Archive for March, 2014

Depression Increases Mortality Risk in Adults with Acute Coronary Syndrome

Graham Beaton

In the February 2014 issue of the journal Circulation, The American Heart Association published a scientific statement indicating that depression is a risk factor for poor prognosis among patients with acute coronary syndrome (ACS) (any group of symptoms attributed to the obstruction of the coronary arteries).

To arrive at this conclusion, the American Heart Association’s Scientific Statement and Manuscript Oversight Committees conducted a scientific literature review on the effects of depression following diagnosis of ACS. Specifically, they looked to see if depression affected the rates of all cause mortality, cardiac mortality and other non fatal cardiac events in individuals with ACS.

The results of the literature review revealed that depression increased the risk of adverse outcomes in patients with ACS, suggesting that depression should be considered as a risk factor .that needs to be addressed. This is an important finding as approximately 20% of patients who are hospitalised with ACS meet the diagnostic criteria for suffering from major depression, and an even larger percentage of patients exhibit symptoms of depression. Thus, by screening people with ACS for depression, and providing additional care for those in need, the rates of cardiovascular mortality and subsequent non fatal cardiac events could be reduced, improving both the quality and length of life in people with ACS.

Graham Beaton is a Naturopathic Doctor practicing in Ottawa. If you are concerned about cardiovascular health, depression, how depression is affecting your cardiovascular risk, or have questions about Naturopathic Medicine, please call 613-290-6115.

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Measles Cases Reported in Ottawa

Graham Beaton
Naturopathic Doctor – Ottawa, ON

The word measles is not typically heard in Canada, unless one is discussing vaccinations. In Canada, the number of measles cases decreased dramatically after the introduction of measles vaccines in the early 1960s. That said, the second case of measles this year was confirmed by Ottawa Public Health earlier this month. This brings the total number of confirmed cases of measles in Canada since January 2014 to 24. The recent cases in Ottawa and in the rest of Canada, have renewed a call by public health officials to ensure that individuals are properly immunized.

Measles – What is it?
Measles, caused by the rubeola virus, is a highly contagious systemic disease that is characterized by fever, maculopapular rash (flat red area of the skin that is covered with small bumps), cough, coryza (irritation and inflammation of mucous membranes inside the nose), conjunctival inflammation (inflammation of the outermost layer of the eye and inner surface of the eyelids) and Koplik spots (bluish white spots on the inside lining of the mouth lateral to the molar teeth). Frequently, those infected may also experience headache, malaise and muscle pain.

The measles rash typically appears 2 to 6 days after the appearance of nasal symptoms and 2-3 days after the appearance of Koplik spots. The rash begins on the face or behind the ears as individual flat red areas of skin that blanch with pressure. In the following 12 to 24 hours, small bumps appear within the rash and the rash spreads from the head to the trunk to the extremities. The appearance of the rash on the trunk and extremities follows the same progression as on the head and face (e.g. appearance of red rash, followed by appearance of red bumps on affected areas). The progression of the rash typically takes about 4 days.

Measles is spread mainly via inhalation of respiratory droplets and infects up to 90% of people who come into close contact with an infected person. Unfortunately, it is not always possible to know if one was exposed to someone who was infected as measles is infectious up to 4 days prior to the onset of rash – and remains infectious until 4 days after the rash has appeared.

Who is susceptible to the outbreak?
People who have previously had measles or those who have received the measles vaccine are immune to the virus, as are young infants of immune mothers during the first few months of life (due to passing of maternal antibodies while in utero and via breastmilk). Thus, people who have not been vaccinated, infants and young children of non-immune mothers, young children who are not beingbreastfed, individuals with poor immune function or those on immune suppressing medications are susceptible.

What are the complications of measles?
There are several complications associated with measles infections. They include diarrhea, otitis media (ear infection), pneumonia (a secondary bacterial infection with measles) and encephalitis. In children, the most common complication of measles is acute otitis media, which occurs in 7-9% of cases. Pneumonia occurs in 1-6% of infected children, and accounts for up to 60% of measles related deaths in children. Measles related diarrhea can also result in death in malnourished individuals. Uncommon complications include reduced platelet production, hepatitis, appendicitis, pericarditis (inflammation to the sac that surrounds the heart), myocarditis (inflammation to the heart muscle), glomerulonephritis (kidney disease), hypocalcemia (low calcium levels), Stevens-Johnson syndrome (serious disorder where skin and mucous membranes have severe reaction to medication or infection) and toxic shock syndrome (a potentially fatal illness caused by bacterial toxin).

Mortality rates are typically 1 to 3 in 1000 cases in healthy individuals with access to medical care. Amongst individuals who are malnourished, have poor immune function or who have limited access to health care, mortality rates may be as high as 20%.

Those most susceptible from measles complications include children younger than the age of 5 and adults over the age of 20. Furthermore, pregnant women are at high risk for complications of measles infections, which can affect both the mother (increased risk of pneumonia) and the fetus (increased risk of miscarriage in first trimester and premature delivery later in pregnancy, and low birth weight).

How to prevent infection
The only way to prevent measles infection is to be vaccinated with an approved MMR vaccination. It is currently recommended in Ontario that healthy children receive their first MMR vaccination at 12 months of age. This first shot produces protection in about 85% to 98% of recipients. Because not all children respond adequately to one dose of the MMR vaccination, a second shot is recommended, and is typically given to children at 4 to 6 years of age. Both the first and second doses can also be given at an earlier age (6 and 9 months) if there is a higher risk of measles infection (in HIV infected children or to children who live in areas with a high number of cases).

Learning about vaccines, the diseases they prevent, and risk
There is a lot of misinformation available about vaccines and potential side effects, and it is often difficult to know how to interpret this information and what information is true. If you would like more information on measles or measles vaccinations, please speak to your family medical doctor, pharmacist or give the clinic a call and I would be happy to discuss the benefits and risks of vaccinations with you.

I am a Naturopathic Doctor practicing in Ottawa. In practice, I work with my patients to improve their health using an evidence based approach that is safe and effective.

For more information on measles, vaccinations or Naturopathic Medicine, or to book an appointment, please call 613-290-6115. Ottawa Collaborative Care Centres is located at 102 Lewis Street in the Centretown neighbourhood of downtown Ottawa.

For a global map of the number of reported measles cases by country please click here (from the World Health Organization – reporting measles cases dated between August 2013 and January 2014).