Flip-Flops, Flat Shoes Relieve Arthritic Knees

Flip-Flops, Flat Shoes Relieve Arthritic Knees



March 29, 2010 -- If you have knee pain from arthritis, wearing flat, flexible shoes may reduce the stress on your joints and keep you more comfortable, according to new research.

In a comparison study that evaluated the force or "load" on arthritic knees while wearing clogs, athletic shoes with stability features, flat walking shoes, flip-flops, and going barefoot, the flat and flexible shoes won out, says study lead author Najia Shakoor, MD, an associate professor of internal medicine at Rush Medical College and an attending physician at Rush University Medical Center in Chicago.

Her study is published online in Arthritis Care & Research.

"We know barefoot is good for your knee load from previous studies," Shakoor tells WebMD. "Then we thought, do different shoes have different effects on the knee?" So they compared the four shoe types with going barefoot.

The surprise? "The shoes that we intuitively recommend to our patients [with knee arthritis] and thought might be best -- stability shoes and clogs -- were associated with the highest load."
Best Shoes for Knee Pain: Study

Arthritis of the knee is common and a major source of disability and impaired quality of life, the researchers say. Shakoor's team evaluated 31 men and women who had knee arthritis, evaluating their gait as they wore:

* Clogs
* An athletic shoe that promises to minimize inward rolling of the foot
* Flat walking shoes
* Flip-flops

The study was supported by the National Institutes of Health.

Shakoor measured what's known as a knee adduction moment, "which measures the extent of the force upon your knee as you walk."

"Flat walking shoes, barefoot, and flip-flops were essentially the same in load on the knee," she says. "But clogs and stability shoes result in a 15% higher load."

"These are just initial studies, and it's too early to recommend [changes]," she says. "But several studies are suggesting that perhaps flat, flexible footwear may help decrease loads on the knee compared to footwear that is less flexible and has higher heels. Stability shoes have higher heels [than other athletic shoes]."

"We think it's the flatness and the flexibility that may provide the benefit."

And, she cautioned: "We are definitely not advocating flip-flops. A flat walking shoe would be better than a flip-flop for other reasons -- stability and the risk of falling."

Shakoor will continue her research. With Rush University and a podiatrist, she hopes to develop a walking shoe for people with knee arthritis. She says Rush will hold the patent.
Best Shoes for Knee Pain: Other Views

"This finding [about the best shoes for knee pain] came as absolutely a surprise to me," says Jeffrey A. Ross, DPM, MD, a spokesman for the American College of Sports Medicine, associate clinical professor of medicine, and chief of the diabetic foot clinic at Ben Taub Hospital in Houston.

"I would have expected the running shoe to be the best, but it didn't turn out to be," he says.

But Ross says he wishes the researchers had studied more than one type of athletic shoe. Even with the new study results, he says, "I probably would still suggest [people with knee arthritis] wear a low-heel running shoe with a flexible sole."

For people with knee arthritis, the shoe should bend easily, he says, resulting in less stress on the forefoot.

A "neutral" athletic shoe -- one that does not offer motion control or stability features, may also work to reduce load on the knee, he says.

Choosing footwear for people with knee arthritis can be a trial-and-error experience, says James Christina, DPM, director of scientific affairs for the American Podiatric Medical Association. "A lot of foot doctors would say a cushioned shoe, rather than a stability shoe or a rigid control category of shoe," he says.

Christina says the APMA does not have shoe guidelines for people with knee arthritis.

The new study is a valid one, he says, but the shoe that works for one person with knee arthritis may not work for another person.

The foot specialists say that flip-flops, although they didn't increase the forces on the knee, aren't the best shoe type, especially for older adults with knee arthritis. As balance declines, flip-flops can be hazardous and increase the risk of falling, they say.

SOURCES: Najia Shakoor, MD, associate professor of internal medicine, Rush Medical College; attending physician, Rush University Medical Center, Chicago.

James Christina, DPM, director of scientific affairs, American Podiatric Medical Association, Bethesda, Md.

Jeffrey A. Ross, DPM, MD, spokesman, American College of Sports Medicine; associate clinical professor of medicine and chief of the diabetic foot clinic, Ben Taub Hospital, Houston.

Shakoor, N. Arthritis Care & Research, published online Feb. 26, 2010.

©2010 WebMD, LLC. All Rights Reserved.

Triglyceride Test (Triglycerides)

Triglyceride Test
(Triglycerides)



Triglycerides are chemical compounds digested by the body to provide it with the energy for metabolism. Triglycerides are the most common form of fat that we digest, and are the main ingredient in vegetable oils and animal fats.

The triglyceride molecule is a form of the chemical glycerol (tri=three molecules of fatty acid + glyceride=glycerol) that contains three fatty acids. To be absorbed, these parts are broken apart in the small intestine, and afterwards are reassembled with cholesterol to form chylomicrons. This is the source of energy for cells in the body. Fat cells and liver cells are used as storage sites and release chylomicrons when the body needs the energy.

Elevated triglyceride levels are a risk factor for atherosclerosis, the narrowing of arteries with the buildup of fatty plaques that may lead to heart attack, stroke, and peripheral artery disease. Markedly elevated triglyceride levels may also cause fatty liver disease and pancreatitis.

Elevated triglyceride levels in the blood may be associated with other diseases including:

* poorly-controlled diabetes,

* kidney disease,

* some medications (for example, beta blockers, diuretics, birth control pills).

Alcohol consumption can raise triglyceride blood levels by causing the liver to produce more fatty acids. However, there are some beneficial aspects of moderate alcohol consumption, defined as one alcoholic beverage per day (a glass of wine, a bottle of beer, or an ounce of hard liquor), that may balance this triglyceride rise. Moderate consumption may mildly increase HDL (the good cholesterol) levels in the bloodstream and red wine, which contains antioxidants, may decrease the risk of heart disease. However, it is not recommended that people start to drink alcohol to obtain these effects.

Hydronephrosis

Hydronephrosis



Hydronephrosis describes the situation where the urine collecting system of the kidney is dilated. This may be a normal variant or it may be due to an underlying illness or medical condition.

Normally, the kidney filters waste products from blood and disposes of it in the urine. The urine drains into individual calyces (single=calyx) that form the renal pelvis. This empties into the ureter, a tube that connects the kidney to the bladder. The urethra is the tube that empties the bladder.

Picture of the kidney and urinary system

While obstruction or blockage is the most frequent cause of hydronephrosis, it may be due to problems that occur congenitally in a fetus (prenatal) or may be a physiologic response to pregnancy.

Technically, hydronephrosis specifically describes dilation and swelling of the kidney, while the term hydroureter is used to describe swelling of the ureter. Hydronephrosis may be unilateral involving just one kidney or bilateral involving both.

A complication of hydronephrosis is decreased kidney function. The increased pressure of extra fluid within the kidney decreases the blood filtration rate and may cause structural damage to kidney cells. This decrease in function is reversible if the underlying condition is corrected but if the hydronephrosis lasts many weeks, the damage may be permanent.

What causes hydronephrosis?

There are numerous causes of hydronephrosis that are categorized based upon the location of the swelling and whether the cause is intrinsic (located within the urinary collecting system), extrinsic (outside of the collecting system) or if it due to an alteration in function.

Examples of intrinsic causes of hydronephrosis

Ureter

* Kidney stone. Likely the most common reason to have unilateral hydronephrosis is a kidney stone that causes obstruction of the ureter. The stone gradually moves from the kidney into the bladder but if it should act like a dam while in the ureter, urine will back up and cause the kidney to swell. This would be classified as an intrinsic obstruction.

* Blood clot

* Stricture or scarring

Bladder

* Bladder cancer

* Bladder stones

* Cystocele

* Bladder neck contracture

Urethra

* The inability to empty the bladder (urinary retention) for any reason may cause bilateral hydronephrosis.

* Urethral stricture

* Urethral valves

Examples of extrinsic causes of hydronephrosis

Ureter

* Tumors or cancers that compress the ureter and prevent urine flow. Examples include lymphoma and sarcoma, especially if they are located in the retroperitoneum, where the kidneys and ureters are located behind the sac that contains the bowel.

* Retroperitoneal fibrosis

* Ovarian vein syndrome

* Cancer of the cervix

* Cancer of the prostate

* Pregnancy

* Uterine prolapse

* Scarring due to radiation therapy

Urethra

* Prostate hypertrophy or swelling is a common cause of urinary retention and subsequent hydronephrosis in males.

* Prostate cancer

Examples of functional causes of hydronephrosis

Bladder

* Neurogenic bladder or the inability of the bladder to function properly occurs because of damage to the nerves that supply it. This may occur in brain tumors, spinal cord injuries or tumors, multiple sclerosis, and diabetes among other causes.

* Vesicoureteral reflux where urine flows backwards from the bladder into the ureter. Prenatal hydronephrosis is an example, though it may occur at any time in life

Bocavirus Infection

Bocavirus Infection



Bocavirus (also termed HBoV or human bocavirus) is a small (20 nm in size) non-enveloped virus with a single strand of DNA that comprises its genome. The bocavirus genus is a member of the Parvoviridae family, and to date, three strains have been identified: HBoV, HBoV-2, and HBoV-3. Bocavirus is a new viral genus that was discovered in 2005 in upper respiratory secretions from acutely ill children. The name bocavirus was derived by combining the names bovine parvovirus with canine minutevirus with which bocavirus shares some genetic and structural characteristics. The ICTVdB (International Committee on Taxonomy of Viruses database) has detailed its genome and structure.

Although this virus has been found worldwide in humans and animals, there is ongoing research and discussion about this virus as being a pathogen that causes infection, either alone or in conjunction with other virus types. Many investigators consider this newly discovered virus genus as an "emerging viral pathogen" because it is only proven to be associated with infections but not yet proven to be a cause of them, either alone or in conjunction with other viruses. However, another member of the Parvoviridae family, a parvovirus termed B19, causes erythema infectiosum (fifth disease or "slapped cheek" syndrome), hydrops fetalis (severe anemia in pregnant women), and aplastic crisis (cessation of red blood cell production) in individuals that have sickle cell disease. Bocavirus has not been associated with these conditions caused by parvovirus B19.

What are the symptoms and signs of bocavirus infection?

Because bocavirus is usually only found in individuals (usually infants, children, and infrequently in young adults) with lower respiratory infections or diarrhea, these are the following symptoms and signs associated with the presence of bocavirus:

* ARTI (also termed RTIs, acute respiratory tract infections), especially in infants and children


* Cough


* Wheezing


* Fever


* Cyanosis (bluish or grayish tint to skin due to lack of oxygen)


* Rhinorrhea (runny nose)


* Diarrhea


* Vomiting

The infants and children with these nonspecific symptoms often are very ill and require hospitalization. It is important to note that it is not clear yet that bocavirus is either completely or partially responsible for these signs and symptoms. Currently, most of the clinical articles that discuss bocavirus describe patients with at least several of the symptoms and signs listed above, with pneumonia as the major problem. One study found bocavirus rarely associated with patients with COPD (chronic obstructive pulmonary or respiratory disease) so the authors suggest it has no role in COPD. Some investigators report months of bocavirus shedding (having tests demonstrate the presence of the virus in body secretions) in patients with cancer (leukemia), but the significance of this shedding is not clear.

Nibble on Chocolate for a Healthier Heart

Nibble on Chocolate for a Healthier Heart



By Jennifer Warner
WebMD Health News

Reviewed By Laura J. Martin, MD

March 30, 2010 -- Just in time for the Easter Bunny's arrival, researchers have more sweet news about chocolate and heart disease.

A new study suggests that eating a small piece of chocolate every day may reduce your risk of heart attack and stroke.

Researchers in Germany say that people who ate the equivalent of one square of a 100 gram (3.5 oz) chocolate bar per day had a 39% lower risk of having heart attack or stroke than people who ate much less chocolate.

But before you stock up on chocolate Easter eggs, researchers warn that the key to reaping the health benefits of chocolate is moderation. A single 100-gram bar of chocolate contains about 500 calories, and eating too much can contribute to unhealthy weight gain.

"Small amounts of chocolate may help to prevent heart disease, but only if it replaces other energy-dense food, such as snacks, in order to keep body weight stable," researcher Brian Buijsse, a nutritional epidemiologist at the German Institute of Human Nutrition in Nuthetal, Germany, says in a news release.
Chocolate and Heart Attack Risk

The study, published in the European Heart Journal, followed 19,357 adults for 10 years. The participants received medical checkups at the start of the study in 1994-1998, and every two to three years filled out questionnaires about how often they ate a 50 gram bar of chocolate. They could also indicate if they ate half or a bar or more than one.

The participants were not asked about what kind of chocolate they ate, but researchers asked a subset of 1,568 participants to describe the chocolate they ate in the last 24 hours to give an indication of what proportions might be found in the entire study. The results within this subset showed 57% ate milk chocolate, 24% dark chocolate, and 2% white chocolate.

By the end of the study, researchers found that people who ate the most chocolate, an average of 7.5 grams per day, had a 27% lower risk of heart attack and a 48% lower risk of stroke than people who ate the least amount of chocolate, an average of 1.7 grams per day.

"To put it in terms of absolute risk, if people in the group eating the least amount of chocolate (of whom 219 per 10,000 had a heart attack or stroke) increased their chocolate intake by six grams a day, 85 fewer heart attacks and strokes per 10,000 people could be expected to occur over a period of about 10 years," Buijsse says.

People who ate the most chocolate also had blood pressure that was about 1 point systolic (the top number in a blood pressure reading) and 0.9 point diastolic (the bottom number) lower than people who ate the least amount of chocolate.
Flavanols in Chocolate Help Heart

Researchers say the benefits of chocolate on reducing heart disease risk appear to be because of the high flavanol content of cocoa. Flavanols are a type of antioxidant, and chocolates with a higher percentage of cocoa, such as dark chocolate, contain more flavanols.

"Flavanols appear to be the substances in cocoa that are responsible for improving the bioavailability of nitric oxide from the cells that line the inner wall of blood vessels," Buijsse says. "Nitric oxide is a gas that, once released, causes the smooth muscle cells of the blood vessels to relax and widen; this may contribute to lower blood pressure. Nitric oxide also improves platelet function, making the blood less sticky."

Experts say together with previous research the results of this study build a strong case that eating a daily dose of chocolate is healthy for the heart.

"Basic science has demonstrated quite convincingly that dark chocolate particularly, with a cocoa content of at least 70%, reduces oxidative stress and improves vascular and platelet function," Frank Ruschitzka, professor of cardiology and director of heart failure/transplantation at the University Hospital Zurich in Switzerland, says in the release.

SOURCES: Buijsse, B. European Heart Journal, March 31, 2010, online advance edition. News release, European Heart Journal.