Dr K K Aggarwal

eMedinewS Editorial

Seven steps to shape your personal plan (Harvard Health Beat)

• Select a goal. Choose a goal that is the best fit for you. It may not be the first goal you feel you should choose. But you’re much more likely to succeed if you set priorities that are compelling to you and feel attainable at present.
• Ask a big question. Do I have a big dream that pairs with my goal?
• Pick your choice for change. Select a choice that feels like a sure bet. Do you want to eat healthier, stick to exercise, diet more effectively, ease stress? It’s best to concentrate on just one choice at a time. When a certain change fits into your life comfortably, you can then focus on the next change.
• Commit yourself. Make a written or verbal promise to yourself and one or two supporters you don’t want to let down: your partner or child, a teacher, doctor, boss, or friends. That will encourage you to slog through tough spots.
• Scout out easy obstacles.
• Brainstorm ways to leap over obstacles. Now think about ways to overcome those roadblocks.
• Plan a simple reward. Is there a reward you might enjoy for a job well done?

Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

Alternate therapy for adults with poorly controlled asthma

Tiotropium bromide effective when added to low–dose inhaled corticosteroids

A drug commonly used for the treatment of chronic obstructive pulmonary disease (COPD) successfully treats adults whose asthma is not well–controlled on low doses of inhaled corticosteroids, reported researchers supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. “This study’s results show that tiotropium bromide might provide an alternative to other asthma treatments, expanding options available to patients for controlling their asthma. The goal in managing asthma is to prevent symptoms so patients can pursue activities to the fullest,” said NHLBI Acting Director Susan B. Shurin, M.D.

According to the study, adding tiotropium bromide to low doses of inhaled corticosteroids is more effective at controlling asthma than doubling inhaled corticosteroids alone, and as effective as adding the long–acting beta agonist salmeterol. The results were published online in the New England Journal of Medicine and presented at the Annual Congress of the European Respiratory Society in Barcelona, Spain.

Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

Aging gracefully

Age-related changes in our facial appearance are unavoidable.

1. Sun protection. Protecting face from the sun is the single best way of keeping it youthful. Much of the damage comes from the UVA part of the light spectrum, so you need to put on sunscreen that protects against it and UVB light, which causes sunburn.

2. Creams and lotions. Moisturizers soothe dry skin and may temporarily make wrinkles less noticeable. Moisturizers for the face contain water to make them less greasy, and many have substances -glycerin, for example-that may help bind water to the skin. Exfoliant creams can improve the appearance of older skin by getting rid of dead skin cells that don’t slough off as readily as they did when we were young. Several prescription creams have been shown to reduce wrinkles and so-called liver spots caused by sun exposure. These FDA-approved creams contain retinoids, compounds related to vitamin A that seem to work by inducing collagen production in the dermis and altering melanin, the pigment that causes liver spots. There are several varieties of retinoids. Tazarotene and tretinoin are the ones used in the FDA-approved products.

3. Botulinum toxin injections. These injections are used to treat the expression lines of the forehead and between the brows. They work by partially immobilizing the muscles that form expression lines so the skin smoothes out, although some deep expression lines may not go away. Botox is the familiar brand name. Other FDA-approved botulinum toxins are Myobloc and Dysport. The FDA issued a new warning in 2009 about the botulinum toxin spreading from injection sites, although there have been no reports of that happening when the injections were for expression lines.

4. Dermal fillers. Dermal fillers are used to treat lines created by lost collagen and fat. After botulinum toxin injections, dermal filler injections are the most common cosmetic procedure performed in the United States. Prime locations for the injections are two sets of parentheses: the pair of lines that extend down from the nose to the corners of the mouth, known as the nasolabial folds, and another pair that extends down from the corners of the mouth to the chin, known as marionette lines. Many different materials are used as dermal filler. Collagen has fallen out of favor. Currently, the most popular one is hyaluronic acid, a complex sugar found naturally in many tissues. Hyaluronic acid is more expensive than collagen, but lasts longer  up to six months in the nasolabial folds. Like botulinum toxin injections, the effect of the dermal filler shots wears off after several months how long depends on the injection site  but with repeat injections it seems to last a little longer.

5. Laser treatments. Lasers can be used to home in on certain pigments: brown, if the goal is to get rid of freckles and liver spots, red if the target is broken capillaries. They e also used for wholesale resurfacing of facial skin. The uppermost layers are stripped away, and with them, wrinkles from sun damage and scars from acne. The energy from some nonablative resurfacing lasers passes through the outer layer of the skin to work at a deeper level, in the dermis, to stimulate inflammation, which leads to collagen formation. Skin needs time to recover after most laser treatments. It can take a couple of weeks to heal, depending on the type and extent of the treatment. The nonablative treatments tend to heal a bit faster.

(Source Harvard Newsletter)

Dr KK Aggarwal
Editor in Chief