August 28, 2023
Plastic in ocean

The success story of plastic – but what is the price?

Verena Briner, Switzerland Plastics are synthetic products that consist of organic polymers and additives such as bisphenol, ophthalates and flame retardants. Plastic is produced from coal, crude oil and natural gas, and it’s most useful properties are: it is easy to produce, hydrophobic, light, cheap and indestructible. Plastic has been widely used in toys, kitchenware, packaging, construction, electrical industry, machinery and other industries. Due to its properties, the annual production of plastic has increased exponentially worldwide since the 1950s, and reached ca. 400 million tons per year worldwide in 2020. The 7 most used plastics are: polyethylene tetraphthalate (PET), high density polyethylene (PE), polyvinyl chloride (PVC), low density polyethylene (LDPE), polypropylene (PP), polystyrene (PS) and bisphenol (BP). This durability is -on the other hand- the biggest disadvantage of plastic. Littering of single use- plastic products such as PET bottles, coffee cups, plates, bags, etc. results in enormous pollution. Worldwide only 9% of the plastic waste is recycled. Every year more than 2 million tons of plastic reach the sea and the world oceans. Up to 2020 more than 30 million tons of plastic accumulated in the oceans and up to 110 million tons in rivers. The major part of plastic […]
June 30, 2023
Vitamins supplementation in healthy people

Vitamins supplementation in healthy people

Daniel Sereni, France A large proportion of adults in western countries regularly take vitamins supplements. This represents a huge market. But is it useful? It is well established that vitamins are essential for our health. Vitamin deficiencies provoke diseases and foetal and developmental abnormalities. Children are receiving vitamin D supplements for Ricketts prevention and some elderly people need vitamin D because of proven deficiency. There are indications for folic acid (a group B vitamin) supplementation during pregnancy in defined situations. Vitamin deficiency may result from insufficient intake or absorption, and this can lead to serious complications. Deficiency has also to be prevented or corrected in some diseases (for example intestinal or liver disease) or when people are given certain treatments that interfere with the absorption or the metabolism of vitamins. But millions of people without any recognised or suspected deficiency take vitamins every day (usually “multivitamins“). They do so because some medical publications have suggested that vitamin supplements can prevent major and frequent illnesses like cardio-vascular disease and cancer. Most of these assumptions were based on observational studies. There have been also a few randomised clinical trials comparing the outcome of people receiving a vitamin supplement compared to a group receiving […]
May 19, 2023
Anemia is a major but treatable global health problem

Anemia is a major but treatable global health problem

Stefan Lindgren, Sweden and Maria Cappellini, Italy Anemia is the result of a decrease in the level of hemoglobin and too few circulating red blood cells, resulting in poor oxygen delivery to tissues and organs in the body. Anemia may therefore lead to lack of physical and mental capacity, tiredness, loss of breath during physical effort and several other symptoms. In addition, the reason behind anemia may cause additional symptoms from various organ systems. Anemia is a major global health problem with severe consequences for millions of people, particularly young and pregnant women. Moreover, anemia in the elderly though often mild, is quite common and independently associated with important clinical outcomes including decreased quality of life, risk of falls and fractures, cognitive decline, increased length of hospital stay and even mortality. It is often difficult to dissect the cause(s) of anemia in the elderly which is typically multifactorial and a limited diagnostic approach often leads to categorization of the anemia as “unexplained”. The principal mechanisms behind anemia are failure to produce red blood cells due to diseases in the bone marrow, lack of essential components of hemoglobin such as iron, folic acid and vitamin B 12, shorter survival of red […]
April 19, 2023
What are endocrine disruptors and why you should know

What are endocrine disruptors and why you should know

Aart Jan van der Lely, The Netherlands Endocrine disruptors are chemical substances that can interfere with the normal functioning of the endocrine system, which is responsible for producing hormones that regulate various body functions. These chemicals can mimic or block the action of hormones, leading to an imbalance in the body’s hormonal system. There are many sources of endocrine disruptors, including pesticides, herbicides, and industrial chemicals. They can also be found in certain plastics, personal care products, and food packaging. The most well-known endocrine disruptor is probably bisphenol A (BPA), which is found in many plastics and has been linked to a number of health problems, including fertility issues and cancer. Endocrine disruptors can have a range of harmful effects on human health, depending on the specific chemical and the amount of exposure. Some of the potential health impacts include: Reproductive problems: Endocrine disruptors can affect the normal functioning of the reproductive system, leading to infertility, birth defects, and other reproductive problems. Cancer: Some endocrine disruptors have been linked to an increased risk of certain types of cancer, such as breast, ovarian, and prostate cancer. Developmental problems: Exposure to endocrine disruptors during fetal development and early childhood can lead to […]
April 6, 2023

FDIME activities during ECIM 2023, 15 -18 March in Athens

FDIME activities during ECIM 2023 15 -18 March in Athens During the EUROPEAN CONGRESS of INTERNAL MEDICINE in Athens the Foundation for the Development of Internal Medicine in Europe (FDIME) was involved in a variety of activities. Previous Next The most important activity probably was the combined FDIME/EFIM patient session on Friday March 17, mainly organized by members of the FDIME Management Team and chaired by Ramon Pujol and Dror Dicker. After a short introduction about the recent activities of FDIME entitled “Internists, patients and FDIME” and presented by Jan Willem Elte, three patients gave their view after being introduced briefly by three internists, respectively on diabetes developments (Nikolaos Tentolouris), obesity (Dror Dicker) and rare diseases (Ramon Pujol, taking over from Daniel Sereni). The patients were Efstathios Chatzopouloson, who talked about diabetes, Vicki Mooney about obesity and metabolic disease and Eustratios Chatziharalambous about rare diseases/general aspects, followed by a Round Table discussion with all speakers and a general discussion. “Patients address European Internists”. The session was well received with ample discussions and more audience than expected. During the closing ceremony on Saturday March 18 traditionally the two Grant Award winners of 2021 gave a short presentation of their research. Leonardo […]
March 9, 2023
Alcohol

Alcohol

Verena Briner, Switzerland Paracelsus, a famous physician of the 16th century, wrote ‘everything is poison and nothing is poison. It is a question of the dose’. It is true in alcohol consumption. Factors such as gender, cultural reasons, comorbidities and genetics may contribute to alcohol toxicity. The danger of alcohol consumption lies primarily in alcohol addiction, leading to chronic abuse and organ damage. This results in impaired function of the brain and nerves, the heart, the liver, the pancreas, gastro-intestinal tract, immune system and metabolism. In addition, chronic heavy drinking affects family life, work and causes often economic problems. Alcohol is absorbed fast and about 15 minutes after consumption reaches all organs of the body. Alcohol is mainly metabolized in the liver. However, in the stomach and intestine, alcohol results in the production of acetaldehyde (ACD). The ACD formed is an important factor in alcohol dependence. ACD also increases the release of mediators (histamine and bradykinin) to cause flushing. The of ACD is most severe in the brain and the heart. Abstinence from alcoholcauses increase in calcium uptake in  the cells, causing arrythmia, tremor and even seizures. ACD does not pass the blood-brain barrier. In heart muscle, alcohol causes inflammation […]
February 20, 2023
Should sodium glucose co-transporter-2 inhibitors (SGLT2-i) be the first choice in the treatment of diabetes type 2?

Should sodium glucose co-transporter-2 inhibitors (SGLT2-i) be the first choice in the treatment of diabetes type 2?

Should sodium glucose co-transporter-2 inhibitors (SGLT2-i) be the first choice in the treatment of diabetes type 2? Jan Willem Elte The Netherlands For many years metformin has been the first choice drug in the treatment of diabetes type 2  after, of course, life style modifications have been applied. Recently, however, new classes of diabetes drugs have been investigated.  A new consensus report on the management of hyperglycemia in type 2 diabetes developed and published by the joint scientific associations of diabetes in Europe (EASD) and the United States (ADA) has appeared (published in Diabetes Care 2022). This report now recommends that patients with cardiorenal (heart and kidney ) risks should start with a SGLT2-i or a GLP1-RA ( glucagonlike peptide1-receptor agonist) with proven CVD (cardiovascular disease) benefit. In heart failure (HF) SGLT2-i is prefered. A combination of SGLT2-i and GLP1-RA may also be considered in patients with a very high atherosclerotic cardiovascular disease (ASCVD) risk. Use of both agents is recommended independent of HbA1,c, even if not on metformin. It should, however, be realized that the agents (GLP1-RA even more than SGLT2-i) are expensive. Before going into somewhat more detail, it is good to define what is meant by high […]
January 19, 2023
Benefits of inefficient walking: Monty Python-inspired experimental study

Benefits of inefficient walking: Monty Python-inspired experimental study

Source: BMJ2022;379: e072833 (GA Gaesser et al, Phoenix, AZ, USA) Recent research has confirmed results which have in fact been known for a long time. The walk of Mr Teabag (John Cleese) and Mr Putey (Michael Palin) in the legendary Monty Python Ministry of Silly Walks (MoSW) skit in 1970 were duplicated in 13 healthy adults (22 – 71 years, six women and seven men) with no known gait disorders. Participants performed three 5 minute walks around an indoor 30 m course in an exercise physiological laboratory. The first trial consisted of walking at a freely chosen speed. The next two trials consisted of low efficiency walks similar to the ones of Mr Teabag and Mr Putey (Figure).  The famous silly walks of Mr Teabag (the fictive Minister of Silly Walks) can be described as walking with bow knees, throwing the legs in the air every few steps, and walking backwards sometimes before walking on. The walks of Mr Putey were less pronounced. Ventilation and gas exchange were recorded and collected to determine oxygen uptake (VO₂) and energy expenditure (EE), which were the main outcome measures. VO₂ and EE were about 2.5 times higher during the Teabag walk, but not […]