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MCI & AD: Searching for Protective Strategies

MCI & AD: Searching for Protective Strategies

According to current data, Alzheimer’s disease (AD) is the sixth leading cause of mortality in the United States. Mild cognitive impairment (MCI) can occur as people age and may lead to the development of dementia or AD. Studies suggest that patients with MCI have a 10-fold increased risk of developing dementia when compared with those who are cognitively normal. “Considering that we have no effective treatments for AD, it’s critical to identify potentially protective factors for developing MCI and progressing to Alzheimer’s,” says Balwinder Singh, MD, MS. Previous research has shown that the Mediterranean diet has cardioprotective effects and helps reduce the risk of heart-related comorbidities. “A Mediterranean diet involves a high intake of vegetables, legumes, fruits, cereals, and unsaturated fatty acids, mostly in the form of olive oil,” explains Dr. Singh. “It also entails moderate-to-high intake of fish, low-to-moderate intake of dairy products, and a low intake of meat and saturated fatty acids.” Some studies have reported that adherence to the Mediterranean diet can reduce risks of MCI and AD, but others have reported no such protective effects. A New Protector? In the Journal of Alzheimer’s Disease, Dr. Singh and colleagues had a study published in which they conducted a systematic review and meta-analysis of available studies on the association between the Mediterranean diet and risk of MCI and AD. The authors screened 664 studies on the topic, with five meeting their eligibility criteria. Adherence to the Mediterranean diet was defined using the “MeDi score,” a nine-point scale in which a value of zero or one is assigned to the nine components of the Medi­terranean diet. Lower scores...
Optimizing Approaches to Treating Medullary Thyroid Cancer

Optimizing Approaches to Treating Medullary Thyroid Cancer

According to the Joint Committee on Cancer, the 10-year survival rates for stages I, II, III, and IV medullary thyroid cancer (MTC) are 100%, 93%, 71%, and 21%, respectively. Guidelines from the American Thyroid Association (ATA) and the North American Neuroendocrine Tumor Society recommend that standard treatment for clinical MTC consist of total thyroidectomy with prophylactic central lymph node dissection. To understand if this “one-size-fits-all” surgical approach to MTC is effective, Nazanene H. Esfandiari, MD, and colleagues conducted a study of nearly 3,000 patients with MTC. “We wanted to understand the factors that were associated with worse survival, including the role of more versus less extensive surgery,” she says. Disease Severity & Extent of Resection Dr. Esfandiari and colleagues gathered data from the National Cancer Database on patients who were diagnosed with MTC between 1998 and 2005. “Disease severity was characterized by the size of the tumor, the number of cervical lymph node metastases, and the presence or absence of distant metastases,” says Dr. Esfandiari. “We looked at the relationship between tumor characteristics, patient characteristics, and the extent of surgery with regard to overall survival.” Tumors were categorized into those that were 1.0 cm or smaller, 1.1 cm to 2.0 cm, 2.1 cm to 4.0 cm, more than 4 cm, or unknown. Interventions compared in the study included total thyroidectomy, lobectomy, and no surgery. Cervical lymph nodes were grouped as follows: one to five, six to 10, 11 to 15, and 16 or more positive nodes. “We found that the overall survival rate was about 89% for patients with tumors sized 2 cm or smaller and no distant metastases,”...
Is There A Mental Healthcare Crisis In The U.S.?

Is There A Mental Healthcare Crisis In The U.S.?

We are all shocked when we see news stories of multiple people being killed by someone who seems to have gone off the deep end. While these events are extremely rare, it is a true tragedy to have them happen at all. It is often found that the guilty parties were suffering from some mental illness. These are the extremes of mental illness. However, milder forms of mental illness, such as anxiety and depression are very prevalent in the U.S. The unfortunate reality is that for many of these patients, they just cannot get mental healthcare even if they want access to it. How big is the problem? According to a survey of physicians on Sermo, the number one social network exclusively for physicians, approximately 84% of the doctors polled believe there is a mental healthcare crisis in this country. Often times, the primary care physician is left to care for these patients whom they may not feel comfortable taking care of, just because they cannot get an appointment for the patient with a psychiatrist. I often times have a patient who I believe needs to see a psychiatrist but is unable to get an appointment for up to 6 months. If a patient is having a mental healthcare urgency, they usually end up in the ER for lack of access to outpatient healthcare. But, psychiatrists are not to blame. This is rather due to a broken system that is in need of major reforms. Why is there a mental healthcare access crisis in the U.S.? 1. In the 1960’s, psychiatric hospitals closed their doors, making inpatient services very...
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