Dr. Nabieh Al-Hilali's Clinic

Dr. Nabieh Al-Hilali's Clinic Medical and Nephrology Clinic for Dr. Nabieh Al-Hilali, consultant in Nephrology and general medicin

14/02/2018

What to know about lactic acidosis
Last reviewed Fri 9 Feb 2018 By Lana Barhum Reviewed by Stacy Sampson, ح

Lactic acidosis occurs when the body produces too much lactic acid and cannot metabolize it quickly enough. The condition can be a medical emergency.
The onset of lactic acidosis might be rapid and occur within minutes or hours, or gradual, happening over a period of days. The best way to treat lactic acidosis is to find out what has caused it.

Untreated lactic acidosis can result in severe and life-threatening complications. In some instances, these can escalate rapidly.

Fast facts on lactic acidosis:
It is not necessarily a medical emergency when caused by over-exercising.
The prognosis for lactic acidosis will depend on its underlying cause.
A blood test is used to diagnose the condition.

What are the symptoms?
Man having chest pains rapid heart rate, and heart attack at desk
Lactic acidosis symptoms that may indicate a medical emergency include a rapid heart rate and disorientaiton.
Typically, symptoms of lactic acidosis do not stand out as distinct on their own but can be indicative of a variety of health issues.

However, some symptoms known to occur in lactic acidosis indicate a medical emergency.

These include:

disorientation
yellow skin or eyes, known as jaundice
shallow, rapid, or other breathing problems
rapid heart rate

10/02/2018

Comparative effectiveness of novel oral anticoagulants in UK patients with non-valvular atrial fibrillation and chronic kidney disease: a matched cohort study

1. Simone Y Loo1,2,
2. Janie Coulombe1,2,
3. Sophie Dell’Aniello2,
4. James M Brophy3,
5. Samy Suissa1,2,
6. Christel Renoux1,2,4

BMJ FEB 2018
Abstract
Objectives To evaluate the effectiveness and safety of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) among patients with non-valvular atrial fibrillation (NVAF), particularly those with chronic kidney disease (CKD).

Design Population-based matched cohort study.
Setting Over 670 primary care practices in the UK, contributing to the Clinical Practice Research Datalink.
Participants Up to 6818 adult patients newly treated with NOACs between 2011 and 2016, matched 1:1 to new users of VKAs on age, s*x and high-dimensional propensity score.
Interventions Current exposure to NOACs compared with current exposure to VKAs.
Main outcome measures HRs of ischaemic stroke and systemic embolism (SE), major bleeding, gastrointestinal (GI) bleeding, intracranial bleeding, myocardial infarction and all-cause mortality

Results In as-treated analyses, the rates of ischaemic stroke/SE were similar between NOACs and VKAs (HR 0.94; 95% CI 0.62 to 1.42), as were the rates of major bleeding (HR 0.86; 95% CI 0.56 to 1.33). NOACs also significantly increased the risk of GI bleeding (HR 1.78; 95% CI 1.27 to 2.48). In patients with NVAF and CKD, NOACs and VKAs remained comparable with respect to the risk of ischaemic stroke/SE (HR 0.79; 95% CI 0.40 to 1.58) and major bleeding (HR 0.88; 95% CI 0.47 to 1.62), with no difference in the risk of GI bleeding (HR 0.99; 95% CI 0.63 to 1.55). Similar results were obtained in on-treatment analyses using a time-dependent exposure definition.

Conclusions Our results suggest that in the UK primary care, NOACs are overall effective and safe alternatives to VKAs, among patients with NVAF altogether, as well as in patients with NVAF and CKD.

03/02/2018

Treatment and diagnosis of Arachnoiditis
Last reviewed Fri 2 February 2018
By Zawn Villines
Reviewed by William Morrison, MD

Arachnoiditis is a neurological condition that causes pain in the back, perineum (the space between the ge****ls and the re**um), legs, arms, and feet. Arachnoiditis can also affect a person's vision, sight, and mobility.
Arachnoiditis develops when the tissues that protect the brain, the nerves, and the spinal cord are damaged, usually by a traumatic injury.
Arachnoiditis is rare, so it may require many tests and take some time to diagnose. There is no standard test for arachnoiditis, but imaging tests may be used. These include:
• magnetic resonance imaging (MRI)
• computerized axial tomography (CAT) scan
An electromyogram (EMG) may also be used to determine the severity of the damage. This test uses electrical impulses to check how well the nerves are functioning.
Treating arachnoiditis can be difficult. The area around the spinal cord is delicate, and even minor damage can have severe consequences.
Surgery is possible but not always recommended. Surgery is not always effective and exposes the spine to potential further damage. Even when surgery is effective, the benefits are usually temporary.
Most doctors choose instead to manage symptoms using a variety of techniques. These include:
Physical therapy
A range of physical therapy techniques may help ease pain and prevent further damage. Exercise therapy can strengthen the muscles and help a person manage the pain.
Massage may reduce muscle tension due to pain, while water therapy can temporarily help nerve pain.
Some people find that hot or cold packs applied to the spinal cord or painful area of the body can temporarily relieve inflammation.
Pain medications
Pain medications include non-steroidal anti-inflammatory drugs (NSAID), steroid drugs, and narcotic pain medications, such as opioids.
The correct drug depends on a range of factors, including which other medications a person is taking, and whether they experience any side effects.
Nerve stimulation
Treatments that stimulate the nerves or spinal cord may offer relief without medication. Two promising options are:
• Spinal cord stimulation: This uses a device to send an electrical signal directly to the spinal cord, which can offer ongoing pain relief.
• Transcutaneous electrical nerve stimulation (TENS): Similar to a spinal cord stimulator, a TENS unit sends electricity into a painful area to relieve pain and improve movement.
Psychological support
Living with chronic pain can be difficult. Therapy can help some people cope by changing the way they think about the pain and offering emotional support.
Some people also find help from support groups for people with chronic pain or rare diseases. These groups may help people in pain find new resources, share effective lifestyle remedies, and feel less alone.
Alternative remedies
Some people find relief with alternative remedies including acupuncture, diet and lifestyle changes, or homeopathic medicine.
More studies are needed to determine how effective alternative remedies are for treating the symptoms of arachnoiditis.

27/01/2018

Can type 2 diabetes turn into type 1 diabetes?

Last reviewed Sat 27 January 2018
By Zawn Villines
Reviewed by Maria Prelipcean, MD

It is impossible for type 2 diabetes to turn into type 1.
However, it is possible for a person who is initially diagnosed with type 2 diabetes to be diagnosed with type 1 diabetes later.
Type 2 diabetes is the most common type of diabetes, so a doctor might initially think an adult with diabetes has type 2.
This may be particularly true if the person is overweight or has other risk factors for diabetes, such as a sedentary lifestyle.
It is possible for a person with type 1 diabetes to be misdiagnosed with type 2 diabetes.

Though uncommon, type 1 diabetes can appear in adulthood.
A person diagnosed with type 2 diabetes who later receives a diagnosis of type 1 will not have experienced a change in their diabetes but was likely misdiagnosed earlier.
To correctly diagnose the type of diabetes a person has, a doctor will perform several blood glucose tests.
They may also do blood tests to check for antibodies that attack insulin or beta cells in the pancreas. The presence of these antibodies usually means a person has type 1 diabetes.

29/12/2017

What is dextroscoliosis?
Last reviewed Thu 28 December 2017
By Jennifer Huizen
Reviewed by William Morrison, MD

Dextroscoliosis

Dextroscoliosis refers to an abnormal, right-leaning curvature of the spine. It is a type of scoliosis.
The spinal column of people with dextroscoliosis may appear to be curved in an S or C shape.
In this article, we look at how a person can relieve symptoms of dextroscoliosis with treatment and exercise.
What is dextroscoliosis?

Dextroscoliosis is when the spine curves abnormally to the right of the body.
Dextrosoliosis is a type of scoliosis — a term which refers to conditions involving an abnormal curvature of the spine.
Although abnormal curvatures can develop anywhere in a person's spinal column, dextroscoliosis tends to occur in the middle and upper portions of the spine (thoracic spine).
Scoliosis can be caused by neuromuscular conditions, connective tissue disorders, and genetic conditions. But, approximately 85 percent of scoliosis cases have no known cause (idiopathic).
Types of scoliosis include:
• Congenital scoliosis, which is scoliosis that is present at birth.
• Early onset scoliosis, which is when scoliosis occurs before age 10.
• Adolescent idiopathic scoliosis, which causes both curving and twisting of a child's spine as they grow.
• Degenerative scoliosis, which occurs in older people because bones get weaker with age.
• Neuromuscular scoliosis, which is caused by a neurological condition.
• Scheuermann's kyphosis, when the front sections of the vertebrae grow slower than the back sections.
• Syndromic scoliosis, which develops because of an underlying syndrome.
Scoliosis impacts an estimated 2 to 3 percent of people in the United States. Most people develop the condition between the age of 10 and 15.

22/12/2017

Health benefits fish oils and omega-3 oils

Some studies have concluded that fish oil and omega-3 fatty acid is beneficial for health, but others have not. It has been linked to a number of conditions.

Multiple sclerosis
Fish oils are said to help people with multiple sclerosis (MS) due to its protective effects on the brain and the nervous system. However, at least one study concluded that they have no benefit.

Prostate cancer
One study found that fish oils, alongside a low-fat diet, may reduce the risk of developing prostate cancer. However, another study linked higher omega-3 levels to a higher risk of aggressive prostate cancer.
Research published in the Journal of the National Cancer Institute suggested that a high fish oil intake raises the risk of high-grade prostate cancer by 71 percent, and all prostate cancers by 43 percent.

Post-partum depression
Consuming fish oils during pregnancy may reduce the risk of post-partum depression. Researchers advise that eating fish with a high level of omega 3 two or three times a week may be beneficial. Food sources are recommended, rather than supplements, as they also provide protein and minerals.

Mental health benefits
An 8-week pilot study carried out in 2007 suggested that fish oils may help young people with behavioral problems, especially those with attention deficit hyperactivity disorder (ADHD).
The study demonstrated that children who consumed between 8 and 16 grams (g) of EPA and DHA per day, showed significant improvements in their behavior, as rated by their parents and the psychiatrist working with them.

Memory benefits
Omega-3 fatty acid intake can help improve working memory in healthy young adults, according to research reported in the journal PLoS One.
However, another study indicated that high levels of omega-3 do not prevent cognitive decline in older women.

Heart and cardiovascular benefits
Omega-3 fatty acids found in fish oils may protect the heart during times of mental stress.
Findings published in the American Journal of Physiology suggested that people who took fish oil supplements for longer than 1 month had better cardiovascular function during mentally stressful tests.
In 2012, researchers noted that fish oil, through its anti-inflammatory properties, appears to help stabilize atherosclerotic lesions.
Meanwhile, a review of 20 studies involving almost 70,000 people, found "no compelling evidence" linking fish oil supplements to a lower risk of heart attack, stroke, or early death.
People with stents in their heart who took two blood-thinning drugs as well as omega-3 fatty acids were found in one study to have a lower risk of heart attack compared with those not taking fish oils.
The AHA recommend eating fish, and especially oily fish, at least twice a week, to reduce the risk of cardiovascular disease.

Alzheimer's disease
For many years, it was thought that regular fish oil consumption may help prevent Alzheimer's disease. However, a major study in 2010 found that fish oils were no better than a placebo at preventing Alzheimer's.
Meanwhile, a study published in Neurology in 2007 reported that a diet high in fish, omega-3 oils, fruit, and vegetables reduced the risk of dementia and Alzheimer's.

Vision loss
Adequate dietary consumption of DHA protects people from age-related vision loss, Canadian researchers reported in the journal Investigative Ophthalmology & Visual Science.

Epilepsy
A 2014 study published in the Journal of Neurology, Neurosurgery & Psychiatry claims that people with epilepsy could have fewer seizures if they consumed low doses of omega-3 fish oil every day.

Schizophrenia and psychotic disorders
Omega-3 fatty acids found in fish oil may help reduce the risk of psychosis.
Findings published in Nature Communications details how a 12-week intervention with omega-3 supplements substantially reduced the long-term risk of developing psychotic disorders.

Health fetal development
Omega-3 consumption may help boost fetal cognitive and motor development. In 2008, scientists found that omega-3 consumption during the last 3 months of pregnancy may improve sensory, cognitive, and motor development in the fetus.

17/12/2017

Ten causes of epigastric pain

Last reviewed Thu 14 December 2017
By Jon Johnson
Reviewed by Judith Marcin, MD

Epigastric pain is felt in the middle of the upper abdomen, just below the ribcage. Occasional epigastric pain is not usually a cause for concern and may be as simple as a stomach ache from eating bad food.
There are many common digestive problems associated with epigastric pain, as well as a range of other underlying conditions that can cause pain in that area.
Serious cases may be life-threatening, and it is important to work with a doctor to understand the difference between a simple cause of epigastric pain and a more serious underlying condition.

Ten causes of epigastric pain
Epigastric pain is a common symptom of an upset stomach, which can be due to long-term gastrointestinal problems or just the occasional bout of indigestion.
1. Indigestion
2. Acid reflux and GERD
3. Overeating
4. Lactose intolerance
5. Drinking alcohol
6. Esophagitis or gastritis
7. Hiatal hernia
8. Peptic ulcer disease
9. Gallbladder disorder
10. Pregnancy

Diagnosis
An endoscopy may be carried out to find the cause of unexplained epigastric pain.
Diagnosing the cause of epigastric pain is essential to ensure proper treatment. A healthcare professional will likely ask a series of questions about the pain and any additional

symptoms.
If the cause is unclear, they may order tests, including:
• imaging tests, such as X-rays, ultrasound, or an
endoscopy
• urine tests to check for infections or bladder disorders
• blood tests
• cardiac tests

Treatment
Treating epigastric pain will vary according to the cause. For instance, if overeating frequently causes epigastric pain, a person may wish to eat smaller portions and ensure they are eating filling foods, such as lean proteins. They may also want to avoid foods that cause gas.
Conditions such as GERD, peptic ulcers, and Barrett's esophagus may require long-term treatment to manage symptoms. A person should work with their doctor to find a treatment plan that works for them.
If a doctor thinks that taking certain medications is causing the condition, they may recommend switching to a new drug or reducing the dosage.
Over-the-counter or prescription antacids to help reduce frequent acid reflux and epigastric pain caused by stomach acid may be helpful.

13/12/2017

What are the health benefits of vitamin D?

Last updated Mon 13 November 2017
By Megan Ware RDN LD
Reviewed by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT

Health benefits of vitamin D
This section looks at the potential health benefits of vitamin D, from assisting good bone health to possible cancer prevention.

1.Vitamin D is vital for bone health.
Vitamin D plays a substantial role in the regulation of calcium and maintenance of phosphorus levels in the blood, two factors that are extremely important for maintaining healthy bones.
We need vitamin D to absorb calcium in the intestines and to reclaim calcium that would otherwise be excreted through the kidneys.
Vitamin D deficiency in children can cause rickets, a disease characterized by a severely bow-legged appearance due to softening of the bones.
In adults, vitamin D deficiency manifests as osteomalacia (softening of the bones) or osteoporosis. Osteomalacia results in poor bone density and muscular weakness. Osteoporosis is the most common bone disease among post-menopausal women and older men.

2) Reduced risk of flu
Children given 1,200 International Units of vitamin D per day for 4 months during the winter reduced their risk of influenza A infection by over 40 percent.

3) Reduced risk of diabetes
Several observational studies have shown an inverse relationship between blood concentrations of vitamin D in the body and risk of type 2 diabetes. In people with type 2 diabetes, insufficient vitamin D levels may negatively effect insulin secretion and glucose tolerance. In one particular study, infants who received 2,000 International Units per day of vitamin D had an 88 percent lower risk of developing type 1 diabetes by the age of 32.

4) Healthy infants
Children with normal blood pressure who were given 2,000 International Units (IU) per day had significantly lower arterial wall stiffness after 16 weeks compared with children who were given only 400 IU per day.
Low vitamin D status has also been associated with a higher risk and severity of atopic childhood diseases and allergic diseases, including asthma, atopic dermatitis, and eczema. Vitamin D may enhance the anti-inflammatory effects of glucocorticoids, making it potentially useful as a supportive therapy for people with steroid-resistant asthma.

5) Healthy pregnancy
Pregnant women who are deficient in vitamin D seem to be at greater risk of developing preeclampsia and needing a cesarean section. Poor vitamin D status is associated with gestational diabetes mellitus and bacterial vaginosis in pregnant women. It is also important to note that high vitamin D levels during pregnancy were associated with an increased risk of food allergy in the child during the first 2 years of life.

6) Cancer prevention
Vitamin D is extremely important for regulating cell growth and for cell-to-cell communication. Some studies have suggested that calcitriol (the hormonally active form of vitamin D) can reduce cancer progression by slowing the growth and development of new blood vessels in cancerous tissue, increasing cancer cell death, and reducing cell proliferation and metastases. Vitamin D influences more than 200 human genes, which could be impaired when we do not have enough vitamin D.
Vitamin D deficiency has also been associated with an increased risk of cardiovascular disease, hypertension, multiple sclerosis, autism, Alzheimer's disease, rheumatoid arthritis, asthma severity, and swine flu, however more reliable studies are needed before these associations can be proven. Many of these benefits occur through Vitamin D's positive effect on the immune system

01/12/2017

Heart disease risk increased fivefold for bald and graying men

Published Thursday 30 November 2017
By Ana Sandoiu
Fact checked by Jasmin Collier

New findings show that male pattern baldness and getting gray hair prematurely puts men under 40 at risk of heart disease. In fact, these men are five times likelier to develop the condition, representing a risk higher than the one posed by obesity.

Young men with hair loss may need to be screened for heart disease, suggests new research.
High blood pressure, high cholesterol, obesity, smoking, and physical inactivity are just a few of the "traditional" risk factors for developing heart disease, which is the leading cause of death among people in the United States.
But new research suggests that two further risk factors should be added to this list: male pattern baldness and prematurely gray hair.
Results of the study — led by Dr. Kamal Sharma, who is an associate professor in the Department of Cardiology at the U.N. Mehta Institute of Cardiology and Research Centre in Ahmedabad, India — were presented at the 69th Annual Conference of the Cardiological Society of India, held in Kolkata, India.
The first author of the study is Dr. Dhammdeep Humane, who is a senior cardiology resident at the U.N. Mehta Institute of Cardiology and Research Centre.

10/11/2017

Proton Pump Inhibitors Linked to Risk of Chronic Kidney Diseases

November 7, 2017
NEW ORLEANS -- November 7, 2017 -- A recent analysis has linked proton pump inhibitors (PPIs) with the development of kidney disease.

The findings were presented at Kidney Week 2017, the Annual Meeting of the American Society of Nephrology (ASN).

Recent studies have raised concerns over a potential increased risk of kidney problems among PPIs users but the results of those studies were inconsistent.

To investigate, Charat Thongprayoon, MD, Bassett Medical Center, Cooperstown, New York, and colleagues conducted an analysis of published studies that reported the risk of chronic kidney disease or kidney failure among PPI users compared with non-users.

A total of 5 studies with 536,902 participants met the eligibility criteria and were included in the meta-analysis.

Results showed that individuals who used PPIs had a 33% increased relative risk of chronic kidney disease or kidney failure when compared with non-users.

“This study demonstrates a significant association between the use of PPIs and increased risks of chronic kidney disease and kidney failure,” said Dr. Thongprayoon.

“Although no causal relationship has been proven, providers should consider whether PPI therapy is indicated for patients,” he said. “Chronic use of PPIs should be avoided if not really indicated.”

SOURCE: American Society of Nephrology

09/11/2017

Hormonal control of digestion

Last reviewed Wed 8 November 2017
By Tim Newman
Reviewed by Michele Cho-Dorado, MD
Digestion is a complex process that requires different organs to make moves at the right time. For instance, the right enzymes need to be squirted into the right place at the right time and in the right amounts. To help organize this system, a range of hormones are involved, these include:

Gastrin — released in the stomach, this hormone stimulates the production of hydrochloric acid and pepsinogen (an inactive form of pepsin). Gastrin is produced in response to the arrival of food in the stomach. Acidic pH levels reduce the levels of gastrin
Secretin — stimulates bicarbonate secretion to neutralize acid in the duodenum
Cholecystokinin (CCK) — also found in the duodenum, this hormone stimulates the pancreas to release enzymes and the gallbladder to release bile.

Gastric inhibitory peptide — decreases the churning of the stomach and reduces the speed that food empties from the stomach. It also triggers the secretion of insulin.

Motilin — stimulates the production of pepsin and speeds up peristalsis.

03/11/2017

ASCI
Research Paper
Management of High Blood Pressure and Left Ventricular
Hypertrophy in Continuous Ambulatory Peritoneal Dialysis
Patients with Low Dose of Spironolactone.
1Nabieh Al-Hilali,
2Naser Hussain,
3Mohammed AlHilali,
2Vivian Kamel, and 1Hany Negm.
1Nile Badrawi Hospital, Medicare Middle East, Egypt,
2Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait.
3Queen Elizabeth the Queen Mother Hospital, United Kingdom.
* Corresponding Author E-mail: [email protected]
Accepted March 31st, 2014
----------------------------------------------------------------------------------------------------------------------------------------------
ABSTRACT
Introduction: Blockade of the aldosterone effect with spironolactone is an approach that is being used more frequently
in the treatment of hypertension and congestive heart failure. Objectives: The aims of our study were to prospectively
describe trends in the left ventricular structure and function before and after spironolactone use, and to assess the
safety of spironolactone use in peritoneal dialysis.
Patients and Methods: Thirty eight patients on continuous ambulatory peritoneal dialysis were selected for the study.
All patients were adequately dialysed; with serum potassium levels less than 5.6 mmol/l. Eligible patients received
spironolactone tablets 25 mg daily. Spironolactone tablets discontinued according to serum potassium.
Echocardiography was performed at 6 and at 12 months. Biochemical, blood pressure and medication data were
collected.

Results: Controlled blood pressure was achieved after 6 months (p

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