Can mild air pollution be deadly ?

Heavy Industrial air pollution can be harmful to health.

Can even a mild level of air pollution be harmful to health?

Yes !

A study published in BMJ reports that “outdoor air pollution is associated with increased risk of death even at low pollution levels below the current European and North American standards and WHO guideline values”.

City dwellers need to be careful !

References

BMJ Research
Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1904 (Published 02 September 2021)
Cite this as: BMJ 2021;374:n1904

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Do poor sleepers die early ?

Yes !

If someone feels they are not having regular refreshing sleep, then it is bad news.

In a very large U.K. study, involving 487,728 people, the following question was asked: Do you have trouble falling asleep at night or do you wake up in the middle of the night?

About a quarter of people in study answered “never/rarely”; just under half answered “sometimes” and less than one-third reported “usually”.

The people in study were followed up for many years (mean follow-up time = 8.9 years)

The people who reported frequent sleep disturbances (“usually” category) were found to be at risk of dying early.

The risk was highest in those with both diabetes and frequent sleep disturbances.

It needs to be seen whether the sleep disturbance by itself led to early death or whether people who are going to die early have medical problems that cause them to have disturbed sleep !

Sleep well. Don’t compromise sleep time !

References

Associations between sleep disturbances, diabetes and mortality in the UK Biobank cohort: A prospective population-based study
Malcolm von Schantz, Jason C. Ong, Kristen L. Knutson
First published: 08 June 2021
https://doi.org/10.1111/jsr.13392

( UK Biobank study participants experiencing sleep disturbances: 24.2% “never/rarely” ; 47.8% “sometimes” and 28.0% “usually”)

BMJ Minerva. Cognitive decline . . . and other stories. BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1545 (Published 24 June 2021)
Cite this as: BMJ 2021;373:n1545

People who have trouble sleeping are at a higher risk of dying early – especially diabetics

NHS. Why lack of sleep is bad for your health

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Is drinking alcohol within guideline amount safe ?

No !

It would be a shock for many to hear that “No amount of alcohol is absolutely safe”.

A team at Imperial College London analysed MRI scans of heart, brain and liver of people who drink alcohol. They found that higher alcohol consumption was related to smaller brain, weaker heart and fatty liver.

They reported that “there is no ‘safe threshold’ below which there were no toxic effects of alcohol.

Previously other studies have also reported that there is no safe limit for alcohol!

In 2018, a Lancet study reported that the risk of death and risk of cancers increased substantially with increasing levels of alcohol consumption; and there was no safe limit below which there was no risk.

The message is “Avoid alcohol”

If you can’t, then atleast drink as little as possible.

References:

Alcohol consumption in the general population is associated with structural changes in multiple organ systems. Evangelos Evangelou, Hideaki Suzuki, Wenjia Bai, Raha Pazoki, He Gao, Paul M Matthews MD, PhD, Paul Elliott. https://doi.org/10.7554/eLife.65325

Does Drinking Within Low-Risk Guidelines Prevent Harm? Implications for High-Income Countries Using the International Model of Alcohol Harms and Policies
Adam Sherk et al. J Stud Alcohol Drugs. 2020 May

Lancet. GBD 2016 Alcohol Collaborators
Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.
Lancet. 2018; (published online Aug 23.)
http://dx.doi.org/10.1016/S0140-6736(18)31310-2

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Cancer and COVID-19

Cancer patients, as expected, did badly during the 1st wave of the COVID-19 pandemic

Data presented at ESMO ( European Society of Medical Oncology) shows that Cancers had – higher rates of Hospitalisation, higher risk of Complications and increased risk of Death.

Elderly cancer patients on the whole did very badly but surprisingly cancer patients under age of 50 did far worse than their peers without cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Immunotherapy not superior to Chemotherapy in 1st line treatment of bladder cancer

Immunotherapy has revolutionised the treatment of many advanced cancers such Skin cancer Melanoma and Kidney cancers.

Immunotherapy is a standard treatment for 2nd line treatment of bladder cancer.

Two recent trials presented at ESMO virtual meeting explored the use of immunotherapy in 1st line setting. (Pembrolizumab and Durvalumab).

Immunotherapy alone, or in combination with Chemotherapy was not superior even in patients selected by markers thought to favour immunotherapy alone.

For most bladder cancer patients immunotherapy remains a excellent 2nd line option or as a maintenance treatment option.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Hope and incurable Cancer: does hope torment or does it help to cope?

A diagnosis of incurable and advanced cancer is often a massive shock to everyone.

Should we ask them to face reality , accept death and extinguish all hope.

Or should we be offering hope of living a bit longer with treatments while being honest with prognosis.

Hope can be tormenting to some.

Hope can be comforting to some.

What are you views?

Contribute your views at online rapid response @BMJ journal

Don’t torment me with hope. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3016 (Published 09 September 2020)Cite this as: BMJ 2020;370:m3016

In defence of Hope: https://www.bmj.com/content/370/bmj.m3016/rr-3

Are Routine blood tests essential during follow up of low grade Lymphoma?

Bloods tests have the potential to pick up various abnormalities including cancer related abnormalities during follow up of cancers.

But , many patients would be surprised to know that there is ongoing debate about usefulness of routine blood tests atleast in some cancers !

In a recent study, Australian investigators assessed the role of routine blood tests during monitoring of patients with low grade lymphoma.

They found that routine blood tests rarely found or detected disease progression in patients who did not have any symptoms.

References

Routine Blood Tests in Asymptomatic Patients With Indolent Lymphoma Have Limited Ability to Detect Clinically Significant Disease Progression. DOI: 10.1200/JOP.19.00771 JCO Oncology Practice – published online before print June 25, 2020. PMID: 32584701

Effectiveness of Routine Blood Testing in Detection of Disease During Active Surveillance for Indolent Non-Hodgkin Lymphoma. By Matthew Stenger. Posted: 7/16/2020 1:40:00 PM . Last Updated: 7/29/2020 1:59:00 PM

Utility of Routine Surveillance Laboratory Testing in Detecting Relapse in Patients With Classic Hodgkin Lymphoma in First Remission: Results From a Large Single-Institution Study. DOI: 10.1200/JOP.19.00733 JCO Oncology Practice – published online before print May 5, 2020. PMID: 32369413

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Can a Protein rich diet lead to a longer life ?

Yes, a protein rich diet can lead a longer life and reduce risk deaths due to heart diseases.

Before you rush to relish your burger or steak , please note the evidence for beneficial effect is very much in favour of plant proteins than animal proteins.

So Befriend your Beans !

And Love your Lentils !

Reference

Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2412 (Published 22 July 2020)

Cite this as: BMJ 2020;370:m2412

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Health effects of vitamin and mineral supplements

In Western countries, upto two thirds of people take vitamin and mineral supplements regularly.

Many people think it’s common sense to take supplements. Many people don’t realise mega doses of vitamins can cause harm. Paradoxically the people who don’t have a healthy diet are less likely to supplements than those who have a well balanced diet.

A recent article in BMJ reviews the evidence regarding “Health effects of vitamin and mineral supplements” and concludes that “Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases”.

This article is certainly a “food for thought”

Reference

Food for Thought 2020. Health effects of vitamin and mineral supplements. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2511 (Published 29 June 2020). Cite this as: BMJ 2020;369:m2511

Skeie G, Braaten T, Hjartåker A, et al. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr2009;63(Suppl 4):S226-38. doi:10.1038/ejcn.2009.83 pmid:19888276

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

“Think Positive “ and live longer !

People with sunny disposition seems to live longer.

Having a positive outlook on life seems to protect heart.

Is it a case of “chicken vs egg” in that what came first. Do healthy people have a optimistic outlook and pessimistic people have lot of social, personal and health problems. Do life problems make people pessimistic or being optimistic makes one do better?

Researchers have adjusted the data for confounding factors. Evidence so far is very intriguing.

And the next question is – can one learn to be optimistic, change personality and have beneficial health effects. We don’t know at present.

References

1. Guardian. Optimists have lower risk of heart problems and early death.

2. Guardian. Optimism may hold secret to longer life, study suggests.

3. The association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA)

4. JAMA. Association of Optimism With Cardiovascular Events and All-Cause Mortality

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.