Diaton Tonometer Approved in Canada

BiCOM, Inc., a Long Beach, NY company that we have covered before, is reporting that its hand-held transpalpebral (through the eyelid) tonometer, designed for the diagnosis of glaucoma, has now been approved for marketing in Canada. Health Canada's approval will now complement USA FDA and CE MARK clearances. Given the fact that glaucoma is often painless and very devastating, one can only hope that this device will find widespread use not only in ophthalmologist offices, but also in primary care clinics and such.

From the press release:

Diaton tonometry - a new trans-palpebral and trans-scleral methodology has received the Gold Medal at the International Exhibition of Research and new Technology in Geneva & the Gold Medal at the International Exhibition of Innovation Research and New Technology - "Brussels Eureca".

Portability, safety and simplicity make Tonometer Diaton ideal for a wide range of applications: for mass glaucoma screening of the population, at the patient's bedside, in geriatrics homes, in children hospitals, for the military and for home use.

Diaton Tonometer is intended for use by Inpatient & Outpatient Clinics such as Hospitals, Emergency Rooms, Nursing & Elderly Homes, General & Specialty Practitioners as well as Ophthalmologists and Optometrists.

Tonometer Diaton is the ideal solution in the following cases when the use of other devices is problematic or impossible:

mass prophylactic screening of patients;

IOP control during clinical observation of glaucoma patients;

ortoclinostatical probe, as an additional test to diagnose glaucoma and during select the adequate hypotensive therapy;

ophthalmotone monitoring (even at night time);

IOP measuring during contact correction (lenses are not taken out),

IOP measuring in immobilized patients;

IOP measuring in children.

on patients with the following conditions: chronic conjunctivitis, cornea pathology, including keratitis, keratotone, cornea dimness, after penetrating keratoplastics, keratoprosthesis, laser refractive correction of the eyesight, high degree of ametropy, astigmatism;

on patients with medicinal allergies;

Lasik/ PRK (recent clinical trials have proved that Diaton is the only device that can be used for IOP measurement right after these surgeries)

Diaton tonometer is a perfect device for mass screenings for glaucoma for any age group. Undiagnosed and untreated, glaucoma can cause blindness. Glaucoma is the leading cause of blindness in all age groups - from babies to senior citizens. Everyone needs to get diagnosed to preserve eyesight.

Low back pain

Alternative names

Backache; Low back pain; Lumbar pain; Pain - back

Definition

Pain felt in your lower back may come from the spine, muscles, nerves, or other structures in that region. It may also radiate from other areas like your mid or upper back, a hernia in the groin, or a problem in the testicles or ovaries.

You may feel a variety of symptoms if you've hurt your back. You may have a tingling or burning sensation, a dull aching, or sharp pain. You also may experience weakness in your legs or feet.

It won't necessarily be one event that actually causes your pain. You may have been doing many things improperly -- like standing, sitting, or lifting -- for a long time. Then suddenly, one simple movement, like reaching for something in the shower or bending from your waist, leads to the feeling of pain.

Considerations

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body's weight.

Low back pain is the #2 reason that Americans see their doctor -- second only to colds and flus. Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better.

Low back pain may be acute (short-term), lasting less than one month, or chronic (long-term, continuous, ongoing), lasting longer than three months. While getting acute back pain more than once is common, continuous long-term pain is not.

Common Causes

You'll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But prior to that moment in time, the structures in your back may be losing strength or integrity.

The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain:

• Small fractures to the spine from osteoporosis
• Muscle spasm (very tense muscles that remain contracted)
• Ruptured or herniated disk
• Degeneration of the disks
• Poor alignment of the vertebrae
• Spinal stenosis (narrowing of the spinal canal)
• Strain or tears to the muscles or ligaments supporting the back
• Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens
• Other medical conditions like fibromyalgia

Low back pain from any cause usually involves spasms of the large, supportive muscles alongside the spine. The muscle spasm and stiffness accompanying back pain can feel particularly uncomfortable.

You are at particular risk for low back pain if you:

• Work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster)
• Have bad posture
• Are pregnant
• Are over age 30
• Smoke, don't exercise, or are overweight
• Have arthritis or osteoporosis
• Have a low pain threshold
• Feel stressed or depressed

Back pain from organs in the pelvis or elsewhere include:

• Bladder infection
• Kidney stone
• Endometriosis
• Ovarian cancer
• Ovarian cysts
• Testicular torsion (twisted testicle)

Home Care

Many people will feel better within one week after the start of back pain. After another 4-6 weeks, the back pain will likely be completely gone. To get better quickly, take the right steps when you first get pain.

A common misconception about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended.

If you have no indication of a serious underlying cause for your back pain (like loss of bowel or bladder control, weakness, weight loss, or fever), then you should reduce physical activity only for the first couple of days. Gradually resume your usual activities after that. Here are some tips for how to handle pain early on:

• Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
• Apply heat or ice to the painful area. Try ice for the first 48-72 hours, then use heat after that.
• Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).

While sleeping, try lying in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.

Do not perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins. After 2-3 weeks, you should gradually resume exercise.

Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do so.

AVOID the following exercises during initial recovery unless your doctor or physical therapist says it is okay:

• Jogging
• Football
• Golf
• Ballet
• Weight lifting
• Leg lifts when lying on your stomach
• Sit-ups with straight legs (rather than bent knees)

Call your health care provider if

Call 911 if you have lost bowel or bladder control. Otherwise, call your doctor if you have:

• Unexplained fever with back pain.
• Back pain after a severe blow or fall.
• Redness or swelling on the back or spine.
• Pain traveling down your legs below the knee.
• Weakness or numbness in your buttocks, thigh, leg, or pelvis.
• Burning with urination or blood in your urine.
• Worse pain when you lie down or pain that awakens you at night.
• Very sharp pain.

Also call if:

• You have been losing weight unintentionally
• You use steroids or intravenous drugs.
• You have never had or been evaluated for back pain before.
• You have had back pain before but this episode is distinctly different.
• This episode of back pain has lasted longer than four weeks.

If any of these symptoms are present, your doctor will carefully check for any sign of infection (like meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem.

What to expect at your health care provider's office

When you first see your doctor, you will be asked questions about your back pain, including how often it occurs and how severe it is. Your doctor will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

Questions will include:

• Is your pain on one side only or both sides?
• What does the pain feel like? Is it dull, sharp, throbbing, or burning?
• Is this the first time you have had back pain?
• When did the pain begin? Did it start suddenly?
• Did you have a particular injury or accident?
• What were you doing just before the pain began? Were you lifting or bending? Sitting at your computer? Driving a long distance?
• If you have had back pain before, is this pain similar or different? In what way is it different?
• Do you know the cause of previous episodes of back pain?
• How long does each episode of back pain usually last?
• Do you feel the pain anywhere other than your back, like your hip, thigh, leg or feet?
• Do you have any numbness or tingling? Any weakness or loss of function in your leg or elsewhere?
• What makes the pain worse? Lifting, twisting, standing, or sitting for long periods of time?
• What makes you feel better?
• Are there any other symptoms present? Weight loss? Fever? Change in urination? Change in bowel habits?

During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

• Sit, stand, and walk. While walking, your doctor may ask you to try walking on your toes and then your heels.
• Bend forward, backward, and sideways.
• Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

Most people with back pain recover within four to six weeks. Therefore, your doctor will probably not order any tests during the first visit. However, if you have any of the symptoms or circumstances below, your doctor may order imaging tests even at this initial exam:

• Pain that has lasted longer than one month
• Numbness
• Muscle weakness
• Accident or injury
• Fever
• If you are over 65
• You have had cancer or have a strong family history of cancer
• Weight loss

In these cases, the doctor is looking for a tumor, infection, fracture, or serious nerve disorder. The symptoms above are clues that one of these conditions may be present. The presence of a tumor, infection, fracture, or serious nerve disorder change how your back pain is treated.

Tests that might be ordered include an X-ray, a myelogram (an X-ray or CT scan of the spine after dye has been injected into the spinal column), a CT of the lower spine or MRI of the lower spine.

Hospitalization, traction, or spinal surgery should only be considered if nerve damage is present or the condition fails to heal after a prolonged period.

Many people benefit from physical therapy. Your doctor will determine if you need to see a physical therapist and can refer you to one in your area. The physical therapist will begin by using methods to reduce your pain. Then, the therapist will teach you ways to prevent getting back pain again.

If your pain lasts longer than one month, your primary care doctor may send you to see either an orthopedist (bone specialist) or neurologist (nerve specialist).

Prevention

Exercise is important for preventing future back pain. Through exercise you can:

• Improve your posture
• Strengthen your back and improve flexibility
• Lose weight
• Avoid falls

A complete exercise program should include aerobic activity (like walking, swimming, or riding a stationary bicycle) as well as stretching and strength training.

To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:

• If an object is too heavy or awkward, get help.
• Spread your feet apart to give a wide base of support.
• Stand as close to the object you are lifting as possible.
• Bend at your knees, not at your waist.
• Tighten your stomach muscles as you lift the object up or lower it down.
• Hold the object as close to your body as you can.
• Lift using your leg muscles.
• As you stand up with the object, DO NOT bend forward.
• DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to take to prevent back pain include:

• Avoid standing for long periods of time. If you must for your work, try using a stool. Alternate resting each foot on it.
• DO NOT wear high heels. Use cushioned soles when walking.
• When sitting for work, especially if using a computer, make sure that your chair has a straight back with adjustable seat and back, armrests, and a swivel seat.
• Use a stool under your feet while sitting so that your knees are higher than your hips.
• Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
• If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
• Quit smoking.
• Lose weight.
• Learn to relax. Try methods like yoga, tai chi, or massage.

There are five lumbar vertebrae located in the lower back. These vertebrae receive the most stress and are the weight-bearing portion of the back. The lumbar vertebrae allow movements such as flexion and extension, and some lateral flexion.

TOP 10 STRESS BUSTERS

INTRODUCTION: As an instructor for College Success, at Santa Barbara City College, I have found that students face multiple and challenging stressors and have received little to no training on how to proactively and efficiently manage the to-be-expected stresses of life. Common student stressors such as test anxiety, financial worries, and roommate and relationship conflicts, are at best distractions and at worst completely disruptive to learning.

For the Developing Emotional Intelligence segment of this semester long class, I created this learner-centered activity to give students an opportunity to increase awareness of their stressors, discover new strategies to reduce their stress, and to create a tangible tool to remind and inspire them to take action.

While I use this structure in a college success class to identify stress busters, it can be used in any class by changing the content of the top-ten list. For example, a business class could use this activity to create its own list of top ten best marketing practices or a speech class could use this to create a personal top ten list of ways to begin a formal presentation.

PURPOSE

To give students an opportunity to...

• Identify sources of their stress
• Learn new strategies for managing stress
• Select strategies they will implement

SUPPLIES/SET UP

• Dry erase pen or chalk
• 3x5 cards (one per student)
• Coloring tools (pens, crayons, pencils)
• A clock
• Power Point slides for lecture (text appended below)

DIRECTIONS:Total time 45-50 minutes (and a follow up evaluation one week later)

1. Personalize the activity by asking the class, "What are stresses that college students face?" Write their responses on the board so they can see the list of stressors and recognize them in their own lives. (5 minutes)
2. Next ask, "What if you had a list of strategies on how to reduce your stress?" After a rhetorical pause say, "This activity will help you create your personal Top-Ten Stress Busters list so that you have numerous ways to reduce your stress." (1 minute)
3. Using the PowerPoint slides, present the causes and symptoms of stress and some strategies to overcome those symptoms. I provided the American Medical Associations definition of stress as "any interference that disturbs a person's physical or mental well being." I also discussed the impact of persistent stress including emotional issues such as anger, anxiety, depression, and overwhelm as well as physical symptoms such as poor digestion, suppressed immune system, high blood pressure, ulcers, insomnia, and fatigue. I turned this short lecture into a discussion by asking the students to add any other symptoms they might be experiencing. (5-10 minutes)
4. Tell the class, "We have been focusing on the source and symptoms of stress, but now let's look at solutions. Let's start with what NOT to do. What are some unhealthy ways of dealing with stress?" Write their ideas on the board. When they are out of ideas put up the power point slide on unhealthy stress reduction and ask if there are any that were not included in their brainstorming. (5 minutes)
5. Now brainstorm healthy stress reduction techniques, writing students' ideas on the board. Let them know they can draw ideas from the text (pages 198-206 if using the On Course text), their life experience, or any other resources they want. (10 minutes)
6. Once the student's have exhausted all their ideas for healthy stress reduction, put the power point slide up and ask if they see any ideas not on their list. Clarify any they may not understand. Invite them to add any to their list. (5 minutes)
7. Hand out a 3x5 card to the students and ask them to write their personal top 10 Stress Busters. Provide coloring utensils so that students can decorate their card to make it more pleasing or inspiring. (10 minutes)
8. Ask students to decide on one place they will post their top ten-list/menu card as a reminder. Have the class brainstorm all the places they could post their top ten list. Suggest that they look at the card during the week and report back on the impact the card had. (5 minutes)
9. After a week, offer an evaluation to follow up on the impact of the exercise. I asked: What did you learn? What did you like and/or dislike? How would you change, modify or improve this activity? Where did you post your card? Did you look at your card? What impact did it have on our stress?

EXPERIENCES

I began by asking students to share what stressors college students face. Many took this as an opportunity to vent. Common stressors included conflicts with parents ("My mom is driving me crazy!"), preparing for exams, meeting deadlines for multiple classes, making ends meet with their limited budgets, body image issues, time management, and romantic relationship conflicts. Some seemed relieved to speak about their stressors while others appeared to get down or depressed when discussing the stressors. One student was visibly depressed about how messy her car and home were. "Every time I see my room, I feel like such a loser." I could feel the weight of their stress. I was glad to be having a lesson on how to manage the stress they experience. When I asked the students to record their ideas about healthy stress reducers, there was an immediate shift in the room. Some students changed their body posture and sat up straight. Those who had appeared down seemed relieved to discuss solutions rather than stay focused on the stressors (a classic shift from Victim to Creator, as On Course would suggest). I reminded them that we are motivated by avoiding pain and by seeking pleasure so taking a moment to see how bad the stress is, was a good idea as it might increase their motivation to seek solutions and make changes. Students noticed a pattern of suggestions. Many included exercise, social support, and meditation (anything that causes you to be deeply relaxed), and then looked for activities that incorporated all three. One student said that dancing was her favorite because she got to be with her friends, sweat out her angst, and tap into her inner self. For her, dancing is efficient stress management.

OUTCOMES

Nearly all 20 evaluations supported my observation that the students enjoyed the activity and were pleased to have specific options as well as a physical reminder of what to do when they are experiencing stress. The evaluations also told me that the students had indeed posted their cards and used them. Comments included:

"I learned several methods to reduce stress that I really like and will use and have used since we made the cards."

"I got a bit of peace of mind! It calmed me down, because I was not at a loss of what I can do to relax."

"I learned that getting my assignments in does not have to make me a bundle of nerves. Music, friends and exercise make a big difference."

"I posted the card on the front of my binder for now, and I looked at it when I was preparing for an exam. The results were relaxing because I decided to go for a jog on the beach, which cleared my mind of the negative thoughts I was thinking."

"The activity had a great impact. I was overwhelmed by all my finals and every time I looked at the card, I started to have positive thoughts. I also felt less and less overwhelmed every time I looked at the card. Great idea!"

"My favorites were to get regular sleep and to dance. I put my postcard on my dashboard in my car. Every time I drove somewhere it reminded me to write in my journal and to go to bed before midnight. I did go to bed at 11 p.m. the last two nights in a row and I feel much more alert during the day."

LESSONS LEARNED

The first time I did it, I heard one student say, "I am going to laminate my card." I realized the students were interested in saving these cards and might be even more motivated to do so if the cards looked colorful and inviting. I used colors the second time around and while a few students did not use the colors, most did and many commented in the evaluation on enjoying that aspect.

A quarter of the evaluations said the activity made a big difference for them and that they would have liked the activity to be offered earlier in the semester. I have been offering it when the class is covering On Course's Chapter 8 Emotional Intelligence and because it usually comes just before finals week, but I can see that students are under stress from the start and would appreciate some tools to manage that stress as soon as possible. I think stress management should continue to be covered in chapter 8 Emotional Intelligence, but I am going to review my lesson plan schedule to see if I can offer this activity at least one week earlier. I will use this activity again. It was an excellent learner-centered activity to provide the experience of acknowledging and accepting our stressors and then shifting to creatively implement strategies that will reduce stress and nurture emotional intelligence. Students reported they enjoyed the activity, used the card, and felt it was beneficial.

Risk Factors for Falls Identified in Older Adults With Diabetes

In older adults with diabetes, decreased peroneal compound muscle action potential, higher levels of cystatin-C, and poor contrast sensitivity each increased the risk for falls, according to the results of a study reported in the March issue of Diabetes Care.

"Older adults with type 2 diabetes are more likely to fall, but little is known about risk factors for falls in this population," write Ann V. Schwartz, PhD, from the University of California, San Francisco in San Francisco, and colleagues from the Health, Aging, and Body Composition Study. "We determined whether diabetes-related complications or treatments are associated with risk of falls in older diabetic adults."

At annual visits, 446 participants with diabetes in the Health, Aging, and Body Composition cohort of well-functioning older adults reported falls in the previous year. Mean age at enrollment was 73.6 years, and average duration of follow-up was 4.9 years. Odds ratios (ORs) for more frequent falls were estimated with continuation ratio models.

The proportion of patients who reported falling was 24% in the first year and 22%, 26%, 31%, and 30% in each subsequent year, respectively.

Adjusted models revealed that factors associated with the risk for falls were decreased peroneal nerve response amplitude (OR 1.50; 95% confidence interval [CI], 1.07 - 2.12, worst quartile vs others); higher cystatin-C, which is a marker of reduced renal function (OR, 1.38; 95% CI, 1.11 - 1.71, for 1 SD increase); poorer contrast sensitivity (OR 1.41; 95% CI, 0.97 - 2.04, worst quartile vs others); and low hemoglobin A_1c (HbA_1c) levels in insulin users (OR, 4.36; 95% CI, 1.32 - 14.46; HbA_1c level ≤ 6% vs > 8%). In patients treated with oral hypoglycemic agents but not insulin, low HbA_1c level was not associated with the risk for falls (OR, 1.29; 95% CI, 0.65 - 2.54, HbA_1c level ≤6 vs > 8%).

Although adjustment for physical performance explained some of these associations, it did not explain them all.

"In older diabetic adults, reducing diabetes-related complications may prevent falls," the study authors write. "Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C ≤6% increased risk of falls."

Limitations of the study include observational design limiting causal inferences; self-reported falls causing the potential for misclassification; peripheral nerve function and vision measured 3 and 2 years, respectively, after baseline; enrollment limited to well-functioning participants; lack of gold standard measurement of glomerular filtration rate; and participants not queried about hypoglycemia.

"Diabetes-related complications (reduced peripheral nerve function, renal function, and vision) contribute to risk of falls in older adults with diabetes," the study authors conclude.

The National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the Intramural Research Program of the National Institutes of Health, National Institute on Aging, supported this study. The costs of publication of this article were defrayed in part by the payment of page charges, mandating that it must therefore be hereby marked "advertisement."

Clinical Context

Older patients with type 2 diabetes have an increased risk for falls, likely associated with complications of peripheral neuropathy, reduced vision, and poor renal function, but little is known about the magnitude of risk factors for falls in these patients. Other factors such as weight loss and level of glycemic control may also affect fall risk. Current recommendations for an HbA_1c goal of 7% or lower for older adults are not met for many older patients with diabetes, and a higher goal is recommended for adults who are frail.

This is a longitudinal cohort study within a study of 3075 men and women aged 70 to 79 years from 2 US sites in the Health, Aging, and Body Composition Study, of whom 446 had diabetes. In these patients, peripheral nerve function was measured 3 years after baseline, and the patients were observed for risk factors for falls.

Study Highlights

• Adults studied had type 1 or 2 diabetes by self-report, use of hypoglycemic agents, clinician diagnosis, or high fasting glucose level or 2-hour oral glucose tolerance test at baseline.
• Participants were asked at the annual visit, "In the past 12 months, have you fallen and landed on the floor or ground?" with 1, 2 to 3, 4 to 5, and 6 or more as possible responses.
• Follow-up visits occurred once yearly for 4.9 years.
• Of the 446 participants, 6% died between visits 4 and 6, and 2.5% did not complete visit 6.
• At visit 3, high contrast visual acuity, contrast sensitivity, and depth perception were measured.
• Peripheral nerve function was measured at visit 4.
• Light touch discrimination was measured with esthesiometer probes and lower extremity vibration sensitivity with a Vibratory Sensory Analyzer (Medoc, Minneapolis, Minnesota).
• Motor nerve conduction studies were performed for the peroneal nerve.
• Nerve conduction velocity was determined between the ankle and the popliteal fossa or fibular head.
• Estimated glomerular filtration rate was calculated to determine the presence of renal disease, and cystatin-C was measured.
• Blood pressure was measured at baseline and at visits 2, 4, and 6; prescription and over-the-counter medications were assessed at all visits except visit 4.
• Physical performance tests were obtained at baseline and at visits 4 and 6, and strength was tested at visit 2.
• Participants completed a 6-meter walk, a 6-meter narrow walk, and 5 chair stands; standing balance was assessed with semi-tandem, full tandem, and 1-leg balance tests.
• Mean age at baseline was 73.6 years, 55.4% were men, HbA_1c level was 7.6%, and 14% of patients reported insulin use at baseline.
• Mean body mass index (BMI) was 28.8 kg/m², mean weight was 80.7 kg, mean duration of diabetes was 12.8 years, and of those who used oral agents, 40.7% reported using sulfonylureas.
• Among patients using insulin, 6.1% had an HbA_1c level of 6% or less, 17.6% had an HbA_1c level of 6% to 7%, 34.2% had an HbA_1c level of 7% to 8%, and 42.1% had an HbA_1c level of more than 8%.
• At baseline, 62% had known diabetes and the remaining participants were diagnosed with use of blood glucose measurements.
• In the first year, 24% reported falling and the rate of falls was 22%, 26%, 31%, and 30% in the subsequent years.
• In patients who did not use insulin, an HbA_1c level was not associated with fall risk.
• In those who used insulin, HbA_1c level of 6% or lower was associated with an increased OR for falls of 4.36 vs an HbA_1c level of more than 8%.
• Low peroneal nerve response amplitude at the popliteal fossa was independently predictive of falls.
• Peroneal nerve conduction velocity between the ankle and popliteal fossa or fibular head was not associated with higher risk for falls.
• Seated or standing blood pressure was not associated with falling, but diastolic, and not systolic, change in blood pressure was associated with increased fall risk.
• Weight loss, but not BMI, was associated with increased fall risk.
• Grip strength; knee extensor strength; standing balance time; chair stands; and the 6-meter walk, but not the 6-meter narrow walk, were associated with falls.
• Higher cystatin-C level (OR, 1.38), poor contrast sensitivity (OR, 1.41), and reduced peroneal nerve amplitude (OR, 1.50) were associated with falls.

Pearls for Practice

• An HbA_1c level of 6% or lower vs 8% or higher is associated with falls in older patients with diabetes who use insulin but not in those who use oral hypoglycemic agents.
• Predictors of falls in older patients with diabetes are reduced peripheral nerve function, poor vision, weight loss, and poor renal function.

Microwave Glucose Sensor for Bloodless Diabetes Monitoring

Dr. Randall Jean and his engineering colleagues at Baylor College came up with a noninvasive way to measure blood glucose through the use of non-invasive microwave technology. The idea is that microwaves could be used in determining a substance's dielectric constant:

For diabetics, the daily routine of pricking their finger to check blood-sugar levels can be an annoying and inconvenient task. But now, a Baylor University researcher has developed an electromagnetic sensor that could provide diabetics a noninvasive alternative to reading their blood glucose levels, and new research shows the sensor works and is effective.

"We are definitely excited," said Dr. Randall Jean, associate professor of electrical and computer engineering at Baylor. "This is a relatively new area the market is exploring and we've demonstrated that using microwave energy can work."

The sensor uses electromagnetic waves to measure blood glucose levels in the body. As the energy goes from the sensor through the skin and back to the sensor, the glucose level is measured through the transference of energy. Jean said the microwave frequency range is wide enough to isolate the effect of sugar in the blood and minimize the characteristics of other things like body fat and bone, which could alter accurate readings. Jean also said using electromagnetic waves is relatively safe because they do not ionize the body's molecules like x-rays can do.

To measure glucose levels, users must press their thumb against the sensor, and a new study by the Baylor researchers shows that the sensor is accurate. Researchers took samples of nearly 20 people and compared those samples to levels measured by an over-the-counter commercial sensor. The researchers found Baylor's noninvasive sensor has the potential of achieving the same or even better accuracy than current commercial sensors, many of which prick the finger to sample blood.

Famous Physicians

• Aamir Jalal Al Mosawi-Described a new model fot the management of end-stage renal failure
• William Osler Abbott (1902–1943) - co-developed the Miller-Abbott tube
• Thomas Addis (1881–1949) — pioneered urine testing and the study of renal diseases
• Virginia Apgar (1909–1974) — anesthesiologist who devised the Apgar score used after childbirth
• Hans Asperger (1906–1980) — Austrian paediatrician after whom Asperger's Syndrome is named
• William Stewart Agras, feeding behavior
• Jean Astruc (1684–1766) — wrote one of the first treatises on syphilis
• Averroës (1126–1198)
• Avicenna (980–1037) — Persian physician
• Frederick Banting (1891–1941) — isolated insulin
• Christiaan Barnard (1922–2001) — performed first heart transplant
• Charles Best (1899–1978) — assisted in the discovery of insulin
• Norman Bethune (1890–1939) — developer of battlefield surgical techniques
• Theodor Billroth (1829–1894) — founding father of modern abdominal surgery
• Charaka Indian physician
• Jean-Martin Charcot (1825–1893) — pioneering neurologist
• Charles R. Drew (1904–1950) — blood transfusion pioneer
• Helen Flanders Dunbar (1902–1959) important early figure in U.S. psychosomatic medicine.
• Galen (129 – c. 210) — Roman physician and anatomist
• Garcia de Orta (1501–1568) — revealed herbal medicines of India, described Cholera
• Christiaan Eijkman (1858–1930) — pathologist, studied beriberi
• Pierre Fauchard father of dentistry
• Girolamo Fracastoro (1473–1553) — wrote on syphilis, forerunner of germ theory
• Sigmund Freud (1856–1939) — founder of psychoanalysis
• Daniel Carleton Gajdusek (born 1923) — studied Kuru, Nobel prize winner
• William Harvey (1578–1657) — English physician, described the circulatory system
• Ernst Haeckel (1834–1919) — physician and anatomist
• Henry Heimlich (born 1920) — inventor of the Heimlich Maneuver and the Vietnam War era Chest Drain Valve
• Orvan Hess (1906–2002) — Fetal heart monitor and first successful use of Penicillin
• Hippocrates (c. 460–370 BCE) — Greek father of medicine
• Elliott P. Joslin (1869-1962) — pioneer in the treatment of diabetes
• Edward Jenner (1749–1823) — English physician popularized vaccination
• Carl Jung (1875–1961) — Swiss psychiatrist
• Leo Kanner (1894–1981) — Austrian-American psychiatrist known for work on autism
• Seymour Kety (1915–2000) — influential American neuroscientist
• Tsendiin Khaidaw — reviver and innovator of traditional Mongolian medicine
• Robert Koch (1843–1910) — formulated Koch's postulates
• Theodor Kocher — thyroid surgery and first surgeon to win the Nobel Prize
• Rene Theophile Hyacinthe Laennec (1781–1826) — inventor of the stethoscope
• Janet Lane-Claypon (1877–1967) — pioneer of epidemiology
• Joseph Lister (1827–1912) — pioneer of antiseptic surgery
• Richard Lower (1631–1691) — studied the lungs and heart
• Amato Lusitano (1511–1568) — discovered venous valves, studied blood circulation
• Madhav (8th century A.D.) — medical text author and systematizer
• Maimonides (1135–1204)
• Marcello Malpighi (1628–1694) — Italian anatomist, pioneer in histology
• Otto Fritz Meyerhof (1884–1951) — studied muscle metabolism (Nobel prize)
• George Richards Minot (1885–1950) — Nobel prize for his study of anemia
• Charles Horace Mayo (1865–1939) — co-founder, Mayo Clinic
• William James Mayo (1861–1939) — co-founder, Mayo Clinic
• William Worrall Mayo (1819–1911) — co-founder, Mayo Clinic
• Richard Morton (1637–1698) — identified tubercles in consumption (phthisis) of lungs; basis for modern name tuberculosis.
• Egas Moniz (1874–1955) — developed Lobotomy and brain artery angiography.
• William McBride — discovered teratogenicity of thalidomide
• Daniel J. Murray - studied mental health; key figure in successful mind body and spirit.
• Herbert Needleman — scientifically established link between lead poisoning and neurological damage; key figure in successful efforts to limit lead exposure
• Charles Jean Henri Nicolle (1866–1936) — microbiologist who won Nobel prize for work on typhus
• Gary Onik - inventor and pioneer of ultrasound guided cryosurgery for both the prostate and the liver
• William Osler (1849–1919) — called the "Father of Modern Medicine"
• Ralph Paffenbarger — conducted classic studies demonstrating conclusively that active people reduce their risk of heart disease and live longer
• Paracelsus (1493–1541)
• Ambroise Paré (1510–1590) — advanced surgical wound treatment
• Wilder Penfield (1891–1976) — pioneer in neurology
• Joseph Ransohoff (1915–2001) — neurosurgeon who invented the modern technique for removing brain tumors
• Rhazes (c. 854 – 925) (Abu Bakr Mohammad Ibn Zakariya al-Razi)
• Jonas Salk (1914–1995) — developed a vaccine for polio
• Lall Sawh (born 1951) — Trinidadian Surgeon/Urologist and pioneer of Kidney transplantation in the Caribbean
• Ignaz Semmelweis (1818–1865) — a pioneer of avoiding cross-infection — introduced hand washing and instrument cleaning
• John Snow (1813–1858) — anaesthetist and pioneer epidemiologist who studied cholera
• Susruta (c. 500 BCE) — Indian physician and pioneering surgeon
• Thomas Sydenham (1642–1689) — clinician
• James Mourilyan Tanner (born 1920) — developed Tanner stages and advanced auxology
• Helen B. Taussig (1898–1986) — founded field of pediatric cardiology, worked to prevent thalidomide marketing in the US
• Carlo Urbani (1956–2003) — discovered, and died from, SARS
• Andreas Vesalius (1514–1564) — Belgian anatomist, often referred to as the founder of modern human anatomy.
• Vidus Vidius (1508–1569) First professor of Medicine at the College Royal and author of medical texts.
• Rudolf Virchow (1821–1902) — German pathologist, founder of fields of comparative pathology, cellular pathology.
• Allen Oldfather Whipple (1881–1963) — devised the Whipple procedure in 1935 for treatment of pancreatic cancer
• Pricilla White — developed classification of diabetes mellitus and pregnancy to assess and reduce the risk of miscarriage, birth defect, stillbirth, and maternal death
• Carl Wood in vitro fertilization
• Ole Wormius (1588–1654) — pioneer in embryology
• Sir Magdi Yacoub (born 1935) — One of the leading developers of the techniques of heart and heart-lung transplantation
• Boris Yegorov (1937–1994) Russian - First physician in space, 1964

Welcome

I'm a Medical Student actually in Second Year MBBS. I've created this blog to post interesting medical stuff like articles, thoughts and many more. Hope that this will help many medical students as well as doctors, and at the same time will provide us a platform for discussion.

Remember : "Knowledge grows when shared"

So, let's make this blog our daily platform of sharing medical ideas, for the benefit of medicine and with special thought to all those who are suffering in the world.