Category: Knowledge

Clinical Updates

Clinical Updates



Obesity, type 2 diabetes tied to jump in NAFLD cases

At the annual meeting of the American College of Physicians. Younossi and other researchers conducted a meta-analysis of studies in 20 countries, which was published in Hepatology Communications and found that the global prevalence of NAFLD is 24%, but nearly 75% of patients with the disease are obese, and 58% of people with diabetes also have NAFLD.

Study: Insect consumption may improve gut inflammation

Research suggests that eating crickets may improve inflammation in the gut and its overall health, according to a study led by Valerie Stull, a postdoctoral research fellow at the University of Wisconsin-Madison. The investigators looked at whether cricket consumption was tolerable and safe and changed markers of inflammation or lipid metabolism, and they assessed whether insect fibers such as chitin — the chief component of a cricket’s exoskeleton — could work as prebiotics.

Report: Medicaid could save over $4.8B with fully electronic transactions

Medicaid could save over $4.8 billion per year if all of the program’s claims processes were to become fully electronic, according to a report from the Council for Affordable Quality Healthcare. The move could save payers $6.84 per transaction, the report estimates.


CDC looks at patient health data exchanged by physicians

CDC researchers found that referrals, laboratory results and medication lists were the most common types of patient health information sent by office-based physicians, while they most often received lab results, imaging reports and medication lists. The findings in National Health Statistics Reports, based on 2015 National Electronic Health Records Survey data, also showed that lab results were the most commonly electronically integrated data, while medication lists were the most commonly searched data in the EHR.


Using analytics to incentivize value-based health care

Value-based care encourages medical professionals to prioritize outcomes and efficiency with preventative health care, but the strategy can be difficult to incentivize for health professionals. Analytics could help solve this problem by collecting patient data, indicating where there are gaps in the patient’s care and creating priority and outreach lists, says Jennifer Carney of Beth Israel Deaconess Care Organization.


Health data access remains a challenge for patients

Patient access to health records remains a challenge, with a survey finding that 63% of Americans are unaware of where their health care data is stored or who has access to it. The CMS has launched the MyHealthEData Initiative for Medicaid and Medicare’s EHR programs, and the agency has started using Medicare Blue Button 2.0, a new software protocol for developers.


Compiled By Tarun Kothari MD





IBS and 5 Things to Know

IBS and 5 Things to Know

IBS—From Symptom to Disease: Five Things to Know

In a recent Healio Gastronenterology article, Dr. William Chey, of the University of Michigan, explained the challenges of IBS and why we need to create a future in which we can identify an effective solution for some IBS patients that is based on a more personalized medicine approach.

Dr. Chey points out that IBS is a symptom-based condition defined by the presence of abdominal pain and altered bowel habits.

“The clinical phenotype can be quite diverse so while all patients have pain, some patients can have problems with diarrhea, others can have problems with constipation, and still others can have a mixture of both constipation- and diarrhea-related features,” he said in the article.

IBS—being a symptom-based condition—isn’t one disease, according to Dr. Chey. “It’s likely several different diseases that happen to present with the same symptoms. Yet, given our current understanding and a lack of validated biomarkers, we cannot parse IBS patients on the basis of pathophysiological abnormalities. Instead, we rely upon symptoms to establish a diagnosis and choose a treatment.

Dr. Chey’s Five Things to Know about IBS:

  1. IBS is currently a condition defined by characteristic symptoms of pain and abnormal bowel habits.
  2. There are many potential causes for IBS symptoms—IBS isn’t one disease—it’s likely a number of diseases which happen to present with the same symptoms.
  3. Most tests are done to RULE OUT diseases like colon cancer, inflammatory bowel disease and celiac disease that can mimic the symptoms of IBS.
  4. Researchers are developing tests to RULE IN IBS, but they are in their infancy at the present.
  5. The future will pair symptom based criteria like the Rome IV criteria with tests that help a doctor to understand the cause for a patient’s IBS symptoms and, in that way, choose the right therapy for a specific patient.

More about IBS

Irritable bowel syndrome (IBS) is a disorder of bowel function (as opposed to being due to an anatomic abnormality). Patients who suffer from irritable bowel syndrome have changes in bowel habits such as constipation or diarrhea, and abdominal pain along with other symptoms including abdominal bloating, and rectal urgency with diarrhea. In addition, IBS may be associated with a number of non-intestinal (“extra intestinal symptoms”), such as difficulty with sexual function (pain on intercourse or lack of libido), muscle aches and pains, fatigue, fibromyalgia syndrome, headaches, back pain, and sometimes urinary symptoms including urinary urgency, urinary hesitation or a feeling of spasm in the bladder.

In the United States, it is estimated that 10-15 percent of the adult population suffers from IBS symptoms, yet only 5 to 7 percent of adults have been diagnosed with the condition. IBS is the most common condition diagnosed by gastroenterologists and one of the most common disorders seen by primary care physicians.

The exact cause of irritable bowel syndrome is not known. However, tremendous advances in our understanding of this common and disabling disorder have been made in the last 10 years. Abnormal motility in terms of the bowel moving too fast (which causes diarrhea) or too slow (which causes constipation) is certainly part of this syndrome. However, this represents only one part of a complicated disorder. The symptoms of pain, incomplete emptying of the bowels, and bloating cannot be explained only by abnormal gut GI motility. Over the last 20 years a number of very well done scientific studies have demonstrated that individuals with IBS tend to have higher levels of sensitivity in the intestines compared to individuals who do not have IBS.

Source: The American College of Gastroenterology


Eat Turmeric to Boost Memory and Lift Spirits, Says New Study at UCLA

Eat Turmeric to Boost Memory and Lift Spirits, Says New Study at UCLA

Eat Turmeric to Boost Memory and Lift Spirits, Says New Study at UCLA

A new study by UCLA researchers has concluded that the daily consumption of curcumin, a powerful medicinal compound found in turmeric, could improve memory and lift your mood. Prabha Siddarth, an Indian American research statistician at UCLA’s Semel Institute, was also among the paper’s authors.


From fighting inflammation to relieving sore joints to clearing infections, the health benefits of turmeric, which contains the powerful medicinal compound called curcumin, have been long known. And now a new study conducted by UCLA researchers claims that the yellow colored Indian spice can improve memory and mood in people with mild, age-related memory loss.

The research, published online Jan. 19 in the American Journal of Geriatric Psychiatry, examined the effects of an easily absorbed curcumin supplement on memory performance in people without dementia, as well as curcumin’s potential impact on the microscopic plaques and tangles in the brains of people with Alzheimer’s disease.

The study followed a group of adults for 18 months while monitoring their behavior and cognitive abilities. It involved 40 subjects (age 51–84 years) who had mild memory complaints. Participants were randomly assigned to receive either a placebo or 90 milligrams of curcumin twice daily for that time period.

Those who took a daily supplement of curcumin experienced significant improvements in their memory and attention abilities, while the subjects who received the placebo did not, said Dr. Gary Small, director of geriatric psychiatry at UCLA’s Longevity Center and of the geriatric psychiatry division at the Semel Institute for Neuroscience and Human Behavior at UCLA, and the study’s first author. In memory tests, he said, the people taking curcumin improved by 28 percent over the 18 months. Those taking curcumin also had mild improvements in mood.

Indian American research statistician at UCLA’s Semel Institute Prabha Siddarth was also among the paper’s authors.

“Exactly how curcumin exerts its effects is not certain,” said Small. “But it may be due to its ability to reduce brain inflammation, which has been linked to both Alzheimer’s disease and major depression.”

“These results suggest that taking this relatively safe form of curcumin could provide meaningful cognitive benefits over the years,” Small added.

However, four people taking curcumin, and two taking placebos, experienced mild side effects such as abdominal pain and nausea.

The researchers plan to conduct a follow-up study with a larger number of people. That study will include some people with mild depression so the scientists can explore whether curcumin also has antidepressant effects.

Submitted for posting by Dr. Sadanand Mishra.

The Cost of Medical Liability Claims

The Cost of Medical Liability Claims

34% of physicians have been sued:

The AMA released three new trend reports demonstrating the high frequency and cost burden of medical liability claims.

“Information in this new research paints a bleak picture of physicians’ experiences with medical liability claims and the associated cost burdens on the health system,” David O. Barbe, MD, MHA, president of AMA, said in a press release. “The reports validate the fact that preserving quality and access in medicine, while reducing cost, requires fairness in the civil justice system. Every dollar spent on the broken medical liability system is a dollar that cannot be used to improve patient care.”

In the first report, the AMA evaluated how often physicians are subjected to medical liability claims. The report found that it is common for physicians to get sued, with 34% having a claim filed against them during their career. The likelihood of getting sued increases with age — almost half (49.2%) of physicians aged 55 years and older have been sued vs. 8.2% of physicians aged 40 years and younger.

The occurrence of liability claims varies greatly between specialties, according to the report. General surgeons and OB/GYNs have the greatest risk of being sued, whereas pediatricians have the lowest risk. More than half of general surgeons and OB/GYNs have been sued before the age of 55 years.

“Even though the vast majority of claims are dropped, dismissed or withdrawn, the heavy cost associated with a litigious climate takes a significant financial toll on our health care system when the nation is working to reduce unnecessary health care costs,” Barbe said.

The second report examined indemnity payments, expenses and claim disposition and found that the average expense incurred on medical liability claims increased 64.5% from 2006 to 2015, amounting to $54,165. Dropped, dismissed or withdrawn claims (68.2% of all claims in 2015) still contributed to the cost burden, averaging a cost of $30,475 per claim in 2015 and contributing to 38.4% of total expenses, according to the report.

In the third report, the AMA assessed the annual changes in medical liability insurance premiums from 2008 to 2017. The report revealed that more premiums increased than decreased since 2015, which was a reversal of the trend observed earlier in the study. In addition, 12% to 17% of premiums rose from the prior year since 2010.




Homemade Yogurt Resolves Irritable Bowel Symptoms

Homemade Yogurt Resolves Irritable Bowel Symptoms

Damian McNamara

December 07, 2017

ORLANDO — The daily consumption of homemade yogurt can lead to a complete resolution of symptoms in patients with irritable bowel syndrome, a prospective study shows.
“We were surprised by the response. We had 189 patients in the study, and 169 had remission within 6 months,” said Manju Girish Chandran, MBBS, from the Mary Breckinridge ARH Hospital in Hyden, Kentucky.
And some of the participants had lived with symptoms of irritable bowel syndrome for 9 or 10 years, she reported here at the World Congress of Gastroenterology.
“Our study is based on the fact that there is an internal gut–brain microbiome axis,” Dr. Chandran told Medscape Medical News. “If you modulate the intestinal microbiome, you can actually achieve remission in some cases.”
Medication does not adequately treat the symptoms of irritable bowel syndrome for many people, she said. As a result, “they just live with it.”
That is one of the reasons Dr. Chandran and her colleagues wanted to assess the potential of homemade yogurt with Lactobacilli to influence the gut microbiome.

Part of a Regular Diet

For their study, the team enrolled 189 consecutive patients diagnosed with irritable bowel syndrome at one of two medical centers in Eastern Kentucky.
Patients were instructed to consume 2 to 3 cups of yogurt every day and record their symptoms in a chart. Their responses were assessed every 2 months for 6 months.
Complete remission — defined as the relief of pre-existing irritable bowel syndrome symptoms and one or two normal bowel movements daily — was achieved by 89% of the study participants.
The yogurt is inexpensive and easy to make. First, boil a gallon of milk for 5 minutes and let it cool to lukewarm. Next, mix in 1 cup of Dannon plain yogurt, which is used as a starter and source of Lactobacilli. Place in an oven with the light on overnight (do not turn the oven on), and then refrigerate the next morning. Save 1 cup from each batch to use as a starter for the next batch.
“You can make enough yogurt for 1 week, and it’s pretty cheap,” Dr. Chandran pointed out. “And it doesn’t have to be eaten as plain yogurt.” Because it can be mixed with fruit or used in a smoothie, it doesn’t “feel like it’s a medicine; it is part of a regular diet.”
This is the first study to show “that yogurt — even though it’s homemade — is usable in IBS,” said Ronnie Fass, MD, from the MetroHealth Medical Center in Cleveland.
“In traditional diets, we recommend that people with IBS be careful with milk-related products,” he told Medscape Medical News. “This study suggests what we thought all along is not so clear cut.”
“The homemade yogurt with Lactobacillus was very effective at controlling symptoms of belly pain and alterations in bowel movements. It did both, to my surprise,” Dr. Fass said. “This is the kind of study that could change standard of care, although more work is needed.”