Health Rounds: Procedure that delivers electric pulses to intestine improves type 2 diabetes
High-voltage electrical pulses to the upper region of the small intestine in a minimally invasive procedure can significantly improve type 2 diabetes, researchers reported at the Digestive Disease Week, opens new tab meeting.
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The magnitude of improvement is comparable to the diabetes benefits seen with gastric bypass weight loss surgery, particularly in patients who receive the highest-dose electrical pulses, the researchers said.
'This first-of-its-kind study demonstrates that non-thermal pulsed electric field energy treatment of the duodenum can significantly and durably improve... insulin resistance and beta cell function,' the main body processes involved in type 2 diabetes, Dr. Richard Pratley of the AdventHealth Diabetes Institute in Orlando, Florida, who worked on the study, said in a statement.
As nutrients move from the stomach into the small intestine, the cells of the duodenum play a crucial role in glucose regulation. Typically in type 2 diabetes, the duodenum is inflamed and dysfunctional. Delivery of the electric pulses triggers the body to regenerate healthy cells that can help control blood sugar levels.
The 51 mostly overweight or obese patients with type 2 diabetes who participated in the trial of the Endogenex Pulsed Electric Field System known as ReCET, showed significant improvements in insulin sensitivity and pancreas beta cell function at 12 weeks, with improvements persisting at 48 weeks, the researchers reported.
Patients also had significant improvements in blood sugar control and body weight.
The researchers are now testing the procedure in a pivotal trial in overweight individuals with type 2 diabetes inadequately controlled by non-insulin glucose-lowering medications.
While the current studies are looking at blood sugar control and weight loss, study leader Dr. Barham Abu Dayyeh of Cedars-Sinai in Los Angeles said the treatment is likely to also work for type 2 diabetes in patients who are not overweight.
'We believe any patient who has type 2 diabetes, is struggling to maintain control of their disease, and is progressing toward (needing multiple diabetes medications) or insulin will be target candidates,' he said.
PROCEDURE FOR PREVENTING PANCREATITIS DOESN'T WORK
A common surgery done to prevent pancreatitis does not actually work, a new study has found.
About one in 10 people are born with a condition called pancreas divisum, in which pancreas ducts fail to fuse properly. While often asymptomatic, it can sometimes be a factor in recurrent pancreatitis, a serious and painful condition.
Retrospective studies have suggested that a minimally invasive surgery called endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) eases acute pancreatitis in 50% to 70% of such patients.
However, ERCP itself can cause acute pancreatitis in 10%-20% of patients and may instigate other issues later, such as scarring of the pancreas opening, which may lead to other symptoms, study leader Dr. Gregory Cote of Oregon Health & Science University said in a statement.
Despite the known risks of the procedure, until now there have been no trials comparing miES to a sham procedure.
At the Digestive Disease Week meeting, his team reported on 148 patients with pancreas divisum and an average of three previous episodes of pancreatitis who were randomly assigned to undergo miES or a sham procedure.
During a median follow-up of 33.5 months, there was no statistically significant difference in the number of patients who had another bout of acute pancreatitis. There were also no differences in numbers of patients who reported pancreas-related pain more than a month after the procedure or who developed chronic pancreatitis, diabetes, or inadequate production of digestive enzymes by the pancreas.
The findings are 'actually quite extraordinary when you consider that many doctors have advocated for this procedure for decades,' Cote said.
'Guidelines currently recommend/acknowledge pancreas divisum as a risk factor for pancreatitis, and suggest ERCP as a treatment. These guidelines are likely to change based on this study,' he said.
He added that some patients with conditions such as a narrowing or blockages of the pancreatic duct might still benefit from ERCP. Patients with those conditions were not included in this study.
VASECTOMY RARELY FAILS, BUT SEMEN ANALYSIS SHOULD BE PERFORMED
Vasectomy failure is very rare but happens more often than previously believed, researchers reported at the American Urology Association annual meeting, opens new tab in Las Vegas.
They said a post-vasectomy semen analysis to ensure that sperm is not present should become routine.
Reviewing nearly half a million vasectomies performed between 2007 and 2021, they found a post-vasectomy pregnancy rate of 2.26 for every 1,000 patients observed for one year after the procedure.
Historically, the pregnancy rate had been roughly 1 in every 2,000 patients observed for a year.
Vasectomy failure rates were highest during the first four months after the procedure, at 4.7 pregnancies per 1,000 per year.
Pregnancy rates were lower in patients with older partners and when procedures had been performed more recently.
After taking patients' risk factors into account, the researchers saw an increased risk of failure when the doctor performing the vasectomy was not a urologist, when the procedure was done in a doctor's office, or when a semen analysis was not performed after the procedure.
(This is an excerpt of the Health Rounds newsletter, where we present latest medical studies on Tuesdays and Thursdays)
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The Independent
an hour ago
- The Independent
Joe Giordano, surgeon who helped save President Reagan's life after assassination attempt, has died
Dr. Joseph Giordano, a surgeon who played a central role in saving President Ronald Reagan's life after an assassination attempt in 1981, has died. He was 84. He died on June 24 at a hospital in Washington, D.C. from an infection related to a lengthy illness, his family said. Giordano was in charge of The George Washington University Hospital's trauma teams that treated Reagan after the president had been shot and badly wounded on March 30, 1981. Over the course of several dramatic hours, doctors stabilized Reagan, retrieved a bullet an inch from his heart and stanched massive internal bleeding. 'Dr. Giordano and the doctors at GW, without them, Ronald Reagan would have died,' said Jerry Parr, the president's lead Secret Service agent at the time, in a 2010 interview for the book " Rawhide Down." Revamps GW emergency room Giordano, the grandson of Italian immigrants, was born and raised in New Jersey. He graduated from Georgetown University in 1961 and six years later obtained a medical degree from Jefferson Medical College in Philadelphia. After a stint in the U.S. Army, he joined GW as a vascular surgeon. A few weeks before he started in 1976, GW's chief of surgery told Giordano that he would have another job — fixing and managing the emergency room. 'The handling of trauma patients down there is a real mess,' his boss said. Giordano quickly discovered that assessment was correct. Inexperienced doctors were leading inefficient medical teams. Care was haphazard. Giordano watched as at least one patient died because treatment was rendered too slowly. Seeking out experts, he spent a month working at what would become the R Adams Cowley Shock Trauma Center at the University of Maryland. The teams at Shock Trauma operated with speed and precision. They were methodical. He brought the approach to GW. Soon, the hospital's trauma center was regarded as among the best in the country. 'We had everything going like clockwork,' said Dr. David Gens, who helped treat Reagan and went on to a long career in trauma surgery. 'Joe had us properly trained. We had the right protocols. Everyone had a job. Organization and time are essential. So that when something happened, when the president came in, we were well organized. Thanks in part to Joe's foresight, we saved the president's life.' 'STAT to the ER' It was a typical March Monday for Giordano when a would-be assassin, John Hinckley, Jr., opened fire on Reagan as the president left a speech at the Washington Hilton Hotel. Parr, the Secret Service agent, shoved Reagan into a limousine, and it hurtled from the scene. On the ride back to the White House, Parr realized Reagan had been hurt, perhaps from being flung into the armored Lincoln. Not knowing the extent of the injuries — doctors would soon discover he had been shot — Parr directed the limousine to the hospital. At GW Giordano was treating a patient when the intercom began blaring: 'Dr. Giordano, STAT to the ER. Dr. Giordano, STAT to the ER.' Though he had turned over responsibility for running the emergency room to another doctor, Giordano was still in charge of the trauma teams. He knew something must be terribly wrong for him to be summoned that way. In the ER, he found a man he recognized as the president on gurney. Nurses had already cut off Reagan's clothes and inserted IV lines. Strangely, the first thing that Giordano noticed about the president was his dark hair. It seemed so natural. 'I wondered," Giordano recalled in a 2010 interview, 'if he dyed it.' 'How are you doing, Mr. President?' he asked. 'I'm having trouble breathing,' Reagan replied. Bleeding won't stop Gens, a chief surgical resident, provided Giordano a quick summary of the situation: The president had been shot in the left side, his chest was filling with blood and they were about to insert a chest tube to drain the chest cavity. Giordano did not hesitate. 'You better let me do this one.' He typically would have let a resident handle such a procedure, but he felt it would be irresponsible to put such pressure on young doctors. He made an incision eight inches below Reagan's left armpit and inserted the tube. It relieved pressure on Reagan's lung and allowed him to breathe more easily. But the bleeding did not stop. Doctors decided they had to operate. Giordano and Gens performed a peritoneal lavage — known as a 'belly tap' — and ensured that Reagan's abdomen was clear of blood. They then turned over the patient to a chest surgeon, Dr. Benjamin Aaron, who halted the bleeding and retrieved the bullet. Reagan spent 11 days at GW and fully recovered from his wounds. Three others were injured in the shooting: White House Press Secretary Jim Brady; Secret Service agent Timothy McCarthy; and Thomas Delahanty, a police officer. Hinckley was found not guilty by reason of insanity. He was confined at a psychiatric hospital until a federal judge in 2022 ordered his unconditional release. 'Today, Mr. President, we are all Republicans' Giordano would go on to become GW's chairman of surgery, a post he held for 18 years before retiring in 2010. That same year, he joined the board at Partner for Surgery, a nonprofit group that arranges surgery for people living in rural Guatemala. Tapping his contacts in the medical community, Giordano recruited doctors and nurses to travel to the Central American country to provide the badly needed medical services, said Frank Peterson, the group's founder. Giordano also led several medical teams on such missions. 'The one word I would use to describe him is humanitarian,' Peterson said. 'He had the skills and capabilities that made a world of difference to people who were in need.' Though Giordano played a decisive role in saving Reagan's life, the physician may best be remembered for a line he delivered in the operating room. Just before he was administered anesthesia, Reagan dramatically got up on an elbow, took off his oxygen mask and said, 'I hope you are all Republicans.' Giordano, a staunch liberal, didn't miss a beat: 'Today, Mr. President, we are all Republicans.' Years later, the surgeon jokingly reflected that "it was okay to be a Republican for a day, especially that day.'
Times
an hour ago
- Times
Meet the influencers calling drinking bleach ‘health revolution'
When Christina Dominguez complained of a scratchy throat, a friend from the small community church she attended in Liberty Hill, Texas, told her to do something she had read about online: gargle with chlorine dioxide — also known as industrial bleach. 'I gargled three drops with a very sore throat and it was gone the next day,' Dominguez said. 'My friend said it cured her Covid. I am new to it and don't know much, but I'm a believer.' Ignoring health authority warnings around the ingesting of chlorine dioxide, alternative health influencers are recommending people drink it with water, spray it on skin and even use it in enemas as a 'cure' for everything from measles to cancer, HIV and autism. First touted as a 'miracle cure' in the United States in the mid-1990s, the German biophysical researcher Andreas Kalcker is one of the earliest and most prominent proponents, describing chlorine dioxide as 'possibly the greatest medical discovery of the last hundred years'. But the so-called bleacher movement received relatively little attention until President Trump, at the height of the Covid-19 outbreak in 2020, suggested coronavirus sufferers 'inject' disinfectant. He later claimed he was being sarcastic. Yet adherents kept pushing the theory, largely on the fringes until they were embraced by Trump's second-term health secretary, the vaccine sceptic Robert F Kennedy Jr. Kennedy, who has built a huge following promoting anti-vaccine conspiracy theories, has not explicitly promoted chlorine dioxide as a treatment. But during his Senate confirmation hearing in January, he referred to the chemical substance and praised Trump for 'looking at all of the different remedies' for Covid, 'including even chlorine dioxide'. • 'RFK Jr is a disaster': staff describe chaos in 'anti-science' regime In recent months, interest has exploded among social media groups such as those called 'Chlorine Dioxide' and 'Secret Mineral', some of which have added thousands of new followers on Facebook from the US, UK and across the world. In the groups, users discuss their growing mistrust of science and the medical community, particularly in the wake of the pandemic. In May, the movement was given its first mainstream boost when Kalcker was invited to a 'Truth Seekers' conference at the Trump National Doral hotel in Miami, a two-day event featuring anti-vaxxers and conspiracy theorists. Though the conference was a closed event, The Times found video and photographs posted on the social media accounts of attendees. A number of products appeared to be on sale to ticket-holders, including chlorine dioxide-based nasal sprays sold by Michelle Herman. Kalcker, who claims to be the inventor of the most commonly used chlorine dioxide solution, marketed as Miracle Mineral Solution (MMS), talked up the health benefits to the thousand-strong audience, some of whom paid $2,000 to attend. 'It's very easy, you drink it all the day,' he told attendees in a speech that was recorded on video. 'The important thing is not to drink a lot in the morning. More is not better, more often is better. It works on cancer … it helps necrotic fingers grow back. It's simply amazing.' Influencers and peddlers of chlorine dioxide make money by selling self-published books about the supposed treatment, by marketing MMS and by posting how-to videos on their online platforms. Half a dozen members of the most popular chlorine dioxide Facebook group, which has 30,000 members, told The Times they used the solution for minor ailments such as a sore throat or psoriatic skin. However, some said they were using it as the sole treatment for diseases as serious as cancer and neurodevelopmental disorders such as autism — against all medical advice. Dominguez, a 31-year-old mother of two, said she kept her use of chlorine dioxide on the 'down low' because 'if you look at regular search engines like Google they make it seem like something bad, so that no one uses it. Think of how big pharma would lose money when this is used for so many different things.' In 2019, the Food and Drug Administration (FDA) warned that 'ingesting these products is the same as drinking bleach', listing possible side-effects including abdominal pain, nausea, vomiting, diarrhoea and acute liver failure. The American Association of Poison Control Centers recorded more than 16,000 cases of chlorine dioxide poisoning, including 2,500 cases of children under 12, in 2020, the last year it published figures on the trend. Many of those individuals suffered serious side-effects, the group noted, including a six-year-old autistic girl who required hospital treatment for liver failure. 'The problem with chlorine dioxide is that these benefits people are claiming are really not proven,' said Dr Josh King, medical director at the Maryland Poison Center and an associate professor at the University of Maryland School of Medicine. Fiona O'Leary, an anti-chlorine dioxide campaigner, said she told managers of Trump National Doral of her concerns about the Truth Seekers event in a failed bid to get it cancelled. Speaking to The Times, she said of the bleacher movement: 'It's always been crazy, but this is totally different to what we've seen before.' Several of the listed speakers and special guests at the Truth Seekers conference have previously faced legal action or been investigated by the authorities. In 2021, Kalcker was charged in Argentina with falsely promoting a type of toxic bleach as a medical cure after the death of a five-year-old boy whose parents gave him Kalcker's chlorine dioxide solution in the belief it would ward off Covid-19. In a response to The Times, Kalcker wrote: 'As a biophysics researcher focused on electromolecular medicine, I believe it's crucial that any discussion about chlorine dioxide solution is grounded in scientific understanding.' Mark Grenon, who attended the event as a special guest, was the main distributor of MMS in the US before he was sentenced in 2023 to five years in federal prison for selling an 'unapproved and misbranded drug'. Grenon, the self-styled archbishop of the Genesis II Church of Health and Healing in Florida, was released this year on probation. Also at the conference was Kerri Rivera, a former Chicago real estate agent turned pseudo medical expert who has more than 17,000 followers on Instagram. She encourages parents to give their autistic children doses of chlorine dioxide as part of a 'protocol' that rids the body of parasites she claims causes autism. Experts say autism is a neurological condition that is not caused by viruses, vaccines or parasites and for which there is no known cure. The authorities in Germany, where Rivera was believed to be living at some point, investigated accusations that she had caused bodily harm to a child, though no charges were filed. Rivera, speaking in both Spanish and English, describes herself on Instagram as 'a woman whose life changed' when her son was diagnosed with autism and claims that for the past 19 years she has 'helped many children lose their autism diagnosis'. On Instagram and in private online support groups she recommends parents giving drops to children orally, through enemas, and in baths. 'Almost all of the people with autism have high levels of pathogens; virus, bacteria, parasites and heavy metals,' Rivera wrote in her book Healing the Symptoms Known as Autism, which was removed by Amazon in 2019. 'Chlorine dioxide kills pathogens and helps the body to detoxify itself,' she added. When reached by The Times, Rivera declined to address the allegations, but has previously defended chlorine dioxide and her credentials, saying: 'This is a medical issue. I have a degree in homeopathy and work with MDs and PhD scientists.' In April, a report by the Centers for Disease Control and Prevention (CDC) found that autism diagnoses are increasing but attributed the rise to better early detection and evaluation services. Immediately after, Kennedy contradicted the CDC, repeating the claim that 'environmental toxins' and the prevalence of food additives were behind the spike. Emma Dalmayne, an autism campaigner who has several autistic children and was diagnosed herself, said giving any legitimacy to bleach cures was dangerous. 'It's one thing if a consenting adult decides to take this, but we are seeing children held down and given enemas,' she told The Times. 'Sometimes drops are put into their babies' bottles.' Dalmayne said her advocacy has attracted hate mail, threats and even bullets through the post, believed to be sent by members of the bleacher community trying to 'silence' her. She called the chlorine dioxide proponents 'very clever, preying on fears and insecurities', adding: 'Parents are jumping on these 'cures' because they don't want to face the fact that they gave birth to an autistic child. And the kids can't advocate for themselves. It's heartbreaking, actually.' Dalmayne, a 49-year-old mother of five, joined one of Rivera's support groups and shared screenshots with The Times of messages that appeared to show parents reporting vomiting, rashes, seizures and chemical-smelling urine in their severely autistic children after administering chlorine dioxide. One mother called 'Katrina' asked Rivera: 'Hello Kerri, when a child has pain during detox but can't tell me because they can't talk or can't understand, and are crying out what (sic) you recommend, what I might give for pain or calm?' They did not receive a response that could be seen on the site. But in reply to another message of concern about the enema protocol, an administrator for Rivera's group wrote: 'If you move slowly and respect the child's tolerance, there is nothing to fear.' Dalmayne considered it child abuse and has lodged a petition on to have Instagram remove Rivera's account, which has attracted more than 35,000 signatories. Dalmayne said she was waiting for a response from Instagram. Most of the campaigning against chlorine dioxide therapies has come from outside the US. Dalmayne is based in London and O'Leary in Ireland. O'Leary speculates it may be because non-conventional therapies are much more widely accepted in America, where the market is less tightly regulated. 'The problem is there isn't the legislation,' said O'Leary, who describes four of her five children as being on the autistic 'spectrum'. 'Years have gone by where we've been protesting and raising awareness and all of these things.' Meanwhile, several Truth Seekers speakers and guests have praised Kennedy on their social media accounts. Others have posted pictures taken with him before he took up the role. Herman said she met Kennedy in 2023, when she spoke to him 'for 30 minutes' about chlorine dioxide. 'He listened intently, indicated he was not familiar with it but was nonetheless very intrigued and asked for more information,' she said. 'I've been connecting with many of the high-profile medical freedom players to educate them on the benefits of chlorine dioxide and to counteract the misinformation.' After several chlorine dioxide proponents, including Herman, called on Kennedy to remove federal warnings about the use of chlorine dioxide, an FDA web page featuring a warning about chlorine dioxide's life-threatening effects was taken down in April and replaced with a 'page not found' notice. The page is still not functioning. An FDA spokesman told The Times: 'There is not any new FDA action and the general public health position on [chlorine dioxide] being dangerous has not changed.' At the same time, alternative health proponents like Herman are cheering on what they call a 'health revolution'. 'The wholesale reform of these agencies is long overdue and we are thrilled that RFK Jr is in charge,' Herman said. 'A real healthcare can finally ensue. We are excited to have played a part in this revolution.'
Daily Mail
an hour ago
- Daily Mail
Yes, men have a pelvic floor too... and ignoring it could lead to devastating consequences
They're usually only thought to affect women, especially those who have just given birth or are in the throes of menopause. In fact, as many as one in three women will be diagnosed in their lifetime with pelvic floor dysfunction, a condition that makes it difficult to relax or control the muscles around the bladder, bowels and sex organs. Though the pelvic floor is most often associated with women, men have this group of muscles as well, which also support their bladder and bowels, as well as their prostate. And experts warn pelvic floor dysfunction has become increasingly common in men, leaving them prone to incontinence, painful sex, infections and erectile dysfunction. Urologists and physical therapists told men are more likely to ignore telltale symptoms like bladder urgency, constipation, bladder and rectal pain and trouble getting an erection. Age, obesity, recent injuries or surgical trauma have all been linked to the embarrassing condition. But even otherwise healthy lifestyle habits like heavy lifting could loosen or tighten muscles in young, fit men. Doctors also told this website while pelvic floor dysfunction is not linked to deadly conditions like cancer, leaving it untreated can severely worsen a man's quality of life. Dr David Shusterman, a urologist at Modern Urologist in New York City, told 'It's a quality of life problem, not a quantity of life problem.' Dr Leia Rispoli, an interventional pain management specialist and physiatrist at DISC Sports & Spine Center in California, told this website: 'If left untreated, this can obviously lead to not only social and mental health issues for men but also having chronic constipation issues or chronic urinary issues can lead to further organ issues down the road.' Exact estimates vary, but recent research suggests as many as one in six men in the US - 27million - may suffer from pelvic floor dysfunction. Most of these men are between 30 and 50, Dr Shusterman estimates. The pelvic floor is a group of muscles and ligaments that support bladder, bowel and uterus in a women and bladder, bowel and prostate in a man. Men also have a unique set of pelvic floor muscles called the urogenital triangle, which includes the penis, urethra and scrotum. These all help a man achieve and maintain an erection and support healthy ejaculation. Pelvic floor dysfunction occurs when these muscles can't properly loosen and relax or contract, leading to trouble passing urine or stool, or, on the flip side, urinary or bowel incontinence. Men specifically may also suffer pain around their penis, testicles, scrotum, rectum and tailbone due to tension and pressure. Pelvic trauma, surgery, stress, anxiety and sitting for long periods of time are most likely to weaken pelvic floor muscles over time. Chronic constipation from conditions like irritable bowel syndrome may also lead to excess straining. Dr Shusterman said: 'If you're in the bathroom and you're just pushing very hard, that would also cause some pelvic floor dysfunction. You're just kind of overusing the muscles there.' Minor injuries may also be to blame. Dr Rispoli said even something 'as small as someone falling onto their buttocks during a snowboard accident' could be enough to 'begin the cycle of persistent pelvic pain.' Intensive exercise also creates pressure in the area. Weightlifting and body weight exercises like squats, for example, push down on the pelvis and lead to pressure. 'A lot of it just goes straight down to the pelvic floor,' Dr Shusterman said. Dr Shusterman notes it's 'hard to diagnose' pelvic floor dysfunction in men because it can masquerade as other conditions like prostatitis - inflammation of the prostate gland - and constipation. 'It's a diagnosis of exclusion,' he said, meaning other conditions have to be ruled out first. However, pelvic floor dysfunction has become increasingly common in men, which could be due to increased awareness. Earlier this year, the American Urological Association released new guidelines encouraging doctors to pay more attention to pelvic floor issues in men and refer them to appropriate providers. Dr Rispoli said: 'It's more common for women to have pelvic issues and feel like they have a gynecologist they can go to or urogynecologist that treats what they have, and men feel a little bit more resistant to be able to get help from the appropriate specialist [for] pelvic floor dysfunction.' To prevent and improve pelvic floor issues, Dr Shusterman recommends lifting or doing squats from an inclined position to 'push upward instead of downward.' Cyclists can also invest in a 'prostate seat' for their bike, which has a cutout in the center to take pressure off the perineum, the area between the genitals and the anus. Treatment is largely focused on long-term physical therapy to work on the muscles rather than medication. Dr Shusterman said: 'The goal is to try to build up the pelvic muscles a little bit better.' This is done with biofeedback, which uses sensors to monitor muscle activity and translate it into visual or auditory cues on a computer screen so users can see the behavior. Shockwave therapy can also help restore blood flow to the pelvic floor, further strengthening it. 'It's a longer term issue and whatever the problems are that brought this on need to continue to be treated,' Dr Shusterman added.
