by wet nebulisation or from an inhaler with a spacer device (holding chamber). This review now includes in-patient studies, as well as those in casualty and community setting, comparing these two delivery methods in acute asthma attacks. In adults, no important differences were found between the two methods, whilst in children those randomised to wet nebulisation spent longer in casualty. Metered-dose inhalers with a spacer can perform at least as well as wet nebulisation in delivering β2-agonists in acute asthma.

Reference:

Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma

1. Christopher J Cates^1,*, 
2. Jacqueline A Crilly²,
3. Brian H Rowe³

Editorial Group: Cochrane Airways Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 21 JUL 2008

DOI: 10.1002/14651858.CD000052.pub2

FUNNY flu... facts

Structure of the influenza virion.

The word “influenza” comes from the Italian influentia because of the belief that the influence of the planets, stars, and moon caused the flu— reasons for sudden and widespread sickness


“Cures” for the Spanish flu included drinking whiskey, smoking cigars, eating milk toast, gargling with salt water, getting fresh air, and partaking of interesting concoctions like “Grippura.” Some doctors doused their patients with icy water while others “bled” their patients. Yet other doctors tried surgery by slicing open a patient’s chest, spreading his ribs, and extracting pus and blood from the pleural cavity (the cavity surrounding the lungs), which was almost always fatal in flu victims


The English adopted the word “influenza” in the mid-eighteenth century, while the French called it la grippe from gripper, meaning “to grasp or hook.” There is also a similar-sounding phrase in Arabic, anf-al-anza, which means “nose of the goat,” used because goats were thought to be carriers of the disease


Viruses (from the Latin virus meaning “poison, slimy liquid”) are much simpler than bacteria. Viruses are just inert bundles of genetic material encased in a shell called a capsid or a fatty membrane called an envelope. The flu, for example, is caused by an RNA virus of the family Orthomyxoviridae (from the Greek orthos meaing “straight” and myxa meaning “mucous”).

The source of flu vaccines are chickens and, consequently, vaccines can be dangerous to people who are allergic to eggs. Those people should never receive the injectable or nasal spray vaccine without doctor’s approval

Managing Jet Lag... Simple interesting solutions...

Before the flight

Attempt to partially adapt to the destination time zone in advance. This includes starting the daily routine one hour before or after one normally does during the week before departure. The use of a light box might help speed up the body's body clock adjustment significantly.

Light therapy or phototherapy (classically referred to as heliotherapy) consists of exposure to daylight or to specific wavelengths of light using lasers, light-emitting diodes, fluorescent lamps,dichroic lamps or very bright, full-spectrum light, usually controlled with various devices. The light is administered for a prescribed amount of time and, in some cases, at a specific time of day.

During the flight

One option to counteract jet lag is to break the trip into smaller segments if it is too long and stay overnight in some city. Additionally, it may be advisable to adjust sleeping hours on the plane to match the destination time.

Upon arrival

A helpful way to minimize jet lag is to adapt to the local time and eat accordingly. Also, exposure to sunlight during the day is helpful.

There seems to be some evidence that for most people, traveling west to east is more disruptive. This may be because most people have a circadian period which is a bit longer than 24 hours, making it easier to stay up later than to get up earlier

Gradual adjustment over the course of several days of the onset of sleep while maintaining its regular length of 7–8 hours can reduce fatigue and prevent depression. When the goal is to catch-up with local time (vs. fallback to), this can be aided by avoiding afternoon naps and eating an early and carbohydrates-rich, low-protein dinner.

Melatonin

A 2005 study showed that melatonin was effective in helping people fall asleep at doses of 0.3 milligrams (mg). Then, to treat the jet lag, the recommended dose of melatonin is 0.3–0.5 mg, to be taken the first day of traveling. Administration of higher doses can cause sleepiness, lethargy, confusion, and decreased mental sharpness

Fasting

A 2008 animal study suggested that lack of food helps to override the light-controlled circadian body clock. One of its authors suggested in a statement that "a period of fasting with no food at all for about 16 hours is enough to engage this new clock. The neat thing about this second clock is that it can override the main clock and you should just flip into that new time zone in one day". One approach to implement this would be to eat nothing on the plane and fast until it is breakfast time at the destination

Viagra

A recent study in hamsters showed that sildenafil citrate (known commercially as Viagra) aided in a 50% faster recovery from shifts comparable to eastward travel experienced by humans and was effective starting at low doses. However, this use has not been tested in humans and is considered an off-label use by the drug's manufacturers.

Circadian rhythm - What to do and When to do it BEST?

A circadian rhythm is any biological process which displays an endogenous, entrainable oscillation of about 24 hours. 
(Entrainment means that within the study of chronobiology, occurs when rhythmic physiological or behavioral events match their period and phase to that of an environmental oscillation) 


These rhythms are driven by (or composed of) a circadian clock, and rhythms have been widely observed in plants, animals, fungi and cyanobacteria. 


The term circadian comes from the Latin circa, meaning "around" (or "approximately"), and diem or dies, meaning "day". 
The formal study of biological temporal rhythms, such as daily, tidal, weekly, seasonal, and annual rhythms, is called chronobiology. 
Although circadian rhythms are endogenous ("built-in", self-sustained), they are adjusted (entrained) to the local environment by external cues called zeitgebers, commonly the most important of which is daylight.

Some features of the human circadian biological clock

ONCE THIS is understood - you will understand JET LAG better - Tomorrow!