Recycled Pacemakers: Safe for use in developing world

Recycled pacemakers donated from U.S. funeral homes could offer a safe way to get the heart devices to people in the developing world who otherwise might not be able to afford them, a U.S. study said.

An estimated 1 million to 2 million people around the world die each year because they have no access to a pacemaker, an implanted device that uses electrical pulses to the heart to maintain a normal heartbeat.

One potential, largely untapped source of pacemakers for the world's poor could be the significant number of people in the U.S. who die with a still-functioning device - some 19 per cent of the deceased, according to one survey of morticians in Michigan and Illinois.

The majority of those are buried with the body or, if removed, thrown away as medical waste but a small percentage are donated to developing nations through charities.

"Implantation of donated permanent pacemakers can not only save lives but also improve quality of life of needy poor patients," wrote study leader Bharat Kantharia, of the University of Texas Health Science Center, in the American Journal of Cardiology.

Kantharia and his team collected 122 pacemakers, half of which had enough battery life left - more than three years - to be used again. They were partially sterilized, then sent to a hospital in Mumbai, India, where they were sterilized again and implanted in 53 heart patients.

New pacemakers in India cost $2,200 to $6,600, not including doctor and hospital fees or the cost of the wires connected to the pacemaker.

All of the patients survived the surgery and fared well immediately afterwards, with no cases of infection or pacemaker malfunctions over an average follow-up of nearly two years.

All but two of the 40 patients reported a marked improvement in their symptoms and quality of life. Four died, but their deaths were not linked to the pacemakers.

A number of significant hurdles remain. One of the biggest is simply getting pacemakers from the U.S. to impoverished patients who need them.

Another is the need for further safety studies.

Lose That Weight Now! You know you want to.

Here is some good advice from another doctor who is on the cutting edge in the treatment of obesity, Dr Phil.

He talks to patients about how their weight is contributing to medical problems and encourages them to aim for a modest weight loss by making simple changes such as cutting out fruit juices and Cola or other high-calorie beverages and walking in five- to 10-minute increments several times a day. "I encourage patients to lose 5% to 10%, see where they are and then try for another 5% to 10%," he says.

He and his staff, which includes other physicians, dietitians and behavioural psychologists, insist that patients keep good food journals, which the health professionals review. "A lot of time they aren't eating the wrong foods, but they are just eating too much," he says.

Most 90% of people can lose weight with diet, exercise and behaviour modification. The longer people keep food logs, the better they do, he says. When people get off track, it's because they are often no longer keeping food journals and they're not being weighed weekly.

He believes primary-care doctors could make great strides in helping patients lose weight by inviting them to come into the office every week to be weighed: "That helps keep them focussed and accountable."

Achieving steady weight loss is not easy, because it means a change in your lifestyle or behaviour and most patients know it, he says. "Despite some patients being prompted and guided to do all the right things, their minds are completely resistant to the necessary behavioural change required, and therefore they experience less or no weight loss."

Better Blood Tests Can Confirm Heart Attacks

LOS ANGELES (AP) — A new generation of blood tests can quickly and reliably show if a person is having a heart attack, very soon after the severe chest pains start. Currently, tests are not sufficiently definitive.

The newer, sensitive tests give a much better way to tell who needs help fast. Each year, 15 million people in Europe and the United States go to emergency rooms (A&E) with symptoms of a heart attack, but most are suffering from other complaints.

Those who are truly having a heart attack need to have blocked arteries cleared or opened quickly, to limit the damage to the heart muscle, caused by the lack of blood flow.

Currently Doctors have two main ways of diagnosing a heart attack. 1) They can use an electrocardiogram, or ECG, to measure the electrical activity of the heartbeat for abnormalities. Unfortunately, that test is not always conclusive and relies on the calibration of the instrument and the expertise of the operator.

2) Doctors can also use blood tests to detect elevated levels of a heart muscle protein known as troponin, this is a sign of heart muscle injury. The problem with the old troponin test is its lack of sensitivity. It takes longer to detect increased troponin levels and by that time, heart damage may have already occurred.

Greater Accuracy

In extensive test cases, the accuracy of the newer tests was 94 to 96% accurate, compared with 85 to 90% for the older tests.

Mayo Clinic cardiologist Dr. Allan Jaffe advocates using the newer tests. Several doctors said the new tests do not cost more than the older versions they are replacing, and are usually covered by insurance.

"You diagnose heart attacks faster and more accurately. You detect more people who are acctually having heart attacks and you can give them the priority they need," said Jaffe, who is independant of the studies and has no role in them.

He does agree that further studies are needed to determine if earlier detection of heart injury results in more lives being saved, but this is certainly a big step forward.