google7fe7e6420122196f.html Preventive Medicine: November 2008

Saturday, November 29, 2008


today, i'm going to attend infertility simposium in my city. So, i want to post a topic about infertility prevention, hehe, yup i just want to be prepared for the simposium.hope it's helpful.

infertility prevention

As we know, most types of infertility cannot be prevented. Here are some facts from CDC (Centre for Disease Control)

  •  Smoking has been linked to low sperm counts and sluggish sperm movement in men, and an increase in miscarriage in women. 
  • Alcohol (especially binge drinking or chronic abuse), affects the fertility of both men and women trying to conceive either naturally or through infertility treatments. Alcohol is toxic to sperm; it reduces sperm counts, can interfere with sexual performance, disrupt hormone balances and increase the risk of miscarriage. 
  • Other useful methods include meditation, relaxation, moderate physical activity and yoga. 
  • A well-balanced diet includes carbohydrates, protein and fibre. All women should increase folic acid intake (found in green leafy vegetables, fruit, cereals, but also available as supplements) prior to and during the first three months of pregnancy, to reduce the risk of neural tube defects such as spina bifida. Women trying to get pregnant may want to limit caffeine intake to no more than 250 milligrams of caffeine a day (one or two cups of coffee).
  • Excessive excersise can lead to menstrual disorders in women and affect sperm production in men due to the heat build-up around the testicles.
  • Avoid environmental poisons and hazards such as pesticides, lead, heavy metals, toxic chemicals, and ionising radiation. Check with your doctor that any medication or herbal remedies (prescribed or over-the-counter) that you may be taking do not affect fertility. Give up recreational drugs such as marijuana and cocaine as these have been linked to low sperm counts in men and infertility in women.
  •  Limit sex partners and use condoms to reduce the risk of getting a sexually transmitted disease (STD). STDs that go undetected and untreated can damage the reproductive system and cause infertility. If you think you may have an STD, get treatment promptly to reduce the risk of damage to your reproductive system.
  • Maintain a body weight close to the ideal for your height to reduce the possibility of hormone imbalances. Being overweight or underweight can affect your hormone production and cause infertility.
and if you want to know some of drugs that are usually prescribed for infertility problem, you can see the list here 

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Friday, November 28, 2008

Secondary Stroke Prevention of Among People With TIA and Stroke

The principle aims in treating stroke are three-fold: (1) to reopen an occluded cerebral artery (thrombolysis), (2) to provide protection against the metabolic cascade caused by ischemic injury leading to neuronal death (neuroprotection), and (3) to prevent recurrent stroke (secondary prevention). Secondary prevention of stroke is the most important of these three since neither thrombolysis nor neuroprotection are currently practical in the majority of patients

Blood Pressure Reduction

Among the 12,000 people who have had previous TIA or stroke (in a population of 1 million people), about 6,000 (50%) have hypertension.Lowering the blood pressure of these 6000 hypertensive TLA/stroke patients by 5-6 mm Hg diastolic and 10-12 mm Hg systolic for two to three years would reduce the annual incidence of stroke in these people from about 7% (n = 420 strokes) to 4.8% (n = 288) (relative risk reduction: 28%, 95% CI: 15%–39%),53 assuming they have the same rate of stroke as individuals who do not have hypertension .This reduction of about 132 strokes per year is 6.6% all (2000) strokes occurring in the population each year. Treating 45 hypertensive TLA/stroke patients for one year (at least) would avoid one stroke each year.

Cigarette Smoking

About 30% (3,600) of TIA/stroke patients are cigarette smokers. Although there have been no randomized trials, observational studies suggest that if all 3,600 TIA/stroke patients who smoke were to stop smoking, the annual number of strokes could be reduced by at least one-third, from about 7% (252) to 4.7% (169), avoiding about 83 strokes each year (4.1% of all strokes). This means that 43 people with TIA/stroke need to stop smoking avoid one stroke of any type each year.

Aids to stop smoking may be required, such as counseling, nicotine gum, or skin patches.

Cholesterol Reduction
TIA/stroke patients, trials in different patient populations suggest that lowering serum cholesterol over a few years years with hydroxymethylglutaryl coenzyme A reductase inhibitors (or “statin” drugs) could reduce the number of strokes by about 24% (95% CI: 8% to 38%), from 7% (336) to 5.3% (255) per year. This reduction, of about 81 strokes, would be 3.4% all (2000) strokes in the population each year. About 59 TIA/stroke patients with hypercholesterolemia would need to be treated effectively avoid one stroke each year.


Antiplatelet Therapy

Antiplatelet therapy is appropriate for about 75% (7875) of people with TIA (2000) or ischemic stroke (8,500) and, if given to all, could reduce the annual incidence of stroke from about 7% (551) to 5.8% (457), thus avoiding about 94 strokes each year (4.7% of all strokes). Treating 83 TIA/ischemic stroke patients for one year (at least) would avoid one each year.

Besides clopidogrel,  no single antiplatelet agent exists that is more effective than aspirin. Aspirin reduces the risk of important vascular events by about 13%  from about 7.0% (551) to 6.0% (472), thus avoiding 79 strokes each year (4.0% of all strokes). Clopidogrel reduces the risk important vascular events by 8.7% (95%CI: 0.3% to 16.5%) compared aspirin, indicating that it would further reduce the risk from 6.0% (472) to 5.5% (433), thus avoiding about 39 more strokes each year, and 118 strokes compared with control.

The combination of dipyridamole and aspirin may also be more effective than aspirin alone. The addition of the second European Stroke Prevention Study (ESPS-2) to four previous studies that had compared the combination of aspirin and dipyridamole with aspirin alone reveals that the combination of aspirin and dipyridamole is associated with about a 15% relative risk reduction compared with aspirin alone.If these results can be confirmed in ongoing trials (e.g., ESPRIT), and the 7875 people with TIA/stroke take the combination of aspirin and dipyridamole for at least a year, the total number of strokes each year could be reduced from 6.0% (472) to 5.1% (402), thus avoiding about 70 more strokes each year than aspirin alone, and 188 strokes compared with control. One hundred patients need to be treated with aspirin, 66 with clopidogrel, and 53 aspirin plus dipyridamole for at least one year to avoid stroke each year.


Anticoagulant Therapy

Oral anticoagulant therapy (INR 2.0 to 3.0) is indicated for about 20% (2100) of patients with TIA/ischemic stroke who have high-risk sources of embolism from the heart to the brain. Treating these 2100 people with oral anticoagulants would reduce the number of strokes each year by about two-thirds, from 12% (252) to 4% (84),thus avoiding 168 strokes each year (8.4% of all strokes). About 12 people with TIA/stroke and a potential cardiac source of embolism need to be treated with oral anticoagulants for one year prevent one stroke each year.


CE for Symptomatic Carotid Stenosis

CE is indicated for individuals who have had recent symptoms of carotid territory TIA or mild ischemic stroke, severe (>70% in NASCET, >80% ECST) carotid stenosis, and who are fit and willing for surgery. Only about 8% (816) of TIA/ischemic stroke patients meet these criteria.If all 816 appropriate TIA/stroke patients undergo CE, the three-year risk of major stroke or death could be reduced from about 26.5% (8.8% per year) to 14.9% (5.0% year). This is an average absolute risk reduction of 3.8% per year, which equates to about 31 strokes prevented each year (1.5% of all strokes) by performing CE on 816 patients. At least 26 patients would need to be treated with CE to avoid one stroke per year. The number needed to treat prevent one stroke is higher if the perioperative risk of major stroke or death is higher than about 7%.


CE for Asymptomatic Carotid Stenosis

About 10,000 (1%) people in the population (4% of the aged 50–75 years) have asymptomatic carotid stenosis of 60%–99%.47 If these 10,000 people are accurately identified and undergo CE, the number of strokes could be reduced
from 11% (1100) at five years to 5% (500),thus avoiding up to 600 strokes over five years, or 120 strokes per year (6% of all strokes).

Carotid Angioplasty and Stenting

Carotid angioplasty and stenting is a promising but currently experimental procedure that is in duced from 11% (1100) at five years to 5% trial.

Summary of the Potential Impact of the Different Strategies of Secondary Stroke Prevention for TIA and Stroke Patients on Stroke Prevention in the Population



Aspirin + dipyridamole




Blood pressure-lowering therapy




Smoking cessation




Cholesterol-lowering statin therapy


Carotid endarterectomy


(John W. Norris M.D.-Vladimir Hachinski M.D.)


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Cancer Vaccine?

vaccination is one of the preventive medicine's weapon

In medical industry, recently ,new vaccine for cervical cancer is approved by FDA. So, it's interesting to know about the CANCER VACCINE

The term cancer vaccine refers to a vaccine that either prevents infections with cancer-causing viruses, or treats existing cancer.

Some cancers, such as cervical cancer and some liver cancers, are caused by viruses, and traditional vaccines against those viruses, such as HPV vaccine and Hepatitis B vaccine, will prevent those cancers.

Gardasil: cervical cancer vaccine

GARDASIL is the only cervical cancer vaccine that helps protect against 4 types of human papillomavirus (HPV): 2 types that cause 70% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. GARDASIL is for girls and young women ages 9 to 26.Anyone who is allergic to the ingredients of GARDASIL, including those severely allergic to yeast, should not receive the vaccine. GARDASIL is not for women who are pregnant. GARDASIL does not treat cervical cancer or genital warts.GARDASIL may not fully protect everyone, and does not prevent all types of cervical cancer, so it’s important to continue routine cervical cancer screenings. GARDASIL will not protect against diseases caused by other HPV types or against diseases not caused by HPV.The side effects include pain, swelling, itching, bruising, and redness at the injection site, headache, fever, nausea, dizziness, vomiting, and fainting. GARDASIL is given as 3 injections over 6 months.


melanoma and renal cancer have failed to be faced by the cancer vaccine, possible explanations include:

1) disease stage being treated was too advanced: it is difficult to get the immune system to fight bulky tumor deposits, because tumors actively suppress the immune system using a variety of mechanisms (e.g. secretion of cytokines that inhibit immune activity). The most suitable stage for a cancer vaccine is likely to be early disease, when the tumor volume is low, 

2) escape loss variants (cancer vaccines that target just one tumor antigen are likely to be less effective. Tumors are highly heterogeneous and antigen expression differs markedly between tumors (even within deposits in the same patient). The most effective cancer vaccine is likely to raise an immune response against a broad range of tumor antigens to minimise the chance of the tumor being able to mutate and become resistant to the therapy.)

3) prior treatments (numerous clinical trials in the past have treated patients who have received numerous cycles of chemotherapy. Chemotherapy is often myelosuppressive and destroys the immune system. There is little point giving a cancer vaccine to a patient who is immune suppressed).

4) some tumors progress very rapidly and/or unpredictably, and they can literally outpace the immune system. It may take two to three months for an immune response to a vaccine to mature, but some cancers (e.g. advanced pancreatic) can produce marked clinical deterioration, or even death, within this timeframe.

5) many cancer vaccine clinical trials examine immune responses by patients as their primary goal. Correlations are then made, typically showing that the patients who made the strongest immune responses were the ones who lived the longest, and this is taken as evidence that the vaccine is working. The alternative explanation, however, is that the patients who made the best immune responses were the healthier patients with the better prognosis, and they would have survived longest in any event, even without the vaccine. In other words, the immune responses may simply be a simple reflection of a better health status, not an indication that the vaccine had any beneficial effects. As such, these immune 'false friends' may have tempted some to embark on expensive phase III trials without a solid rationale.

From Wikipedia, the free encyclopedia

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Thursday, November 27, 2008

essence of preventive medicine

hi...this is  my blog for my concern about preventive medicine..

as a medical doctor, honestly i do hope that every person in this world is healthy..
though some of disease can't be prevented
i believe that there will always be the way..
for the medical world to grow..and to find out the process of a disease
and finally, the goal is to prevent us from the disease
this is the essence of preventive medicine

"to prevent is better than to cure
to inform is better than to diagnose" - Kumpulan Blog-Blog Indonesia

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