This video contain the 5 essential items that I need to function everyday.
1. Shower chair
2. Indoor walker
3. Orthtoics and AFO
4. Leakage Pads
5. MSWA/NDIS/Friends/Family
5 Essentials that I can’t live without! Multiple Sclerosis Essentials
Risk of stroke increases with insulin resistance, study suggests
A study of more than 100,000 people with type 2 diabetes (T2D), presented at the annual meeting of the European Association for the Study of Diabetes (EASD), held online this year, found that insulin resistance is associated with stroke.
The higher the insulin resistance, the greater the risk of stroke, the research, from Dr Alexander Zabala and colleagues at the Karolinska Institute and researchers at Gothenburg University and the National Diabetes Registry in Sweden, found.
Insulin resistance – when the body’s cells don’t respond properly to insulin and can’t easily take up glucose from blood – is a key feature of T2D and levels vary from patient to patient.
Dr Zabala used estimated glucose disposal rate (eGDR) as a measure of insulin resistance.
eGDR has previously been shown to be a good proxy for insulin resistance and is calculated using a formula that factors in a patient’s waist circumference, HbA1c (average blood sugar level) and whether they have high blood pressure.
Health records were used to calculate the eGDR of 104,697 T2D patients in Sweden. The participants had an average age of 63 and 44.5% were female.
They were followed up for an average of 5.6 years, during which 4,201 (4%) had a stroke.
Analysis revealed that the higher a person’s insulin resistance, the greater their chance of having a stroke. Those with the lowest insulin resistance (the highest eGDR) were 40% less likely to have a stroke than those with the highest insulin resistance.
Age, cholesterol levels, smoking, heart conditions and other traditional risk factors for stroke were all adjusted for.
The study also found that higher insulin resistance was linked to a higher risk of death after a stroke. Those with the lowest resistance were 28 per less likely to die during the follow-up period than those with the most severe insulin resistance.
Further analysis showed high blood pressure to be more strongly linked to stroke than waist circumference or HbA1c.
The study’s authors conclude: “We found that in individuals with type 2 diabetes, a low eGDR, a simple measure of insulin resistance, was associated with an increased risk of stroke and mortality.”
Dr Zabala adds: “eGDR could be used to help T2D patients better understand and manage their risk of stroke and death.
“It could also be of importance in research. In this era of personalised medicine, better stratification of type 2 diabetes patients will help optimise clinical trials and further vital research into treatment, diagnosis, care and prevention.”
Corticosteroid injections of hip linked to ‘rapidly destructive hip disease’
Corticosteroid injections are a common treatment option for pain and inflammation in patients with osteoarthritis of the hip. But a new study adds to concerns that hip steroid injections may lead to increased rates of a serious complication called rapidly destructive hip disease (RDHD), according to a paper in The Journal of Bone & Joint Surgery. The journal ispublished in the Lippincott portfolio in partnership with Wolters Kluwer.
The increased rates of RDHD are especially apparent in patients receiving repeated and/or high-dose corticosteroid hip injections, according to the report by Kanu Okike, MD, MPH, of Hawaii Permanente Medical Group, Honolulu, and colleagues. Their study includes the largest series of patients with post-injection RDHD reported to date.
New evidence of increased RHDH risk following corticosteroid injection
Dr. Okike and colleagues used two different research approaches to assess the possible association between intra-articular (i.e., inside the joint) corticosteroid injection and RDHD. The first part of the study compared 40 hips that developed RDHD and 717 hips that underwent total hip arthroplasty for other reasons between 2013 and 2016.
After adjusting for other factors, “[H]ip corticosteroid injections were found to increase the likelihood of RDHD approximately 8.5-fold,” according to the authors. The analysis also showed evidence of a “dose-response” effect: the likelihood of RDHD was about 5 times greater in patients who received low-dose corticosteroid injections and nearly 10 times greater with high-dose injections. “A similar dose-response pattern was observed for the number of injections performed,” Dr. Okike and coauthors add.
In the second part of the study, the researchers reviewed data on 688 hips that underwent corticosteroid injection during the same period. Thirty-seven of these hips developed post-injection RDHD, for an incidence of 5.4 percent. The diagnosis of RDHD was made an average of five months after injection; all patients underwent THA.
As in the first part of the study, the risk of post-injection RDHD was higher in hips that received a higher dose of corticosteroids and a greater number of injections. The authors suggest that the risk of RDHD following a single, low-dose injection is relatively low: about two percent. However, risk may increase to five percent following multiple low-dose injections or a single high-dose injection, and up to 10 percent following multiple high-dose injections.
As they became aware of the possible link with RDHD, orthopaedic surgeons at the study hospital started ordering fewer hip corticosteroid injections and avoiding high-dose injections. In subsequent years, the number of RDHD cases decreased, even as the number of THAs performed for other reasons remained stable.
“[T]he present study provides evidence of an association between RDHD and intra-articular hip corticosteroid injection,” Dr. Okike and colleagues conclude. They add that while the evidence suggests that hip corticosteroid injections lead to an increased risk of RDHD, the study cannot confirm a true causal effect.
The researchers believe their findings can help to guide clinical practice for patients with painful hip osteoarthritis. Dr. Okike and colleagues note that their department has added a discussion of post-injection RDHD to the informed consent process for patients considering hip corticosteroid injection and has stopped performing high-dose corticosteroid injections.
Study shows how management of serious diabetic foot ulcers was possible during the COVID-19 lockdown
New research being presented at the European Association for the Study of Diabetes (EASD), held online this year (27 Sept-1 Oct), reveals how Belgium’s efforts to maintain a diabetic foot care programme during the COVID-19 pandemic can offer valuable lessons to the rest of the world.
“Thanks to the great efforts of diabetic foot clinics, continued availability of diabetic foot ulcer services during lockdown, although in a limited capacity, were really helpful, and may be the reason why we didn’t see late presentation and the impact on the severity of ulcers was limited to slightly larger wounds”, says lead author Dr An-Sofie Vanherwegen from Sciensano, Brussels, Belgium. “Our findings will hopefully guide diabetic foot clinics in serving their patients using innovative strategies, such as telemedicine, during the current, and eventual future, public health crises.”
It is estimated that around a quarter of all people living with diabetes worldwide will develop a foot ulcer in their lifetime [1]. The ulcers develop as diabetes damages the nerves and blood supply to the feet. Without timely treatment, these ulcers are hard to heal and form the leading cause of lower limb amputations in Western countries [2].
In 2005, a national diabetic foot care programme (IQED-Foot) was established in Belgium [3], that has resulted in 34 multidisciplinary diabetic foot clinics recognised by the Belgian Ministry of Health for the treatment of diabetic ulcers. Since then, a clear decline in the lower-limb amputation rate has been noted in Belgium [4].
“As the COVID-19 pandemic unfolded, there were concerns about the impact on Belgians with diabetic foot ulcers. People need to be seen quickly if an ulcer begins to form—that gives diabetic foot clinics the greatest chance of treating the wound successfully”, explains Vanherwegen.
A national lockdown in Belgium between March 14th and May 3rd 2020, placed restrictions on free movement and only urgent care was provided in hospitals. However, diabetic foot clinics were advised by professional associations to consider all active diabetic foot problems as urgent.
To gauge the impact of the pandemic on the presentation rate and severity of diabetic foot ulcers in these clinics, researchers distributed a survey to the recognised clinics across Belgium asking about the measures they had taken during and after the lockdown to maintain their activities. A total of 24 diabetic foot clinics participated in the survey.
During the lockdown, one clinic closed, but the 23 others remained open for urgent care, whilst applying COVID-19 measures—almost three-quarters (71%) of clinics selected patients based on urgency and high risk for ulceration; whilst 79% reported partially switching to remote consultations; 13 clinics (54%) reduced the frequency of consultations for patients ; and half spread out patient appointments during the day to allow for physical distancing.
Between January 1st and September 30th, 2020, patient and ulcer characteristics were recorded by 22 foot clinics for 887 consecutive patients presenting with new moderate to severe diabetic foot ulcers—a big enough sample for it to be representative of the picture across Belgium. Patients were assigned to three groups based on the date of first contact with the clinic—pre-lockdown (322 patients), during lockdown (93), and post-lockdown (472)—and compared to data from the same time period of the IQED-Foot data collection in 2018. No differences in patient characteristics (eg, age, gender, medical history, diabetes type and duration) were noted between the groups.
The study found that compared to the same time period in 2018, the average weekly presentation rate of patients during lockdown was substantially reduced (by almost 60%―from 1.4 patients per week in 2018 to 0.6 patients per week in lockdown). However, there was no change in average patient-reported delay in presentation, although patients during and after lockdown tended to present with slightly larger ulcer. No significant differences in depth, infection or loss of protective sensation were detected between the three groups.
The authors recognise several limitations of study including that no data on mild foot ulcers were collected, however, these tend to have a much better prognosis. In addition, no information was available on people with a foot ulcer who were unable to present to a recognised diabetic foot clinic.
Unusual visual examination of objects may indicate later autism diagnosis in infants
Unusual visual examination of objects in infants may indicate later autism diagnosis CREDIT UC Regents
infants 9 months of age and older is predictive of a later diagnosis of autism spectrum disorder (ASD), a new UC Davis Health study has found.
Unusual visual inspection is defined as:
- looking out of the corners of the eyes,
- holding an object up very close to the face,
- looking at something with one eye closed, or
- staring at an object uninterrupted for more than 10 seconds.
“Unusual visual inspection behavior has long been associated with autism but never yet as early as 9 months of age,” said Meghan Miller, associate professor in the Department of Psychiatry and Behavioral Sciences and UC Davis MIND Institute and the first author on the study.
The study, published in the Journal of Abnormal Psychology, also found that this behavior at 9 months predicted 12-month social behavior, but not vice versa.
“The findings support major theories of autism which hypothesize that infants’ over-focus on objects might be at the expense of their interest in people. Ultimately, this study suggests that unusual visual inspection of objects may precede development of the social symptoms characteristic of ASD,” Miller said.
Visual inspection, repetitive behavior and social engagement in children with autism
About 1 in 54 children in the U.S. has been identified with ASD. Younger siblings of children with autism are at an elevated risk of being diagnosed with autism, at a rate of approximately one in five.
The researchers evaluated 89 infants whose older siblings have ASD (High-Risk group) and 58 infants with siblings with typical development (Low-Risk group). The infants completed a task designed to measure a variety of different ways of playing with and using objects at 9, 12, 15, 18, 24 and 36 months of age.
The examiners rated each infant’s social engagement behavior after every assessment session. They measured the infant’s frequency of eye contact, frequency of smiling at other people, and overall social responsiveness.
They also tallied the number of times the infant engaged in unusual visual inspection, spinning, and rotating behaviors with the objects. Spinning was defined as dropping, tossing or manipulating an object in order to make it spin or wobble. Rotating behavior indicated turning, flipping, or rotating the object at least twice.
At 36 months, the infants were classified into one of three groups: Low-Risk Non-ASD (58 children), High-Risk Non-ASD (72 children) and Diagnosed with ASD (17 children).
The study found that differences in unusual visual inspection were most prominent, consistent and present earliest in infants who developed ASD. At 9 months, the ASD group engaged in this behavior more frequently than both other groups and the behavior continued at higher rates at all ages.
Differences in frequencies of spinning and rotating were later-appearing, more time-limited, and related to familial ASD risk rather than the infant’s autism diagnosis.
“An increased focus on objects early in life may have detrimental cascading effects on social behavior,” said Sally Ozonoff, professor in the Department of Psychiatry and Behavioral Sciences and the MIND Institute at UC Davis and principal investigator of the study. “Findings from our study suggest that unusual visual exploration of objects may be a valuable addition to early screening and diagnostic tools for ASD.”