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	<title>Noorali Bharwani Professional Corporation</title>
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	<link>http://nbharwani.com</link>
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		<title>Low Dose Aspirin Increases the Risk of Upper Gastrointestinal Bleeding</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/low-dose-aspirin-increases-the-risk-of-upper-gastrointestinal-bleeding</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/low-dose-aspirin-increases-the-risk-of-upper-gastrointestinal-bleeding#comments</comments>
		<pubDate>Tue, 14 May 2013 06:00:43 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[aspirin]]></category>
		<category><![CDATA[gi bleeding]]></category>
		<category><![CDATA[heart disease]]></category>
		<category><![CDATA[NSAIDS]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2580</guid>
		<description><![CDATA[Low-dose acetylsalicylic acid &#8211; also known as aspirin &#8211; (75 mg⁄day to 325 mg⁄day) is recommended for primary and secondary prevention of cardiovascular events, but has been linked to an increased risk of upper gastrointestinal bleeding (UGIB), according to a study published by Valkhoff and his colleagues (Can J Gastroenterol. 2013 Mar;27(3):159-67). They analyzed several studies. All studies found low dose aspirin use to be associated with an increased risk of UGIB. The mean number of extra UGIB cases associated with low dose aspirin use was 1.2 per 1000 patients per year. Sounds like a small number when you think of the number of people who take aspirin all over the world. But the authors indicate use of low dose aspirin was associated with a 50 per cent increase in UGIB risk. What about other anti-inflammatory drugs? Are they safe? Commonly used traditional anti-inflammatory drugs like ibuprofen are also known as non-steroidal anti-inflammatory drugs (NSAID) are widely used for all kinds of pain. An editorial by Jacob Josh, Professor of Medicine, University of Ottawa, Ottawa, Ont. titled, &#8220;Anti-inflammatory drugs: What is safe?&#8221; (CMAJ August 29, 2006), says &#8220;Sixteen thousand deaths a year in the United States and 1900 a year in Canada were blamed on NSAID-induced gastric perforations, obstructions and bleeds. NSAID use was complicated also by numerous other side effects, including hypertension, heart failure and renal insufficiency.&#8221; The risks are not limited to long-term use. Clinically significant adverse cardiovascular events are noted within the first 30 days of treatment. Do you always have to take an NSAID if you are in pain and thus increase the risk of complications? Not really. You can try other modalities of pain relief by rest, application of ice and use of acetaminophen. Acetaminophen, up to 4 g/day, is as effective as an orally administered NSAID in about 40 per cent of patients with mild to moderate osteoarthritis. Then there are occassions when pain cannot be relieved by what we call conservative measures. So we have to weigh our options. First, we should assess patient risk. There is an increased risk of gastric toxicity if: -the patient is over 65, -has had previous upper GI bleed, -there is concurrent therapy with low-dose aspirin, corticosteroids or anticoagulants. Under these conditions we should try prescribing a coxib (like Celebrex) or traditional NSAID with concurrent cytoprotection (to protect the stomach lining) with misoprostol or a proton pump inhibitor. If the patient has had a recent heart attack or episode of congestive heart failure, then he should not take NSAID or coxib. Josh says, &#8220;In case of uncontrolled hypertension, we should not choose an NSAID or coxib until the blood pressure is well controlled. If the patient has controlled blood pressure that becomes elevated while taking an NSAID or coxib, even by 5 mm Hg systolic, adjust the antihypertensive medications or stop the anti-inflammatory, or both.&#8221; Monitor renal function as well. Josh says there is nothing like a safe NSAID or coxib. In high-risk patients, we should avoid them. Concomitant use of low dose aspirin does not protect you from cardiac side-effects of NSAID or coxib. There is adequate data to suggest aspirin enhances the gastric toxicity of anti-inflammatory drugs as mentioned earlier. If you are in pain, careful use of painkillers is very important. If you are taking aspirin as a prophylaxis against cardiac problems then weigh your risk factors and your options. If you are taking NSAID for chronic pain then you need to know your risks. Discuss risk vs. benefits of the medications you are taking with your doctor.]]></description>
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		<title>Georgia (and the Masters) on my mind!</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/georgia-and-the-masters-on-my-mind</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/georgia-and-the-masters-on-my-mind#comments</comments>
		<pubDate>Sat, 04 May 2013 06:00:50 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[golf]]></category>
		<category><![CDATA[travel]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2556</guid>
		<description><![CDATA[We (Tony, Dan and yours truly) arrived in Atlanta, Georgia on Friday April 5. We were picked up by our friend from Kentucky, Harry and drove to Reynolds Plantation in Greensboro, GA. We checked into our hotel, The Ritz-Carlton. Reynolds Plantation is a golf and lake community providing a lifestyle with six golf courses and access to Lake Oconee, Georgia&#8217;s second largest lake. It has 10,000 acres of land, four full service marinas and 90 miles of shoreline. We had tickets to the Masters for Tuesday April 9 practice round and Thursday April 11, first day of the Masters. We had decided to golf for three days at Reynolds Plantation before going to Augusta. On Saturday we golfed at The National and Great Waters &#8211; 36 holes for the day. On Sunday we golfed The Plantation Course and Harbour Club. Monday we golfed in the morning at The Oconee and drove to Augusta in the afternoon. In Augusta, we were accommodated in a beautiful house by our host. On Tuesday, we were driven to the Augusta National Golf Club by our host who had special privileges at the Club House. We drove through the famous Magnolia Lane and then given a tour of the clubhouse. We had breakfast at the clubhouse where only members and their guests are allowed. We also had lunch on the lawn which is also a restricted area. We had our pictures taken with the Masters trophy which sits in the clubhouse. Practice round is the only day cameras and cellphones are allowed on the course. We had an opportunity to walk around the course, follow some famous golfers on the course, take hundreds of pictures of who’s who on the PGA tour, we had a group photo with Dave Stockton, the short game guru of many players including Phil Mickelson. In the evening we had a kitchen encounter in a private home with &#8220;Mr. 59&#8243; Al Geiberger and his two sons who are also well known in their own sporting fields. Al Geiberger, won eleven times on the PGA Tour, with victories that included one major championship, the 1966 PGA Championship. On June 10, 1977, in the second round of the Danny Thomas Memphis Classic played at the Colonial Country Club in Cordova, Tennessee, he became the first person in history to post a score of 59 (par was 72) in a PGA event. Incidentally, Dave Stockton was one of Geiberger’s playing partners that day. That Tuesday afternoon we were free so we booked a course (The River Golf Club) in North Augusta, South Carolina &#8211; a 45-minute drive from Augusta, GA. On Wednesday, April 10, we played 36 holes of golf at Palmetto Golf Club in Aiken, South Carolina. So, by that time we had played nine rounds of golf in five days &#8211; this is the most golfing I have done in five days. At the end of it I felt tired but rejuvenated that I still had stamina to do this amount of activity! A self vote of confidence &#8211; so to speak. Thursday was the big day &#8211; first day of the Masters. We arrived at the course at seven in the morning, first tee time was at eight. Parking is free near the course &#8211; about five minutes walk from one of the gates. We went through the security and carefully walked to 14 and 15 hole and put our chairs at the rope around the green. If you are found running then you will be thrown out. There are too many rules to take care of. No cell phones or cameras are allowed inside after Thursday. There are thousands of people, so if you part with the members of your group then you will have hard time contacting them. Once you put your chair down then nobody will move it. You can walk around and follow a group of golfers for a while. It is a long course. Every fairway has a hilly area to climb. When you are tired you can sit down and watch all the golfers go by. You can decide how you want to spend the day. I was thrilled to see all the players in person so closely from the ring side sit. It was a memorable moment. We returned home on Friday to watch the rest of the Masters on TV. Masters ticket are one of the most difficult to buy. You can go to their website and apply. You can buy them from a certified ticket broker. According to Augusta Chronicle (April 7 2013), &#8220;&#8230; practice round tickets were ranging from as low as $350 for Monday, to more than $1,000 for Wednesday, ticket brokers said. A four-day tournament badge was going for about $6,500 but &#8230; prices can fluctuate wildly on any given day.&#8221; The law also sets a 2,700-foot boundary around the venue where no tickets can be resold. Augusta National policy prohibits the resale of Masters tickets.]]></description>
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		<title>HPV Vaccine for Boys Reduces Incidence of Genital Warts and Cancer</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/hpv-vaccine-for-boys-reduces-incidence-of-genital-warts-and-cancer</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/hpv-vaccine-for-boys-reduces-incidence-of-genital-warts-and-cancer#comments</comments>
		<pubDate>Tue, 30 Apr 2013 06:00:32 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[cervical cancer]]></category>
		<category><![CDATA[genital warts]]></category>
		<category><![CDATA[HPV]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2547</guid>
		<description><![CDATA[In 2008, in one of my columns, I wrote about the importance of vaccination against human papillomavirus (HPV) infection. It is beneficial to young teens before they have had sexual contact. The vaccine has demonstrated high level of antibody response amongst teens who have not been exposed to the virus. Initially the target group was young girls. By preventing HPV infection, we can prevent deaths from cervical cancer. The vaccine is almost 100 per cent effective against four types of HPV, two of which are responsible for 70 per cent of all cervical cancers. The vaccine may have cross-protection against some other HPV viruses. Unfortunately, HPV infection can occur with the first sexual intercourse, and half of Canada’s young women become sexually active by age 16. In 2007, Australia became one of the first countries to implement a nationally funded HPV vaccination programme for girls and young women. An editorial in the British Medical Journal published on April 18, 2013 titled, &#8220;HPV vaccination &#8211; reaping the rewards of the appliance of science,&#8221; lauds the Australian effort and its success. The analysis of data on 85,770 new patients from six Australian sexual health clinics showed a remarkable reduction in the proportion of women under 21 years of age presenting with genital warts &#8211; from 11.5 per cent in 2007 to 0.85 per cent in 2011. The near eradication of genital warts in young Australian women will probably have a major impact on the costs of sexual healthcare. Now it is time for the boys to do something about sexually transmitted infection. Many young boys are sexually active. They show up with venereal warts from HPV infection. Kudos to Prince Edward Island (PEI). It has become the first Canadian province to extend publicly funded school-based HPV vaccination to boys, as reported by the Canadian Press on April 19, 2013. In 2007, the National Advisory Committee on Immunization (NACI) recommended that girls and women aged nine to 26 be vaccinated for HPV. In 2012, NACI included males of the same age in that recommendation to prevent genital warts and anal-genital cancers. On April 25, 2013 the Canadian Press (CP) reported a policy statement released by the Society of Obstetricians and Gynecologists of Canada asking provincial and territorial governments to extend HPV vaccination programs to cover boys as done by PEI. Common sense would say that it is difficult to justify not offering boys the same protection as girls get. CP report says provinces and territories have been slow to follow the advice, given the high cost of the vaccines, which are administered in three doses. A full course of HPV vaccine costs between $400 and $500 if purchased outside the provincial programs, where the shots are provided for free. But the experts say health care cost savings from reduction of genital warts and its consequence over months and years should take care of the cost of the vaccine. It is time boys get the same protection as girls.]]></description>
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		<title>How much do you know about sleep?</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/how-much-do-you-know-about-sleep</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/how-much-do-you-know-about-sleep#comments</comments>
		<pubDate>Tue, 16 Apr 2013 06:00:48 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[sleep]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2539</guid>
		<description><![CDATA[This is a summary of an article written by Dr. Till Roenneberg, a professor of chronobiology and medical psychology at the Ludwig-Maximilians University in Munich, and published in the Washington Post on November 21 2012 titled, &#8220;Five myths about sleep.&#8221; Roenneberg is the author of &#8220;Internal Time: Chronotypes, Social Jet Lag, and Why You&#8217;re So Tired.&#8221; Roenneberg says, &#8220;We spend between a quarter and a third of our lives asleep, but that doesn&#8217;t make us experts on how much is too much, how little is too little, or how many hours of rest the kids need to be sharp in school.&#8221; First myth Roenneberg would like to debunk is &#8211; you need eight hours of sleep per night. He quotes Napoleon, who said, &#8220;Six hours for a man, seven for a woman and eight for a fool.&#8221; But this is not correct either. The truth is the ideal amount of sleep is different for everyone and depends on many factors, including age and genetic makeup. Roenneberg&#8217;s research team has surveyed sleep behavior in more than 150,000 people. About 11 percent slept six hours or less, while only 27 percent clocked eight hours or more. The majority fell in between. Women tended to sleep longer than men, but only by 14 minutes. When comparing various age groups &#8211; ten-year-olds needed about nine hours of sleep, while adults older than 30, including senior citizens, averaged about seven hours. Roenneberg&#8217;s team identified the first gene associated with sleep duration &#8211; if you have one variant of this gene, you need more sleep than if you have another. Roenneberg says that we generally cannot oversleep. When we wake up unprompted, feeling refreshed, we have slept enough. In our industrial society we sleep about two hours less per night than 50 years ago and this significantly decreases our work performance and compromises our health and memory. Second myth &#8211; early to bed and early to rise makes a man healthy, wealthy and wise. There was some truth in this when most of the work was done outdoors in natural light. The timing of sleep &#8211; earlier or later &#8211; is controlled by our internal clocks, which determine our optimal &#8220;sleep window.&#8221; With the widespread use of electric light, our body clocks have shifted later while the workday has essentially remained the same, says Roenneberg. This leaves us chronically sleep deprived. Studies show that teenagers who sleep later and start school later exhibit improved academic performance, higher motivation, decreased absenteeism and better eating habits. Third myth &#8211; exercise helps you sleep. Exercising may contribute to falling asleep earlier, and it certainly helps us sleep soundly through the night, says Roenneberg. But it&#8217;s exposure to light, not physical activity, that synchronizes our body clocks with daylight. Sleep is not only regulated by the body clock, but also by how long we were awake (also known as the buildup of &#8220;sleep pressure&#8221;). Fourth myth &#8211; sleep is just a matter of discipline. Parents who think that putting their children early to bed will make it easier for them to wake up early in the morning will be disappointed. Roenneberg says early-to-bed teenagers will still have a hard time getting up at the crack of dawn. They go to school at their biological equivalent of midnight with profound consequences for learning and memory. Teenagers should sleep with daylight coming into their bedrooms and should refrain from using light-emitting devices after 10 p.m. Fifth myth &#8211; most couples have very different sleep habits. Roenneberg says this is a matter of biology and genetics, not habits and personal preference. Women generally fall asleep earlier than men. Women, however, tend to control the sleep times in a partnership. Given how much time we spend in our beds, men and women don&#8217;t seem to give any consideration to sleep patterns when choosing a mate, concludes Roenneberg.]]></description>
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		<title>Five Things You Should Know About Proctalgia Fugax (Pain in the Butt)</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/five-things-you-should-know-about-proctalgia-fugax-pain-in-the-butt</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/five-things-you-should-know-about-proctalgia-fugax-pain-in-the-butt#comments</comments>
		<pubDate>Fri, 05 Apr 2013 23:25:19 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[anus]]></category>
		<category><![CDATA[pain]]></category>
		<category><![CDATA[pain-in-the-butt]]></category>
		<category><![CDATA[proctalgia fugax]]></category>
		<category><![CDATA[rectum]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2526</guid>
		<description><![CDATA[Proctalgia fugax was first described in Ancient Rome over 2000 years ago and still carries the Latin name which translates to &#8220;fleeting rectal pain.&#8221; I wrote about this some years ago. If you go to my website (nbharwani.com) and search proctalgia fugax, you will find that this is the most discussed article &#8211; more than 100 people have shared their experience with this condition. Because of my interest in this, my attention was drawn to an article in the Canadian Medical Association Journal (CMAJ March 19 2013) titled &#8220;Five things you should know about proctalgia fugax.&#8221; First thing you should know is proctalgia fugax has many triggers. There are episodes of sharp fleeting pain that recur over weeks, are localized to the anus or lower rectum, and last from seconds to several minutes with no pain between episodes. The authors of the article say that there are numerous precipitants including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger. Second thing you should know is proctalgia fugax is common. In the general population, the prevalence of the condition may be as high as eight to 18 per cent. Seventy five per cent are women. It usually affects patients between 30 and 60 years of age. Third thing you should know is that anal sphincter spasm may cause the pain in proctalgia fugax. The authors say that although the cause of proctalgia fugax is unclear, spasm of the anal sphincter is commonly implicated. It may occur after sclerotherapy for hemorrhoids and vaginal hysterectomy. Stress, anxiety and irritable bowel syndrome may be associated with proctalgia fugax. Fourth thing you should know is proctalgia fugax is a diagnosis of exclusion. That means there is no test to tell if the person is suffering from this condition. We have to exclude common painful conditions of anus and rectum before we can say a person is suffering from proctalgia fugax. These conditions are: hemorrhoids, cryptitis, ischemia, abscess, fissure, rectocele and cancer. Finally, the fifth thing you should know about this condition is that the treatments are geared towards relaxing the anal sphincter spasm. These treatments are: oral diltiazem, topical glyceryl nitrate (gives you headache), nerve blocks and salbutamol act by relaxing the anal sphincter spasm. But these treatments are not very effective. Persistent symptoms require thorough investigations of anal and rectal areas and if no pathology is found then reassurance to patient is very important. There is no known effective treatment for this condition. There are anecdotal reports of benefit from trying any of the following treatments: -Reassurance and warm baths -Topical glyceryl trinitrate 0.1 per cent or diltiazem two per cent whenever required -Salbutamol inhalation 200µg regular three times a day or whenever required -Warm water enema at the time of symptoms -Clonidine 150µg twice a day -Local anesthetic block or botulinum toxin injection -Help to relieve anxiety and stress]]></description>
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		<title>Oops! What did your surgeon forget in your body?</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/oops-what-did-your-surgeon-forget-in-your-body</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/oops-what-did-your-surgeon-forget-in-your-body#comments</comments>
		<pubDate>Tue, 05 Mar 2013 15:11:38 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[surgery]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2519</guid>
		<description><![CDATA[OK, don&#8217;t worry. It is not that common. In an article published in the Journal of the American College of Surgeons (January 2013) titled, &#8220;Retained Surgical Items: A Problem Yet to Be Solved,&#8221; by Stanislaw P.A. Stawicki, MD, and others says retained surgical items (RSI) continue to occur. But the exact numbers are difficult to document due to the low frequency of RSI in a single institution and due to the medicolegal implications. Literature suggests retained surgical items have traditionally been estimated to occur at a rate of 0.3 to 1.0 per 1,000 abdominal operations, and approximately 1 in 8,000 to 18,000 of all inpatient operations. Seven teaching institutions were invited to participate in this retrospective, multicenter, case-control study of RSI risk factors was conducted between January 2003 and December 2009. Fifty-nine RSIs and 118 matched controls were analyzed (RSI incidence 1 in 6,975 or 59 in 411,526). Retained surgical items occurred despite use of confirmatory x-rays (13 of 27 instances) and/or radiofrequency tagging (2 of 32 instances). The researchers concluded: -higher body mass index -unexpected intraoperative events -longer procedure duration and -occurrence of any safety omissions like an incorrect count were associated with increased RSI risk. Trainee presence was associated with 70 per cent lower RSI risk compared with trainee absence. The researchers are not sure why this would be the case. This requires further study. They further say, &#8220;Our findings highlight the need for zero tolerance for safety omissions, continued study and development of novel approaches to RSI reduction, and establishing anonymous RSI reporting systems to better track both the incidence and risks associated with this problem, which has yet to be solved.&#8221; As one can expect, the operating room is a complex environment where technology, team dynamics, potent pharmaceuticals, and technically difficult operations create high potential for adverse events. The researchers highlight at least three major obstacles to reducing the incidence of RSI, including locating missing items identified by an incorrect count, reducing the rate of incorrectly-correct counts, and improving team attentiveness and compliance with safety procedures and documentation. If you are having surgery in the near future then remember, the incidence of retained surgical items is extremely small. The people who work in the operating rooms are highly trained and dedicated and your safety, I am sure, is their first concern.]]></description>
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		<title>Circumcision: The Controversy Continues</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/circumcision-the-controversy-continues</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/circumcision-the-controversy-continues#comments</comments>
		<pubDate>Tue, 19 Feb 2013 07:00:13 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[pediatrics]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2512</guid>
		<description><![CDATA[&#8220;What advice should a physician give to parents considering whether or not to have their baby circumcised?&#8221; asks Dr. Jeff Blackmer. Dr. Blackmer is a Director of Ethics at the Canadian Medical Association (CMA). His column appears in the Bulletin of the CMA which is part of the Canadian Medical Association Journal (CMAJ February 5, 2013). The Canadian Paediatric Society (CPS) evaluates scientific evidence and sets guidelines in matters affecting children&#8217;s health. Since 1996, CPS has advised physicians that circumcision of newborn should not be routinely performed as there was no medical benefit. This, of course, has not changed the practice. Some parents request circumcision for their sons for religious reasons or family tradition. In August, 2012 the American Academy of Pediatrics (AAP) updated its 1999 policy on circumcision to say that there are some medical benefits to having the procedure. Circumcision lowers risk of urinary tract infection, cancer of the penis, and sexually transmitted infection. Blackmer says that CPS is reviewing the evidence and may release an updated statement. In 2011, Dr. Noni MacDonald, Section Editor of CMAJ wrote an article in the CMAJ under the title, &#8220;Male circumcision: get the timing right.&#8221; (CMAJ April 19, 2011). Dr. Noni MacDonald is a Professor of Paediatrics and of Computer Science at Dalhousie University with a clinical appointment in Paediatric Infectious Diseases at the IWK Health Centre in Halifax Canada. She is the former Dean of Medicine at Dalhousie University. &#8220;The most commonly performed surgical procedure in the world &#8211; male circumcision &#8211; is done for therapeutic, prophylactic, religious, cultural and social reasons. Discussions of male infant circumcision for health reasons are always split,&#8221; says MacDonald in her article. Those who support circumcision say that there are significant potential health benefits including a decreased risk for some sexually transmitted infections, a decrease in HPV-related penile cancer and reduced phimosis and paraphimosis (tightness of the foreskin). Those who oppose circumcision say that the procedure is not without likely complications &#8211; about 1.5 per cent &#8211; and it is a painful procedure for the newborn. Medical organizations in western countries have discouraged infant circumcision for many years. MacDonald asks, &#8220;The question now is whether the findings from the randomized trials of adult male circumcision in sub-Saharan Africa that show circumcision halves the risk of acquiring HIV and decreases risk for HSV-2 (a herpes simplex virus that can cause genital herpes) and high-risk HPV in heterosexual African adult men push these organizations to change their positions on routine infant circumcision.&#8221; MacDonald adds, &#8220;&#8230; none of the sub-Saharan African studies examined infant circumcision; all involved adult male circumcision. There is no new evidence that infant circumcision provides any added benefit to the neonate, infant or young child with respect to HIV and HPV protection. The potential benefit from circumcision only begins to accrue when the male becomes sexually active.&#8221; The dilemma is: if the infant is not going to benefit from circumcision until he is sexually active then should we offer circumcision during peripubertal time? Would the male adolescent be willing to go through the procedure? Currently, infants have no choice. The choice for them is made by their parents. The World Health Organization agrees there is evidence that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides partial protection and should not replace other interventions to prevent transmission of HIV. Well, what is the conclusion? I will quote Dr. Blackmer from his ethics corner column mentioned earlier. It says, &#8220;Some parents will always choose circumcision, some will always reject it, and some will decide based solely on the evidence.&#8221; The only thing a physician can do is present the evidence and let the parents make the decision.]]></description>
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		<title>Preventing Cervical Cancer &#8211; New Guidelines Published in 2013</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/preventing-cervical-cancer-new-guidelines-published-in-2013</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/preventing-cervical-cancer-new-guidelines-published-in-2013#comments</comments>
		<pubDate>Tue, 05 Feb 2013 07:00:16 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[Cancer]]></category>
		<category><![CDATA[cervical cancer]]></category>
		<category><![CDATA[pap smear]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2500</guid>
		<description><![CDATA[Every woman should know it is important to have regular Pap smear test. Since World War II, the test has been the most widely used and successful cancer screening technique in history. It is named after the Greek doctor who invented it &#8211; Dr. George Nicholas Papanicolaou. An article in the Canadian Medical Association Journal (CMAJ January 8, 2013) says, &#8220;The incidence of and mortality due to cervical cancer in Canada have decreased substantially in the past 50 years, and long-term survival rates after treatment are high. Lifetime incidence was 1.5 per cent in 1972, and is now 0.7 per cent; risk of death from cervical cancer is now 0.2 per cent. Most advanced cervical cancer (and associated mortality) occurs among women who have never undergone screening or who have had a long interval between Papanicolaou (Pap) tests.&#8221; For example, in 2011, an estimated 1300 new cases of cervical cancer were diagnosed in Canada, with about 350 deaths. The risk increases after age 25 years and older, peaking during the fifth decade of life. Pap smear test helps pick early lesions before they become cancerous. This means less invasive treatment is required and the prognosis is better. In the same issue of the CMAJ, the Canadian Task Force on Preventive Health Care has published new guidelines for Pap smear test. These guidelines, which are based on the current scientific evidence, are as follows: -For women aged less than 20 years, no routine screening for cervical cancer. (Strong recommendation; high-quality evidence) -For women aged 20-24 years, no routine screening for cervical cancer. (Weak recommendation; moderate-quality evidence) -For women aged 25-29 years, routine screening for cervical cancer every three years. (Weak recommendation; moderate-quality evidence) -For women aged 30-69 years, routine screening for cervical cancer every three years. (Strong recommendation; high-quality evidence) -For women 70 years of age or older who have undergone adequate screening (i.e., three successive negative Pap test results in the last 10 yr), routine screening may stop. For all other women 70 years of age or older, should continue screening until three negative test results have been obtained. (Weak recommendation; low-quality evidence) Where the recommendations are weak, the decision to undergo Pap smear test depends if the health care provider and the patient think that there is an indication to do one. If the woman is sexually active, she has multiple partners or she has sexually transmitted infection then there would be an indication to do one. One drawback with these updated recommendations is they do not address screening with tests for human papilloma virus (HPV), because there is not yet sufficient data on its effect on mortality and incidence of invasive cancer, says the article. In a commentary related to the guidelines, Dr. Janet Dollin says, &#8220;When Dr. Georgios Papanicolaou developed his famous test in the 1940s, we did not know that cervical cancer is a preventable sexually transmitted infection.&#8221; The role of cancer causing virus like HPV was not known. We now know infection with specific strains of HPV is a necessary precursor to cervical cancer. Some of these viruses cause genital warts &#8211; another sexually transmitted infection. Dr. Dollin says, &#8220;Indeed, improving uptake and access to HPV vaccination and cervical screening would do more to lower the rates of cervical cancer than deciding at what age to start Pap testing and how frequently it should be done.&#8221; The National Advisory Committee on Immunization (NACI) recommends the vaccination of boys and girls to prevent the burden of HPV disease. Dr. Dollin says that the US Preventive Services Task Force recommends screening for women aged 21-65 years with a Pap every three years or, for women aged 30-65 years who want to lengthen the screening interval, a combination of Pap and HPV testing every five years.]]></description>
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		<title>The Importance of Vitamins in Our Diet</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/the-importance-of-vitamins-in-our-diet</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/the-importance-of-vitamins-in-our-diet#comments</comments>
		<pubDate>Tue, 22 Jan 2013 07:00:51 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[diet]]></category>
		<category><![CDATA[vitamins]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2494</guid>
		<description><![CDATA[In general, most people know the importance of vitamins in our diet. But many people do not know which vitamins are really important in maintaining good health. I would like to revisit an article I had discussed about ten years ago on this topic. Not much has changed since. The topic was also discussed in a Clinical Practice article in the New England Journal of Medicine (NEJM) titled, &#8220;What vitamins should I be taking, doctor?&#8221; Medical teaching says that a healthy individual, who eats a good diet, does not require vitamin supplements. He should be able to meet his vitamin needs from his healthy diet. But the public interest in vitamin supplements is enormous – sometimes due to misguided reasons. Almost 30 percent of our population takes vitamin supplements. And there is no control over it. Because the food we eat contains too many nutrients, it would be almost impossible to conduct double blind trials to see if vitamins do have improved clinical outcomes. Also the users of vitamin supplements may have healthier lifestyles or behaviours than nonusers. This would distort any clinical trial results. The good thing about vitamin supplements is that there is greater likelihood of good than harm and cost of supplements is not that high so the authors of the article in the NEJM recommend the following vitamin supplements for healthy individuals. There is substantial evidence that higher intake of: 1. folic acid (400 ug/day), 2. vitamin B6 (2 mg/day), 3. vitamin B12 (6 ug/day), and 4. vitamin D (400 IU/day) will benefit many people, and a 5. a multivitamin will ensure an adequate intake of other vitamins for which the evidence of benefit is indirect. The authors say a multivitamin is especially important: -for women who might become pregnant -for persons who regularly consume one or two alcoholic drinks per day -for the elderly, who tend to absorb vitamin B12 poorly and are often deficient in vitamin D -for vegetarians, who require supplemental vitamin B12 and -for poor urban residents, who may be unable to afford adequate intakes of fruits and vegetables. It should be noted that recent recommendation for vitamin D suggests all adults should take 1,000 to 2,000 IU daily. The upper level for safe vitamin D intake has not been well defined but is probably as high as 250 μg (10,000 IU) daily but in clinical practice, supplementation with this dose of vitamin D is rarely required. Physicians who encourage their patients to take vitamin supplements should also educate their patients regarding healthy lifestyle and about healthy nutritious diet. Foods contain many additional important components, such as fiber and essential fatty acids and vitamin pills cannot be a substitute. Vitamin pills do not compensate for the massive risks associated with smoking, obesity, or inactivity, say the authors of the NEJM.]]></description>
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		<title>Genetically Engineered Frankenfish is Considered Safe</title>
		<link>http://nbharwani.com/2013/medicine-hat-news/genetically-engineered-frankenfish-is-considered-safe</link>
		<comments>http://nbharwani.com/2013/medicine-hat-news/genetically-engineered-frankenfish-is-considered-safe#comments</comments>
		<pubDate>Tue, 08 Jan 2013 07:00:46 +0000</pubDate>
		<dc:creator>Dr. Noorali Bharwani</dc:creator>
				<category><![CDATA[Medicine Hat News]]></category>
		<category><![CDATA[fish]]></category>
		<category><![CDATA[food]]></category>
		<category><![CDATA[genetics]]></category>
		<category><![CDATA[microbiology]]></category>

		<guid isPermaLink="false">http://nbharwani.com/?p=2480</guid>
		<description><![CDATA[Have you heard of &#8220;frankenfish&#8221;? It is a Frankenstein fish. Yuck, right? Well, have no fears. A media report including one in the Washington Post (December 21/2012) says, &#8220;Federal health regulators say a genetically modified salmon that grows twice as fast as normal is unlikely to harm the environment, clearing the way for the first approval of a scientifically engineered animal for human consumption.&#8221; The Canadian Press reported on January 4, 2013, &#8220;Canadian &#8216;frankenfish&#8217; moves closer to FDA approval for human consumption.&#8221; In the U.S., the Food and Drug Administration (FDA) said the fish is unlikely to harm populations of natural salmon, a key concern for environmental activists. The AquaAdvantage salmon has been called by the critics as frankenfish. They see the development of frankenfish unethical and worry it could cause human allergies and eventually destroy the natural salmon population if it escapes and breeds in the wild. FDA has said in the past that animals that are cloned are safe to eat. But frankenfish is not a clone. The DNA has been changed to produce a desirable effect. There is added growth hormone from the Pacific Chinook salmon that allows the fish to produce growth hormone all year long. Typical Atlantic salmon produce the growth hormone for only part of the year. The company says frankenfish will have the same flavour, texture, colour and odour as the conventional fish. This is only one example of genetically altered food. There are many other foods which have been genetically changed. The Health Canada website (http://www.hc-sc.gc.ca/) says, &#8220;Health Canada conducts a thorough safety assessment of all biotechnology-derived foods to demonstrate that a novel food is as safe and nutritious as foods already on the Canadian marketplace.&#8221; Internationally, more than 10 species specific consensus documents have been developed, including for corn, soybean, wheat, rice, canola and sugar beet to ensure safety of these foods for human consumption. As of 2012, Health Canada has approved over 81 genetically modified foods for sale in Canada. No applications have been turned down as long as they meet Health Canada&#8217;s strict guidelines. According to Wikipedia, commercial sale of genetically modified foods began in 1994, when Calgene Inc. first marketed its Flavr Savr delayed ripening tomato. Since then the technology has been used in different areas. There are organisms which have been genetically engineered and there are crops which have undergone genetic changes. Some fruits and vegetables have been genetically changed to prevent disease in the crops. For example, Papaya has been genetically modified to resist the ringspot virus. Today, 80 per cent of Hawaiian papaya is genetically engineered. As of 2005, about 13 per cent of the zucchini grown in the US was genetically modified to resist some viruses. Most vegetable oil used in the US is produced from genetically modified crops. We can go on. There are many such examples. No reports of ill effects have been documented in the human population from genetically modified food. Looks like genetically modified food is here to stay. And we are eating it every day.]]></description>
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