There has been numerous questions asked about the safety of mobile phone and so far no one has given conclusive proof that it is dangerous. What I do know, is that if there are dangers, it should not be used by the young simply because the skull is thinner than in adults and microwaves can reach the developing brain.

Below is an email sent to me. I am sure it is controversial and it is certainly food for thought.

Interesting article in today’s Daily Telegraph – page 30 of the main section. The most important part is “Evidence is increasing that radiation from handsets presents a cancer hazard, particularly to children and to those who use their phones for more than a decade. On Monday, some of the data will be presented at a US Senate hearing. Later this month, a long-awaited 13-nation study should be published.  The official European environment Agency (EEA) is sounding a discreet alarm. And the French government is so concerned that it is developing measures to ban the devices from primary schools, stop their promotion to children under 12, and prevent them being sold without a headset to heavily reduce radiation exposure.”

It goes on to say that earlier studies were flawed, because at that time people had not been using mobile phones for long enough for problems to reveal themselves, but that more recent studies in Sweden have shown that long-term users are twice as likely to get incurable brain cancer on the side of the head where the phone is held, and people who started to use mobile phones before the age of 20 were much more likely to contract the cancers.

Apparently there are nearly two mobile phones per person in the UK! One possible outcome is that phones may have to prominently display the radiation level of each phone – apparently they vary wildly.

Hope this post will not cause you chest pain stress.

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According to Deidre Murphy and Jennifer Walsh, two Obstetricians from Dublin, even small changes in Body Mass Index (BMI) between pregnancies can affect health. Mothers who put on or lose a lot of weight between pregnancies are putting themselves and their babies at risk.

A two unit increase in BMI doubles the risk of having a large baby, high blood pressure and pre-eclampsia. Larger increase adds to this risk and there is a greater risk of stillbirth and other complications.

Losing weight, on the other hand, increases the risk of having premature babies or low birth weight babies.

Their message is clear. Maintain a healthy weight before, during and after pregnancy and remain at the same weight before the next pregnancy.

Dr. Walsh said, “Women of reproductive age are bombarded with messages about diet, weight and body image. There is growing concern on the one hand about an epidemic of obesity, and on the other about a culture that promotes ‘size zero’ as desirable, irrespective of a woman’s natural build.

Pregnancy is one of the most nutritionally demanding periods of a woman’s life, with an adequate supply of nutrients essential to support foetal well-being and growth.

With at least half of all pregnancies unplanned, women need to be aware of the implications of their weight for pregnancy, birth and the health of their babies.”

Their review cited the Swedish Study of 207,534 women between 1992 and 2001 and assessed the link between BMI changes and the impact on the pregnancy and the mother’s health.

Tam Fry, member of the National Obesity Forum said, “I think these doctors are absolutely right.”
He said that being overweight is also associated with Polycystic Ovary Syndrome. This can result if difficulty in conceiving.

Women should be aiming for a normal weight before they have their second child.

Dr. Phil Hariram.
Diet and Pregnancy.

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Patients with Rheumatoid Arthritis should benefit from the new range of drugs called Tumour Necrotic Factor Inhibitors (Anti-TNF).

Tests on three of these new drugs slowed progression and reduced symptoms by up to 50%.

Research at the Medical University of Vienna, Austria, has shown that these three drugs are most effective in combination with the standard treatment, methotrexate.

In their published article, the team said, “The emerging agents show that a new era has started in the treatment of Rheumatoid Arthritis.”  UK expert, Paul Emery said, “They are strikingly effective and they work  on different targets from the existing drugs. That’s the joy of it.”

The three drugs in the trial are MabThera (rituximab), Orenca (abatacept), and tocilizumab.

These drugs are, however, not cheap. It is estimated that it will add around £250 million to the NHS drug bill.

Rheumatoid Arthritis is a debilitating joint disease and develops when the immune system attacks the joints causing destruction, stiffness and pain. It is estimated that there are about 400,000 rheumatoid arthritis patients in the UK.

Orenca was the first drug to target T cell in blood and tissue. Other Anti-TNF drugs are Enbrel (etanercept) and Remicade (inifliximab).

As these drugs affect the immune system, there is a higher risk of infections. They can cause headaches, fevers and increase blood cholesterol.

Ailsa BOSWORTH of the National Rheumatoid Arthritis Society said, “It means that we have some choice, and that’s very important if you are 22 and facing a lifetime of the Disease.”

Dr. Phil Hariram.

Arthritis Treatment.

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Acid reflux is extremely common in infants and usually resolves in the first year. For these children, conservative treatment is all that is needed. Small frequent feeds, thickened feeds and positioning the infant to minimise reflux are measures used.

However, true GERD in children, although uncommon, warrants investigations. Before considering investigations, it is important to exclude other potential causes of vomiting in infants. These include cows’ milk protein allergy, infections and systemic conditions that can cause vomiting.

The common investigations done are endoscopy with biopsy and 24 hour pH monitoring of the esophagus. The symptoms of GERD in children are a major worry for parents and part of the overall treatment of acid reflux in these cases is reassurance for the parents and families.

Acid reflux commonly starts between four weeks and four months after birth. It is estimated that up to 65% of normal children have acid reflux in the first year. After one year this figure drops dramatically.

True GERD is a serious and distressing condition. The common acid reflux symptom is vomiting. In addition there can be poor weight gain and respiratory symptoms such as persistent coughing. When GERD is severe and reflux reaches the lungs, the child can develop stridor, wheezing and in infants prolonged periods of apnoea.

The prevalence of GERD in children is one in 300 children. In true GERD the lower esophageal sphincter is not functioning well, and medication is necessary to control acid reflux.

Dr. Phil Hariram.

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Studies comparing thickened feeds with placebo produce confusing results. Here are a few.

A study of 20 children aged between one and sixteen weeks compared children on feeds thickened by carob flour and children on Saint John’s bread. Carob flour is a bean gum preparation and Saint John’s bread is a feed without fibre or polysaccharides. After a week regurgitation with carob flour was decreased but the change in frequency and volume was not significant.

Another study of 24 children aged 5-11 months on feeds thickened with carob flour was compared to formula milk thickened with rice flour. After two weeks there was a significant reduction of symptoms and the number of vomiting episodes in the group using carob flour.

The trial also found that coughing was more frequent in the group of infants on feeds thickened by rice flour.

A study of 20 children of mean age of 28 months compared sodium alginate with placebo showed a reduction of regurgitation of up to 33% in the group on sodium alginate.

Sodium alginate has a high sodium content and this drug, therefore, should be used very carefully in pre-tern babies.

Dr. Phil Hariram,

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Studies show that position has an effect on the level of reflux in infants.

Prone position significantly reduces reflux compared with supine (lying on your back) position. There is, however, a relationship between prone position and SIDS (sudden infant death syndrome) in infants. Do not put your child in the prone position unless advised to by your specialist.

A study of 24 children of average age of 5 months showed significantly less reflux in the prone position or left lateral position compared with the supine and right lateral position. The study also showed no improvement in children with the head elevated.

Another study compared prone position with head elevated in a harness with children in an infant seat in a supine position. The prone position showed reduced reflux compared to the supine position.

A large study showed that children sleeping in a prone or in the left lateral position are at an increased risk of SIDS.

Dr. Phil Hariram.

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Gastro-esophageal reflux disease in infants develop following reflux of stomach contents into the esophagus.

A survey of children attending hospital for further investigations found in a group of 69 children with GERD with a mean age of 16 months, 72% had recurrent bouts of vomiting, 36% had abdominal pain, 29% had feeding difficulties, 28% had failure to thrive and 19% were irritable.

In true GERD, 90% of children developed vomiting before they were six weeks old. Other problems related to GERD are haematemesis (vomiting of blood) and anaemia, cough, apnoea and wheeze.

A study comparing children with respiratory dysfunction and a control group found that 42% of children with respiratory problems had GERD compared to 8% in the control group.

If GERD is caused by hiatus hernia, 30% will persist to the age of 4 years.

Most cases of reflux in infants resolve within a year to a year and a half.

Dr. Phil Hariram,

Gastro-esophageal reflux disease in infants develop following reflux of stomach contents into the esophagus.

A survey of children attending hospital for further investigations found in a group of 69 children with GERD with a mean age of 16 months, 72% had recurrent bouts of vomiting, 36% had abdominal pain, 29% had feeding difficulties, 28% had failure to thrive and 19% were irritable.

In true GERD, 90% of children developed vomiting before they were six weeks old. Other problems related to GERD are Haematemesis (vomiting of blood) and anaemia, cough, apnoea and wheeze.

A study comparing children with respiratory dysfunction and a control group found that 42% of children with respiratory problems had GERD compared to 8% in the control group.

If GERD is caused by hiatus hernia, 30% will persist to the age of 4 years.

Most cases of reflux in infants resolve within a year to a year and a half.

Dr. Phil Hariram,

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In children with reflux symptoms, conservative treatment is very often effective. Reflux in infants is very common and the problem usually settles down by the year one.

There are, however, a few children where symptoms persists. If this is associated with failure to thrive, weight loss, restlessness, crying, poor feeding pattern, or anaemia, then intervention is necessary.

Opinion vary as to whether investigations should precede drug treatment or carried out if drug treatment fails. Investigations include endoscopy and biopsy, and 24 hour pH monitoring. Either way medication to treat acid reflux is warranted. The likelihood is that the child has esophagitis.

Although not as effective as the newer proton pump inhibitors such as omeprazole, ranitidine still remains an effective acid reflux treatment in children with GERD.

Seventy percent of children with esophagitis will respond to an eight week course of high dose ranitidine. A high dose is 4mg/Kg body weight per dose twice to three times a day.

The grade of esophagitis has significant effect on the cure rate. In children with Grade 1 esophagitis at onset of treatment, 90% is expected to improve but in grade 3 and 4 expect 43%.

With side effects of these drugs so rare and a high healing rate, ranitidine is a very good acid reflux treatment in children.

Dr. Phil Hariram.

Two group of drugs are mainly used as acid reflux treatment in GERD in children. The acid reflux treatment is in the form of acid suppression.

H2-receptor antagonists were the first group available. The first of these was cemetidine (Tagamet). Its use is now largely replaced by ranitidine (Zantac).

Protein Pump Inhibitors have been shown to be more effective than H2 receptor antagonists.

Here is a trial from the JAMA archives.

This trial was done by M.Karjoo & R.Kane.

The trial included 153 patients aged between 6 and 18 years of age with endoscopically confirmed peptic esophigitis as cause of chronic abdominal pains.

All 153 patients were treated with high doses of ranitidine and those that failed to improve on ranitidine were then treated with omeprazole 20mg daily. Omeprazole is a proton pump inhibitor.

The trial showed 70% responded to an eight week course of ranitidine. Of the 30% of patients that failed to respond to ranitidine and given omeprazole daily for eight weeks, 87% had good response.

The grade of esophagitis at the onset was a significant factor in the results. Grade 1 esophagitis had 90% response while there was only 43% in Grade 3 and 4 with ranitidine.
Of the five patients who failed to respond to omeprazole, three had Nissen Fundoplication.

The trial showed that omeprazole was effective in treating esophagitis in children and adolescents where ranitidine was ineffective.

Dr. Phil Hariram.