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-6,191,604,370,950,872,000 | Kim Peek, who lent inspiration to the fictional character Raymond Babbitt—played by Dustin Hoffman—in the movie Rain Man, was a remarkable savant. A savant is an individual who—with little or no apparent effort—completes intellectual tasks that would be impossible for ordinary people to master.
Kim Peek’s special abilities started early, around the age of a year and a half. He could read both pages of an open book at once, one page with one eye and the other with the other eye. This style of reading continued until his dead in 2009. His reading comprehension was impressive. He would retain 98 percent of the information he read. Since he spent most of his days in the library with his dad, he quickly made it through thousands of books, encyclopedia and maps. He could read a thick book in an hour and remember just about anything in it. Because he could quickly absorb loads of information and recall it when necessary, his condition made him a living encyclopedia and a walking GPS. He could provide driving directions between almost any two cities in the world. He could also do calendar calculations (“which day was June 15, 1632?”) and remember old baseball scores and a vast amount of musical, historical and political facts. His memory abilities were astounding.
Unlike many individuals with savant syndrome, Kim Peek was not afflicted with autistic spectrum disorder. Though he was strongly introverted, he did not have difficulties with social understanding and communication. The main cause of his remarkable abilities seems to have been the lack of connections between his brain's two hemispheres. An MRI scan revealed an absence of the corpus callosum, the anterior commissure and the hippocampal commissure, the parts of the neurological system that transfer information between hemispheres. In some sense Kim was a natural born split-brain patient.
Split-brain surgery, or corpus calloscotomy, is normally a harsh way of alleviating epileptic seizures, the occurrence of sporadic electrical storms in the brain. The procedure involves severing the corpus callosum, the main fibrous bond between the brain’s left and right hemispheres. After a split-brain surgery the two hemispheres do not exchange information nearly as efficiently as before. This impairment can result in split-brain syndrome, a condition where the separation gives rise to changes in behavior and agency.
Michael Gazzaniga and Roger W. Sperry, the first to study split brains in humans, found that several patients who had undergone a complete calloscotomy suffered from split-brain syndrome. In patients with split-brain syndrome the right hemisphere, which controls the left hand and foot, acts independently of the left hemisphere and the patient’s ability to make rational decisions. This can give rise to a kind of split personality, in which the left hemisphere gives orders that reflect the person’s rational goal, whereas the right hemisphere issues conflicting demands that reveal hidden preferences. One of Gazzaniga and Sperry's patients pulled down his pants with the left hand and back up with the right in a continuing struggle. On a different occasion, this same patient's left hand made an attempt to strike the unsuspecting wife as the right hand grabbed the villainous limb to stop it. Another of their patients, Paul S, had a fully functional language center in both hemispheres. This allowed the researchers to question each side of Paul's brain. When they asked the right side what their patient wanted to be when he grew up, he replied "an automobile racer." When they posed the same question to the left, however, he responded "a draftsman."
Kim Peek is similar to Paul S in this respect. There is no doubt that he must have had a fully developed language-center in both hemispheres. Language is processed in areas of the temporal lobe on the left side of the head. When you read with your left eye, the information first ends up in the right hemisphere and must be transferred to the left hemisphere via the corpus callosum to be processed. This long transfer from one side of the brain to the other is usually a disadvantage. Since Kim Peek didn't have a corpus callosum or a hippocampal commissure, his brain would have had to develop the abilities to process language in both hemispheres. This, of course, gave him a major advantage in terms of speed-reading and information retention. You might think the same would apply to other hemisphere-specific abilities, such as visual imagery and math, which are primarily left-hemisphere based. However, Kim Peek was unable to "reason his way through" mathematical problems. Despite his brilliant mind, his IQ was 87, significantly below normal. It was also difficult for him to follow directions of certain kinds.
There are several respects in which Kim Peek was not like Gazzaniga and Sperry's split-brain patients. He did not exhibit any symptoms of truly split personality or conflicting desires deriving from separate hemispheres. How did he avoid this split in information integration when information could not cross over the three main connections between the hemispheres?
We know that the brain can also transfer information indirectly through subcortical areas. Normally, it is a relatively small amount of information that is transferred that way. But Kim Peek may have developed additional subcortical connections for information transfer.
It's not all animals that have a corpus callosum. Australian Marsupials, such as the kangaroo and the wallaby, are example of creatures that rely heavily on an enlarged anterior commissure or subcortical pathways for information transfer between hemispheres. Kangaroos, wallabies and possums also have a fibrous bundle connecting hemispheres called the fasciculus aberrans.
In Kim Peeks it seems that information that didn't need to travel simply stayed put in the respective hemisphere. At some point, of course, the information would have to be combined to yield a whole. Kim Peek was able to give a full account of any book he read, he didn't give two accounts pertaining of every other page of the books he read. So subcortical connections must have been in charge of hemispheric information transfer.
Peek's ability to retain large amounts of information may have had something to do with another condition he was afflicted with called macrocephaly. This brain abnormality consists in an excessively large head and a correspondingly huge brain. Kim's head was so heavy that it took several years before he could hold it up on his own.
As a baby the real rain man was diagnosed with mental retardation and the physicians told his parents that he never would be able to read or talk. They recommended sending their little boy to a mental institution and geting on with their lives. Despite the recommendation, Kim’s parents chose to raise him at home. They quickly realized that their little boy with the oversized head had a remarkable brain. Due to his parets' efforts, Kim had the oppotunity to develop his amazing talents. A large head does not equal intelligence or ability to retain information. But it does provide more storage space for someone who is able to process the content of 10,000 books, which was the number of books Peek had read by the time of the his death in 2009.
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-8,714,437,965,375,051,000 | Flonase equivalent
image
Some of the most common over-the-counter
over-the-counter
The term over-the-counter (OTC) refers to a medication that can be purchased without a medical prescription.
https://en.wikipedia.org › wiki › Over-the-counter_drug
(OTC) nasal sprays include Flonase (fluticasone propionate), Nasacort (triamcinolone), and Afrin (oxymetazoline). Experts usually recommend steroid nasal sprays as go-to options for allergies because they are highly effective in lessening nasal symptoms.Dec 23, 2021
Full
Answer
Is Flonase and fluticasone propionate the same?
There is no difference between Fluticasone Propionate Nasal Spray and Flonase. Fluticasone Propionate is generic for Flonase. It means that you can buy both and they will always have the same effect. And the adverse effects are the same, as you may presume. I used them both and felt no difference.
Is Flonase OTC or prescription?
Flonase became available OTC in 2015. It was one of the first prescription steroid nasal sprays to make the switch to OTC and it’s certainly the most popular. It is a direct copy of prescription Flonase. At that point, Veramyst (fluticasone furoate) was still only available as a prescription.
What drug class is Flonase?
Outline
• Generic Name
• Trade Name
• Indication
• Action
• Therapeutic Class
• Pharmacologic Class
• Nursing Considerations. Join NURSING.com to watch the full lesson now. Hey guys, let’s talk about fluticasone also known as Flonase or Flovent.
What is Flonase used for?
Flonase Nasal Spray is an over-the-counter and prescription medicine used to treat non-allergy nasal symptoms such as runny nose, stuffy nose, sneezing, and nasal itching in adults and children aged 4 years and older. It is not known if Flonase Nasal Spray is safe and effective in children younger than 4 years of age.
image
What is the generic for Flonase?
The generic product is called fluticasone propionate nasal spray. It’s approved for use in adults and children who are at least 4 years old. The generic spray contains a synthetic, inflammation-fighting corticosteroid.
Is there a pill equivalent to Flonase?
Claritin is an antihistamine and Flonase is a corticosteroid. Both Claritin and Flonase are available over-the-counter (OTC) and as a generic. Claritin is taken orally in tablet or liquid form, while Flonase is a nasal spray.
Is Nasacort and Flonase the same?
Both are OTC corticosteroid nasal sprays that relieve nasal allergy symptoms, including nasal congestion. But unlike Nasacort® 24 Hour nasal sprays, FLONASE nasal sprays are also indicated to relieve itchy, watery eyes†† to provide you with the symptom relief that you need to be greater than your allergies.
Is there an over-the-counter version of Flonase?
About Flonase Allergy Relief Flonase® Allergy Relief (fluticasone propionate 50 mcg spray) is an approved over-the-counter (OTC) treatment for hay fever symptoms including nasal congestion, runny nose, sneezing, itchy nose and itchy, watery eyes in the United States.
Is Flonase a steroid or antihistamine?
Is fluticasone (Flonase) an antihistamine or decongestant? Fluticasone (Flonase) is neither. It is a type of steroid that helps to lessen the inflammation caused by allergies.
Which is better Flonase or Benadryl?
Flonase (fluticasone) is a good first-choice treatment for allergies of the nose, but long-term use can increase the risk of nosebleeds. Benadryl (Diphenhydramine) is often better than other antihistamines at treating allergy symptoms and hives. It can provide quick relief of allergy symptoms for both kids and adults.
Which is stronger Flonase or Nasacort?
Official answer. Nasacort and Flonase are equally effective, safe, and well tolerated for the treatment of allergic rhinitis. Therefore the choice of either Nasacort or Flonase comes down to personal preference, availability or price.
What is the best nasal spray for sinus congestion?
Best over-the-counter nasal spray overall: Afrin Pump-Mist Maximum Strength. Best over-the counter nasal spray for kids: Kid’s Flonase. Best over-the-counter nasal spray for sinus headache: Mucinex Sinus-Max Full Force Decongestant Spray. Best over-the-counter nasal spray for allergies: Flonase Allergy Relief Nasal …
Who should not use Nasacort?
Avoid getting Nasacort Allergy 24HR in your eyes. Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using Nasacort Allergy 24HR.
Why was Flonase discontinued?
Issues Voluntary Nationwide Recall of Fluticasone Propionate Nasal Spray USP 50 mcg Per Spray 120 Metered Sprays Due to Potential for Small Glass Particles. When a company announces a recall, market withdrawal, or safety alert, the FDA posts the company’s announcement as a public service.
Is CVS fluticasone the same as Flonase?
Fluticasone propionate is the active ingredient in the brand name drug called Flonase.
Is Nasonex the same as Flonase?
The key differences may be: What they treat: Both drugs treat nasal symptoms of allergic rhinitis, but Nasonex also treats nasal polyps, and Flonase also treats eye symptoms. If they need a prescription: Flonase is available OTC without a prescription, but Nasonex isn’t.
Should I use allergy pill or nasal spray?
Steroid nasal sprays have been proven to more effectively reduce nasal stuffiness, sneezing and post-nasal drip than allergy pills (anti-histamines). In fact, allergy pills on their own do not help with nasal congestion.
What is the difference between Flonase and Zyrtec?
Zyrtec also treats symptoms from other allergies, such as allergies to molds and dust mites. Flonase and Zyrtec belong to different drug classes. Flonase is a corticosteroid and Zyrtec is an antihistamine. Flonase is a nasal spray and Zyrtec is taken orally in tablet form.
Before Taking This Medicine
You should not use Flonase Nasal Spray if you are allergic to fluticasone.Fluticasone can weaken your immune system, making it easier for you to ge…
How Should I Use Flonase?
Use Flonase exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommend…
flonase Dosing Information
Usual Adult Dose for Rhinitis:Flonase Nasal Spray: 1 or 2 sprays (50 mcg/spray) in each nostril once a day as needed. After 6 months of daily use a…
What Happens If I Miss A Dose?
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to m…
What Happens If I Overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.An overdose of Flonase Nasal Spray is not expected to produce life…
What Should I Avoid While Using Flonase?
Avoid getting the spray in your eyes or mouth. If this does happen, rinse with water.Avoid being near people who are sick or have infections. Call…
What Other Drugs Will Affect Flonase?
Tell your doctor about all your current medicines and any you start or stop using, especially: 1. antifungal medicine; or 2. antiviral medicine to…
Does Flonase offer free returns?
We’re still looking for data on The Allergy Kit’s offer free return policies. For comparison, Flonase does not offers free returns & exchanges. Click for more details.
Does Flonase have curbside pickup?
We’re still looking for data on The Allergy Kit’s offer in-store pickup. For comparison, Flonase does not offers curbside pickup. Click for more details.
Does Flonase offer layaway?
We’re still looking for data on The Allergy Kit’s offer in-store layaway. For comparison, Flonase does not offers layaway programs. Click for more details.
Does Flonase have order tracking?
We’re still looking for data on The Allergy Kit’s offer order tracking support. For comparison, Flonase does not offers order tracking. Click for more details.
Does Flonase offer workers discounts?
We’re still looking for data on The Allergy Kit’s offer essential worker discounts. For comparison, Flonase does not offers front-line worker discounts. Click for more details.
Does Flonase accept cryptocurrency?
We’re still looking for data on The Allergy Kit’s accept cryptocurrency support. For comparison, Flonase does not accepts cryptocurrency payments. Click for more details.
Does Flonase accept Google Pay?
We’re still looking for data on The Allergy Kit’s accept Google Pay support. For comparison, Flonase does not accepts Google Pay. Click for more details.
What is Flonase?
Flonase is a nasal spray that contains fluticasone ( 1 ). Nasal spray is a topical application that affects the nasal mucosa (lining of the nose) and the nasal passage. Fluticasone belongs to a class of drugs called corticosteroids. Fluticasone helps prevent the release of substance in the body that causes inflammation. It can be used for allergic and non-allergic sinus symptoms. Flonase is an over-the-counter drug so you don’t need a prescription. But if you have any systemic diseases or are on any other drug than consult your doctor before taking flonase.
What group is flonase?
Flonase belongs to the corticosteroid group of drugs and like any other drug available on the market, it also has some side effects ( 4 ).
How to use GSE for nasal irrigation?
For nasal irrigation, mix a few drops of GSE and 1/4 teaspoon of salt in a glass (8 oz.) of warm water . Never use tap water for nasal irrigation because it contains many microorganisms that might cause infection. Always use bottled water or boiled water. Use this mixture to irrigate your nasal passage.
What is the difference between omnaris and flonase?
Flonase vs Omnaris. Flonase belongs to class of drugs called corticosteroid, while omnaris belongs to the glucocorticoid class of drugs. Omnaris is a relatively new drug. Both of these drugs are used to treat seasonal allergies.
What is omnaris nasal spray?
Omnaris (ciclesonide) is a nasal spray that belongs to the glucocorticoid class of drugs ( 11 ). Omnaris prevents the release of inflammation causing substance in the body. It is suitable for kids over 6. It is effective in cases of seasonal allergies ( 12 ). But for year around allergies it should not be given to a child younger than 12 years. Omnaris is a steroid so you should not stop taking it suddenly because that can cause side effects.
What is Nasonex used for?
Nasonex (mometasone) is a steroidal nasal spray that is used to treat allergies and nasal congestion. The steroid present in nasonex is mometasone. This prevents the release of inflammatory elements within the body. This drug should be used with caution in children and pregnant females.
How to make saline solution?
You can buy an over the counter saline solution or make one yourself. To make a saline solution, mix 1/4th teaspoon of salt in 8 Oz. of distilled water. Do not use tap water to make saline because it contains microorganisms. Put the saline solution in a small spritz bottle. Use 2 spritz 3 times a day. The over the counter saline is mostly isotonic but you can also use hypertonic solution. Studies have shown that both these solutions help clear up the nasal passage and keep the sinuses healthy and infection free.
What is Flonase?
Flonase is a nasal spray containing fluticasone propionate. Fluticasone propionate is a corticosteroid that prevents the release of substances in the body that cause inflammation.
What are the side effects of flonase?
Get emergency medical help if you have signs of an allergic reaction to Flonase: hives, rash; feeling light-headed; difficult breathing; swelling of your face, lips, tongue, or throat. signs of a hormonal disorder–worsening tiredness or muscle weakness, feeling light-headed, nausea, vomiting.
How long does it take for fluticasone to work?
It may take up to several days of using Flonase nasal spray before your symptoms improve. Tell your doctor if your symptoms do not improve after a week of treatment. Fluticasone can lower blood cells that help your body fight infections. Avoid being near people who are sick or have infections.
How old do you have to be to take flonase?
Flonase is for use in adults and children who are at least 4 years old and is available without a prescription.
Can you give a child fluticase nasal spray?
These conditions can be serious or even fatal in people who are using fluticasone. Do not administer Flonase Nasal Spray to a child younger than 4 years old without medical advice.
Is it safe to take flonase?
To make sure Flonase is safe for you, tell your doctor if you have ever had : sores or ulcers inside your nose; injury of or surgery on your nose; glaucoma or cataracts; liver disease; diabetes; a weak immune system; or. any type of infection (bacterial, fungal, viral, or parasitic).
Can you share fluticasone with another person?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Do not share this medicine with another person, even if they have the same symptoms you have. Your dose will depend on the fluticasone brand or strength you use, and your dose may change once your symptoms improve.
Donec dictum metus
Bioequivalence of the Clarinex RediTabs Tablet and also the formerly marketed RediTabs Tablet was experienceded in grownups.
Etiam posuere augue
Unless your physician told you or else, you have to not use this medicine if the patient is more youthful than 6.
Nulla luctus eleifend
This medicine is not anticipated to be unsafe to an unborn infant however it could enter bust milk. If you have any of these symptoms quit taking Alavert and contact your local emergency clinic for immediate aid.
Welcome to our website
Very soon, you’ll have the ability to delight in very high top quality medicines and their fast distribution, incorporated with excellent customer support. Alavert (loratadine) is an antihistamine medicine planned for the procedure of allergy symptoms (itching, watery eyes, drippy face, sneezing) and skin reactions.
What is the drug used for rhinitis?
Drug features. Both Nasacort and Flonase are used to treat symptoms of allergic rhinitis, which is often simply called allergies. This condition causes inflammation of the lining of the nose. You may recognize it by the sneezing and stuffy, runny, or itchy nose it causes.
Does flonase interact with nasacort?
Little information is available on drug interactions with Nasacort. Flonase, though, may interact with HIV drugs such as ritonavir, atazanavir, indinavir, nelfinavir, saquinavir, and lopinavir.
Is Nasacort a similar drug to Flonase?
Side effects. The side effects of Nasacort and Flonase are very similar. The charts below compare examples of their possible side effects. Serious side effects of Nasacort and Flonase are rare as long as you follow the directions carefully. Common side effects.
Is Nasacort a generic?
The generic versions of Nasacort and Flonase are likely to cost less than their brand-name versions. Typically, Nasacort and Flonase Allergy Relief are not covered by prescription drug insurance plans because they’re over-the-counter drugs. However, the generic of Flonase is also available as a prescription drug .
Does flonase help with allergies?
Flonase can also treat eye symptoms related to allergies. These can include itchy, watery eyes. The table below compares other key features of Nasacort and Flonase. Key features. Nasacort Allergy 24 Hour. Flonase Allergy Relief.
Is it safe to take nasacort and flonase?
Nasacort and Flonase can both cause problems for people with certain medical conditions. If you have any of the conditions marked in the table below, talk to your doctor about whether taking Nasacort or Flonase is safe for you. Medical conditions to discuss with your doctor. Nasacort. Flonase.
What is the interaction between nasonex and flonase?
An interaction is when a substance changes the way a drug works, which can be harmful or prevent the drug from working well. Before starting Flonase or Nasonex, be sure to tell your doctor about all medications, vitamins, and herbs you’re taking.
What is the name of the medication that reduces inflammation caused by allergies?
Flonase and Nasonex are allergy medications that belong to a class of drugs called corticosteroids. They can reduce inflammation caused by allergies.
Does insurance cover Flonase allergy relief?
Typically, OTC drugs such as Flonase Allergy Relief aren’t covered by prescription drug insurance plans. However, your plan may cover OTC Flonase if your doctor writes you a prescription for it.
Is Flonase the same as Nasonex?
Both Flonase and Nasonex have generic versions. The generic and brand-name versions of these nasal sprays are available in most pharmacies. Generic versions of Flonase and Nasonex contain the same active ingredients as the brand-name versions, but typically cost less.
Does Nasonex help with rhinitis?
Both Flonase and Nasonex are used to treat allergic rhinitis, which is inflammation of the lining of the nose. Symptoms of this condition can include sneezing and a stuffy, runny, or itchy nose. These symptoms can be seasonal (occurring during certain seasons, such as spring) or perennial (occurring throughout the year).
Does Nasonex have a prescription?
If they need a prescription: Flonase is available OTC without a prescription, but Nasonex isn’t. To help you decide which drug may be better for you, talk to your doctor.
Is Flonase a side effect?
I have also had this same experience. (symptoms below). I think I have an allergy to Flonase! The details of severe and less severe side effects of the drug are found here: http://www.rxlist.com/flonase-side-effects-drug-center.htm I think it’s the Flonase, in my case adverse reactions are: mild swelling (throat), sore throat, white sores/dry spots in the throat, nausea and vomiting, sinus irritation and congestion, pain in the lymph node area.
Is astepro the same as flonase?
s unfortunate when medication costs so much sometimes that we have to find an alternative. Flonase and Astepro are likely the right names. Flonase is a corticosteroid spray and Astepro is an antihistamine spray. Dymista is a combination medication so it makes sense that the doctor is suggesting the two medications will work as the Dymista did. Let us know how it goes.
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8,310,596,593,464,742,000 | Neuroblastoma
You are here:
Risk factors for neuroblastoma
A risk factor is something that increases the risk of developing cancer. It could be a behaviour, substance or condition. Most cancers are the result of many risk factors. But sometimes neuroblastoma develops in children who don’t have any of the risk factors described below.
Neuroblastoma is the most common solid tumour outside of the brain in children. It accounts for 8%–10% of all cancers in children.
About 80% of neuroblastomas occur before the age of 5, and the average age at diagnosis is 2.5 years. It is the most common cancer in babies under the age of 1 year. Neuroblastoma is very rare in children over 10 years of age. This cancer occurs slightly more often in boys than in girls.
The following are risk factors for neuroblastoma. All of the known risk factors are not modifiable. This means that you can’t change or avoid them. Until we learn more about these risk factors, there are no specific ways you can reduce the risk.
Risk factors are generally listed in order from most to least important. But in most cases, it is impossible to rank them with absolute certainty.
Known risk factors
There is convincing evidence that the following factors increase the risk for neuroblastoma.
Family history
About 1%–2% of children diagnosed with neuroblastoma have a family history of the disease. The risk for neuroblastoma seems to be highest for siblings or an identical twin of children who already have the disease.
Genetic conditions
Genetic conditions are caused by changes to certain chromosomes. These chromosome changes are passed from parents to children. Neuroblastoma has been known to develop in children with the following genetic conditions, which involve changes in immature nerve cells (called neural crest cells, or neuroblasts). Other chromosome changes have also been found in children with neuroblastoma.
• Hirschsprung’s disease is a condition in which nerves are missing from part of the intestines. As a result, the large intestine doesn’t work properly and can get blocked.
• Congenital central hypoventilation syndrome (CCHS) is also called primary alveolar hypoventilation. It is a rare disorder that affects breathing. People with this disorder take shallow breaths, especially when they are sleeping.
• Neurofibromatosis type 1 (von Recklinghausen disease) is a condition in which non-cancerous tumours develop in the nerves and skin, causing areas of the skin to become lighter or darker.
• Beckwith-Wiedemann syndrome affects how different parts of the body grow. It causes large body size, large tongue, large organs, a defect in the abdominal wall and low blood sugar in newborns.
• DiGeorge syndrome causes poor development of several body systems, which leads to medical problems such as heart defects, cleft palate and emotional and behavioural problems.
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Unknown risk factors
It isn’t known whether or not the following factors are linked with neuroblastoma. It may be that researchers can’t show a definite link or that studies have had different results. Further study is needed to see if the following are risk factors for neuroblastoma:
• exposure to alcohol or certain medicines (including diuretics, pain medicines, antiseizure medicines, oral contraceptives and fertility hormones) during pregnancy
• exposure to viruses or environmental factors (such as chemicals or radiation) during pregnancy or after birth
• father’s occupational exposure in certain industries (including electronics-related jobs and jobs with exposure to electromagnetic fields, hydrocarbons or wood dust)
• mother’s occupational exposure in certain industries (including farming, florist and garden workers and hair dressers)
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Stories
Heather Moyes I encourage every woman – regardless of how young or how old – to be aware of their body
Read Heather's story
How can you stop cancer before it starts?
It's My Life! icon
Discover how your lifestyle choices can affect cancer risk and how you can take action with our interactive tool – It’s My Life!
Learn more | {
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-3,542,700,191,226,819,000 | Immune System Boosters in Kids | Legit 2020 Review
Immune System Boosters in Kids
What Is the Immune System as well as What is Its role?
Prior to going any type of better, it’s crucial to recognize what your immune system is and also its function. “Our immune system is essentially a system in our body to permit us to remain healthy and balanced, battle infections, and also to heal when we are exposted to viruses, virus, or if we merely just get ill,” Nicole Azuli, PhD, assistant researcher of neuroscience at the Mount Sinai School of Medicine, informed us. Our immune system keeps us risk-free and well, “and a lot of things enter into making it operate well,” Dr. Azuli said. Your diet plan and also nutrition, stress and anxiety, rest, and also workout all influence just how well our immune system works. And also for some, it simply boils down to genetics.
>>Discover the best supplements to boost your immune system<<
Your body immune system separates you and lethal infections. But as you grow older so does your immune age, making you a lot more vulnerable to illness. Luckily, we are finding lots of things you can do to reverse the clock and also stay healthy. In this episode of our video series Science with Sam, figure out how your immune system works as well as just how you can provide it a boost.
Your body immune system is comprised of two departments: the inherent immune system and also the adaptive body immune system, each with its own battalion of specialist cells as well as defensive tools.Immune System Boosters in Kids
The inherent immune system is the initial line of protection. It’s composed of cells like the scary-sounding macrophage, and also the much less scary-sounding neutrophil. These general-purpose guards patrol the blood stream in search of anything that should not exist. When they discover a trespasser, they neutralise the threat by engulfing it like Pac-Man, spraying it with deadly chemicals or suicidally eliminating their DNA and also tossing it around the intruder like a web.
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After that there’s the adaptive body immune system, which you can take the immune system’s special forces, exclusive agents educated to combat particular virus. Unlike the inherent system, which can attack any kind of getting into cell or infection, these cells are just reliable versus one opponent, and also they have to be educated to eliminate them initially.
B cells deal with germs and infections by making Y-shaped healthy proteins called antibodies that neutralise an invader or tag it for strike by other parts of the immune system.
After that there are T cells. These coordinate and accomplish strikes on contaminated cells. Assistant T Cells hire supports by sending chemical messages known as cytokines. Killer T-Cells are the cutting edge soldiers, educated, as the name suggests, to destroy the opponent.
When we come across a condition for the first time, it takes a while for the flexible body immune system to find out exactly how to combat it. Once it’s up and also running, it develops a memory, allowing a quick as well as brutal action to future infections– usually counteracting it prior to you also notice. This is the property of injections and the reason why you only obtain illness like chicken pox as soon as.
>>Discover the best supplements to boost your immune system<<
If you would like to know more about vaccinations, there’s a video everything about them, just struck the web link at the end of this video clip. Better yet, sign up for New Scientist today and get 20 percent off if you enter the code SAM20 at checkout.
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Your immune system functions so well that, most of the moment, you will not even see it. However it weakens as you get older, making you a lot more prone to infection. That’s a key reason that people over the age of 70 are most vulnerable to illness like covid-19, or perhaps the flu.Immune System Boosters in Kids
This decline occurs to all of us, but it can be accelerated by way of living aspects like cigarette smoking and also inactivity. Obesity is likewise connected to a much faster decrease in immune effectiveness.
All of which implies that, although the toughness of your body immune system is connected to your age, a 40-year-old can have the immune system of a 60-year-old. Or on the flipside, a healthy 60-year-old might have the immune system of a 40-year-old.
>>Discover the best supplements to boost your immune system<<
Researchers have lately developed means to gauge your immune age. Thankfully, it turns out your immune age can go down as well as up. And also there are some easy ways to turn back the clock on your immune system.
As we grow older, several of our immune cells start to be mischievous. Take neutrophils, those early -responder cells. As they age, they get worse at searching down burglars, blundering through your tissues, creating damages.
The origin of the problem is an over active enzyme involved in their sense of direction. Calling down that enzyme invigorates the neutrophils so they recognize where they’re going. As well as there’s a straightforward, drug-free means to do it: exercise.Immune System Boosters in Kids
One study in older adults showed that those who got 10,000 actions a day usually had neutrophils just as good as a young person.
Just how to Strengthen Your Immune System?
Making adjustments to your way of living such as obtaining the recommended 7 hours of sleep each night and reducing your stress and anxiety are two tested methods to enhance your immunity as poor rest as well as high degrees of stress adversely impact our body’s ability to fight infection, Dr. Azuli explained. “And so I tell individuals, ‘Don’t fret so much concerning taking a supplement, or taking some special tea, or whatever latest drink is mosting likely to affect your immune system. It’s really just a matter of simply trying to chill out and get more rest,'” she described.
Adults should aim for 7 to eight hours of sleep each evening, due to the fact that when we do not get enough rest, “our body is essentially needing to burn the midnight oil throughout our waking hrs just to keep it working properly,” Dr. Azuli explained. Caffeine can make you seem like you’re working terrific, yet eventually, a lack of rest suggests the resources that would certainly go to aiding your body be prepared to combat illness, problems, as well as microorganisms is routed toward aiding you survive the day. It’s like playing a group sport but being brief a couple of gamers, Dr. Azuli claimed. You might be able to win (in this instance fight off disease and also virus), but it’s going to be a great deal harder.
>>Discover the best supplements to boost your immune system<<
The very same goes for stress and anxiety. If you’re experiencing chronic stress and anxiety, your hormones, particularly cortisol (aka the anxiety hormone), can be influenced, which can cause more problems that can be “turbulent to your immune system,” Dr. Azuli said. “So the stress, I think, is really something that can be challenging for a great deal of individuals to manage, yet it’s very important to keep under control, since it can really open a Pandora’s box of issues when it involves aiding support your immune system.”
Along with obtaining more rest and also minimizing your tension levels, exercise can also help support your body immune system, according to Dr. Azuli. When you work out, your body obtains stronger. Dr. Azuli described that the far better shape you’re in, the simpler it is for you to exist, suggesting your body doesn’t need to work as difficult to see to it your joints and also cardio system, for example, are operating at an optimal level. The most effective part is, any type of sort of activity will certainly assist strengthen your body immune system. You can run, you can walk, you can do 10 mins of extending– “all of it matters towards helping to keep you fit and to maintain your immune system having the ability to function as finest it can,” Dr. Azuli stated.
What Foods Can Help Strengthen Your Immune System?
Immune System Boosters in Kids
Food can also impact exactly how well your immune system features, yet there isn’t an exact list of products you must eat to boost your immunity. Dr. Azuli suggests restricting the amount of refined, high-salt, and also high-sugar foods you’re consuming. “All those things are going to have a negative effect on our wellness, and also subsequently, on our body immune system,” she said. You can still have foods like donuts and also chips, however like the majority of points, it’s about equilibrium. Dr. Azuli stressed obtaining a series of nutrients in your body as well as not adhering to limiting diet plans as they can bring about vitamins and mineral deficiencies, which can have an unfavorable effect on exactly how your body immune system functions.
Consuming foods that normally contain vitamin C (citrus fruits, leafed eco-friendlies, and also pleasant potatoes, for example) and zinc (red meat, beans, and nuts and also seeds) can assist. If you aren’t getting these nutrients from food resources, supplementing with vitamin C and zinc can work, Dr. Azuli stated. When feasible, she recommends trying to obtain these nutrients from food as your body will soak up as well as utilize them better. Taking a single supplement won’t all of a sudden enhance your immune system, and also Dr. Azuli recommends taking an alternative method and making way of life modifications in order for your immune system to function well.
making sure to get more sleep, minimizing anxiety, exercising, as well as eating a variety of nutrient-rich foods, are your best choice if your objective is to have a stronger immune system. “You may locate that you’re able to accomplish what you need to do for your health and wellness simply by making the way of living modifications in and also of themselves,” Dr. Azuli claimed. And also as constantly, if you have any questions or problems about your health and wellness, consult a medical specialist such as your medical care doctor.
Exercise also has benefits for your T cells. Before they are launched onto active duty, T-cells mature in an obscure organ called the thymus gland in your chest. The thymus deteriorates gradually, resulting in a drop-off in the number of T cells.
Exercise has a massive level of impact on the rate of this deterioration. A research study demonstrated that amateur bikers matured between 55 and 79 had youthful thymus glands as well as their T-cell matters resembled those of much younger individuals.
One more vital influencing your immune age is your gut microorganisms. There is good evidence that poor gut health is a cause of early aging which a healthy and balanced microbiome can minimize your immune age. Consuming a healthy, varied diet regimen rich in fibre, plant issue and also fermented foods can assist preserve a healthy community of gut germs.
Your body has actually an extremely progressed, detailed defense system that’s effective at keeping you well, but only if you look after it.
I do not know about you but I’ve been a bit less energetic of late, so I’m considering this something of a wake-up telephone call.
Looking after your body immune system is a piece of cake, as well as it’s as very easy as a stroll in the park.
>>Discover the best supplements to boost your immune system<<
Disclosure: we are a professional review site that receives compensation from the companies whose products we review. We test each product and give high marks to only the very best. We are independently owned and the opinions expressed here are our own. | {
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In Swedish massage, the person to be massaged lies on a massage table and is draped with a towel or sheet. It is a full-body massage treatment, except in areas that are contraindicated or where the client requests not to be touched. Aromatic or unscented oil or lotion is used to facilitate the massage movements. Each session usually lasts 30-60 minutes. Depending on the client's preferences, a massage session may involve the use of several or all of the following basic techniques: effleurage, petrissage, friction, vibration, and tapotement.
A satisfying sensation doesn’t necessarily imply successful treatment, unfortunately. Scratching mosquito bites feels great… but it’s not helping them! Trigger points may be like mosquito bites: it may feel terrific to massage those mysterious sensitive spots in soft tissue, but it may not be doing much to actually “release” or resolve them. It may be a purely sensory experience, the satisfaction of dealing with an “itch” that we cannot easily reach on our own.
Lithonia DeKalb 30058 Georgia GA 33.7356 -84.1009
“Resonate” in this context means that physical pain may transmogrify into emotional pain and vice versa. Emotional and physical pain readily create and reinforce each other. I assume that catharsis is inherently valuable, and I think that’s a fairly safe assumption. I discuss the relationship between pain and emotions in from many angles in several articles, like Pain is Weird, Pain Relief from Personal Growth, The Anatomy of Vitality, Why Do We Get Sick?, The Art of Bioenergetic Breathing, Insomnia Until it Hurts, and Anxiety & Chronic Pain. Whether catharsis is medically helpful for pain obviously depends on many factors, but it’s certainly possible — just as they can reinforce each other, relief from one may also be coupled to relief from the other. BACK TO TEXT
Massage is hindered from reaching the gold standard of scientific research, which includes placebo-controlled and double blind clinical trials.[86][87] Developing a "sham" manual therapy for massage would be difficult since even light touch massage could not be assumed to be completely devoid of effects on the subject.[86] It would also be difficult to find a subject that would not notice that they were getting less of a massage, and it would be impossible to blind the therapist.[86] Massage can employ randomized controlled trials, which are published in peer reviewed medical journals.[86] This type of study could increase the credibility of the profession because it displays that purported therapeutic effects are reproducible.[87]
Fibromyalgia syndrome is a common and chronic disorder characterized by widespread pain, areas of tenderness, and a number of other symptoms. While massage can be an effective way to manage fibromyalgia pain, most studies done on the effects of massage on fibromyalgia symptoms only showed short-term benefits of massage. Only one study proved to have long-term benefits.9 Though more studies are needed to confirm the positive effects of massage on this condition, you could go to a registered remedial therapist for massage therapy to help with the pain.
Swedish massage is proven to lower blood pressure and reduce stress, according to the International Journal of Preventative Medicine, as well as to relieve depression and anxiety and aid in recuperation from chronic illness. Swedish massage is also referred to as classical massage, and — contrary to popular understanding — does not originate from Sweden. There are five main strokes, or movements, that make up a Swedish massage: effleurage, friction, petrissage, tapotement and vibration. Each technique was created to help soothe, stimulate, soften, and rejuvenate muscles and other soft tissue.
Luthersville Meriwether 30251 Georgia GA 33.1798 -84.7577
Sports Massage can be characterized two ways: pre-activity and post-activity massage. Pre-activity uses dynamic stretching to allow the connective tissue to work through a full range of motion, thereby reducing possible injury. Post-activity massage focuses on recovering the muscle tissue that may have been impacted doing the particular sport. It involves long strokes to flush out the toxins that causes soreness in the muscles and joints.
Tallapoosa Haralson 30176 Georgia GA 33.7602 -85.3
In its Comprehensive Accreditation Manual for Hospitals, The Official Handbook, updated in August 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) suggests massage therapy can be used successfully in pain management. Some hospitals are including massage therapists in patient care teams to fight pain. Their teams may include a physician, nurses, a nutritionist, a yoga instructor, and a massage therapist. Hospitals are now including massage due to public demand. More research needs to be done to evaluate not only the effectiveness of such teams but to determine which combination of therapies works best for different types of patients and different types of pain.
In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; reflexology was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.[5] Accordingly In 2017 the Australian government named reflexology as a practice that would not qualify for insurance subsidy, saying this step would "ensure taxpayer funds are expended appropriately and not directed to therapies lacking evidence".[6]
Suwanee Gwinnett 30024 Georgia GA 34.0425 -84.0262
Massage should not be done directly over bruises, inflamed or infected skin, skin rashes, unhealed or open wounds, tumors, abdominal hernia, fragile bones, or areas of recent fractures. Massage may cause bruising and rarely, hematoma (a localized collection of blood outside of blood cells), venous thromboembolism, and a condition known as spinal accessory neuropathy.
Carrollton Carroll 30119 Georgia GA 33.6189 -85.0736
Deep tissue massage centers on realigning the deeper layers of connective and muscle tissue. It aims to release the chronic patterns of tension in the body through slow strokes and deep finger pressure on the tense areas, either following or going across the fiber’s of the muscles, tendons and fascia. It is particularly helpful for continually tight and contracted areas such as stiff necks, low back tightness, and sore shoulders.
Alhough he was a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association at the time, Pietrunti says that he ultimately decided to pursue licensure in massage therapy as well. This provided that missing link while also being “a good way to ‘bridge the gap’ and provide a better service to my clients,” he says.
Combine these with the 4,146 active players in the NFL (National Football League) MLB (Major League Baseball), NBA (National Basketball Association), NHL (National Hockey League) and MLS (Major League Soccer); the 244 Olympic athletes on Team USA who competed in the 2018 Winter Games; and all of the “weekend warriors” who play sports on a more sporadic basis and this represents a huge number of individuals who rely on their bodies to consistently perform at higher levels.
Clarkdale 30020 Georgia GA 33.8307 -84.6496
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
Massage therapy catered specifically to you and what your body needs. Intuitively knowing which style of massage to use from from a wide array of options such as shiatsu, deep tissue, lomilomi, Swedish, prenatal, acupressure, reflexology and many more I am Passionate about offering the service of massage creating an integrative, therapeutic, lasting experience.
Milner Lamar 30257 Georgia GA 33.141 -84.1759
The Swedish massage is the foundation of the art of massage. It’s typically characterized by friction techniques, kneading, and long strokes, and can be performed using either gentle pressure or deeper pressure. The Swedish massage is the usual go-to if you’re dealing with a lot of stress from work, school, or just everyday life! It’s a soothing, relaxing massage that relaxes muscle tissue while increasing the body’s circulation, sending healthy, oxygen-rich blood to your muscles and tissues.
As someone who is sensitive to touch, I was beyond hesitant to get a massage. I went there with a specific need and was able to modify the massage offered to fulfill my request. My therapist was Camille who asked me questions, listened to what I said and listened to the way my body responded to touch. I had gone in for a therapeutic massage to decrease edema in my feet, ankles and calves. When I woke up the next morning I was amazed at the difference in the swelling. I left there not only feeling confident the treatment would help but educated in how I can help myself. I have found what I need in The Tucson Massage Company.read more
A high attention to detail is important to be successful in sports massage. I also feel my professional communication with clients and other practitioners assists with this process. It’s vital to get all the necessary facts about the client and follow up with them after each session. I also feel it’s important that I have experience in endurance training and racing to help with the rapport with my clients.
Newnan Coweta 30271 Georgia GA 33.3514 -84.7561
There are five main techniques in Swedish massage: effleurage, friction, petrissage, tapotement and vibration. Within each category there are various movements, all intended to ease muscle tension and pain. Each movement has a specific purpose for loosening, warming, soothing or stimulating your muscles during your massage. Here is a breakdown of each of the five Swedish massage techniques:
Referred pain spreads the goodness. Undoubtedly another reason that massage pain can feel good is the phenomenon of referred sensation. If you stimulate internal tissues anywhere in the body, muscle or otherwise, the brain really has trouble telling quite where the sensation is coming from. When you press hard enough on your muscles, particularly on sensitive trigger points, the pain is often experienced as though it originated from a much broader area.
Mcdonough Henry 30252 Georgia GA 33.4768 -84.055
The NCCIH adds that massage therapy may also be potentially harmful to women who are pregnant. Even though research has found that it offers this demographic some positive effects, such as decreased depression and anxiety and reduced leg and back pain, it is still important to obtain approval from her healthcare provider first to ensure that she can receive a safe sports massage.
A therapeutic Swedish massage is considered the luxury massage. It includes the application of the hands on the body from your temples and neck to your back and limbs. A massage therapist applied a very gentle pressure to the soft tissues. The light strokes and kneading produces true relaxation from a peaceful state of mind to the elimination of muscle tension. Combined with soothing surrounds and hydrating oils, Swedish massages are favored by most.
When you are looking for massage therapy, be sure to check which type of massage a practitioner can provide. Match that with the benefits you hope to get from the massage session. You may want to chat with several different practitioners to find the one who understands your needs and is used to working with people with similar goals. Be sure also to discuss any allergies, such as to scents or plant oils, so your massage will be relaxing and beneficial without that concern.
Contrary to popular belief, Swedish Massage was not created by anyone from Sweden. The History of Swedish massage by Robert Calvert describes where Swedish massage came from. Per Ling a Swedish Physiologist and gymnastics instructor created something known as the Swedish Movements or Swedish Movement Cure (link to Massage Today Article: November, 2010, Vol. 10, Issue 11 The Swedish Movement CureBy Judi Calvert, LMP ) but it was focused on movement which is only one component of Swedish Massage and not the basic techniques of efflerage, pettrissage and so on (see below). Johann Mezger promoted Swedish Massage and helped make it more popular in the US.
Haralson Coweta 30229 Georgia GA 33.2322 -84.5685
Massagetique is not intended to be a substitute for professional advice, medical treatment, or diagnosis. Always seek the advice of your qualified health care provider or physician with any questions you may have regarding any symptom or medical condition. Never disregard professional or medical advice or delay in seeking evaluation or treatment because of something you have read on Massagetique.
Barnesville Lamar 30204 Georgia GA 33.0457 -84.1515
George Taylor, M.D., writing in 1885, uses the terms "clappings, knockings, stroking, kneading, pullings, shakings and vibratings" as the passive movements used by Ling in his Swedish gymnastic system. However, he gives very little attention to describing those movements. This may be explained first because Ling provided no explanations and second by the following passage from Taylor: "But the employment of duplicated [passive] movements, it must be confessed, is attended with difficulties that will prevent their general use as a medical resource. An ordinary course of medical instruction does not confer the necessary qualifications for their successful application; the tact necessary to prescribe and apply them properly is only acquired by long and patient practice, and the labor is excessively severe."
Snellville 30278 Georgia GA 33.8505 -84.0208
In addition, while the research remains inconclusive, many massage therapists feel that their techniques can lead to the release of toxins into your bloodstream. Because of this, it's commonly recommended that people receiving a massage drink a lot of water for the remainder of the day to help their liver and pancreas process any excess toxins. Doing so may help you avoid feeling nauseous, fatigued or excessively sore afterward.
Norcross Gwinnett 30093 Georgia GA 33.906 -84.184
Owner, R.M.P., N.C.T.M.B Born in South Africa, and with many years of International Massage Therapy experience, Janine studied Massage in Austria & Germanty. Her bodywork is attentive and precise. Janine is a Maryland State Registered massage Practioner, Licensed with the National Board of Massage Therapy Practioners & also a member of AMTA. Ha started Massage Metta in Bethesda, MD late last year with the intention of providing a bodywork session that will meet the needs of Stay at Home Moms to Weekend Warriors & Professional Athletes alike. She truly practices the Metta Philosophy by treating all beings with Loving Kindness. Janine lives in Potomac Maryland with her husband & their lazy dogs, Chowka & Tequila.
Whether you’re an athlete with a daily high demand placed on your body or recovering from an injury or illness, deep tissue massage likely has some benefits to offer you. Massages have been utilized for thousands of years throughout the world to lower both physical and psychological stress. And today, research continues to show that whether used alone or in conjunction with other treatments, massage therapy is an effective way to help treat common conditions like arthritis, anxiety and chronic lower back pain.
Deep tissue massage is a type of massage that aims at affecting the deeper tissue structure of the muscles. It also affects the connective tissue, known as fascia. Deep tissue massage helps with both small muscle injuries as well as chronic problems. Deep tissue massage is an excellent way to deal with a whiplash or sports injury, postural misalignment, treating spasms as well as muscle tension. During a deep tissue massage the therapist concentrates on releasing specific chronic muscle tension as well as the muscular knots, or adhesions.
Español: leer un gráfico de reflexología podal, Italiano: Leggere una Mappa di Riflessologia Plantare, Português: Ler um Diagrama de Reflexologia Podal, Deutsch: Eine Tafel der Fußreflexzonen lesen, Русский: читать диаграмму рефлексологии стопы, Français: lire une planche de réflexologie plantaire, Nederlands: Een voetreflexologie kaart leren lezen, العربية: قراءة خرائط تدليك القدم, Bahasa Indonesia: Membaca Tabel Pijat Refleksi Kaki
Diagnosing or treating disease would constitute the practice of medicine and would be illegal for anyone who does not have a professional license to do these things. Although many diagnose and treat disease, I am not aware of any prosecutions. In some states that license massage therapists, unlicensed reflexologists might also be prosecutable for practicing massage therapy without a license [11].
Franklin Heard 30217 Georgia GA 33.278 -85.134
Because the deep tissue massage is used for stiffness, knots, chronic pain, contracted areas, and muscle tightness, your massage therapist will apply pressure and use deep strokes in order to get everything feeling back to normal again. Deep pressure is used to break apart your painful, stubborn knots. Knots can be described as a group of rigid tissue.
Norcross Gwinnett 30010 Georgia GA 33.9604 -84.0379
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8,685,727,418,089,623,000 | TinaJuanFitness.info
Comparing Yoga and Pilates
Yoga and Pilates are the two most popular types of mind-body exercise classes not just in the United States but also here in the Philippines. People are always asking me which of the two they should take. My standard answer is both. Of course, this is easy for me to say because I teach both types of classes and I can conveniently fit both formats into my weekly class schedule. Other people may be not be so fortunate because the classes are offered at different times in their fitness centers or only one type of class is taught there. So here is a comparison between yoga and Pilates to help you decide which is better for you. For people who have little knowledge of either discipline, this will be an introduction of sorts.
Yoga is a five thousand year old philosophy that encompasses an entire lifestyle including ethical and spiritual values, not just exercise. The poses or asanas were originally invented so yoga practitioners could hold their bodies in static positions for long periods while they were meditating.
Pilates exercises were invented by German Joseph Pilates to strengthen his sickly body and later, to rehabilitate injured soldiers during World War I. Pilates introduced the technique to the dance world when he immigrated to the U.S. Pilates originally called his system "Contrology".
Since yoga is a philosophy, there is much more to yoga than just the poses or asanas performed during a class. In this article, I am only comparing the similarities and differences between yoga and Pilates exercise classes.
I also need to point out that there are many variations of yoga (Iyengar versus Ashtanga, for example) and there are different ways you can do Pilates (mat-based versus machine as well as exercises with a mini-ball, rubber band, foam rollers, and etc) so the comparison will be based on the general principles of both formats.
Yoga is considered the "father" of all exercise while chi kung (from which tai chi is derived) is called the "mother". We can definitely call Pilates a child of yoga and chi kung because many of the exercises were obviously borrowed from yoga but have the flowing movement of chi kung.
Mind-body-spirit
Yoga and Pilates are similar in their encouragement of "mindful movement". Unlike, running or walking, where your movement becomes automatic, you have to keep your mind totally focused on what your body is doing when you practice yoga or Pilates.
Joseph Pilates said, "Contrology develops not only the muscles of the body, suppleness of the limbs, and functioning of the vital organs and endocrine glands, it also clarifies the mind and develops the will." Some of his other favorite sayings were "the mind shapes the body" and "where the mind goes, the body will follow".
Meanwhile, B.K.S. Iyengar said, "Asanas have been evolved over the centuries so as to exercise every muscle, nerve and gland in the body. But their real importance lies in the way they train and discipline the mind."
According to Michele Hebert, an international mind-body fitness consultant, most mind-body exercises including yoga and Pilates have three similar characteristics to achieve a healthy balance between mind, body, and spirit. These characteristics are mindfulness, correct physical form, and breathing. Hebert says that the mind stays focused on the correct movement of the body while the breath is considered the "bridge" that links the mind and body. Slow down your breath and you relax; speed it up and you feel energized.
Mara Carrico, author of Yoga Journal's Yoga Basics, gives a simple guideline to remember when doing any type of mind-body exercise: Focus (for the mind), relax (for the body), and breathe (for the spirit). Mind, body, spirit = focus, relax, breathe.
Static versus dynamic
Yoga exercises are static (Ashtanga is an exception), meaning you get into the pose, you hold it for several breath cycles, and then you get out of the pose. Pilates exercises, meanwhile, are constantly moving. You perform five to ten repetitions of an exercise, and then you move on to the next. Not only that, Pilates strives to develop a graceful and fluid rhythm as you perform the repetitions and as you move from one exercise to another. It's no wonder that Pilates became a favorite of dancers like Martha Graham and George Balanchine.
Coordinated breathing
Breathing is a big thing with both yoga and Pilates. Both believe in coordinating the breath with the movement. Pilates has one basic style of breathing, which is called "ribcage breathing" and the purpose is to stabilize and protect your spine while you are in different positions by holding your abdominal muscles tight but still allowing you take deep breaths by expanding the ribcage.
Yoga, meanwhile, has many styles of breathing for many different purposes. There is belly breathing to relax you. There is "ujjayi breathing" where you make a Darth Vader sort of sound at the back of your throat to help keep your focus during the poses. There is the "breath of fire" to energize you. There is alternate nostril breathing to calm you down. And there are still many other more advanced breathing techniques for deeper meditation.
Another difference between the breathing of yoga and Pilates is that in yoga, you use your nose to inhale and exhale while in Pilates, you inhale through the nose and exhale with the mouth. Yogis believe the mouth is only for eating and talking while Pilates uses forced mouth exhalations to reinforce the tightening effect in the abdominal muscles.
Proper spinal alignment
Yoga and Pilates both pay special attention to the proper alignment of the spine when doing the exercises. To stabilize the spine, both disciplines use special techniques, which are very similar but have different names. Basically, you use muscular contraction to hold the pelvis, lower back, or ribcage stabilized so you can safely and effectively move the limbs. In yoga, it is called the system of bandhas or locks. In Pilates, it is called "placements" as in pelvic placement. Proper spinal alignment is vital to protect the spine. These techniques can and should be used not just in yoga and Pilates but also when lifting weights, and doing other forms of athletic exercises.
A celebration of the spine
Good friend and fitness colleague, Lawrence Biscontini, likes to say that yoga and Pilates are a celebration of the spine. Joseph Pilates said that you are only as healthy as your spine. Yoga believes your spine houses energy centers or chakras, which if blocked lead to poor health. Yoga and Pilates will both develop a strong and flexible spine. Well-designed classes have exercises where the spine is taken forward, backwards, sideways, and rotated.
Flexible strength
A common misconception that people have about yoga and Pilates is that they are all about stretching. Perhaps this is because one of the benefits that you get from both formats is improved flexibility. The truth is yoga and Pilates develop what is called "flexible strength" - muscles that are strong enough to lift, stabilize, and move the body through a full range of motion. Joseph Pilates liked to use the image of a cat to describe the lean musculature and ease of movement achieved by his exercises. Yoga will do the same.
Yoga and Pilates use the weight of the body as resistance to challenge the muscles to become stronger. Yoga has more standing exercises that develop leg strength as well as balance. Pilates is mostly done lying on your back, on your stomach, on your side and sitting down. That's why I like to do both forms of exercise to have a good blend of standing and mat exercises.
Yoga also tends to have more exercises that challenge the upper body (chest, upper back, arms) than Pilates does unless you are doing machine-based Pilates, in which case the springs attached to the machines deliver sufficient resistance to strengthen the upper body muscles.
Aerobics
Aerobic or cardiovascular exercise is any exercise that is done continuously for 15 to 60 minutes or more while using the arms and legs in a rhythmic fashion. The goal of aerobic exercise is to increase the amount of blood pumped per beat to improve the efficiency and stamina of the heart, lungs, and blood vessels. Examples are walking, running, swimming, dancing, etc.
Unless you are doing Ashtanga yoga, which moves rapidly from one position to another, yoga and Pilates do not qualify as cardiovascular or aerobic exercise. Thus, if you want a complete exercise program, you have to supplement your yoga and/or Pilates classes with some form of aerobic exercise.
Calories
It's not that easy to calculate how many calories you burn in yoga and Pilates since the intensity of the class depends on the kind of exercises being done and the strength level of the class participants.
In general, a 130-pound person would burn approximately 260 calories an hour for a light to moderate Pilates mat-class and 236 calories for a yoga class. "Intense" Pilates would burn approximately 346 calories while an intense yoga class would burn about 400 calories per hour.
Your weight affects how many calories you burn (the more you weigh, the more calories you burn), so use the following formula to make it more accurate: Divide the number of calories burned by 130 pounds. Multiply the answer by your weight in pounds.
For example, divide 260 calories by 130 pounds. The answer is 2 calories per pound. Multiply that by 110 pounds. The answer is 220 calories.
Weight loss versus inch loss.
All this talk about calories leads to a common question: Can yoga or Pilates help you lose weight? Definitely it can as part of a total program of watching what you eat and doing cardio exercise. For weight loss, you want to burn 1,000 to 2,000 calories a week through exercise. If you are doing no other form of exercise but twice a week of moderate Pilates, burning 520 calories a week would not be enough and you would have to add aerobic exercise or a sport like badminton or tennis. However, if you are doing three Ashtanga classes (an intense form of yoga) a week that are one-and-a-half hours long (the length of most yoga classes), then the caloric burn of 1,800 calories is enough to help you lose weight.
But beyond weight loss, yoga and Pilates have a greater impact on your appearance because of the inches you lose from the firming and toning effect on the muscles. It is not uncommon to drop to a smaller size of clothes but weigh more or less the same.
Flatter abs
No doubt, Pilates has the most number of exercises that focus on the abs, waist, and trunk. Almost every variation you can think of for the abs is offered in Pilates. If abdominal and waist whittling is what you are looking for, Pilates is the ticket for you. This is not to say that yoga will not strengthen your abs and trunk because it will but Pilates just has much more focus on that area.
Mat-based versus machine Pilates
This has nothing to do with comparing yoga with Pilates but I want to add a comparison between mat-based and machine-based Pilates because people also ask about it. If Pilates is the only form of muscle toning that you do, then a combination of both would be ideal because Pilates machines offers more resistance and types of exercise for the arms and legs (especially the upper body) than mat-based classes. Meanwhile, abdominal exercises in mat Pilates are usually harder than machine Pilates because the machine supports the legs during exercises that involve leg raises. By mixing mat and machine Pilates, you get a more total muscle-strengthening program. If you do weights or yoga, mat Pilates will be sufficient and you won't need to add Pilates machine exercises.
The best of both worlds
In my opinion, doing yoga and Pilates combines the best of both worlds. However, if you can only choose one, choose yoga if you are want more flexibility, strength in the upper and lower body, mental concentration, relaxation, and stress release. Choose Pilates if your goal is a more defined mid-section as well as long and lean muscles.
Some centers offer hybrid classes called "Yogalates" or "Yogilates", which combine yoga with Pilates and this is a good option for those who are pressed for time. But I still find that doing separate yoga and Pilates classes allows you to more fully experience and reap the benefits that each form of exercise has to offer.
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-1,058,948,606,755,828,900 | Ethinylestradiol
Applied filters
Safety in Lactation: Combined hormonal contraceptives
27 October 2020Combined hormonal contraceptives (CHC) are a combination of an oestrogen and progestogen administered either orally, transdermally or vaginally (via a vaginal ring). The oestrogen component…
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1 June 2020This updated Medicines Q&A evaluates the available evidence regarding an interaction between St John’s Wort and combined and progestogen only hormonal contraceptives. Summary The interaction…
Reproductive Health Patient Group Direction (PGD) Templates
25 March 2020SPS and the Faculty of Sexual and Reproductive Health (FSRH), with the support of specialist stakeholders working within clinical practice, have produced PGD templates for…
Is there a lactose-free hormone replacement therapy (HRT)?
24 February 2020This Medicines Q&A provides a summary of the currently available HRT preparations that contain lactose and suggests options for lactose-free alternatives.
What is a suitable combined oral contraceptive pill in a patient who is taking hepatic enzyme-inducing drugs, such as carbamazepine, phenytoin, rifampicin or rifabutin?
16 May 2019This updated Medicines Q&A provides advice on a suitable oral contraceptive that can be used in a woman using an enzyme-inducing anti-epileptic or anti-tubercle drug.… | {
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ultimate-esports.com
Information Archive
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naturopathy
If you are searching for an alternate to standard medicine, naturopathy may perhaps be the suitable alternative for you. For people who have not listened to of naturopathy or acquired naturopathy remedy before, here’s a complete guidebook to cover what it is, what its benefits are, and other valuable details.
What is naturopathy and what are its important ideas?
Naturopathy is a variety of choice drugs that focuses on the body’s means to mend itself. Naturopaths use a wide variety of normal modalities, which includes diet, acupuncture, and herbal drugs, to take care of their clients. The intention of naturopathic therapy is to market all round health and properly-being, fairly than simply treating ailment indicators.
How does naturopathy differ from standard medication?
The main variation amongst naturopathy and traditional medication is the tactic to cure. Naturopathic medical practitioners just take a holistic tactic to health, contemplating all elements of a person’s life when earning remedy suggestions. They also focus on avoidance and endorse healthy lifestyle choices as a way to reduce condition. Conventional medicine, on the other hand, tends to aim on managing diseases once they’ve presently formulated.
What are some of the most widespread treatment options utilised in naturopathy?
There are a lot of distinct types of naturopathic solutions, but some of the most popular consist of acupuncture, diet counselling, and organic drugs. Naturopathic medical doctors could also recommend way of life variations, such as strain reduction methods or training applications.
What are the rewards of naturopathic cure?
Naturopathic cure can give several benefits, such as enhanced over-all wellbeing, increased energy stages, and decreased stress. Naturopathic therapies are also generally much less invasive and have fewer side effects than conventional health care treatments.
Are there any risks related with naturopathic remedy?
The pitfalls involved with naturopathic procedure are generally minimal. On the other hand, as with any sort of health-related remedy, there is always a possibility of adverse response to specified therapies or medicines. It is crucial to discuss any opportunity challenges with your naturopathic physician before commencing procedure.
Discovering a capable naturopath in your spot
There are lots of expert naturopaths in Melbourne to select from, and you can verify a practitioner’s credentials in the Australian Register of Naturopaths & Herbalists. It’s significant to pick out a naturopath who is fully qualified, insured and experienced in providing naturopathy treatment options that are tailored to the client’s specific demands and specific conditions.
See also What Are Scleral Lenses For Keratoconus? | {
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-7,392,725,874,414,180,000 | Back pain: here’s how to maintain a healthy back for a happy life
Get moving! Exercise is the best therapy and prevention for back pain
Anatomically, we are not all that different from our ancestor Homo erectus, the first to walk upright and the perfect endurance runner, but back pain is much more common in our modern, sedentary society. The human body, from skeleton to muscles, is designed to move when upright. But instead, we sit still. It’s not physically strenuous, so why do we still feel the strain?
Back pain: here’s how to maintain a healthy back for a happy life
Back pain: a modern affliction
‘All too often, we carry heavy physical and mental loads that put pressure on the spine, intervertebral discs, cartilage and joints,’ says Dr Peter Gartner, medical director at the Park Igls Mayr clinic in Tyrol. This can have numerous, painful consequences. Park Igls physiotherapists Lisa French and Mina Siehs advise: ‘Sitting for long periods of time is not recommended. Remember to change your sitting position often. The spine needs constant movement – strain and relief – to stay healthy.’ The importance of movement is becoming increasingly clear in both therapeutic intervention and prevention of back pain. ‘Too little physical activity can significantly affect muscle tension imbalances and therefore cause pain,’ Lisa French explains.
Back pain: here’s how to maintain a healthy back for a happy life
Causes of and treatment of slipped discs
Back pain is now society’s number one common ailment, and, in fact, MRI scans have already detected slipped discs in a third of young Austrian adults. ‘The intervertebral discs need continuous strain and release to ensure long-term functionality. Uneven strain over long periods can affect disc structure, making them more prone to injury. It is important to regularly activate the girdle of muscles that supports our spine, allowing pressure to be evenly distributed and giving all tissue a healthy share of the strain. Uneven strain and lack of muscle movement can overload the discs in the long run. And when we’re in pain, we respond by adopting an unhelpful protective posture… it’s a vicious circle!’ Mina Siehs highlights.
Holistic diagnosis with a psycho-social dimension
Holistic diagnosis with a psycho-social dimension
‘Broadly speaking, we differentiate between two types of back pain in diagnosis: specific and non-specific,’ Dr Gartner explains. ‘The first has a specific anatomic, traumatic or pathological cause like an abnormality, accident or inflammatory disease, for example a kidney inflammation or ankylosing spondylitis, while non-specific back pain cannot be ascribed to a concrete cause. So each patient and their particular situation must be examined as a whole,’ he stresses. Every chronic pain diagnosis, therapy and prevention plan should therefore incorporate a psycho-social approach.
Individual, holistic treatment at Park Igls
Individual, holistic treatment at Park Igls
Treating back trouble with sprays and infusion therapy isn’t necessarily the answer. ‘Infusion therapy and sprays can and do provide relief, but they cannot treat the causes,’ Dr Gartner warns. ‘In most cases, non-specific pain returns.’ The winning combination is pain therapy with physiotherapy, psychotherapy and lifestyle changes. Exercise therapy is also effective, and, according to physiotherapist Mina Siehs: ‘the type of exercise is best decided between doctor and patient on a case-by-case basis.’ There are lots of great options.
Fascia training, movement training and strength training
Fascia training is becoming more and more popular. ‘Fascia therapies like massage, rollers or stretches have an immediate effect on the nervous system which causes the tissues to relax. However, the effect doesn’t usually last long.’ Other active strategies include movement training and strength training which increase resilience (due to physiological changes in the tissue) and encourage the patient to carry on independently. This can also alleviate symptoms in the long term. Spiraldynamik® is a therapeutic approach based on movements that stabilise the back and the entire locomotor system, whereas the Feldenkrais® Method helps patients relearn patterns of movement. Yoga exercises increase the range of motion, while the revolutionary kybun® training stabilises the core and back muscles – and it’s gentle on joints. Finally, running and walking – virtually the most natural forms of movement – are also effective. The most important thing is for exercise to be fun, otherwise we’re unlikely to keep going at it. And the back pain will never go away. | {
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-6,884,872,254,420,284,000 | Fachbegriffe der Medizin - Medizinische Fachbegriffe
Haut- und Gewebebank
Hautarzt
Hautausschiag
Hautausschlag
Hauteffloreszenzen
Hautentz?ndung
Hautgrie?
Hautinzision
Hautkarzinom
Hautpilzerkrankung
Hautplastiken
Hautrotz
Hauttransplantation
Hauttuberkulose
Hautweichteildefekt
Hautweichteillappen
Hautwolf
Headsche Zonen
Hebephrenie
Heberdenscher Knoten
Heilung
Heimlich-Handgriff
Helicobacter pylori
Heliotherapie
Helminthes
Haut- und Gewebebank
Einrichtung, in der Haut und Gewebe von Spendern bis zur Transplantation versorgt und gelagert wird.
zurück zum Index
vorheriger Eintrag: Haut Cutis
nächster Eintrag: Hautarzt
Weiter Einträge bei uns:
Klavikulafraktur
Knochenbruch des Schlüsselbeins
Follikelpersistenz
Erhaltenbleiben des Eifollikels über den Termin des Eisprungs, des Ovulationstermins, hinaus. Dadurch wirken die Follikelhormone weiter. Die Folge können krankhafte Wucherungen der Gebärmutterschleimhaut , glandulär zystische Hyperplasie mit abnormen Blutungen, sein.
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399,481,698,065,472,960 | Cod Liver Oil Controversies
Not all cod liver oil is made from cod livers…
Some “Cod Liver Oil” products have been made from fish such as pollock and haddock (sourced from Alaska and/or Russia) or other fish species, both wild-caught and farmed, as a less expensive source of oil. The oil, regardless of the country of origin, can then be bottled and sold as “true Norwegian” or “Arctic cod liver oil”.
This is allowed because the international production of cod liver oil is regulated by only one rule—the final product must match the specific EPA ratio (EPA to DHA) found in cod liver oil.
Further, the fish body and flesh has been used – rather than the liver oil. It is the liver that contains the naturally occurring vitamins A and D, which is not found in the flesh of the fish. The oil is then supplemented with synthetic or natural vitamin A, which is why some cod liver oil products have high levels of vitamin A. Vitamin A toxicity is greatly misunderstood. While some forms of synthetic vitamin A may be toxic at moderate doses, natural, fat-soluble vitamin A, found in foods like cod liver oil, is safe at much higher amounts. It is recommended to take omega-3, vitamin A, and vitamin D together and in the correct ratios – Cod Liver Oil naturally provides the ideal composition for this – which is why high quality CLO is sometimes referred to as ‘functional food’.
Nordic Naturals Arctic Cod Liver Oil is derived entirely from 100% sustainably caught Wild Arctic Cod which are then processed using oxygen-free technologies. They are a vertically integrated company who looks after the whole production process from boat to bottle; this ensures exceptional quality and safety of their products.
It is for the above reasons that True Medicine only stocks and recommends Nordic Naturals fish oils. Quality should always be a priority when it comes to your body. Just another reason to always seek the advice of a qualified Naturopath before taking any supplements.
Sorry, comments are closed for this post. | {
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7,100,257,801,627,153,000 | Binge Eating Disorder (BED): Causes, Symptoms and Treatment
0
1057
binge eating disorder
binge eating disorder
To simply put, a Binge eating disorder occurs when you eat too much even when you are full. Basically, when you start eating something, then you are more likely to eat too much that causes a binge eating disorder. Let’s discuss what exactly binge eating disorder is in detail:
General Description of Binge Eating Disorder
Most often, when you suffer from a binge eating disorder, you stop listening to your body and start eating too much. Although, BED can be seen in men and women with normal weight, and BED leads to weight gain. BED leads to excessive overeating and most often happens regularly.
People who struggle with binge eating start feeling guilty and often have depression or anxiety. But, you must know every problem contains a solution. Similarly, binge eating disorder can be cured, and hypnosis treatment is one of them.
What Causes Binge Eating Disorder?
binge eating disorder causes
Before you throw yourself to know the treatment to cope with binge eating, you must know the causes. The first thing, identify what triggers overeating and develop a binge eating disorder. The following are some reasons behind your overeating habit:
• Biological
Genetic abnormalities, including genetic mutation or hormonal irregularities, can be associated with BED.
• Emotional & Psychological
Low self-confidence, anxiety, depression, and emotional trauma can lead to binge eating or compulsive overeating.
• Anxiety & Stress
Most often, when people coping with anxiety and stress, they are more likely to overeat. But emotional eating is temporary, so here binge eating can be resolved.
• Social Risk Factors
It can be seen in adults, when someone comments on their body shape if they are skinny or too thin, then they start overeating. Social risk factors can be the reason for binge eating.
Symptoms for Binge Eating Disorder
binge-eating-symptoms
Once you know the causes of binge eating, now it’s time to know what the symptoms of binge eating disorder are:
• Non-stop eating even after finishing your meal
• Unable to stop eating
• Eating food continually without feeling hungry
• Feeling guilty after overeating
• Eating alone when you feel anxiety or stress
• Hiding food to eat later
• Eating without any eating plan or during no mealtime
• Feeling unsatisfied even after eating a full plate of food
If all of the above symptoms you carry, then you are struggling with a binge eating disorder. For this, you can opt for numerous treatment options.
You may also interested in “Food Aversion: Why You Start Refusing Certain Food?
Treatment Options to Combat Binge Eating Disorder
Get to know about the primary treatment options that you can apply with ease to manage binge eating:
• Don’t Skip Your Meal
Most often, people avoid food to get their bodies in shape, but when they fail to achieve their target, they start overeating. So, for this reason, it is recommended to eat well and don’t skip your meal. When you skip your meal, most probably, you eat too much when you crave food. Try to stick to your diet and eating schedule because this is the simplest method to stop binge eating.
• Be Mindful While Eating
Mindfulness helps people to focus on their food instead of other things. This is because when you watch TV while eating something, then there are some chances that you’ll overeat. So, try to pay attention to your body and food and identify when you get full. Listen to your body, and when you succeed, then you can control your binge eating disorder.
• Hydrate Your Body
One of the effective ways to stop binge eating is to drink plenty of water throughout the day. It is also recommended to drink one glass of water 30 minutes before you eat to stop overeating. Everyone knows the benefits of water as it can boost metabolism and reduce weight.
• Eat Fiber-Rich Food
Fiber helps to keep you full, and you’ll less likely to overeat. Try to add fiber-rich food to your diet. Intake of fiber can cut-off appetite and reduce food intake.
• Add The Right Food to Your Breakfast
Right food means food that contains low calories and nutrient-dense food. When you fill your plate with the right food, then it can keep you full and reduce hunger.
Additional Treatment Options for Binge Eating
• Cognitive Behavioral Therapy (CBT)
Basically, CBT analyzes the relationship between emotions, negative thoughts, and behavior for eating food. After analyzing the negative thoughts, then strategies can be implemented to help people. CBT includes goal setting, achieving a daily meal schedule, and changing negative thoughts.
• Interpersonal Psychotherapy (IPT)
IPT is based on the idea that binge eating is a method to cope with personal problems. Personal problems involve relationship problems, grief, stress, depression, or other social problems. This therapy can be in the form of a group session or a one-to-one basis.
• Medications
Numerous medications help to avoid binge eating and are proven to be cheaper than traditional therapy. They help to reduce hunger, compulsion, and depression as well.
How Does Hypnosis for Binge Eating Work?
According to psychologists, Hypnosis for Binge Eating can help you to stop binge eating. With the help of Hypnosis for Binge Eating, you can engage with your unconscious and make a new alliance to change your lifestyle. When you dedicate yourself to hypnosis session to overcome overeating disorder, then you may notice:
• You start recognizing the compulsive overeating pattern
• You take a step ahead for a practical approach to overcoming overeating
• You start feeling some changes in your life
• You start feeling better about yourself
Hold Yourself Back from Binge Eating Disorder
Before opting for medical treatment for binge eating, first, you must try all of the above tips to manage to overeat. Make sure to identify symptoms and then get to know about causes that trigger binge eating. Once you know the causes, only then it will be beneficial to use the above methods to combat overeating.
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Article
Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective
1
Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
2
Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, 34537 Bad Wildungen, Germany
3
Department for Neurology and Child and Adolescent Psychiatry, 9020 Klagenfurt am Wörthersee, Austria
4
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2021; https://doi.org/10.3390/jcm9072021
Submission received: 28 May 2020 / Revised: 18 June 2020 / Accepted: 22 June 2020 / Published: 27 June 2020
(This article belongs to the Special Issue Advances in Eating Disorders)
Abstract
:
High expressed emotion (EE) is common in caregivers of patients with anorexia nervosa (AN) and associated with poorer outcome for patients. In this study, we examined the prevalence of high EE in caregivers of adolescents with AN and analyzed predictors for EE using multivariate linear regression models. We further analyzed whether EE is reduced by the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) intervention using general linear mixed models and whether a reduction of EE predicts patients’ outcomes. Caregivers were randomly allocated to the SUCCEAT workshop (N = 50) or online intervention (N = 50) and compared to a comparison group (N = 49). EE and patients’ outcomes were assessed at the baseline, post-intervention, and at the 12-month follow-up. Up to 47% of caregivers showed high EE. Lower caregiver skills, higher AN symptom impact, higher levels of depression and motivation to change in caregivers were significant predictors for high EE. EE significantly decreased in the SUCCEAT groups and the comparison group according to the caregivers’, but not the patients’ perspective. The level of reduction could partially predict subjective improvement and improvement in clinically assessed AN symptoms and body mass index of patients. Implementing interventions for caregivers addressing EE in the treatment of adolescents with AN is strongly recommended.
1. Introduction
Expressed emotion (EE) is a concept that describes a set of attitudes and behaviors (e.g., criticism, hostility, warmth, emotional involvement) of relatives towards an ill person. Specifically, the components of EE that have been mainly investigated so far are critical comments/criticism (CC) and emotional overinvolvement (EOI) [1,2]. High EE may represent a maladaptive response to an illness and may contribute to an exacerbation of psychiatric symptoms [2]. EE has been extensively studied in schizophrenia and has been confirmed to be a robust and significant predictor of relapse [3]. High levels of EE have further consistently been associated with treatment outcome, relapse, and treatment dropout in several other psychiatric disorders, including depression, bipolar disorder, anxiety disorders, and also eating disorders (EDs) [1,2,3].
In the field of EDs, caring for someone with an ED is known to be associated with high EE [1,4,5]. Caregivers often show extreme patterns of emotional reactions [6]. They might respond too intensely and too emotional, be too directive, negative and hostile, and blame the patient (CC), or they can be overprotective, overinvolved, and take over control (EOI). In a systematic review, up to 73.2% of caregivers showed high levels of CC and 89.3% showed high levels of EOI [5]. High EE has been found to be associated with caring for older patients and longer illness duration [4], higher anxiety and depression in caregivers [7], more contact time with the patient [8], higher caregivers’ distress [8,9], and less caregiver skills [9]. Other studies revealed no clear association of high EE with the patients’ weight or ED psychopathology [1,10], time spent caregiving, and ED severity [9]. Only few studies investigated the ED patients’ point of view of EE within the family. Perceived EE in the family assessed by ED patients was reported to be higher than in healthy controls [11]. Patients reported higher EOI for their mothers, but no difference between mothers and fathers for CC [9]. The level of perceived EE from the patients’ point of view was independent from age, contact time, and duration of treatment [11]. However, it has consistently been shown that high levels of EE in caregivers, especially in mothers, seem to negatively affect engagement, outcome, and effectiveness of ED treatment [1,2,3,10,12,13]. Thus, considering EE of caregivers in the patients’ treatment seems to be highly relevant.
The key role of interpersonal relationships, particularly, communication and high EE within the family has also been highlighted in the interpersonal maintenance model of anorexia nervosa (AN) [14,15,16]. EE was related to caregivers’ distress. Caregivers’ distress was related to patients’ distress, which predicted eating disorder symptoms [8]. Interventions based on this model were developed to reduce high EE [17] in order to improve the psychological wellbeing in caregivers and support recovery from the ED in patients [4]. These interventions address misperceptions of EDs and unhelpful reactions to the illness [18] and aim to improve communication skills, reduce negative emotion and build a warm and compassionate family atmosphere [19]. Caregivers learn to use reflective listening and motivational interviewing techniques, reduce confrontation, and be warm, calm, and compassionate.
A meta-analysis showed a moderate-sized reduction of EE in caregivers after participating in such interventions, including workshop-based, online, and self-help interventions [18]. Other recent studies also reported a reduction of high EE following interventions for caregivers [20,21,22]. However, having investigated the effects of such interventions, the previous literature almost exclusively focused on the parents’ perception, while not considering the perception of the patients, although including the patients’ perception is recommended and valued to gain additional insight in the family climate of ED patients [1]. One study that included the patients’ perspective found that patients did not perceive a change in their caregivers’ level of EE after caregivers participated in a specialized intervention [23], while in another study, qualitative improvement in caregivers’ EE was mentioned by patients [24].
So far, only few studies have investigated whether a reduction in EE can also improve the patients’ treatment outcomes. Two studies reported that an improvement of maternal EE was associated with better ED symptoms at the end of the treatment [10,25]. However, whether the level of reduction in parental EE is associated with the level of reduction in ED symptoms has not been investigated up to now.
SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders in Austria) is an intervention for caregivers of adolescents with AN based on the interpersonal maintenance model [14,15,16] that has already been shown to effectively reduce caregiving burden and increase caregiver skills [26]. This paper presents secondary analyses of the SUCCEAT study, focusing on various aspects of high EE. Firstly, we aimed to examine the prevalence of high EE in a sample of caregivers and whether the level of EE assessed in parents is associated with the level of EE assessed in patients. Secondly, we explored whether different characteristics of caregivers and patients can predict the level of EE. Thirdly, this study aims to investigate whether EE can be reduced by participating in the SUCCEAT intervention and whether a change in assessed parental EE is also perceived by patients. Finally, we aimed to investigate whether a reduction in high EE is associated with patients’ outcomes (AN symptoms, body mass index (BMI)).
2. Methods
2.1. Study Design
The SUCCEAT study is a two-arm parallel-group quasi-randomized controlled efficacy trial comparing two types of the SUCCEAT intervention (workshop and online) to a non-randomized control group. This study was conducted between 2014 and 2019. Caregivers of children and adolescents (10–19 years) with typical or atypical AN who received regular inpatient or outpatient treatment according to the National Institute for Health and Care Excellence (NICE) guidelines [27] were included. Caregivers and patients who were not fluent in German or suffered from severe comorbidities (e.g., psychosis) were excluded. For detailed information on the study protocol, see Franta et al. [28]. Written informed consent was obtained from all the participants prior to data collection. The SUCCEAT study protocol and all the informed consent forms were approved by the Ethics Committee of the Medical University of Vienna (#1840/2013). The SUCCEAT study was registered at ClinicalTrials.gov (Identifier: NCT02480907).
2.2. Recruitment and Randomisation
Caregivers of the SUCCEAT intervention group were recruited at the Eating Disorder Unit of the Department of Child and Adolescent Psychiatry at the Medical University of Vienna. If willing to participate, caregivers completed the baseline assessment and were allocated to one of the two intervention arms: workshop (SUCCEAT–WS) or online (SUCCEAT–ONL). The start dates of the groups had been previously fixed. The first block of participants was allocated to the SUCCEAT–WS group, the following block—to the SUCCEAT–ONL group, and so forth. Block sizes of eight participants were planned, however, sizes actually varied due to varying numbers of incoming participants prior to the upcoming group (median group size = 7). Caregivers were informed about the group allocation after they had completed the baseline assessments. Those who declined to participate in the allocated intervention arm were excluded from the study. The procedure slightly differed from the originally planned randomization [28] due to practical reasons, now corresponding to the definition of quasi-randomization [29]. However, there were no systematic differences between the WS and ONL groups at the baseline. Details on the randomization procedure are reported elsewhere [26].
2.3. Interventions
SUCCEAT is an intervention for caregivers of children and adolescents with AN based on the cognitive interpersonal model of maintaining factors for EDs [14,15,16] with the aim to reduce EE and burden in caregivers and improve caregiver skills. Dysfunctional communication, unhelpful reactions and emotions were addressed to increase communication skills, skills to handle difficult behavior, and strategies to encourage autonomy in patients in order to reduce EE. Additionally, caregivers’ burden, wellbeing, and self-care were addressed as burden and psychopathology had been highly correlated with EE. The program was delivered in eight weekly modules as a WS or ONL, designed with the same content and structure and guided by two professional clinicians. Caregivers received weekly handouts, a manual to read more about the topics addressed [30], and a DVD [31] with case examples of unhelpful and helpful communication. A detailed description of the interventions is provided by Franta et al. [28] and Truttmann, Philipp et al. [26].
2.4. Comparison Group
The SUCCEAT groups were compared to a non-randomized comparison group (COMP) of caregivers who received other forms of family treatment within the same time frame at two other facilities: the Department for Neurology and Child and Adolescent Psychiatry, Klagenfurt, Austria (four double sessions of systemic family therapy [32]), and the Parkland Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen, Germany (two-day workshop on multi-family therapy based on the Maudsley model of multi-family therapy for AN [33]). Several other inpatient and outpatient units that offer treatment as usual with and without any specialized intervention for caregivers were invited to participate as the control group declined the offer. Therefore, only the two named facilities that already implemented well-established family treatment agreed to participate and served as the COMP group.
2.5. Assessment Measures
Caregivers and patients completed self-report questionnaires at baseline (T0), at post-intervention (T1, approximately 3 months after T0), and at 12-month follow-up (FU) (T2), including the assessment of EE described below.
The Family Questionnaire (FQ [34]) is a self-report questionnaire for caregivers to detect the emotional climate and EE within the family. The 20 questions were answered using a four-point Likert scale providing two subscales of EE in caregivers: “Emotional overinvolvement” (EOI) and “Criticism” (CC). We used the established cut-off values (CC score ≥ 23, EOI score ≥ 27) to define high EE.
The Family Emotional Involvement and Criticism Scale (FEICS [35]) is a self-report questionnaire for children and adolescents to assess perceived EE within the family. Two subscales were calculated (“Emotional Involvement” and “Criticism”) using 14 questions that were answered using a four-point Likert scale. For the FEICS scores, no established cut-off values are available.
In addition, self-assessments for caregivers were used to explore predictors of high EE and associations with perceived changes as described below (for details, see Franta et al. [28]).
The General Health Questionnaire (GHQ [36]) was fulfilled by caregivers and used to assess the level of psychological morbidity and distress in caregivers; a higher score indicates higher psychological distress.
The Eating Disorder Symptom Impact Scale (EDSIS [37]) assessed specific caregiving difficulties in caregivers associated with the ED of a child, such as difficulties related to “nutrition”, “dysregulated behavior”, “guilt”, and “social isolation.” A higher global score represents higher AN symptom impact in the family reported by caregivers.
The Beck Depression Inventory (BDI-II [38]) measured depression in caregivers; higher scores indicate higher levels of depression.
The State and Trait Anxiety Inventory (STAI [39]) assessed anxiety in caregivers; higher scores indicate higher levels of anxiety.
The Caregiver Skills (CASK) Scale [17] was used to measure self-assessed skills in caregivers (e.g., “insight and acceptance”, “emotional intelligence”, “frustration tolerance”). A higher total score means more caregiver skills.
The University of Rhode Island Change Assessment Scale (URICA [40]) was used to measure motivation to change in caregivers regarding their own behavior, revealing three scales: “precontemplation”, “contemplation”, and “action.” A lower score on the precontemplation scale and higher scores on the contemplation and action scales represent higher motivation to change in caregivers.
Finally, two more assessments for patients were used as described below.
The Eating Disorder Examination (EDE [41]) is a semi-structured interview with patients reflecting the clinical assessment of ED psychopathology (“restraint”, “eating concerns”, “weight concerns”, “shape concerns”). A higher global score indicates higher ED psychopathology.
The Eating Disorder Inventory-2 (EDI-2 [42]) was completed by the patients and assessed subjective ED symptoms from the patients’ perspective (e.g., “drive for thinness”, “perfection”, “dissatisfaction with the body”, etc.). A higher total score indicates more subjective ED symptoms.
Sociodemographic and clinical characteristics of caregivers (sex, age, marital status, highest educational degree, time spent caregiving) and patients (sex, age, AN subtype, BMI percentile, illness duration, type of current treatment) were obtained.
2.6. Statistical Analysis
The statistical analyses were performed using IBM SPSS Statistics 25.0 and R. We first calculated descriptive statistics and compared key sociodemographic and clinical characteristics between caregivers and patients of the SUCCEAT–WS, SUCCEAT–ONL, and the COMP group. We used Chi² tests for categorical and ANOVA tests for continuous variables, respectively, and Kruskal–Wallis tests for variables with skewed distribution. We calculated t-tests to analyze differences in CC and EOI scores between a mother and a father and Pearson correlation coefficients to explore associations between CC and EOI obtained from the parents and patients. To analyze predictors for assessed parental and patients’ CC and EOI scores at the baseline, we first carried out a series of univariate linear regressions. The following predictors were considered: sex and age of the parent, parental psychological distress and psychopathology (including the GHQ, BDI, and STAI scores), AN symptom impact on the family (EDSIS score), self-reported caregiver skills (CASK score), parental motivation to change (URICA scores), the average time spent caregiving per day (<3 h vs. ≥3 h), the patient’s age, treatment type (inpatient vs. outpatient), ED duration in months, BMI percentile (≤1st percentile vs. >1st percentile) and ED symptomatology (EDE and EDI-2 total scores). Variables reaching significance in univariate regressions (p < 0.05) were then considered for multivariate regression models using the forward selection method where variables were added to the model of ascending p-values.
In order to analyze the efficacy of the SUCCEAT intervention on EE, we calculated general linear mixed models using the FQ/FEICS scores (CC and EOI) obtained at the baseline, post-intervention, and at 12-month FU as the within factor and the group as the between factor. Firstly, we contrasted the SUCCEAT–WS group to the SUCCEAT–ONL intervention group. Secondly, we tested whether the SUCCEAT intervention (including all WS and ONL participants) differ from participants of the COMP group. Additionally, we performed sensitivity analyses by calculating paired sample t-tests for each group to explore the baseline-to-post-intervention and the baseline-to-12-month FU effect sizes (Cohen’s dz). Furthermore, we explored the moderating effect of the patient’s treatment type (inpatient vs. outpatient) on the EE outcome by adding a time x treatment type interaction term to the mixed design model.
Further, we explored whether a pre–post change in assessed parental CC and EOI scores corresponds to a change in CC and EOI assessed in the patients by calculating Pearson correlation coefficients.
Finally, we used linear regression analyses to analyze whether the degree of reduction in CC and EOI can predict improvements in ED symptomatology of the patients by using the EDE and EDI-2 change scores as well as the change in the BMI percentile as outcome variables and CC/EOI change scores as predictor variables.
3. Results
3.1. Sample
In total, 149 caregivers (83% mothers, 17% fathers; mean age (SD): 47.2 (4.74) years) provided informed consent and were included in the study. Forty-five percent had a university degree and 77% were married or lived in a partnership. According to their self-reports, the average amount of time spent with their child diagnosed with AN during weekdays was distributed as follows: 0–1 h (10%), 1–3 h (19%), 3–4 h (35%), > 4 h (35%). A total of 50 caregivers were allocated to the SUCCEAT–WS intervention, another 50 caregivers—to the SUCCEAT–ONL intervention, and 49 caregivers were included in the COMP group.
Of the 149 caregivers participating, we obtained data from 144 related patients with AN. The patients were predominantly female (83%) with a mean age of 15.1 years (SD: 1.7). According to ICD-10, most patients were diagnosed with AN restrictive subtype (89%), followed by AN binge/purging subtype (9%) and atypical AN (2%). At the baseline, the median sex-and age-specific BMI percentile was 1%, the average ED duration was 16.6 months (SD: 13.8), 59% received inpatient treatment, and 41% received outpatient treatment of their ED.
Baseline sample characteristics by intervention arm are shown in Table 1. There was a significantly lower proportion of caregivers with university degree in the COMP and patients of caregivers in the COMP had a significantly longer ED duration and higher subjective ED symptomatology scores as measured with EDI-2 and received inpatient treatment more often compared to SUCCEAT groups.
Dropout of caregivers in terms of non-completion at one of the FU assessments was 14.8% at the post-intervention assessment (SUCCEAT–WS: 4.0%, SUCCEAT–ONL: 6.0%, COMP: 34.7%) and 29.6% at the 12-month FU assessment (SUCCEAT–WS: 14.0%, SUCCEAT–ONL: 28.0%, COMP: 46.9%). Dropout of patients was 13.9% at the post-intervention assessment (SUCCEAT–WS: 8.3%, SUCCEAT–ONL: 6.1%, COMP: 27.7%) and 35.4% at the 12-month FU assessment (SUCCEAT–WS: 31.2%, SUCCEAT–ONL: 32.7%, COMP: 42.6%). Caregivers and patients who dropped out did not significantly differ from those who completed the study regarding the baseline EE scores (all p-values > 0.200).
3.2. Baseline EE Characteristics
Among the total sample, high CC defined as scores above the pre-defined cut-off in the FQ were observed in 39.2% (95% CI: 31.3; 47.1) and high EOI—in 46.6% (95% CI: 38.5; 54.7) of caregivers. Mean baseline CC and EOI scores obtained from the parents and patients are shown in Table 1. Mothers had slightly higher CC (mean: 21.79, SD: 5.52) and EOI scores (mean: 26.56, SD: 5.18) compared to fathers (CC: mean: 18.87, SD: 5.48; EOI: mean: 24.74, SD: 4.43); however, these differences did not reach statistical significance (CC: t = 1.613, p = 0.109; EOI: t = 1.672, p = 0.097).
3.3. Bivariate Correlations between Parents’ and Patients’ EE Scores
At the baseline, the parental EE scores were not significantly associated with the EE scores obtained from the patients’ perspective neither for CC (r = 0.078, p = 0.356) nor for EOI (r = 0.115, p = 0.171). This correlation slightly increased at post-intervention (CC: r = 0.142, p = 0.126; EOI: r = 0.117, p = 0.206) and 12-month FU (CC: r = 0.216, p = 0.042; EOI: r = 0.269, p = 0.011). Considering mothers and fathers separately, we found a strong association between CC scores of fathers and patients at the baseline (r = 0.509, p = 0.009), while there was no association between CC scores of mothers and patients (r = 0.006, p = 0.946). No difference between mothers and fathers were found for EOI scores.
3.4. Predictors for EE Scores at the Baseline
Firstly, we explored whether different characteristics of parents and patients are predictive of the EE scores obtained from the parents. In the univariate regression analyses (Table S1 in the electronic Supplementary Materials), we found that the level of parental psychological distress, AN symptom impact, depression, anxiety, caregiver skills, parental motivation to change, and the current treatment setting (inpatient vs. outpatient) of the child were significantly associated with either the CC or EOI score or both. In the multivariate regression model (Table 2), lower caregiver skills, higher level of AN symptom impact, and an outpatient treatment setting were significant predictors for CC with the final model explaining 46.2% of the variance. The parental EOI score was significantly predicted by higher levels of AN symptom impact, higher distress, depression, as well as higher motivation to change and lower caregiving skills with the final model explaining 63.5% of the variance.
We repeated this analysis using the EE scores obtained from the patients’ perspective as the outcome variable. In the univariate regression analyses (Table S2 in the electronic Supplementary Materials), ED duration and ED symptomatology as measured with EDE and EDI-2 were significantly associated with CC and parental motivation to change and BMI were significantly associated with EOI. In the multivariate regression model (Table 3), only higher ED symptomatology (EDI-2 score) significantly predicted CC explaining 14.2% of the variance. The EOI score was significantly predicted by lower BMI (<1st BMI percentile) and lower parental motivation to change. However, the final model only explained 8.1% of the variance.
3.5. Intervention Outcomes on EE
The change in EE scores by group from the baseline to the post-intervention and the 12-month FU assessment is shown in Figure 1. We first tested whether the SUCCEAT–WS group differs from SUCCEAT–ONL group. We found that the assessed parental CC (F = 7.391, p = 0.001) and EOI scores (F = 45.704, p < 0.001) significantly decreased over time across both groups, but there was no significant time × group interaction effect (CC: F = 0.437, p = 0.782; EOI: F = 0.953, p = 0.435). Considering the patients’ perspective, there was no significant main effect of time and group difference neither for CC nor for EOI.
When contrasting the SUCCEAT groups to the COMP group, we found the same pattern of results. The assessed parental CC (F = 5.400, p = 0.005) and EOI scores (F = 36.112, p < 0.001) significantly decreased over time across the groups, but this change was the same for the SUCCEAT and COMP groups (CC: F = 0.089, p = 0.914; EOI: F = 1.612, p = 0.202). Again, no significant effects of time and time x group interaction effects were observed when considering the patients’ perspective.
Sensitivity analyses using t-tests revealed that for the assessed parental CC, baseline-to-post-intervention reductions were highest for the SUCCEAT–ONL group (dz = 0.44, t = 3.788, p < 0.001) compared to the SUCCEAT–WS (dz = 0.20, t = 1.806, p = 0.077) and COMP groups (dz = 0.32, t = 2.172, p = 0.038). These effects remained stable to the 12-month FU for the SUCCEAT groups (WS: dz = 0.24; ONL: dz = 0.54) and slightly decreased in the COMP group (dz = 0.20). For the assessed parental EOI, baseline-to-post reductions were slightly higher for the SUCCEAT groups (WS: dz = 0.68, t = 5.739, p < 0.001; ONL: dz: 0.76, t = 5.927, p < 0.001) compared to the COMP group (dz = 0.36; t = 2.061, p = 0.048). The effect sizes further increased at the 12-month FU in all the groups (WS: dz = 0.76, ONL: dz = 1.11, COMP: dz = 0.89). Considering the patients’ perspective, all effect sizes were close to zero in all the groups.
Further analyses revealed that the type of patients’ treatment (inpatient vs. outpatient) was a significant moderator of the intervention outcome. Caregivers of outpatients reported a significantly higher reduction in CC scores than caregivers of inpatients (time x treatment type interaction: F = 4.076, p = 0.018). Regarding EOI, reductions of EOI scores were reported to be faster (from the baseline to post-intervention) in caregivers of outpatients, whereas the reduction was delayed (post-intervention to the 12-month FU) in caregivers of inpatients (time x treatment type interaction: F = 5.011, p = 0.008). This moderator effect was independent of the group.
Figure 2 presents the bivariate correlations between the baseline-to-post-intervention change of parental and patients’ CC and EOI scores. In the SUCCEAT group, parental change of CC was moderately associated with the change of CC in patients (r = 0.230, p = 0.031). In the COMP group, this association was not significant (r = 0.209, p = 0.285). For EOI, no significant associations in the change scores were observed (SUCCEAT: r = 0.160, p = 0.137; COMP: r = −0.088, p = 0.655).
3.6. Impact of EE Change on the Patient’s ED Symptomatology
Table 4 shows whether a reduction in parental or patients’ EE scores significantly predicted improvements in ED symptoms (EDE and EDI-2 scores, BMI percentile) for the total sample and separately for inpatients and outpatients. We found that for the total sample, improvements in CC were significantly associated with improvements in ED symptomatology and BMI. On the contrary, reductions in EOI did not significantly predict improvements in ED symptoms.
4. Discussion
This study explored EE in caregivers and adolescents with AN at the baseline and following a skills training for caregivers, including a long-term FU. In addition, we aimed to investigate whether changes in EE affect patients’ outcomes.
Firstly, the caregivers’ perspective of EE was analyzed. One third of caregivers showed elevated CC scores and nearly half of the caregivers reported high EOI scores. These prevalence figures are somewhat lower compared to previous studies using the same questionnaire [5,7]. This may be due to older patients (mostly adults) and a longer illness duration in these reports (mostly far longer than one year) compared to our participants (approximately one year). Even though we only observed a tendency that longer illness duration is associated with higher EE scores in this study, this association can be assumed from the literature [4,5,10]. CC and EOI scores tended to be higher for mothers than for fathers, albeit these results did not reach statistical significance due to the small number of fathers included in this study. This is not fully in line with several previous reports describing mothers to be more overinvolved than fathers [5,9,43] and fathers to be more critical than mothers [5,43].
Low perceived caregiver skills, high AN symptom impact on caregivers, and an outpatient treatment setting were significant factors associated with CC, accounting for nearly 50% of the variance. High AN symptom impact on caregivers, depression in caregivers, higher psychological distress, higher motivation to change in caregivers, and less caregiver skills accounted for over 60% of the variance of EOI. Other studies also found associations of high EE with psychological distress or depression [1,43,44]. Caregivers’ distress and self-care should therefore be the core elements in interventions for caregivers, beside emotion regulation strategies and communication skills. Less perceived skills were associated with both higher CC and higher EOI. This may reflect that caregivers who feel less competent to deal with ED in the family demonstrate high EE, probably because they feel overwhelmed with this situation. Consequently, one might also assume that enhancing caregivers’ skills can have a positive impact on EE. Interestingly, higher motivation to change in parents was associated with higher EOI. This sounds paradoxical. However, caregivers who experience frustration and helplessness when confronted with ED symptoms or associated conflicts more often, which may consequently enhance EE, might also be highly motivated to change their own behavior or aspects of the actual situation. Therefore, it may be of benefit to target motivation to change in interventions for caregivers. Further research is needed to investigate the role of motivation to change in caregivers regarding high EE. Caregivers of outpatients reported higher scores for CC than caregivers of inpatients. It might be assumed that parents of outpatients feel more responsible for an improvement of symptoms compared to inpatients, whereas the responsibility for symptom improvement is delegated to the ED treatment team. This may lead to higher distress and burden in parents of outpatients which may promote more critical comments. Besides, an outpatient treatment setting might induce more situations where high EE can occur compared to an inpatient setting. In contrast to the literature [43], there was no association with illness severity (patients with lower BMI or higher ED psychopathology). No associations were also found for age of caregivers and age of patients, with only a tendency for caregivers of older patients to report higher EOI scores, in contrast to other studies reporting significantly higher EE in caregivers of older patients [4,5]. This may be because the mean age of patients within those studies was higher than in our sample. As the patient’s age and duration of illness often correlate, we assume that including adult patients in the study may lead to a similar result. The time spent caregiving did not play a role in our study regarding EE levels either, in contrast to another study [8]. This study included adult patients and concluded that caring for patients that live in the same household involves more time and leads to higher EE. However, as we only included adolescents, the great majority of whom still lived at home, the time spent caregiving may not play such an important role.
We also explored predictors of high EE based on the patients’ perspective. Regarding the patients’ point of view on EE, high ED psychopathology was solely associated with CC, whereas a lower BMI and higher motivation to change in caregivers were associated with EOI. Therefore, a somewhat more severe illness (lower BMI and higher ED psychopathology) was correlated with high EE in the family. Moreover, when parents were more motivated to change, the perceived EOI was higher, which is similar to the findings for parents described above. However, our model only accounted for 4% (CC) and 8% (EOI) of the variance. Hence, other factors associated with the patients’ perception of EE in the family should be investigated in future research.
Another aim of the study was to explore whether parental and patients’ perceptions of EE are correlated. Regarding the total group, there were no significant correlations at the baseline, while the correlations between caregivers and patients slightly increased with time and reached significance at the 12-month FU. It is unclear why parents and patients’ perceptions are stronger associated with time, even though the patients’ perception of high EE within the family did not decrease like the caregivers’ perception did. We assume that either the patients’ or the parents’ ability to precisely assess the real family climate improves with time, probably due to successful weight restitution or less severe symptoms at T2 or because patients gain valuable insights on family dynamics during their ongoing psychotherapy. However, the low correlations indicate that the parent’s and patient’s perceptions of EE diverge, which can be targeted in family-based interventions. Interestingly, we found a significant high correlation between the fathers’ and patients’ perceptions of CC at the baseline and at post-intervention which has to be interpreted with caution due to the low number of fathers included in this study.
We further investigated the efficacy of the SUCCEAT intervention on EE in caregivers. A significant reduction of EE was observed in the SUCCEAT group for the short-term and the long-term FU. This is in line with the literature, showing that EE in caregivers can be reduced after participating in an intervention for caregivers including psychoeducation and skills training [18,20,21,45]. EE was also reduced in the COMP group with no significant difference to the SUCCEAT intervention. That might be because the facilities that recruited participants for the COMP group already implemented specialized family interventions (multi-family therapy [33] or systemic family therapy [32]) also including expressing emotions, conflict management, and communication within the family as the core elements. To note, there were no differences between the three study arms with regard to the majority of caregivers’ and patients’ sociodemographic and clinical characteristics at the baseline. However, the groups differed with respect to the highest educational degree, ED duration, treatment setting, and subjective ED symptoms with the caregivers of the SUCCEAT group having higher educational levels and the COMP patients having a longer illness duration, higher subjective ED psychopathology, and having been treated in an inpatient setting more often. This should be considered when interpreting the results regarding group differences. Yet, there was no difference for EE scores at the baseline between the three arms. The sensitivity analyses showed that reductions in EOI were generally higher than in CC and that intervention effects remained stable or increased further up to the 12-month FU except for CC in the COMP group where we found a small rebound effect indicating that parents of the COMP group were a bit more critical at the 12-month FU again. Indeed, the current literature suggests that CC is more susceptible to increase again in the long term [43]. Interestingly, the improvement of CC and EOI was stronger in caregivers of outpatients than of inpatients and EOI also improved faster. This might be due to the fact that caregivers of outpatients may have more time and more opportunities to use and practice the communication skills trained in the interventions than caregivers of inpatients.
Unfortunately, no improvements were found when considering the patients’ perception of EE within the family. Thus, the patients did not perceive EE to be significantly reduced over time neither in the SUCCEAT nor in the COMP groups. This could be due to several reasons. Firstly, we used questionnaires that measure the same construct, but did not include exactly the same item contents, impeding direct comparisons. The FQ measures subjective CC and EOI towards the patient, whereas the FEICS assesses CC and EOI within the whole family from the patient’s point of view, but not specifically towards the parent who completed the FQ. Secondly, in most cases, only one parent (either mother or father) participated in the intervention. It might be the case that the caregivers who did not participate did not change regarding their EE compared to the ones that participated and therefore they may still contribute to a highly negative emotional climate. Thus, if possible, both parents should be encouraged to participate in a caregiver’s skills training and be included in further research. Another possible explanation is that parents feel a reduction of EE more intensely, whereas patients do not experience small changes. Rienecke [1] assumed patients with AN to be acutely sensitive to parental EE, so they may have difficulties to experience a change even if the frequency of EE has reduced. In that case, children and adolescents might need more information on EE themselves in order to be more sensitive to notice a change in the family climate [46]. It might be possible to encourage patients themselves to read some chapters of the manual or to watch some parts of the DVD used in the intervention. Another possibility is to arrange one family meeting where this topic can be discussed together or to implement this issue in the patients’ therapy.
Although there was no reduction in EE from the patients’ point of view, we found a significant association between the perceived change in CC in parents and the perceived change in CC in patients from the baseline to post-intervention in the SUCCEAT group only. However, this correlation was marginal. No such association was observed for EOI. These results were similar to another study [23] that reported a significant reduction of EE in caregivers, no perceived reduction in patients, but a positive correlation between changes in perceived EE between caregivers and patients. Furthermore, patients might experience qualitative improvements in EE as indicated by Goddard et al. [24] which might not have been covered with the questionnaire used in this study.
Finally, we investigated whether reductions in parental or perceived EE affect the outcome of ED pathology and BMI in AN patients. Indeed, improvement in the assessed parental CC was associated with greater changes in subjective ED symptoms. Similarly, greater improvement in CC assessed in patients was associated with greater changes in subjective ED symptoms, clinically assessed ED psychopathology, and BMI. For EOI, no clear association was observed. These results contribute to the literature indicating that a reduction in parental EE is associated with patients’ outcomes [10,25]. Although our analyses were explorative, these results indicate that reducing EE through a caregiver skills training can positively affect the ED psychopathology and BMI in patients. These results highlight the benefit and need in a caregiver training in the routine ED treatment.
This study has a couple of strengths. It is the first study investigating whether a change in EE can predict a change in ED psychopathology and BMI in adolescent patients. A long-term outcome was included. Both SUCCEAT groups were uniformly designed and guided by the same two professional clinicians. The study has some limitations, too. The number of fathers included in this study was low. Therefore, the role of fathers and the correlation between patients and both parents as well as between mothers and fathers require further investigation. Furthermore, as ED duration and treatment setting (outpatient or inpatient setting) differ significantly between the three groups at the baseline, results regarding group differences should be interpreted with some caution.
5. Conclusions
Our study confirms that high EE is common in caregivers of adolescent patients with AN. It further highlights that EE can be reduced after interventions for caregivers and that this reduction positively influences patients’ outcomes. Our results therefore underline the importance of including a focus on parental EE into the treatment of adolescents with AN. Parental EE was high and was associated with higher distress, higher depression, and a lack of skills. We found that parental EE was significantly reduced after participating in the SUCCEAT intervention or a specialized family intervention and that this reduction remained in the long term. Although the patients’ perceptions did not match well with the caregivers’ perceptions of EE, there was some evidence that reductions in EE positively affect the patient’s treatment course. Altogether, we can strongly recommend to include interventions for caregivers, such as SUCCEAT, into the treatment of adolescents with AN in order to improve the outcome for caregivers and for patients. Patients might further benefit from a conjoint meeting with parents to discuss family climate and to get sensitive to perceive possible changes.
Supplementary Materials
The following are available online at https://www.mdpi.com/2077-0383/9/7/2021/s1: Supplementary Tables S1 and S2.
Author Contributions
Conceptualization, A.F.K.K., J.T., J.P., and G.W.; methodology, C.F., J.P., and M.Z.; formal analysis, M.Z.; investigation, J.P., S.T., A.Z., C.F., and T.W.; resources, H.I., E.A.-W., G.S., M.M., D.M., A.F.K.K., and G.W.; data curation, M.Z.; writing—original draft preparation, J.P.; writing—review and editing, M.Z., A.F.K.K., G.W., and J.P.; visualization, M.Z.; supervision, A.F.K.K. and G.W.; project administration, J.P., S.T., C.F., and T.W.; funding acquisition, A.F.K.K. and G.W. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by the Gemeinsame Gesundheitsziele aus dem Rahmen-Pharmavertrag/Pharma Master Agreement (a cooperation between the Austrian pharmaceutical industry and the Austrian social insurance; grant No. 99901002500 given to G.W. and A.K.).
Acknowledgments
We thank all the patients and caregivers who participated, as well as all the staff members that helped to conduct the study.
Conflicts of Interest
J.P. was a coach in the SUCCEAT workshop and online intervention. J.T. co-authored the book that was used as the basis for intervention. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.
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Figure 1. Change of high expressed emotion scores in the SUCCEAT workshop, online, and comparison groups from the baseline (light-grey box) to the post-intervention (mid-grey box) and the 12-month follow-up (dark-grey box) assessment: (a) Criticism score (parent perspective), (b) Emotional Overinvolvement score (parent perspective), (c) Criticism score (patient perspective), (d) Emotional Overinvolvement score (patient perspective). The size of the box represents the interquartile range (IQR); the whiskers indicate the minimum/maximum values in case no outliers were observed. Outliers (defined as values > 1.5 x IQR from the 25th quantile and 75th quantile) are depicted as circles. Abbreviations: 12M-FU, 12-month follow-up.
Figure 1. Change of high expressed emotion scores in the SUCCEAT workshop, online, and comparison groups from the baseline (light-grey box) to the post-intervention (mid-grey box) and the 12-month follow-up (dark-grey box) assessment: (a) Criticism score (parent perspective), (b) Emotional Overinvolvement score (parent perspective), (c) Criticism score (patient perspective), (d) Emotional Overinvolvement score (patient perspective). The size of the box represents the interquartile range (IQR); the whiskers indicate the minimum/maximum values in case no outliers were observed. Outliers (defined as values > 1.5 x IQR from the 25th quantile and 75th quantile) are depicted as circles. Abbreviations: 12M-FU, 12-month follow-up.
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Figure 2. The scatterplot depicting the association (Pearson correlation coefficients) between high expressed emotion change scores (baseline to post-intervention) of parents and patients: (a) Criticism change scores; (b) Emotional overinvolvement change scores. A significant positive correlation indicates that higher levels of change based on the parents’ perspective are associated with higher levels of change based on the perspective of patients.
Figure 2. The scatterplot depicting the association (Pearson correlation coefficients) between high expressed emotion change scores (baseline to post-intervention) of parents and patients: (a) Criticism change scores; (b) Emotional overinvolvement change scores. A significant positive correlation indicates that higher levels of change based on the parents’ perspective are associated with higher levels of change based on the perspective of patients.
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Table 1. Sample characteristics at the baseline (caregivers and eating disorder patients).
Table 1. Sample characteristics at the baseline (caregivers and eating disorder patients).
SUCCEAT–WS
(N = 50)
SUCCEAT–ONL
(N = 50)
COMP
(N = 49)
p
Caregivers’ characteristics
Mothers (%)84.0%88.0%75.5%0.248 1
Age (Mean, SD)46.64 (5.43)47.72 (4.25)47.27 (4.48)0.523 2
University degree (%)60.0%46.0%27.7%0.006 1
Married or living in partnership (%)84.0%75.0%70.2%0.264 1
Time spent with the patient during weekdays (%)
0–1 h/day6.1%10.2%15.2%0.386 1
1–2 h/day18.4%22.4%15.2%
3–4 h/day32.7%42.9%30.4%
>4 h/day42.9%24.5%39.1%
FQ–CC score (Mean, SD)20.76 (5.96)21.78 (5.47)21.82 (5.54)0.559 2
FQ–EOI score (Mean, SD)26.10 (5.17)25.44 (4.98)27.22 (5.05)0.222 2
Patients’ characteristics
Females (%)90.0%96.0%100%0.061 1
Age (Mean, SD)14.66 (1.91)15.12 (1.80)15.43 (1.08)0.068 2
ED diagnosis (%)
AN restrictive90.0%90.0%87.8%0.995 1
AN binge/purging8.0%8.0%10.2%
Atypical AN2.0%2.0%2.0%
ED duration (Mean, SD)10.41 (7.10)16.03 (16.05)23.77 (12.93)<0.001 1
BMI percentile (Median)1.162.740.450.091 3
Inpatient treatment (%)48.0%48.0%81.6%<0.001 1
EDE score (Mean, SD)3.27 (1.62)3.32 (1.39)3.22 (1.36)0.945 2
EDI-2 score (Mean, SD)67.32 (39.55)69.62 (38.79)91.57 (47.35)0.009 2
FEICS–CC score (Mean, SD)12.15 (4.17)12.52 (4.44)13.51 (4.08)0.272 2
FEICS–EOI score (Mean, SD)23.92 (4.43)23.53 (4.17)22.91 (3.94)0.503 2
1 Chi² test; 2 ANOVA test; 3 Kruskal–Wallis test. Abbreviations: AN, anorexia nervosa; CC, criticism; COMP, comparison group; ED, eating disorder; EDE, Eating Disorder Examination Interview, EDI-2, Eating Disorder Inventory-2; EOI, emotional overinvolvement; FEICS, Family Emotional Involvement and Criticism Scale; FQ, Family Questionnaire; ONL, online; SUCCEAT, Supporting Carers of Children and Adolescents with Eating Disorders in Austria; WS, workshop.
Table 2. Multivariate regression (forward selection method) predicting criticism and emotional overinvolvement (FQ, parents).
Table 2. Multivariate regression (forward selection method) predicting criticism and emotional overinvolvement (FQ, parents).
Predictorb(SE)t (df)pR²ΔR²
Outcome: FQ, criticism
Model 1 0.351
CASK, total score−0.240 (0.029)−8.165 (1,123)<0.001
Model 2 0.4350.084
CASK, total score−0.171 (0.032)−5.378<0.001
EDSIS, total score0.127 (0.030)4.253 (2,122)<0.001
Model 3 0.4620.27
CASK, total score−0.160 (0.032)−5.079<0.001
EDSIS, total score0.137 (0.030)4.624<0.001
Treatment type 11.849 (0.755)2.450 (1,121)0.016
Outcome: FQ, emotional overinvolvement
Model 1 0.500
EDSIS, total score0.253 (0.023)11.035 (1,122)<0.001
Model 2 0.5670.068
EDSIS, total score0.195 (0.025)7.741<0.001
BDI, total score0.203 (0.047)4.354 (2,121)<0.001
Model 3 0.6010.033
EDSIS, total score0.173 (0.025)6.863<0.001
BDI, total score0.195 (0.045)4.320<0.001
URICA, contemp.0.173 (0.055)3.170 (3,120)0.002
Model 4 0.6200.020
EDSIS, total score0.154 (0.026)5.956<0.001
BDI, total score0.160 (0.046)3.4370.001
URICA, contemp.0.169 (0.054)3.1640.002
CASK, total score−0.064 (0.026)−0.2486 (4,119)0.014
Model 5 0.6350.015
EDSIS, total score0.137 (0.027)5.119<0.001
BDI, total score0.101 (0.053)1.9160.058
URICA, contemp.0.162 (0.053)3.0740.003
CASK, total score−0.061 (0.025)−2.3980.018
GHQ, total score0.248 (0.113)2.185 (5,118)0.031
1 1 = inpatient, 2 = outpatient. Abbreviations: BDI, Beck Depression Inventory; CASK, Caregiver Skills Scale; contemp., contemplation; EDSIS, Eating Disorder Impact Scale; FQ, Family Questionnaire; GHQ, General Health Questionnaire; URICA, University of Rhode Island Change Assessment.
Table 3. Multivariate regression (forward selection method) predicting criticism and emotional overinvolvement (FEICS, patients).
Table 3. Multivariate regression (forward selection method) predicting criticism and emotional overinvolvement (FEICS, patients).
Predictorb(SE)t (df)pR²ΔR²
Outcome: FEICS, criticism
Model 1 (final) 0.145
EDI-2, total score0.040 (0.009)4.555 (1,122)<0.001
Outcome: FEICS, emotional overinvolvement
Model 1 0.041
BMI percentile 1−1.681 (0.701)−2.399 (1,136)0.018
Model 2 0.0850.044
BMI percentile 1−2.025 (0.701)−2.8940.004
URICA, precon.−0.191 (0.074)−2.563 (2,135)0.011
1 Categorized as follows: 1 ≤ 1st percentile, 2 > 1st percentile. Abbreviations: EDI-2, Eating Disorder Inventory-2; FEICS, Family Emotional Involvement and Criticism Scale; precon., precontemplation; URICA, University of Rhode Island Change Assessment.
Table 4. Results of linear regression analyses predicting the change in patient’s eating disorder symptoms by the change in high expressed emotion.
Table 4. Results of linear regression analyses predicting the change in patient’s eating disorder symptoms by the change in high expressed emotion.
EDE Change ScoreEDI-2 Change ScoreBMI Perc. Change
T0–T1T0–T2T0–T1T0–T2T0–T1T0–T2
Change in CC (FQ)p = 0.731p = 0.239p = 0.040p = 0.073p = 0.995 p = 0.099
Change in EOI (FQ)p = 0.515p = 0.148p = 0.113p = 0.050p = 0.969p = 0.066
Change in CC (FEICS)p = 0.040p = 0.087p = 0.005p < 0.001p = 0.006p = 0.561
Change in EOI FEICS)p = 0.096p = 0.438p = 0.580p = 0.867p = 0.982p = 0.307
Abbreviations: CC, criticism, EOI, emotional overinvolvement, EDE, Eating Disorder Examination Interview, EDI-2, Eating Disorder Inventory-2, FQ, Family Questionnaire, FEICS, Family Emotional Involvement and Criticism Scale; T0–T1, difference between the baseline and post-intervention scores; T0-T2, difference between the baseline and 12-month FU scores.
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MDPI and ACS Style
Philipp, J.; Truttmann, S.; Zeiler, M.; Franta, C.; Wittek, T.; Schöfbeck, G.; Mitterer, M.; Mairhofer, D.; Zanko, A.; Imgart, H.; et al. Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective. J. Clin. Med. 2020, 9, 2021. https://doi.org/10.3390/jcm9072021
AMA Style
Philipp J, Truttmann S, Zeiler M, Franta C, Wittek T, Schöfbeck G, Mitterer M, Mairhofer D, Zanko A, Imgart H, et al. Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective. Journal of Clinical Medicine. 2020; 9(7):2021. https://doi.org/10.3390/jcm9072021
Chicago/Turabian Style
Philipp, Julia, Stefanie Truttmann, Michael Zeiler, Claudia Franta, Tanja Wittek, Gabriele Schöfbeck, Michaela Mitterer, Dunja Mairhofer, Annika Zanko, Hartmut Imgart, and et al. 2020. "Reduction of High Expressed Emotion and Treatment Outcomes in Anorexia Nervosa—Caregivers’ and Adolescents’ Perspective" Journal of Clinical Medicine 9, no. 7: 2021. https://doi.org/10.3390/jcm9072021
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-5,362,491,413,091,149,000 | Dictionary: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Nutritional
[noo-trish-uh n, nyoo-] /nuˈtrɪʃ ən, nyu-/
noun
1.
the act or process of nourishing or of being nourished.
2.
the science or study of, or a course of study in, nutrition, especially of humans.
3.
the process by which organisms take in and utilize food material.
4.
food; nutriment.
5.
the pursuit of this science as an occupation or profession.
/njuːˈtrɪʃən/
noun
1.
a process in animals and plants involving the intake of nutrient materials and their subsequent assimilation into the tissues related adjectives alimentary trophic
2.
the act or process of nourishing
3.
the study of nutrition, esp in humans
n.
early 15c., from Old French nutrition (14c.) and directly from Latin nutritionem (nominative nutritio) “a nourishing,” noun of action from past participle stem of nutrire “to nourish, suckle” (see nourish).
nutrition nu·tri·tion (nōō-trĭsh’ən, nyōō-)
n.
nu·tri’tion·al adj.
nutrition
(n-trĭsh’ən)
Tagged:
Read Also:
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noun the genetic manipulation of plants to create vitamins and minerals that will improve human’s diet; also the analysis of an organism’s set of genes
• Nutritionist
[noo-trish-uh-nist, nyoo-] /nuˈtrɪʃ ə nɪst, nyu-/ noun 1. a person who is trained or expert in the science of . /njuːˈtrɪʃənɪst/ noun 1. a person who specializes in nutrition and the nutritive value of various foods n. 1926, from nutrition + -ist. nutritionist nu·tri·tion·ist (nōō-trĭsh’ə-nĭst, nyōō-) n. One who is trained or is an expert […]
• Nutritious
[noo-trish-uh s, nyoo-] /nuˈtrɪʃ əs, nyu-/ adjective 1. providing nourishment, especially to a high degree; nourishing; healthful: a good, nutritious meal. /njuːˈtrɪʃəs/ adjective 1. nourishing, sometimes to a high degree adj. 1660s, from Latin nutricius “that which nourishes, nurses,” from nutrix (genitive nutricis) “a nurse,” from nutrire (see nourish). Related: Nutritiously. nutritious nu·tri·tious (nōō-trĭsh’əs, nyōō-) […]
• Nutritiousness
[noo-trish-uh s, nyoo-] /nuˈtrɪʃ əs, nyu-/ adjective 1. providing nourishment, especially to a high degree; nourishing; healthful: a good, nutritious meal. /njuːˈtrɪʃəs/ adjective 1. nourishing, sometimes to a high degree adj. 1660s, from Latin nutricius “that which nourishes, nurses,” from nutrix (genitive nutricis) “a nurse,” from nutrire (see nourish). Related: Nutritiously. nutritious nu·tri·tious (nōō-trĭsh’əs, nyōō-) […]
Disclaimer: Nutritional definition / meaning should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. All content on this website is for informational purposes only. | {
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-6,958,185,343,877,000,000 | Sei Hayakawa
Chiba University, Chiba-shi, Chiba-ken, Japan
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Publications (10)34.77 Total impact
• Article: Detection of mumps virus RNA in cerebrospinal fluid of patients with neuromyelitis optica.
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ABSTRACT: Neuromyelitis optica (NMO) is an acute inflammatory disease that preferentially involves the optic nerves and spinal cord. Although many infectious agents, including mumps virus, are postulated to have a role in the pathogenesis of multiple sclerosis (MS), the relationship between NMO and infectious agents remains uncertain. To investigate the relationship between NMO and viruses that have special affinity for the central nervous system, we performed a nested polymerase chain reaction (PCR) to detect mumps virus or enterovirus RNA in cerebrospinal fluid samples from 13 patients with MS, 8 with NMO and 20 with other neurological diseases (ONDs). Nested PCR was positive for mumps virus in 2 (25%) of NMO patients, but in none of those with MS and ONDs. Moreover, nested PCR results became negative in the remission phase in the two PCR-positive NMO patients. Mumps virus may have some role in the pathogenesis of NMO.
Neurological Sciences 04/2011; 32(5):795-9. · 1.32 Impact Factor
• Article: Cytokine and chemokine profiles in neuromyelitis optica: significance of interleukin-6.
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ABSTRACT: Neuromyelitis optica (NMO) is assumed to be immunologically distinct from multiple sclerosis (MS). Adequate studies about cytokines and chemokines in NMO have been lacking. To investigate the contribution of cytokines/chemokines in the pathogenesis of NMO. We measured 27 cytokines/chemokines and Th17 cell-associated cytokines in the cerebrospinal fluid (CSF) of 31 NMO, 29 MS and 18 other non-inflammatory neurological disorders patients. The serum levels of some cytokines/ chemokines were also measured. The correlations between clinical characteristics/laboratory findings and levels of cytokines/chemokines in NMO were examined. The CSF levels of interleukin (IL)-1 receptor antagonist, IL-6, IL-8, IL-13 and granulocyte colony-stimulating factor were significantly increased in NMO, while IL-9, fibroblast growth factor-basic, granulocyte macrophage colony-stimulating factor, macrophage inflammatory protein-1-beta and tumor necrosis factor-alpha were increased in MS. IL-10 and interferon-gamma-inducible protein-10 were elevated in NMO and MS. In serum analyses, only the IL-6 level showed significant elevation in NMO. The CSF IL-6 level had a significant correlation with the CSF glial fibrillary acidic protein level and CSF cells, and a weak correlation with anti-aquaporin-4 antibody titers. Different immunological status and pathophysiologies exist between NMO and MS, and IL-6 may play important roles in the pathogenesis of NMO.
Multiple Sclerosis 12/2010; 16(12):1443-52. · 4.26 Impact Factor
• Source
Article: Expression of chemokine receptors on peripheral blood lymphocytes in multiple sclerosis and neuromyelitis optica.
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ABSTRACT: The role of different chemokine receptors in the pathogenesis of multiple sclerosis (MS) has been extensively investigated; however, little is known about the difference in the role of chemokine receptors between the pathogenesis of neuromyelitis optica (NMO) and MS. Therefore, we examined the expression of chemokine receptors on peripheral blood lymphocytes (PBL) in MS and NMO. We used flow cytometry to analyse lymphocyte subsets in 12 patients with relapsing NMO, 24 with relapsing-remitting MS during relapse, 3 with NMO and 5 with MS during remission. Compared with healthy controls (HC), the percentage of lymphocytes in white blood cells was significantly lower in NMO and MS patients. The percentage of T cells expressing CD4+CD25+ and CD4+CD45RO+ was higher, while that of CD4+CC chemokine receptor (CCR)3+ (T helper 2, Th2) was significantly lower in MS patients than in HC. The ratios of CD4+CXC chemokine receptors (CXCR)3+/CD4+CCR3+ (Th1/Th2) and CD8+CXCR3+/CD8+CCR4+ (T cytotoxic 1, Tc1/Tc2) were higher in MS patients than in HC. The percentage of CD8+CXCR3+ T cell (Tc1) and CD4+CXCR3+ T cell (Th1) decreased significantly during remission in MS patients (P <0.05). No significant differences were identified in the expression of the chemokine receptors on PBL in NMO patients compared with MS patients and HC. Th1 dominance of chemokine receptors on blood T cells and the correlation between CXCR3+ T cell (Th1 and Tc1) and disease activity in MS patients were confirmed by analysing chemokines receptors on PBL. In contrast, deviation in the Th1/Th2 balance was not observed in NMO patients.
BMC Neurology 11/2010; 10:113. · 2.17 Impact Factor
• Article: Serum levels of complement C4 fragments correlate with disease activity in multiple sclerosis: proteomic analysis.
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ABSTRACT: To detect serum biomarkers associated with disease activity in relapsing-remitting multiple sclerosis (MS). We studied serum low-molecular peptide profiling of MS patients and normal controls comprehensively by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Serum level of 1741 Da peptide was increased at the time of clinical relapse in patients than in normal controls and returned toward normal during remission. Tandem mass spectrometry analysis revealed that the peptide was a fragment of complement C4 (NGFKSHALQLNNRQI). This fragment peptide could be a possible marker of disease activity. It may reflect complement activation in the pathogenesis of MS.
Journal of neuroimmunology 11/2009; 218(1-2):112-5. · 2.84 Impact Factor
• Article: Association of anti-aquaporin-4 antibody-positive neuromyelitis optica with myasthenia gravis.
[show abstract] [hide abstract]
ABSTRACT: We describe 2 patients who developed anti-aquaporin-4 antibody-positive neuromyelitis optica (NMO) following the development of anti-acetylcholine receptor antibody-positive myasthenia gravis (MG). A literature review of 13 similar cases in addition to the present 2 cases of NMO with MG showed predominance among Asian women and frequent development of NMO following thymectomy for MG. Moreover, in one of our patients, serial assays of anti-aquaporin-4 antibody and anti-acetylcholine receptor antibody were performed. Accumulating evidence for the coexistence of NMO and MG suggests that a common immunopathogenesis of NMO and MG may exist, and the association of NMO with MG may be more frequent than hitherto believed.
Journal of the neurological sciences 10/2009; 287(1-2):105-7. · 2.32 Impact Factor
• Article: Markedly increased CSF interleukin-6 levels in neuromyelitis optica, but not in multiple sclerosis.
[show abstract] [hide abstract]
ABSTRACT: To investigate differences in helper T cell immune responses in cerebrospinal fluid (CSF) between neuromyelitis optica (NMO) and multiple sclerosis (MS), we measured CSF levels of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-a and interferon-c at the time of relapse in 17 NMO patients and 21 MS patients using fluorescence-activated cell sorting. CSF IL-6 levels were significantly higher in NMO patients than in patients with MS (P = 0.001) and other neurological diseases (P = 0.001). The other cytokines tested were undetectable. Elevated CSF levels of IL-6 in only NMO supports the view of different pathophysiologies of NMO and MS. CSF IL-6 levels may be useful in the differential diagnosis of the two disorders.
Journal of Neurology 09/2009; 256(12):2082-4. · 3.47 Impact Factor
• Article: "Cloud-like enhancement" is a magnetic resonance imaging abnormality specific to neuromyelitis optica.
[show abstract] [hide abstract]
ABSTRACT: Neuromyelitis optica (NMO) is presumably mediated by an autoantibody against aquaporin-4 densely expressed at the blood-brain barrier. In 18 patients with NMO, brain magnetic resonance imaging (MRI) findings were systematically reviewed. Brain MRI abnormalities were found for 89% of the patients, and the most prominent feature was "cloud-like enhancement," multiple patchy enhancing lesions with blurred margin, found in 90% of the patients with positive contrast enhancement. In NMO, brain MRI abnormalities are frequent, and cloud-like enhancement appears to be an MRI finding specific to NMO, possibly caused by primary involvement of the blood-brain barrier by the autoantibodies.
Annals of Neurology 06/2009; 66(3):425-8. · 11.09 Impact Factor
• Article: Peripheral nerve demyelination in multiple sclerosis.
[show abstract] [hide abstract]
ABSTRACT: To elucidate the frequency of peripheral nerve demyelination in multiple sclerosis (MS). There are a number of case reports describing MS patients associated with demyelinating neuropathy, but its frequency in a whole MS population is unknown. Extensive nerve conduction studies were prospectively performed in 60 consecutive patients with relapsing-remitting MS. Multiple excitability measurements using threshold tracking were also performed in median motor axons and superficial radial sensory axons. Nerve conduction abnormalities suggestive of demyelination were found for 3 (5%) of the patients. Two of them developed clinically evident neuropathy, whereas the remaining one had only generalized areflexia in addition to MS symptoms/signs. In all the three, MS preceded demyelinating neuropathy by several years. Excitability testing showed that supernormality and threshold electrotonus at the tested sites (median motor axons at the wrist, and radial sensory axons at the mid-forearm) were similar in the normal and MS groups. MS patients do not generally have peripheral nerve demyelination, but approximately 5% of patients develop demyelinating neuropathy. The association could result from a common pathogenesis possibly due to epitope spreading during the long course of MS. Association of chronic inflammatory demyelinating polyneuropathy with MS is not frequent, but needs to be recognized as a treatable condition.
Clinical Neurophysiology 09/2008; 119(8):1829-33. · 3.41 Impact Factor
• Article: Neuromyelitis optica and anti-aquaporin-4 antibodies measured by an enzyme-linked immunosorbent assay.
[show abstract] [hide abstract]
ABSTRACT: NMO-IgG, a disease-specific autoantibody for neuromyelitis optica, recognizes aquaporin-4 (AQP4) and has been examined by indirect immunofluorescence assay. We developed an enzyme-linked immunosorbent assay (ELISA) to detect anti-AQP4 antibodies by establishing methods for expression in a baculovirus system and purification of recombinant AQP4 as antigen. Elevated anti-AQP4 antibody titers in serum were found in 15 (71%) of 21 patients with neuromyelitis optica, 4.3% of 46 patients with multiple sclerosis, none of 51 normal controls, and 2.6% of 115 patients with other neurological diseases. The ELISA system can be substituted for the conventional NMO-IgG assay.
Journal of Neuroimmunology 06/2008; 196(1-2):181-7. · 2.96 Impact Factor
• Article: Moxibustion, an alternative therapy, ameliorated disturbed circadian rhythm of plasma arginine vasopressin and urine output in multiple system atrophy.
[show abstract] [hide abstract]
ABSTRACT: Previously no alternative therapy approach has been made to ameliorate disturbed circadian arginine vasopressin rhythm (C-AVP-R) in multiple system atrophy (MSA). A 65-year-old man with MSA showed loss of C-AVP-R and nocturnal polyuria. We performed moxibustion at specific acupuncture points on the bladder and inside the feet, once a day, 3 times a week, for 6 months. After the treatment, his C-AVP-R appeared to be normal, and the nocturnal urine output decreased to 75% (p<0.01). Together with the previous studies, it seems possible that somatic warm stimulation by moxibustion in specific points might have facilitated AVP secretion in this patient.
Internal Medicine 01/2007; 46(13):1015-8. · 0.94 Impact Factor | {
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-8,828,193,546,690,707,000 | Elevated homocysteine levels may cause atherosclerosis and thrombiHomocysteinemia may be the result of several underlying abnormalities, genetic as well as environmental (low vitamin intake B6, B12, folic acid)?Lupus anticoagulantLA is a non-specific coagulation inhibitor and a marker for thrombosisLA is an immunoglobulin that binds to phospholipids and proteins associated with the cell membrane. presence, cardiolipin antibody presence, phosphatidyl antibody presence, 2-glycoprotein antibody presence, and serum homocysteine and lipoprotein(a) levels The frequencies of varying abnormalities were identified and compared to the prevalence reported SB-408124 HCl in the literature. Results Forty-three of 1944 patients undergoing knee arthroplasty had a history of SB-408124 HCl DVT or PE. Sixteen of 43 (37%) patients had an abnormality and eight of these (19%) had two or more abnormalities. The frequency of nine of the 12 assessments appeared to be greater in this cohort than in the population at large. Conclusions Patients with a personal or familial history of DVT or PE appear to have a high frequency of hereditary prothrombotic abnormalities. Preoperative evaluation by a hematologist may be warranted in patients with a personal or familial history of DVT or PE as the postoperative anticoagulation protocols may be altered and identification of these abnormalities may affect a patients risk for other disease states. Level of Evidence Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. Introduction Knee arthroplasty reliably relieves pain and improves function in patients with end-stage arthropathy of the knee. Among the most common complications after knee arthroplasty is usually deep vein thrombosis (DVT), and pulmonary BNIP3 embolism (PE) is among the most common causes of death postoperatively [2, 11]. Without either mechanical or pharmacologic prophylaxis, 40% to 60% of patients undergoing knee arthroplasty will develop an asymptomatic DVT detected by imaging studies, 15% to 25% a proximal DVT, and 0.5% to 2% a fatal PE [1, 9]. Multiple risk factors for developing a postoperative DVT have been identified and include advanced age, prolonged immobilization, obesity, and prior history (both personal and familial) of DVT or PE [19]. Moreover, a number of studies have shown hereditary prothrombotic genes and/or hematologic abnormalities lead to hypercoagulable says [3, 8, 12, 18, 19, 22]. The majority of these previous studies have retrospectively observed an increased frequency of one or two abnormalities, such as activated protein C deficiency or hyperhomocysteinemia, in nonorthopaedic patients who have designed a DVT or PE. A single study preoperatively screened all hip and knee arthroplasty patients, regardless of known predisposition, and correlated two abnormalities (prothrombin gene mutation and Factor V Leiden mutation) with an increased incidence of DVT or PE [19]. None of the studies have specifically screened high risk knee arthroplasty patients prior to medical procedures to determine the presence of genetic mutations and hemostatic or serum abnormalities. Without this knowledge, a controversy will always exist as to the benefit and power of preoperative SB-408124 HCl screening of patients prior to surgeries (such as knee arthroplasty) that represent a high risk of DVT or PE. Moreover, it remains unclear why only a minority of patients develop symptomatic DVT or PE events despite comparable operative procedures and the same prophylactic regimen. It is unknown if this could be explained by an underlying genetic predisposition. In prior studies investigating genetic predisposition in arthroplasty patients who had a recognized PE postoperatively, four studies identified specific genetic and coagulation abnormalities as impartial risk factors and also suggested these assessments could be useful in identifying these higher-risk patients preoperatively [10, 14, 16, 20]. Based on these prior studies, the senior author began sending patients with a self-reported personal or familial history of thromboembolic events for evaluation by a hematologist prior to elective knee arthroplasty. Thus, we wanted to determine (1) how frequently an abnormality was identified (2) what changes in the postoperative anticoagulation protocol were recommended and (3) how the observed frequency in this cohort compared with those reported in the population at large. Patients and Methods From a group of 1944 patients identified as having a planned primary or. | {
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8,617,859,133,771,309,000 | Weight-Loss Surgery: Myth vs. Fact
For many struggling with severe obesity, weight-loss surgery has emerged as a game changer to help people regain control of their health and improve their quality of life. However, like any medical procedure, weight-loss surgery is surrounded by myths, and distinguishing these from the facts can be helpful as a person starts their weight-loss journey.
The Truth About Weight-Loss Surgery
Myth: Obesity is a lifestyle choice and anyone can be successfully treated with diet and exercise. People with obesity are lazy and have a lack of willpower.
Fact: Obesity is a disease.
Obesity is a complex, multifactorial disease consisting of both genetic and environmental factors. Hormone imbalance and poor metabolism are the primary contributors. These result in establishing an abnormally high weight SET POINT that a person’s body will aggressively attempt to maintain. Just like our brain regulates body temperature, it also regulates weight. When people with obesity diet, several changes occur in order to try to maintain the set-point weight:
1. Metabolism slows down
2. Hunger hormones increase
3. Satiety (feelings of fullness) decreases
This is why patients with obesity struggle to maintain their weight loss and often “yo-yo” diet because they are constantly fighting their body’s tendency to regain weight.
Source: National Library of Medicine
Myth: Bariatric surgery is dangerous.
Fact: Weight-loss surgery is as safe as childbirth.
Research has shown that bariatric surgery is as safe as childbirth and even safer than having your gallbladder removed, which is the most common procedure performed in the country. Also, for most patients, the risk of complications from comorbidities related to their obesity, such as heart disease, diabetes and high blood pressure, are often far greater than the risk of surgery. Studies have shown that patients with obesity who have weight-loss surgery significantly increase their life expectancy.
Myth: People who have weight loss surgery vomit all the time and have a poor quality of life.
Fact: It’s not normal to feel sick after surgery.
It is NOT normal for bariatric surgery patients to frequently vomit. While it is true that patients need to get used to their smaller stomachs, and some may experience vomiting right after surgery, as they learn how to anticipate the amount of food they can take in with each meal, all vomiting should subside.
New York Bariatric Group patient Brittany, lost 130 pounds after her surgery and says she has more energy than ever eating smaller meals. “Post-surgery everything is easier, including working. I work long hours, 12 hour shifts and although I do eat lots of little meals throughout the day, rather than a big breakfast, lunch and dinner, I am able to get through the day and I have more energy to do what I need to do all day long.”
Source: University of California San Francisco Health
Myth: Weight-loss surgery is very painful.
Fact: Patients are back to work in less than two weeks.
Virtually all bariatric procedures are performed minimally invasive, meaning incisions are typically smaller than 1cm each, and while every patient’s pain tolerance is different, most patients say that discomfort after surgery is similar to doing a lot of push-ups. Patients may also experience gas pain for a few days after surgery. Many NYBG patients go back to work 7 to 10 days after surgery. Anjanette lost 140 pounds and was up and walking the day after her surgery. “By the next day I was walking. I didn't go through a lot of pain and within a couple of days I was actually back in the office working again.”
Source: American Society for Metabolic and Bariatric Surgery
Myth: Bariatric surgery is only for the morbidly obese.
Fact: Many people qualify for bariatric surgery.
Bariatric surgery can be an option for even those not necessarily classified as morbidly obese, but still have health issues related to their weight. These health issues could include type 2 diabetes, sleep apnea, hypertension, and joint pain.
Source American Society for Metabolic and Bariatric Surgery
New York Bariatric Group: Bariatric Surgery Leader
If you are looking to start your weight-loss journey. New York Bariatric Group is the best practice around and have the numbers to prove it:
• Surgeons who are leaders in bariatrics, plastic surgery, veins, and medical weight loss.
• 36,000 successful procedures performed with more every day
• The #1 gastric balloon practice by volume – most balloons placed in the United States
• Access to online seminars, support groups, cooking demos, and Q-and-A sessions
• 100s of videos for patients explaining procedures, answering common questions, and showcasing previous patients
• Multiple offices located in three states; NY, NJ, CT
• Since 2000, we boast over 23 years of success!
All of our hospitals are Metabolic Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited facilities, which is a prestigious designation bestowed upon only the top quality bariatric programs.
Stop waiting; start achieving better health today. Together, we’ve got this!
New York Bariatric Group is implementing and enforcing strict guidelines put out by the Center of Disease Control and the Department of Health in order to keep our staff and patients safe.
We are offering in-person and virtual consultations to ensure that everyone is able to get the information and care they deserve without feeling pressure to leave their home.
Back to Blog
Weight-Loss Surgery: Myth vs. Fact
Thomas
Lost 145lbs
Thomas' success story
I went in for surgery. An hour later, I came out a new man.
Everybody treated me like a king. The day of surgery, I was excited. The hospital couldn’t be any nicer. I went in for surgery. An hour later, I came out a new man. My recovery was awesome. I was out of bed that day. My wife and kids were my motivation on getting this surgery. They are my whole life. I’m happy I’m going to be around | {
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3,197,132,552,831,401,500 | Increasing the protein ratio within the diet appears to trigger multiple benefits that promote better fat metabolism.
Researchers from the University of Illinois have shown in studies that greater fat loss is directly related to the increase in the ratio of protein in the diet. These studies have shown through blood glucose and insulin responses that greater fat loss was due to better control of blood sugar and insulin as a result of this higher protein ratio.
Other studies have shown that a high protein intake provides an appetite-suppressive effect and increases satiety between meals. Higher protein intake appears to ease that gnawing hunger that occurs between meals.
See Also:
I’m making serious gains using Max-OT. I do have a few weak body parts however. Should I do extra sets or reps for these weak areas?
Nutritional scientists already understand that a high-protein diet increases thermogenesis (an increase in heat production within the body). This effect triggers a higher rate of fat metabolism. Therefore, a diet that is high in protein and moderate in carbohydrates is the research-proven strategy for rapid improvements in body composition.
For years, AST Sports Science has prescribed a very high protein intake for athletes that want to improve their lean muscle to body fat ratio. Look, protein builds muscle. You can’t build muscle without it. The more lean muscle you have, the higher your metabolic rate. A higher metabolic rate allows your body to burn more fat more efficiently 24-hours a day.
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I have been told that high protein intake will speed fat loss. Is this correct? How does that work?
by Paul Cribb Ph.D. CSCS. time to read: 1 min | {
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-3,081,971,790,855,815,000 | Methadone is an opioid that is commonly prescribed to treat severe pain and withdrawal associated with other opioids, such as heroin, fentanyl and oxycodone. Methadone is a powerful pain reliever and is generally not associated with the euphoric high that other opioids provide.
Because methadone generally does not lead to intoxication, people can mistakenly believe that there is no risk of developing dependence. However, methadone use can rapidly lead to tolerance (the need for larger doses to achieve the same effect) and dependence, even when used as directed.
What Causes Methadone Withdrawal?
The brain has a vast network of opioid receptors that regulate endogenous (naturally present) opioid signaling. The brain self-regulates opioid signaling to prevent overstimulation. An increase in endogenous opioids leads to a reduced response from the brain. The brain’s ability to self-regulate opioid signaling causes tolerance. When drugs are used to increase the effects of opioid signaling, the body responds by reducing its receptiveness to additional opioids. Thus, over time, more drugs are needed in order to achieve the same effect.
Methadone tolerance and dependence develop somewhat independently of each other. The severity of these factors depends on the amount of methadone that is used. Dependence means the body has adapted to the drug, and a person will experience withdrawal symptoms when the drug is removed from their system.
Dependence is different from addiction. Unlike addiction, dependence does not involve compulsive drug-seeking behavior in an effort to obtain a euphoric effect in spite of harmful consequences. Methadone is associated with tolerance and dependence, but it is much less likely to cause addiction. However, dependence and addiction are both capable of producing uncomfortable withdrawal symptoms.
When someone who is dependent on methadone suddenly stops taking it, the body tries to restore opioid levels. It does this through physical and psychological withdrawal symptoms. These symptoms are essentially instructing the body to find more methadone because the body is dependent on it. Methadone withdrawal is not completely understood, and it is still an area of active research.
Methadone withdrawal is associated with uncomfortable physical and psychological symptoms. While these symptoms generally subside over time, extreme cases of methadone withdrawal can be fatal. Methadone is somewhat unique among opioids because of its long half-life (up to 55 hours), so acute withdrawal symptoms can last longer than other opioids.
Physical Withdrawal Symptoms
Physical withdrawal symptoms that are often associated with methadone include:
• Increased pain sensitivity
• Nausea or vomiting
• Diarrhea
• Itchy skin
• Muscle aches
• Headache or lightheadedness
• Sweating
• Chills
• Hypertension
• Seizure or stroke, in extreme cases
Many people report that physical methadone withdrawal feels like a very bad flu.
Psychological Withdrawal Symptoms
Psychological withdrawal symptoms that are often associated with methadone include:
• Drowsiness
• Restlessness
• Anxiety
• Lack of pleasure
• Insomnia
• Depression
• Changes in sex drive
• Paranoia
• Suicidal ideation
• In extreme cases, visual or auditory hallucinations, delirium and psychosis
Symptoms of Post-Acute Withdrawal Syndrome (PAWS)
Post-acute withdrawal syndrome (PAWS) can be a frustrating component of methadone rehab. Many people expect that once acute withdrawal symptoms have passed, they should be free of physical and psychological symptoms associated with withdrawal. Unfortunately, methadone causes substantial, long-lasting changes in the brain that persist even in the absence of methadone. These symptoms are often experienced for months or years after cessation.
The symptoms are typically similar to those experienced during acute withdrawal. The degree and duration of PAWS symptoms may fluctuate, but they subside over time. It is important to recognize that experiencing PAWS or cravings long after you’ve quit does not mean that your recovery has failed.
Protracted Withdrawal Symptoms
Protracted withdrawal is a synonym of PAWS. The Substance Abuse and Mental Health Services Administration defines protracted withdrawal as “the presence of substance-specific signs and symptoms common to acute withdrawal but persisting beyond the generally expected acute withdrawal timeframes.”
Helping Methadone Withdrawal
A first-line approach to help ease the methadone withdrawal process is to taper the dose. By gradually weaning off of methadone, people can stave off debilitating withdrawal symptoms and cravings. Moderate to severe methadone withdrawal management may call for medication. The most common medications associated with methadone withdrawal are clonidine and buprenorphine (Suboxone). These drugs each help reduce the severity of methadone withdrawal symptoms.
Methadone Withdrawal and Death
Death as a result of methadone withdrawal is rare but possible, particularly for people who have used methadone heavily for a long time. Withdrawal-related deaths are likely the consequence of persistent vomiting and diarrhea that go untreated. Vomiting and diarrhea can rapidly cause severe dehydration and massive electrolyte imbalances in the blood, which can cause heart failure.
How Long Does Methadone Stay in Your System?
Methadone has a relatively long half-life (up to 55 hours) compared to other opioids. The length of time that methadone is measurable in your system depends on dosage amount, frequency of use and factors like weight and health status. Methadone will often be present in blood and urine for up to 10–12 days.
People who have a history of opioid use usually metabolize methadone more quickly than opioid-naive people. It is important to understand that the methadone withdrawal timeline is only partially related to how long it takes for the body to remove the drug. Methadone causes chemical changes in your brain that can persist even after the drug is completely out of your system.
In general, one way to estimate the amount of time needed for a drug to be fully metabolized is to multiply the half-life by five. This estimate can be useful for blood and urine screens. However, hair follicle tests can identify drug use for up to several months after last use.
How to Get Methadone Out of Your System
There are no reliable ways to flush methadone out of your system. People with fast metabolisms may produce methadone byproducts slightly faster than people with slower metabolisms. Overall, the only way to get methadone out of your system is to stop taking it and wait.
Detoxing Off Methadone
People who are struggling with methadone use disorder should find a quality rehab center. These centers can evaluate the severity of dependence and provide information about what the client can expect during detox and withdrawal. The most successful recoveries start with a plan, which may include:
• What to take for methadone withdrawals: For most people, following a scheduled taper is an effective way to safely detox. People with moderate or severe dependence may be prescribed clonidine or buprenorphine (Suboxone) to help with withdrawal symptoms.
• Alternative treatments for methadone withdrawal: Individuals should consult their doctor before undertaking any methadone treatment plan that includes over-the-counter medications or herbal remedies, especially if they are on other prescription drugs. Though there is no shortcut for ending detox and withdrawal, steps can be taken to lessen the severity of symptoms:
• NSAIDs for pain management
• St. John’s wort may ease trembling, especially if you restrict caffeine intake. However, St. John’s wort should not be taken if you are on antidepressants, blood thinners or birth control. Ask your doctor if St. John’s wort will interfere with your prescription medications
• Imodium for diarrhea
• Meclizine or dimenhydrinate can quell nausea
• Vitamin supplements (particularly B-vitamins and magnesium) may be helpful, as these vitamins can be depleted with methadone use
• Light exercise may be helpful
• Some studies have found that acupuncture and Chinese herbal medicine can reduce withdrawal symptoms, although the data is preliminary
Outpatient Detox
Many people with mild to moderate methadone dependence have found success in outpatient detox and rehab programs. After an initial evaluation, clinicians can work with you to identify goals, set expectations and deliver a tapering protocol that you can follow at home.
Outpatient detox provides substantial benefits, including access to medical professionals who can address questions or concerns that arise during detox. People with moderate methadone use disorder may be prescribed clonidine or buprenorphine (Suboxone), which can be taken at home to ease symptoms.
Detox at Home
People with mild or moderate methadone dependence can detox at home. However, if you are considering a methadone detox at home, you should discuss your plans with your doctor ahead of time. It also helps to have friends or family who know what you’re doing and can offer support and encouragement. There are no shortcuts in rehab, and home remedies for methadone withdrawal remain unreliable.
Going “cold turkey” is never a recommended plan for methadone rehab. Tapered doses allow your body to gradually wean itself off of the opioid that has been causing chemical and physical changes. People who quit cold turkey suffer from extremely uncomfortable and potentially debilitating withdrawal symptoms. Intense cravings can be difficult to ignore, and relapse is more likely in people who attempt to quit cold turkey.
Finding a Detox Center
Several factors should be considered when you are evaluating rehab facilities:
• Location: Early days of recovery can be difficult. Many people find that distant detox centers allow them to avoid triggers and maximize success.
• Cost: Many insurance programs (including Medicaid in many states) can help with the costs of rehab. Other options include sliding fee scales and grants or scholarships.
• Effectiveness: Many quality rehab centers provide endorsements from satisfied clients, but be cautious of any program that reports 100% success.
• Accreditation: Facilities that are accredited by either The Joint Commission or CARF International guarantee a certain standard of care.
• Staff-to-patient ratio: A low staff-to-patient ratio will ensure that you have access to medical staff.
Our Drug Detox Center
The Recovery Village Palm Beach at Baptist Health
4905 Lantana Rd
Lake Worth, FL 33463
561-340-7269
Key Points: Understanding Methadone Withdrawal and Detox
A few important points to remember about methadone use include:
• Regular use of methadone (even as prescribed) can lead to dependence
• Methadone withdrawal is associated with physical and psychological symptoms that can be profoundly uncomfortable
• PAWS, also known as protracted withdrawal symptoms, may manifest long after you have recovered from acute withdrawal. This is the result of long-term chemical changes that occur in the brain during methadone use, and it does not reflect a failure to recover completely.
• Ending methadone use suddenly (cold turkey) is never recommended. Instead, talk to your doctor about a tapered dose in order to minimize withdrawal symptoms and prevent relapse
• People facing moderate to severe methadone use disorder may be prescribed clonidine or buprenorphine (Suboxone) to relieve discomfort associated with detox and withdrawal.
• Detoxing at home is possible, but it is recommended that you discuss your plans with your doctor in order to establish the correct tapering doses and know what to expect.
• Detox centers provide on-site medical staff who will be there to address questions or concerns that may arise as you undergo methadone detox.
If you or a loved one is struggling with methadone or other opioid use disorders, The Recovery Village Palm Beach at Baptist Health can help. Our multidisciplinary team of experts will guide you through the early days of recovery and get you established on a long-term path to a sober and fulfilling life. Contact us today to learn more about treatment plans that can work well for you.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider. | {
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-584,701,720,958,246,000 | Single Blog Title
This is a single blog caption
Stroke
How Strokes Effect Us
//
Posted By
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Comment0
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Strokes can occur for one of two reasons. It can be the result of a blood clot that has stopped the flow of blood to the brain, or it is when an artery bursts and causes bleeding in the brain. When this happens, the brain does not get the required amount of oxygen and nutrients that it needs. Brain cells will begin to die quickly when this happens. Unless it is treated in time, this can result in permanent loss of body functions controlled by the damaged part of the brain. In some cases, it even results in death.
The Three Types of Stroke
Almost 90 percent of all strokes are Ischemic strokes. This type of stroke is the result of a blood clot restricting blood flow to the brain. Most will survive this type of stroke, but they may have long-lasting cognitive or physical damage.
Hemorrhagic strokes are less common, but they are more dangerous. Roughly 40 percent of hemorrhagic strokes end in death. This type of stroke is caused by a blood vessel rupturing in the brain. Victims usually suffer a sudden severe headache or lose consciousness.
Transient ischemic attacks or TIAs are mini-strokes. They will usually only last 15 minutes at the most. This type of stroke is due to a temporary loss of blood circulation. TIAs need to be taken seriously as they are often a warning sign of a more severe stroke that is about to occur.
Who is at Risk?
Although anyone can suffer a stroke, they are most common in those that are 65 years of age or older. Women are more likely to have a stroke than men. Among all racial groups in the United States, African Americans have the highest risk of experiencing a stroke. This is simply because they are more likely to have high blood pressure or Sickle Cell Anemia which causes blood cells to clump together.
The resulting consequences of a stroke vary from one patient to the next. They can range from confusion and mild weakness to paralysis, impaired speech, impaired vision, or dementia. Over two-thirds of the stroke victims experience some kind of lasting disability.
Causes of Stroke
Over half of all strokes are related to the hardening of arteries. Plaque builds up within the arteries. When pieces of it break off, they can be carried to the brain. This results in a stroke. Blood clots can also build upon the plaque and break off as well with the same results. The following can increase one’s chance of having a stroke.
• High Blood Pressure
• Diabetes
• Smoking
• High Cholesterol
• Obesity
• Kidney Disease
• TIAs or a Previous Stroke
Symptoms of Stroke
Warning signs include numbness, sudden weakness, or trouble seeing. This often only affects one side of the body. You may also notice dizziness, confusion, trouble walking, a sudden headache, or slurred speech.
If a loved one is experiencing signs of a stroke, call 911 immediately. The chances of significant disability and speech damage can be reduced with clot removing surgery or clot-dissolving drugs when administered quickly.
If the symptoms stop, you still need to seek medical attention. Doctors can determine if it was an actual stroke or a warning sign of one to come. Among those that have already had a stroke, 25 percent will experience another one within five years. In addition, anyone that has had a TIA will now have an increased chance of having a higher risk stroke. These more significant strokes can happen within the first few weeks of the TIA.
Treatment
The drug tPA is the best treatment for ischemic strokes. It breaks down the blood clot when administered by IV within three hours of the stroke. This will reduce brain damage. Surgery can also help. Doctors place a tube within the artery to either remove the clot or stop the bleeding.
Medication will play an important part in controlling the causes of the stroke such as diabetes, high blood pressure, or heart disease. Some victims may need nothing more than a daily aspirin. In addition, one needs to adopt a healthier lifestyle. Lifestyle changes included the following.
• Limiting Alcohol
• Stop Smoking
• Maintain a Healthy Weight
• Exercise Regularly
• Eat a Healthy Diet
How can LaBier Assisted Living Help?
LaBier Assisted Living can help you care for a loved one that has suffered a stroke. The staff is highly skilled in helping stroke victims with daily activities such as grooming, hygiene, and managing their medications. Labier can also help with memory care. All of this is provided in a home-like environment supported by quality care and proper nutrition. You will be able to rest assured that your loved one is in good hands.
A senior assisted living facility in Alexandria with over 30 years of experience working with memory care, dementia, stroke, and geriatric clients in the Washington D.C. area. Established in 1997 as an alternative to larger corporate assisted living facilities in Alexandria, VA. Property located at 9417 Macklin Ct, Alexandria, VA 22309, provides a personal and nurturing environment for those that desire to live with the amenities of home.
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-445,679,381,045,305,300 | Can the contraceptive pill cause Telogen Effluvium?
Specific Conditions
Telogen effluvium is a scalp disorder when the hair starts to thin but does not, except under extreme circumstances, lead to baldness.
There are three stages to the hair growing cycle, anagen, when the hair is growing at a rate of around 1 cm a month and can last for up to 7 years, catagen which is the transitional stage lasting around 2 – 4 weeks and finally the telogen which is the resting stage and when the hair is lost. There are many causes that will lead to the hair entering the resting stage before its time thus upsetting the hair’s cycle.
The birth control pill is, as it sounds, a pill to control birth. It has been around for a few decades now but can still cause some controversy in some countries who do not believe birth should be controlled. There are various types of pill but all contain some form of hormone and it is the change of these levels in the body that can upset hair growth. Oestrogen is one hormone that is used to prevent pregnancy and can have an effect on hair growth. At the beginning some experience hair growth as more hair goes into the resting stage.
After this more hair than normal seems to fall out and it can seem as if the hair is thinning when in actual fact it is coming back to normal. However, in others it can cause the thinning of hair known as telogen effluvium but will not cause baldness. Fortunately this is not a permanent condition and once the body has adjusted to the pill hair will come back to normal. In the meantime a change of hairstyle could offer a solution for those who feel that it is affecting their looks.
For some loss of hair can be devastating leading to anxiety and stress and this in turn will also cause hair loss. The body and mind is a complex system that has its own way of ensuring that it is working at its best. As the largest organ the skin is the least important and when there is a change the body’s system will automatically ensure that the vital organs such as the liver and kidneys receive the vital nutrients first.
A good diet is the key to health along with exercise. In order for the body to function it needs a good supply of vitamins and minerals which can be found in many foods. However, not everyone follows this and it causes stress on the body and the hair to suffer. Loss of hair can be a sign either of nutrient deficiency or an illness that has not been detected. Often it is the hair that can lead to a check being carried out as it becomes dull and lifeless and begins to thin. If more hair than normal is seen when brushing or washing then seek the advice of a doctor or hair consultant as there will be a cause.
Taking the pill will also change menstrual periods which in turn can have an effect on the hair as again it is dealing with the body’s hormones. Once it all settles down the hair will come back to its normal state providing the pills are taken as advised and not missed at any time. The general health and well-being of a person also plays a big part as the more vitamins and minerals that are available the more the hair follicles will receive.
There has been much research in recent years into hair and hair growth which has enable specialists to advise on treatments for those losing their hair. There are two medically approved treatments but only one (minoxidil) which can be used by women, which is applied directly onto the scalp which is believed to invigorate the blood supply which carries the supply of nutrients to the hair follicles.
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Ive been having spells of ear ache, waking up out of a deep
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I've been having spells of ear ache, waking up out of a deep sleep with severe deafening ringing in ears and dizziness that I am afraid to move, now i am experiencing another symptom of rawness in the cheeks of my mouth and extreme soreness when I start to eat or drink anything. What's happening to me I am having poor circulation in my leg becuase I have been working at a job that requires me to sit for eight hours, that I have develop large markings on my legs, their are lines in my nails and my toe nail split over a year and still have not repaired it self, help I am a fifty three years old female, and I feel as if I am falling apart, and do know where to start, Should I seek immediately help and to which doctor? help i am very worried.
Hi,
Likely cause of your symptoms is what is known as Meinere's disease. You need to see an ENT specialist regarding this for treatment. Other considerations are labryinthitis, neurological complications, side effect of medications. I would schedule an appointment with the doctor as soon as you can.
If you have any further questions, please ask. If not, please click accept.
Regards
Customer: replied 5 years ago.
Dr. Singh,
Would this Meinere disease also causes the soreness of mouth?
It would cause fullness in the ears and jaw. The mouth soreness could be a result of a nutritional deficiency, gingivitis, infection, etc. You would benefit from seeing your regular doctor and have this examined and blood tests for those causes. In the meantime you may benefit from drinking plenty of fluids and a daily multivitamin.
If you have any further questions, please ask. If not, please click accept.
Regards
Dr. Singh and 3 other Health Specialists are ready to help you | {
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1,685,223,914,840,911,600 | When you select a snack, or add food to your dinner plate, how often do you consider the number of servings you are consuming? Maintaining a healthy weight doesn't mean you must give up all of your favorite foods. You can build a healthy habit by limiting your servings of specific food groups--and sticking with a single serving size of desserts and other high-calorie favorites.
Serving Size Goals by Food Groups
To stick to proper serving sizes, you must first know the number of recommended daily servings for each food group. This varies according to your age, gender, level of activity, and whether you would like to lose weight, gain weight, or maintain your current weight.
The Mayo Clinic's Healthy Weight Pyramid tool allows people to calculate a personalized daily calorie goal, including information about how many servings of each food group to eat. For example, let's consider an individual whose daily calorie goal is 1,600 calories per day. This person should eat five or more servings of vegetables, five or more servings of fruits, six servings of carbohydrates, five servings of protein/dairy, and three servings of fats. But remember, this is only an example. The Mayo Clinic recommends modifications to the number of servings if your calorie goals are higher or lower.
What's a Serving Size?
Don't be intimidated by determining the correct serving size. You need not measure servings exactly, as long as you use some easy points of reference. Just looking at a food can provide helpful clues. The Mayo Clinic suggests that you keep in mind the following when determining a serving size:
• One serving of vegetables is about equal to the size of a baseball, such as a medium bell pepper or half a cup of cooked carrots.
• One serving of fruits is about the size of a tennis ball, such as a medium-sized orange or apple.
• One serving of carbohydrates is roughly the size of a baseball cut in half, such as a small bun or half a cup of cooked pasta.
• One serving of diary or protein products varies based on the type of food. For cheese, a single serving is similar to the size of four dice. For chicken, a 2.5-ounce serving is similar to the size of a deck of cards. A single egg is a serving, while a measuring cup full of 1 percent milk also represents a serving.
• One serving of fat is equal to about two teaspoons of mayonnaise or ranch dressing. A single teaspoon of olive oil also represents a serving of fat.
You might be worried that serving sizes sound quite small. But remember, you need multiple servings from each category every day.
Be Extra Careful with Sweets
People tend to eat much more than a single serving when it comes to sweets, like soda, candy, cookies, and cakes. The Mayo Clinic recommends limiting your daily intake of sugary foods to one serving per day--or approximately 75 calories. For example, a half of a can (six ounces) of sweetened cola equals one serving. Four hard candy peppermints also equal one serving. If it helps, you can think about averaging out your intake of dessert foods over the week. You should always aim for less than 500 sweet calories a week.
Build a Better Habit: Keep Track of Serving Sizes
Now that you know the size of a typical serving of various foods, consider how many servings you generally eat at a single meal. If you don't keep track of serving sizes, it's easy to overindulge. Imagine cooking yourself a big dinner of spaghetti and meatballs: If you don't pay attention to serving sizes, you could easily eat more than your recommended amount of carbohydrates in a single meal. Remember, learning to manage your weight doesn't mean you have to give up your favorite foods. But if you want to stay healthy, you may need to limit the number of servings you eat at each meal. | {
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-2,533,659,811,455,804,400 | Therapeutic effect of zinc-containing calcium phosphate suspension injection in thermal burn-rats
Authors
• How to cite this article: Otsuka M, Shikamura M, Otsuka K, Sogo Y, Ito A. 2013. Therapeutic effect of zinc-containing calcium phosphate suspension injection in thermal burn-rats. J Biomed Mater Res Part A 2013:101A:1518–1524.
Abstract
The aim of this study was to evaluate the efficacy of suspensions of zinc-containing tricalcium phosphate (TCP) in the healing of thermal burns in rats. β-ZnTCP containing 10 mol % zinc, α-ZnTCP containing 0.9 mol % zinc, and ZnSO4·(H2O)7 (ZnSO4) were used. The injections were prepared to suspend ZnSO4, α-ZnTCP, and β-ZnTCP powders in 2 mL of 1% sodium alginate saline solution containing 2 mg of Zn. In vitro Zn release rates were measured in simulated body fluid. The release of Zn from ZnSO4 was very fast, but that from α-ZnTCP and β-ZnTCP was slowed by transformation to hydroxyapatite. The suspensions were injected into group C (control), D1 (ZnSO4), D2 (α-ZnTCP), and D3 (β-ZnTCP) rats after thermal burns treatment for 3 h. The area under the curve for the plasma Zn for group D1 was the highest, and the order was groups D1 > D2 ≥ D3 ≥ C. The wounded area (Aw) of group D1 had almost the same profile as that of group C, and the Aw at 18 days was about 20%. In contrast, the Aw of group D2 and D3 decreased, and on day 15 was 8% and 37%, respectively. The results indicated that the healing process was shorter in the rats given α-ZnTCP and β-ZnTCP than those given ZnSO4 or the control. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2013.
INTRODUCTION
Trace elements, such as iron, iodine, chromium, copper, zinc, and selenium, are essential to many animal species.1 Severe trace element imbalances can be considered risk factors for several diseases. Deficiencies of iron and iodine cause anemia and hypothyroidism. Fifty micrograms to 20 mg per day of those elements are necessary, because the elements serve as structural or catalytic components of large molecules in tissues. Zinc (Zn) is a cofactor for more than 200 enzymes and present in nearly every cell type in the body.2 Because Zn is known to be essential for all highly protein synthesis, proliferating, and differentiation cells in the human body, Zn promotes the formation of tissues and organs.
As bone has higher Zn concentrations than any other tissue, bone generation is stimulated by Zn ions. However, high Zn concentrations can have serious side effects on cells.3 Therefore, the range of Zn concentrations for an optimal biological response, or therapeutic index, would be very narrow. Kawamura et al.4, 5 used Zn-containing calcium phosphate ceramics as novel inorganic biomaterials in rabbit femora. They reported that the Zn-containing calcium phosphate ceramics promoted the proliferation of MC3T3-E1 cells without a cytotoxic effect up to a zinc content of 1.20 wt %, releasing zinc up to a concentration of 3.53 mg/L. However, the viewpoint of cytotoxicity, a zinc content of 1.20 wt % was also the upper limit for the implantable ceramics. Over a zinc content of 1.20 wt %, the ceramics were cytotoxic owing to elevated zinc release from the device. The slow release of Zn from the ceramics stimulated bone cells and induced bone generation.4, 5 Since then, an injectable suspension containing β-tricalcium phosphate (TCP) powder with Zn has been developed and applied to an animal model of osteoporosis where it was effective at recovering bone mineral density.6–8
In contrast, Zn also has an important role in the healing of thermal burns, immune system functioning, and maintaining. Ibs and Rink9 reported that a variety of in vivo and in vitro effects of zinc on immune cells mainly depend on the zinc concentration. All kinds of immune cells, such as natural killer cells, T cells, and B cells show decreased function after zinc depletion. The impaired immune functions due to zinc deficiency are shown to be reversed by an adequate zinc supplementation. In contrast, excessed Zn concentration by high dosages of Zn also evoke negative effects on immune cells and a direct chemotactic activation of neutrophil granulocytes, and those phenomena are similar to those observed with Zn deficiency. In optimized Zn concentration, Zn suppresses natural killer cell killing and T-cell functions whereas monocytes are activated directly. Optimized Zn concentration by controlled Zn release might, therefore, benefit the healing of thermal burns thorough controlling of immune function to prevent inflammation.
In this article, we applied suspension injections of the candidate Zn-related materials for therapeutic treating thermal burns of Zn-deficient rats, and evaluated hearing process as the first step. Furthermore, to improve the quality of life of the patients during therapeutic treatment, we considered that their dosage forms of the candidate compounds changed to transdermal therapeutic dosage form to avoid injection into injury sites as future purpose.
MATERIALS AND METHODS
Materials
A powder of β-TCP containing 10 mol % Zn (β-ZnTCP, 6.17% (w/w) Zn, [Ca2.7Zn0.3(PO4)2]) was prepared as described previously.4, 10 Starting materials were high-purity calcium carbonate (99.99 wt %; Ube Materials, Ube, Japan), reagent-grade phosphoric acid (85 wt %; Nakalai Tesque, Kyoto, Japan), and reagent-grade zinc nitrate hexahydrate (98 wt %; Kanto Chemical Co., Tokyo, Japan). The calcium carbonate was heated at 1000°C for 3 h to obtain calcium oxide. The calcium oxide was added to ultrapure water to obtain a suspension of calcium hydroxide (0.6 Ca mol/L). The suspension was mixed with a zinc nitrate hexahydrate solution (0.5 Zn mol/L) at a molar ratio of 0.10 in Zn/(Ca + Zn). The suspension was vigorously stirred at room temperature by bubbling with nitrogen gas. A phosphoric acid solution (0.6 P mol/L) was added dropwise to the suspensions to produce a gelatinous precipitate. The pH was maintained at 6.5 for several hours by adding a 3% ammonia solution. The reaction mixture was stirred for several days. The precipitate was filtered, dried at 100°C and calcined at 850°C for 3 h followed by pulverization. A powder of α-TCP containing 0.9 mol % Zn (α-ZnTCP, 0.55% (w/w) Zn, [Ca2.973Zn0.027(PO4)2]) was prepared by mixing the β-ZnTCP and pure β-TCP powders at a weight ratio of 11:109, and heating at 1450°C for 5 h followed by pulverization. The heat treatment and pulverization was repeated twice. The β-ZnTCP and α-ZnTCP powders were ground in a high-purity alumina mortar and sieved to a size smaller than 38 μm. Sodium alginate and zinc sulfate hepta-hydrates (ZnSO4) were purchased from Wako Pure Chemical Industries (Osaka, Japan). Other reagents were of analytical grade and used without further purification. All suspension injections were obtained by mixing the powders of ZnSO4, α-ZnTCP, and β-ZnTCP with 2.0 mL of 1% sodium alginate saline solution. The content of Zn in each suspension injections was adjusted to 2.0 mg Zn per animal experiment.
Characterization of calcium phosphates
α-ZnTCP and β-ZnTCP were characterized by powder X-ray diffraction (XRD) and specific surface area measurements. Powder XRD patterns were recorded using a RINT Ultima 3 diffractometer (Rigaku, Tokyo, Japan, conditions; target: Cu, filter: Ni, voltage: 40 kV, current: 40 mA, and receiving slit: 0.1 mm). The specific surface area of dried samples was measured by the nitrogen adsorption method with a surface measurement apparatus (Monosorb, Quantachrome Corporation, Boynton Beach, FL). The powders (about 1.0 g) were dried and degassed in a vacuum at 80°C for at least 1 h in glass sample cells before measurements. Specific surface area (m2/g) was calculated three times for each powder by the single-point BET method.
In vitro Zn release test
The amount of Zn released from the α-Zn-TCP and β-Zn-TCP powders was measured as follows: simulated body fluid6 (SBF) comprised of 142 mM Na+, 5.0 mM K+, 1.5 mM Mg2+, 147.8 mM Cl, 2.5 mM Ca2+, 4.2 mM HCO3, 0.5 mM SO42−, and 1.0 mM HPO42+, (pH 7.25) was used as the dissolution medium. Samples (10 mg) and 10 mL of SBF containing 10 mg/100mL Ca2+ were introduced into 50-mL test tubes with a cap. Each tube was fixed on a sample holder in a thermostatically regulated water bath maintained at 37.0 ± 0.1°C, and shaken at 90 rpm. During the release tests, the entire dissolution medium was replaced with 5.0 mL of fresh buffer at various intervals.
Zn measurements
Zn concentrations were determined at 213.8 nm by atomic absorption spectrometry (type 180-70, Hitachi Co. Ind., Tokyo, Japan). The in vitro data shown represent the averages of three measurements.
Animal experiments (in vivo test)
All animal experiments and maintenance were performed under conditions approved by the Animal Research Committee of Kobe Pharmaceutical University. Seven-week-old male Whister rats around 120 g in weight purchased from Japan SLC, Shizuoka, Japan were used. The rats were maintained in a light (12 h light/dark) and temperature-controlled (25 ± 2°C) barrier facility throughout the study. The rats were randomly assigned to four groups: C, D1, D2, and D3 (four rats per group). All rats were fed a Zn-deficient diet (shown in Table I) for 1 week. The Zn-deficient and normal diets were supplied by Clea Co. (Tokyo, Japan). The hair on the back of the rats was removed under anesthesia by inhalation of ether, and the burn treatment was performed by pushing a glass bottle (with a flat bottom, 10 mm in diameter and 20 mL in volume) containing hot paraffin at 100°C for 10 s On starting the injection study after the burns treatment for 3 h, the rats in groups D2 and D3 were subcutaneous (s.c.) injected twice at upper and lower sites 5 mm distance from the edge of burns into the back with 2 mL volume of the suspensions containing α-ZnTCP or β-ZnTCP powders by using a needle (No. 26 gage), respectively, whereas the rats in group D1 were injected at upper and lower sites 5 mm distance from the edge of burns with 2 mL volume of the ZnSO4 solution divided 14 times for 14 days, because one time injection of the ZnSO4 solution induced necrosis on the injection sites. After the injection, the wounded site was cleaned with a 70% alcoholic solution, covered with sterilized cotton cloth wetted with the 70% alcoholic solution and then, fixed using flexible tape. The rats in groups D1, D2, and D3 were assigned to receive the Zn-deficient diet after starting the injection study for 3 weeks. After the burns treatment, the rats in group C were assigned to receive an injection of saline with 1% sodium alginate, and given a normal diet. Blood samples were obtained at predetermined time intervals from a tail vein under anesthesia. A rat in group C was scarified by another rat during experiments, so the number of rats in group C was reduced to three.
Table I. Zn-Deficient Diet Used
DietRemarksVitamin D (IU/100 g)Ca (mg/100 g)Zn (mg/100 g)
1. The data in the table are from Clea Co. (Japan) and Oriental yeast Co. (Japan).
DZnVit. D and Zn-deficient diet2320.08
NNormal diet15811205.28
Evaluation of therapeutic scores of thermal burns
The thermal burns were photographed with a digital camera, and the scab was assigned a therapeutic score by imaging computer software for Windows (Image J, National Institute of Health).
Measurements of plasma alkaline phosphatase activity
Plasma alkaline phosphatase (ALP) activity was determined using the phenyl phosphoric acid method11 with a UV/VIS spectrometer (type UV160, Shimadzu Co. Ind., Kyoto, Japan) at 500 nm. The kits used were supplied by Wako Chem. Co, Tokyo, Japan. The in vivo data shown represent the average of four measurements each
Statistical testing
All data are the mean and standard deviation of 3–6 measurements. The statistical analysis was conducted using analysis of variance followed by Tukey's post hoc tests, and p-values of 0.005–0.05 were considered significant.
RESULTS
Characterization of materials
Figure 1 shows the powder XRD profiles for α-ZnTCP and β-ZnTCP. α-ZnTCP had significant diffraction peaks at 2θ = 12.3°, 23.8°, and 30.8° corresponding to those for α-TCP with a high crystallinity. β-ZnTCP had significant diffraction peaks at 2θ = 13.5°, 28.1°, and 31.5° corresponding to those for β-TCP with a high crystallinity although the peak positions are slightly shifted toward a higher angle, because it contained 10 mol % Zn as reported previously.4
Figure 1.
X-ray diffraction patterns of α-ZnTCP and β-ZnTCP powders. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Figure 2 shows SEM photographs of α-ZnTCP and β-ZnTCP. The primary particles of β-ZnTCP were less than 1 μm in diameter, and those were aggregated forming secondary particles around 50 μm in diameter with a jagged surface. In contrast, the α-ZnTCP particles had a smooth surface with many dimples, and were around 40–50 μm in diameter. Specific surface areas of α-ZnTCP and β-ZnTCP were 0.303 and 6.37 m2/g, respectively, and the result was consisted with the SEM observations.
Figure 2.
Morphological difference between α-ZnTCP and β-ZnTCP powders.
In vitro Zn release from ZnTCPs in SBF
Figure 3 shows the in vitro Zn release profiles for the Zn-related powders in SBF. The release of ZnSO4 was very fast at the initial stage, with over 90% of Zn dissolved within 2 h, suggesting that ZnSO4 was highly soluble in water. In contrast, the amounts of Zn released from α-ZnTCP and β-ZnTCP were around 25% and 5% after 24 h. The order of dissolution rates for the Zn-related materials was ZnSO4 > α-ZnTCP > β-ZnTCP.
Figure 3.
The effect of crystalline structure on in vitro Zn release from Zn related material powders in SBF. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Effect of crystalline structure of ZnTCP suspension on in vivo plasma Zn levels
To investigate the therapeutic effect of in vivo Zn release on the healing of thermal burns, ZnTCP suspensions were injected into the rats. Figure 4 (left) shows plasma Zn concentration profiles in the rats with thermal burns and healthy (control) rats measured using atomic absorption. The plasma Zn levels in the ZnSO4-administrered model (group D1) increased rapidly and reached 2.8 μg/mL on day 6. Thereafter, they decreased, to around 1.7 μg/mL on days 8–15 and then to around 0.5 μg/mL on day 21. In contrast, the plasma Zn levels in the α-TCP-administered model (group D2) increased to 1.7 μg/mL on day 5, then decreased to less than 0.5 mg/mL after 8 days.
Figure 4.
The effect of crystalline structure on the plasma Zn concentration profiles (left) and Zn-AUC (right) after the s.c. administration of various Zn-related materials in rats with thermal burns. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
The plasma Zn levels in the β-TCP-administered model (group D3) were to almost the constant values between 0.5 and 1.2 μg/mL on days 3–7, and then decreased to less than 0.5 mg/mL after 8 days. The levels in the nonadministered model (group C) were to almost the same profiles of the group D3, and those were the constant values between 0.5 and 1.2 μg/mL on days 3–7, and then decreased to less than 0.5 mg/mL after 8 days.
The area under the curve for the plasma Zn concentration (Zn-AUC) after 21 days is summarized in Figure 4 (right). The Zn-AUC was significantly higher for group D1 than groups D2, D3, and C. The Zn-AUC of group D1 was the highest, and the order was groups D1 > D2 ≥ D3 ≥ C. However, the Zn-AUC for groups D2 and D3 were not significantly different from that of group C. These results suggested that the ZnSO4 solution increased, but the α-ZnTCP and β-ZnTCP suspensions did not affect, plasma Zn levels.
Effect of the crystalline structure of ZnTCP suspension on alkaline phosphatase activity
Because plasma ALP activity is an important parameter of the healing process, it was measured in the rats with thermal burns.12 Figure 5 (left) shows that before the thermal treatment, the ALP level in the control group (group C) was around 28 IU/L, but after the treatment it fluctuated between 20 and 40 IU/L depending on the conditions. The ALP level of group D1 and D2 rats (ZnSO4 and α-ZnTCP) were higher than that of the control group (group C), and showed a maximum of 48 IU/L at 4 days and 46 IU/L at 5 days, respectively. In contrast, the ALP levels of group D3 (β-ZnTCP administration) were almost the same as those of the control rats (group C), except for 47 IU/L at 21 days.
Figure 5.
The effect of crystalline structure on the ALP profiles (left) and ALP-AUC (right) after the s.c. administration of various Zn-related materials in rats with thermal burns. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
The area under the curve for ALP (ALP-AUC) after 21 days is summarized in Figure 5 (right). The ALP-AUC was significantly higher for group D1 than groups D1, D2, and C. The ALP-AUC of group D1 was the highest, and the order was groups D1 > D2 = D3 ≥ C. However, the ALP-AUC for groups D2 and D3 were not significantly different from that of group C. These results suggested that the ZnSO4 solution activated all body cells, but the α-ZnTCP and β-ZnTCP suspensions did not.
Effect of the crystalline structure of ZnTCP suspension on healing of thermal burns
Figure 6 shows the healing of wounded skin (the D2 group) after the α-ZnTCP injection. After thermal treatment, the area was deformed and discolored. After 1 day, it formed a blister, the area was drying and then after 4 days it formed a sable. The sable decreased in area with time, and eventually dropped off after 16 days.
Figure 6.
The change of burns-treated skin (the D3 group) after the β-Zn-TCP suspension was injected. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
To quantitatively evaluate the healing process, the wounded area (Aw) of rat skin was measured using an imaging analyzer. Figure 7 shows the Aw profiles of the thermal burns model after the s.c. administration of various Zn-related material suspensions. The Aw of group C increased about 30% for 2 days, then, decreased with time. The Aw on day 10 and 20 was about 75% and 10%, respectively. The Aw of group D1 given ZnSO4 had almost the same profile as that of group C, and the Aw at 18 days was about 20%. In contrast, the Aw of group D2 given α-Zn-TCP increased about 15% for 1 day, and then decreased. The Aw at 10 and 15 days was 45% and 8%, respectively. The Aw of group D3 given β-Zn-TCP increased about 20% for 1 day, and then decreased. The Aw at 10 and 15 days was 60% and 37%, respectively. The result indicated that the healing process in the groups given the α-ZnTCP and β-ZnTCP suspensions was shorter than that in the groups administered ZnSO4 or the control.
Figure 7.
The effect of crystalline structure on the Aw profiles of the thermal burns model after the s.c. administration of various Zn-related materials. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
The time required for the sable to fall from the skin (Toff) was defined as a therapeutic score for the repair of thermal burns. Toff was evaluated based on visible observations and values are shown in Figure 8. The result indicated that the Toff was 14.5 days, the best for the α-ZnTCP suspension, and their order was α-ZnTCP > β-ZnTCP > ZnTCP > nontreatment.
Figure 8.
The effect of crystalline structure on Toff of the thermal burns model after the s.c. administration of various Zn-related materials. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
DISCUSSION
In vitro Zn release tests (Fig. 3), the Zn release from ZnSO4 was very fast, reflecting high solubility of ZnSO4 in water. In contrast, the Zn release from α-ZnTCP and β-ZnTCP were very slow (Fig. 3), respectively. Specific surface areas of β-ZnTCP was about 20 times larger than that of α-ZnTCP, but the Zn release of β-ZnTCP was much slower than that of α-ZnTCP. Because, α-ZnTCP and β-ZnTCP did not directly dissolve in saturated calcium and phosphate solutions, such as a SBF, but those transformed gradually into hydroxyapatite, stable form (the data not shown), and then Zn ion was released slowly from the crystalline solids (Fig. 3), respectively. The Zn release rate of α-ZnTCP was significantly higher than that of β-ZnTCP, because β-ZnTCP transformed into α-ZnTCP at high temperature as mentioned in the experimental section, indicating that the α-ZnTCP had higher chemical potential than the β-ZnTCP. In in vivo tests, ZnSO4 sample solutions were injected to the group D1 (ZnSO4-administrered model) divided 14 times for 2 weeks to avoid too high plasma Zn concentration, but the maximum plasma Zn levels was significantly high at 2.8 μg/mL on day 6, the levels were still high at around 1.7 μg/mL on days 8–15 (Fig. 4, left). In contrast, the group D3 had only initial shots, however, the profile of the plasma Zn levels in the group D3 (the β-TCP administered) was almost the same as that of the group C (no administrated), and much lower than that of group D1. The profile of the group D2 (the α-TCP administered) was between the group D1 (ZnSO4 administrated) and D3 (the β-TCP administered). Because a too high plasma Zn concentration induces serious side effects on cells, the range of Zn concentrations for an optimal biological response, or the therapeutic index, is very narrow, so, there might be a high risk of side effects from ZnSO4 administration. In contrast, the α-TCP and the β-TCP administrations might be controlled their plasma Zn levels depended on their material characteristics. Because the in vitro Zn release profiles of ZnSO4, α-ZnTCP and β-ZnTCP was significantly different (Fig. 3), reflecting their solubility in water, the Zn-AUC of ZnSO4 administration was about two times higher than that for α-ZnTCP and β-ZnTCP (Fig. 4, right).
In contrast, Krötzsch et al.12 reported that the ALP activity was an acute inflammation marker because the enzyme levels were increased in acute wounds, but not in chronic inflammation processes. They concluded that the ALP activity was an important factor to be considered in acute inflammation in wound injury and their healing process in chronic wound repair. So, the ALP of the rats with thermal burns was measured and evaluated as an index of cell activity. The ALP profiles of all rats were fluctuated (Fig. 5, left) because the ALP values were slightly affected by fluctuation of phosphate and calcium levels in plasma, but that of the group D1 rats (ZnSO4) was significantly higher than those of the other groups (D2, D3, and C).
The ALP-AUC of ZnSO4 (Fig. 5, right), was significantly different from those of α-ZnTCP, β-ZnTCP, and C, because cell activity was linked with a suitable plasma Zn level, and a too high plasma level reduced cell activity because a too high plasma Zn concentration can have serious side effects on cells.13 The range of Zn concentrations for an optimal biological response, or the therapeutic index, is very narrow, so, there might be a high risk of side effects from by ZnSO4. Because the maximum Zn plasma concentrations for α-ZnTCP and β-ZnTCP (Fig. 4, left) were much lower than that for ZnSO4 administration reflecting a controlled slow in vitro Zn release from the calcium phosphate devices (Fig. 3), the slow Zn release patterns of α-ZnTCP and β-ZnTCP were significantly effective on therapeutic score, the Aw at local tissue sites (Figs. 7 and 8), and might be accelerated to repair wounded area by thermal burns treatment. The result suggested that ZnSO4 did not affect the cells at the local tissue site because Zn ions distributed rapidly to the whole body, but the α-ZnTCP and β-ZnTCP suspensions might be activated local cells reflecting their slow release patterns. In initial stage at day 5, the difference between the Aw values of optimal Zn released (D2 and D3) and the control groups (C) were not significant, but the former were slightly lower than the latter, so, it may be that the impaired immune functions on the wounded site at initial stage was inhibited by an adequate zinc supplementation from the ZnTCP suspension.
CONCLUSIONS
The α-ZnTCP and the β-ZnTCP consisting of a calcium phosphate matrix incorporating Zn ions were meta-stable calcium phosphates under a physiological condition, and exhibited a slow Zn release in SBF from the matrices. This study demonstrated the efficacy of the ZnTCP suspension in shortening the healing of thermal burns when injected in zinc-deficient rats. These materials allow for the possibility of controlling systemic and local effects through the period of administration. The results indicated that the therapeutic effect of the slow release of Zn from calcium phosphate materials was significantly more effective than the injection of Zn solutions. The materials could provide for the better treatment of thermal burns.
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Patent Searching and Data
Title:
USE OF AMPHIPHILIC COMPOUNDS FOR CONTROLLED CRYSTALLIZATION OF STATINS AND STATIN INTERMEDIATES
Document Type and Number:
WIPO Patent Application WO/2010/069593
Kind Code:
A1
Abstract:
The invention relates to an improved process comprising amphiphilic compounds for the crystallization of an intermediate used in the process for the preparation of statins and statin intermediates.
Inventors:
KLJAJIC ALEN (SI)
ZUPET ROK (SI)
Application Number:
PCT/EP2009/009149
Publication Date:
June 24, 2010
Filing Date:
December 18, 2009
Export Citation:
Click for automatic bibliography generation Help
Assignee:
KRKA D D NOVO MESTO (SI)
KLJAJIC ALEN (SI)
ZUPET ROK (SI)
International Classes:
C07C59/11; C07D207/337; C07D309/30; C07D405/06
Domestic Patent References:
WO2006079611A12006-08-03
WO2003068739A12003-08-21
WO2001036384A12001-05-25
WO1997003960A11997-02-06
WO1998004543A11998-02-05
WO1999032434A11999-07-01
WO2000049014A12000-08-24
WO2007099561A12007-09-07
WO2004108691A12004-12-16
WO2006097909A12006-09-21
Foreign References:
US5216174A1993-06-01
US5245047A1993-09-14
US5248793A1993-09-28
US5397792A1995-03-14
US5342952A1994-08-30
US5298627A1994-03-29
US5446054A1995-08-29
US5470981A1995-11-28
US5489690A1996-02-06
US5489691A1996-02-06
US5510488A1996-04-23
EP0114027A11984-07-25
EP0363934A11990-04-18
EP0521471A11993-01-07
EP0033538A21981-08-12
EP0022478A11981-01-21
DE3051175C21989-12-21
US5280126A1994-01-18
US6476235B22002-11-05
US6545153B12003-04-08
Other References:
MAHMOUD ET AL.: "Crystal modification of calcium sulfate dihydrate in the presence of some surface-active agents", JOURNAL OF COLLOID AND INTERFACE SCIENCE, vol. 270, 2004, pages 99 - 105, XP002567945
K.-M. CHENG ET AL., TETRAHEDRON LETTERS, vol. 28, no. 2, 1987, pages 155 - 188
Attorney, Agent or Firm:
WESTENDORP I SOMMER (München, DE)
Download PDF:
Claims:
Claims
1.) A process for the crystallization of a compound of formula Ia-If: wherein Ri and R2 may be the same or different and are selected from any one or more of H, Ci-Ce alky] which may be straight or branched, unsubstituted or substituted with a halogen group, Ci-Ce alkoxy group, or Ri and R2 together represent an alkylidene group of the formula CR3Rb wherein R3 and Rb may be the same or different and are selected from any one or more of a Ci-Cn alkyl group, and R3 is selected from any one or more of a C]-Ce alkyl group; and in case of compound Id R3 may also represent a hydrogen atom,
in the presence of an amphiphilic additive.
2.) The process according to claim 1, characterized in that the amphiphilic additive is an amine, preferably is a quarternary amine salt, in particular a quarternary amine salt represented by formula Rp-(NRqR1-R5) Y", wherein Rn, Rr, Rs may be the same or different and are independently selected from the group consisting of methyl and ethyl, Rp is selected from straight chain alkyl groups having 14 to 18 carbon atoms, preferably 16 carbon atoms, and Y" is selected from the group consisting of Br" and Cl", more preferably cetyltrimethylammonium bromide or cetyltrimethylammonium chloride.
3.) The process according to any of the preceding claims, characterized in that the compound Ia is tert-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2- isopropyl-4-phenyl-l//-pyrrol-l-yl)methyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate.
4.) The process according to any of the preceding claims, wherein said compound is present in a mixture, in particular in a solution, which comprises solvent and said compound, or is present in a reaction mixture.
5.) The process according to any of the preceding claims characterized in that the solvent is selected from any one or more of toluene or other aromatic hydrocarbons, tetrahydrofurane, or cyclic and acyclic ethers, ethyl acetate and other esters of alcohols with carboxylic acids, 2- butanone, acetone, and other cyclic and acyclic ketones, methanol, etanol, /so-propanol, n- propanol, ϋo-butanol, sec-butanol, H-butanol and other alcohols, acetonitrile, DMSO, DMF and other amides, hexane, heptane, and other acyclic and cyclic aliphatic hydrocarbons, aliphatic nitriles, or binary mixtures thereof, preferably isopropanol or ethyl acetate.
6.) The process according to any of claims 1 to 2 and 4 to 5, characterized in that the compound Ia is [R-(R*,R*)]-2-(4-fluorophenyl)-β,δ-dihydroxy-5-(l-methylethyl) phenyl-4- [(phenylamino)carbonyl]-l//-pyrrole-l-heptanoic acid tertiary butyl ester.
7.) The process according to any of claims 1 to 2 and 4 to 5, characterized in that the compound Ic is ter/-butyl 2-((4R,6S)-6-((E)-2-(4-(4-fluorophenyl)-6-isopropyl-2-(N- methylmethylsulfonamido)pyrimidin-5-yl)vinyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate.
8.) The process according to any of claims 1 to 2 and 4 to 5, characterized in that the compound Id is (3R,5R)-3,5-dihydroxy-7-((lS,2S,6R,8S,8aR)-8-hydroxy-2,6-dimethyl- 1 ,2,6,7,8,8a-hexahydronaphthalen- 1 -yl)heptanoic acid.
9.) The process according to any of claims 1 to 2 and 4 to 5, characterized in that the compound Ie is lovastatin.
10.) The process according to any of claims 1 to 2 and 4 to 5, characterized in that the compound If is simvastatin.
11.) The process according to any of claims 1 to 10 characterized in that the percentage of the amphiphilic compound used with regard to compound Ia to If is between 0.01% (w/w) and 20% (w/w).
12.) Use of cetyltrimethylammonium bromide for the purification of tert-buty\ 2-((4R,6S)- 6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2-isopropyl-4-phenyl-l//-ρyrrol-l-yl)methyl)-2,2- dimethyl-l,3-dioxan-4-yl)acetate, [R-(R*,R*)]-2-(4-fluorophenyl)-β,δ-dihydroxy-5-(l- methylethyl) phenyl-4-[(phenylamino)carbonyl]-l//-pyrrole-l-heptanoic acid tertiary butyl ester, tert-buty\ 2-((4R,6S)-6-((E)-2-(4-(4-fluorophenyl)-6-isopropyl-2-(N- methylmethylsulfonamido)pyrimidin-5-yl)vinyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate, (3R,5R)-3,5-dihydroxy-7-((lS,2S,6R,8S,8aR)-8-hydroxy-2,6-dimethyl-l,2,6,7,8,8a- hexahydronaphthalen-l-yl)heptanoic acid, lovastatin, 2-((4R,6S)-6-((E)-2-(3-(4- fluorophenyl)-l-isopropyl-lH-indol-2-yl)vinyl)-2,2-dimethyl-l ,3-dioxan-4-yl)acetate or simvastatin.
13.) 7er/-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2- isopropyl-4- pheny]-l//-pyτrol-l-yl)methyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate containing less than 0.10 % (w/w) oflmpl.
14.) Tert-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2- isopropyl-4- phenyl-l//-pyrrol-l-yl)methyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate containing less than 0.10 % (w/w) oflmp2.
15.) Use of amphophilic compound(s) as promotor(s) for crystal growth in the crystallization of statin intermediates
16.) Use of amphophilic compound(s) for crystallizations for production of materials with good nitrations properties or use of amphiphilic compound(s) as crystallization process additive(s) for improving the filterability of crystalline particles obtained by a crystallization process.
17.) Use of cetyltrimethylammonium bromide for the preparation of atorvastatin hemi- calcium.
Description:
USE OF AMPHIPHILIC COMPOUNDS FOR CONTROLLED CRYSTALLIZATION OF STATINS AND STATIN INTERMEDIATES
Field of the Invention
The invention relates to an improved process for the crystallization of organic compounds, which may be intermediates used in the process for the preparation of statin type molecules.
Background of the Invention and Technical Problem
Statins, of which the representative examples may be selected from rosuvastatin, cerivastatin, atorvastatin, fluvastatin, pravastatin, bervastatin, dalvastatin or their analogs or pravastatin, simvastatin, lovastatin or their analogs share a characteristic structure, consisting of respectively a heptenoic or heptanoic acid moiety (free acid, salt or lactone) connected to the aromatic or alicyclic core. Biological activity of statins is closely related to their stereochemistry, especially configuration at the chiral atoms of said heptenoic or heptanoic acid moiety.
Crystalline and amorphous statins can be used for the preparation of pharmaceutical formulations. When amorphous active compounds are used it is important to have a technology with an efficient purification step for advanced intermediates or active pharmaceutical ingredient (API), because standard crystallization procedures for purification cannot be applied productively.
Atorvastatin, [R-(R* ,R*)]-2-(4-fluoro[rho]henyl-[beta],[delta]-dihydroxy-5-(l-me thylethyl)-3- phenyl-4-[(phenylamino)carbonyl]-17/-pyrrole-l-heptanoic acid, is pharmacologically active as a hypolipidemic and hypocholesterolemic agent. In particular, atorvastatin is useful as a selective and competitive inhibitor of the enzyme 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme that converts 3- hydroxy-3-methylglutaryl- coenzyme A to mevalonate, a precursor of sterols such as cholesterol. United States Patent Numbers 5,216,174; 5,245,047; 5,248,793; 5,397,792; 5,342,952; 5,298,627; 5,446,054; 5,470,981 ; 5,489,690; 5,489,691; 5,5109,488; WO97/03960; WO98/04543 and WO99/32434 which are herein incorporated by reference, disclose various processes and key intermediates for preparing atorvastatin.
Fluvastatin, of which the full chemical name is 7-[3-(4-fluorophenyl) -l-(l-methylethyl) -\H- indol-2-yl]-3, 5-dihydroxy-hept-6-enoic acid, as well as its sodium salt, are disclosed in EP- A-O 114 027. From the state of the art, methods for the preparation of fluvastatin and its salts are already known, e.g. from K.-M. Cheng et al. Tetrahedron Letters, 1987, Vol. 28, No. 2, 155-188, or EP 0363 934.
Rosuvastatin or 7-[4-(4-fluorophenyl) -6-(l -methyl ethyl)- 2-(methyl-methylsulfonyl-amino)- pyrimidin-5-yl]- 3,5-dihydroxy-hept-6-enoic acid, can generally be prepared by any known process such as the processes described in EP 0521471, WO 00/49014, WO 2007/099561 and WO 2004/108691.
Simvastatin ([(15,3Λ,7Λ,85,8αΛ)-8-[2-[(2Λ,4Λ)-4-hydroxy-6-oxo-oxan -2-yl]ethyl]-3,7- dimethyl-l,2,3,7,8,8a-hexahydronaphthalen-l-yl]2,2-dimethylb utanoate and lovastatin ([8-[2- (4-hydroxy-6-oxo-oxan-2-yl)ethyl] -3,7-dimethyl-l, 2,3,7,8, 8a- hexahydronaphthalen- 1-yl] 2- methylbutanoate) are produced by fermentation using microorganisms of different species identified as species belonging to Aspergillus, Monascus, Nocardia, Amycolatopsis, Mucor or Penicillium genus, and as e.g. described in EP 33538, EP 22478, and DE 3051175.
Chemical purity of the active ingredient is an important factor for the manufacturing of a safe and effective pharmaceutical. The highest possible purity of the product is especially important if the pharmaceutical product should be taken for a longer period as it is the case in the treatment or the preventing of high plasma cholesterol. The accumulation of the impurities from the pharmaceuticals of lower purity could cause side effects during the medical treatment.
It has now been found out that for a number of statins, pertinent structural impurities can easily be removed from the pharmaceutically active ingredient, if the key intermediates are crystallized in the presence of an amphiphilic compound, more preferably a quarternary amine salt, most preferarably cetyltrimethylammonium bromide (CTABr). The current process for the preparation of the acetonide ester of atorvastatin of formula (Ia)
wherein Ri and R 2 may be the same or different and are selected from any one or more of H, Ci-Ce alkyl which may be straight or branched, unsubstituted or substituted with a halogen group, Ci-C f t alkoxy group, or Ri and R 2 together represent an alkylidene group of the formula CR a R b wherein R a and R b may be the same or different and are selected from any one or more of a Ci-Cn alkyl group, and R 3 is selected from any one or more of a Ci-Ce alkyl group, is carried out using a Paal Knorr reaction by reacting the diketone of atorvastatin, 4- fluoro- (2- methyl- l-oxopropyl-[gamma]-oxo-N-[beta]-diphenyl-benzenebutaneamide with the primary amine, alkyl 2-((4R,6R)-6-(2-aminoethyl)-2,2-dimethyl-l,3-dioxan-4-yl)ace tate.
In one embodiment of the invention R) and R 2 together represent isopropylidene and R 3 is i tertiary butyl.
The group "-Ph-4-F" represents the following group:
The product obtained must be purified due to the impurities present, in particular impurity I (hereinafter described as Imp 1):
with the chemical name of /ert-butyl 2-((4Λ,6Λ)-6-{2-[2-((4i?,6Λ)-6-{2-[2-(4-fluorophenyl)-5- isopropyl-3-phenyl-4-(phenylcarbamoyl)-l//-pyrrol-l-yl]emyl} -2,2-dimethyl-l,3-dioxan-4- yl)acetamido]ethyl}-2,2-dimethyl-l,3-dioxan-4-yl)acetate (C 50 H 64 FN 3 O 8 ), and impurity II (hereinafter described as Imp 2):
with the chemical name of tert-butyl {(4Λ,67?)-6-[2-(l-{2-[(4Λ,6Λ)-6-(2-<ert-butoxy-2- oxoethyl)-2,2-dimethyl-l,3-dioxan-4-yl]ethyl}-5-(4-fluorophe nyl)-2-isopropyl-4-phenyl-l//- pyrrole-3-carboxamido)ethyl]-2,2-dimethyl-l,3-dioxan-4-yl}ac etate (C 48 H 67 FN 2 O 9 ).
Similar problems with structural related chemical or sterochemical impurities are encountered also in the crystallization of the following statins and statin intermediates (Ib-If):
wherein Ri and R 2 may be the same or different and are selected from any one or more of H, Ci-Ce alkyl which may be straight or branched, unsubstituted or substituted with a halogen group, C 1 -C 6 alkoxy group, or Rj and R 2 together represent an alkylidene group of the formula CR 3 R b wherein R 3 and R b may be the same or different and are selected from any one or more of a Ci-Cn alkyl group, and R3 is selected from any one or more of a Cj-C 6 alkyl group; and in case of compound Id R 3 may also represent a hydrogen atom. In one embodiment of the invention Ri and R2 together represent isopropylidene and R 3 is a tertiary butyl.
In another embodiment of the invention Ri, R 2 and R 3 in compound Id represent hydrogen atoms H.
A halogen group can be selected for example from F group, Cl group, Br group, and I group.
Whenever for purification of the statin intermediates the crystallization processes for kinetic polymorphic forms, or amorphous form are preferred over thermodynamic polymorphic form, there is a technical difficulty on industrial scale, because expensive special equipment is needed to cool the crystallization mixture sufficiently quickly in order to prevent transformation to the thermodynamically more stable form. Therefore the technical problem exists to control acceptable filtration properties of the material.
Although it is possible to prepare the kinetic polymorphic form with fast cooling of the crystallization mixture with average cooling rates of reactor jacket temperature at least 1 K/min, adding additional solvent, and subsequently lowering the nucleation temperature, it is not industrially acceptable mainly due to the formation of material with bad filtration properties as a consequence of large jacket-reactor temperature difference (ΔT >10 °C, smaller particles), low yields of the crystallization processes and larger solvent consumption. The particles produced have relatively small average size diameter and consequently bad filtration properties. Since the processes of isolation are longer due to bad filterability, the transformation from kinetic to thermodynamic crystalline form could happen during the filtration process itself.
There is a need for a robust crystallization process, with technically acceptable cooling rates , e.g. <1 K/min, and leading to a product with good filtration properties (bigger particles) and excellent purity of the isolated product. The optimal and shorter production time and lower solvent consumption subsequently lowers the cost of production.
The problem is solved by the addition of amphiphilic additives, preferably custom-made, especially amines, more preferably quarternary amine salts, e.g. bromides or chlorides, of the present invention. Summary of the Invention
According to the invention there is provided a process for the crystallization of a compound of formula Ia-If
wherein Ri and R 2 may be the same or different and are selected from any one or more of H, Ci-Ce alkyl which may be straight or branched, unsubstituted or substituted with a halogen group, Cj-Ce alkoxy group, or Ri and R2 together represent an alkylidene group of the formula CR 3 R b wherein R a and R b may be the same or different and are selected from any one or more of a C]-Cn alkyl group, and R 3 is selected from any one or more of a Ci-Q alkyl group; and in case of compound Id may also represent a hydrogen atom, in the presence of an amphophilic additive, preferably custom-made, especially amine, more preferably quarternary amine salt, most preferarably cetyltrimethylammonium bromide (CTABr). In particular a quarternary amine salt can be a quarternary amine salt represented by formula
Rp-(NRqRrRs) + Y " wherein Rq, R r , R s may be the same or different and are independently selected from the group consisting of methyl and ethyl, Rp is selected from straight chain alkyl groups having 14 to 18 carbon atoms, preferably 16 carbon atoms, and Y ' is selected from the group consisting of Br " and Cl " .
In one embodiment of the invention Ri and R 2 together represent isopropylidene and R 3 is a tertiary butyl. In another embodiment of the invention Ri, R 2 and R 3 in compound Id represent hydrogen atoms H.
The present invention provides an improved crystallization process for preparing the compounds Ia-If, preferably the acetonide ester of atorvastatin (fert-butyl 2-((4R,6S)-6-((3- (phenylcarbamoyl)-5-(4-fluorophenyl)-2- isopropyl-4-phenyl-l//-pyrrol-l-yl)methyl)-2,2- dimethyl-l,3-dioxan-4-yl)acetate), the acetonide ester of rosuvastatin (/ert-butyl 2-((4R,6S)-6- ((E)-2-(4-(4-fluorophenyl)-6-isopropyl-2-(N-methylmethylsulf onamido)pyrimidin-5- yl)vinyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate), the acetonide ester of fluvastatin (terf-butyl 2-((4R,6S)-6-((E)-2-(3 -(4-fluorophenyl)- 1 -isopropyl- 1 //-indol-2-yl)viny l)-2,2-dimethyl- 1,3- dioxan-4-yl)acetate), (3R,5R)-3,5-dmydroxy-7-((lS,2S,6R,8S,8aR)-8-hydroxy-2,6-dime thyl- 1,2,6,7, 8, 8a-hexahydronaphthalen-l-yl)heptanoic acid, lovastatin Ie and simvastatin If.
Tert-bvLiyl 2-((4R, 6S)-6-((3-phenylcarbamoyl)-5-(4-flurophenyl)-2-isopropyl-4-p henyl-l//- pyrrol-l-yl)methyl)-2,2-dimethyl-l,3-dioxan-4 — yl)acetate is preferably prepared by the Paal- Knorr condensation between ?ert-butyl 2-((4R,6R)-6-(2-aminoethyl)-2,2-diemethyl-l,3- dioxan-4-yl)acetate (e.g. prepared by hydrogenation of tert-b\ily\ 2-((4R,6R)-6- (cyanomethyl)-2,2-dimethyl-l,3-dioxan-4-yl)acetate in a solvent such as methanol, ethanol or isopropanol in the presence of a catalyst such as Raney Ni and a base such as e.g. aqueous ammonia) and 2-(2-(4-fluorophenyl)-2-oxo-l-phenylethyl)-4-methyl-3-oxo-N- phenylpentanamide in a solvent system such as e.g. heptane/THF (4:1, v/v), catalyzed by pivalic acid; hexane/THF (4:1, v/v), catalyzed by pivalic acid; heptane/THF (4: 1, v/v), catalyzed by 2-ethylhexanoic acid; or hexane/THF (4:1, v/v), catalyzed by 2-ethylhexanoic acid. Full details of the reaction are given in US 5280126, US 6476235, US 6545153, and WO 2006/097909.
The tert-butyl 2-((4R, 6S)-6-((3-phenylcarbamoyl)-5-(4-flurophenyl)-2-isopropyl-4-p henyl- lH-pyrrol-l-yl)methyl)-2,2-dimethyl-l,3-dioxan-4 — yl)acetate obtained may then after purification directly be converted to atorvastatin salt, such as atorvastatin sodium or atorvastatin hemicalcium, or may first be deprotected in e.g. alcohol, acetonitrile, DMF or THF in the presence of an acid such as a.g. acetic acid or aqueous HCl to yield crystalline [R- (R*, R*)]-2-(4-fluorophenyl)-β,δ-dihydroxy-5-(l-methylethyl)-3- phenyl-4-[(phenylamino)- carbonyl]-lH-pyrrole-l-heptanoic acid tertiary butyl ester, which in turn may also be purified by the purification process of the present invention. The latter is then normally converted to the sodium or potassium salt of atorvastatin, e.g. in methanol or ethanol, or their mixtures with water, in the presence of a base such as NaOH or KOH, followed by extractions with an organic solvent such as ether, ethyl acetate or methyl /e/7-butyl ether. The alkaline salt of atorvastatin is converted to the hemi calcium salt by addition of Ca acetate, Ca chloride, Ca(OHh or Ca salt of 2-ethyl hexanoic acid.
The crystallization process with amphiphilic promotors of crystallization according to the present invention enables improved control over particle size of pharmaceutically active compounds and their intermediate leading to improved filterability of the crystallization mixture appropriate for industrial use. Another improvement of the process are lower cooling rates applied in the presence of amphiphilic compounds, preferably tailor-made amphiphilic compounds (especially amines, more preferably quarternary amine salts, most preferably CTABr), smaller differences in jacket -reactor temperature and finally the production of compounds with a higher level of purity. The crystallization process with the amphiphilic additive also has a higher ratio of product/solvent compared to the standard crystallization processes without additive.
The use of amphiphilic additives can modify the ratio between nucleation and crystal growth processes and can result in larger particle size of the produced material compared to materials prepared identically only without the addition of tailor-made group of additives.
In particular, the present invention teaches the use of amphiphilic compound(s) as promoters) for crystal growth in the crystallization of statin intermediates. Furthermore, the present invention also teaches the use of cetyltrimethylammonium bromide for the preparation of atorvastatin hemi-calcium. Moreover, the present invention teaches the use of amphiphilic compound(s) for crystallizations for production of materials with good filtrations properties or the use of amphiphilic compound(s) as crystallization process additive(s) for improving the filterability of crystalline particles obtained by a crystallization process.
Surprisingly, with the use of amphiphilic additives it is possible to operate a crystallization process in an acceptable way for industrial scales using slow cooling ramps, efficient mixing and resulting in desired polymorphic form without inclusion of pertinent impurities in a reliable way. Even more surprisingly, it has been found by the inventors that the use of amphiphilic aditives not only stabilizes the different crystalline forms but also promotes intensive crystal growth process. Large crystalline particles usually have better filtration properties and are desired on a large-scale crystallization process. In particular pronounced was the effect of purification and improved filterability when CTABr as crystallization additive has been used during the crystallization process.
The purity of the obtained compound (Ia-If) is higher than 98%, preferably higher than 99%, more preferably higher than 99.9%.
Per crystallization cycle approximately 40-70% (w/w) of the Impl present is eliminated is the crystallization is performed with the use of an amphophilic additive according to the invention, while only 10-25% (w/w) are removed if the crystallization is performed under identical conditions without the use of the amphiphilic additive.
Compounds (Ia-If) can further be used for the preparation of any statin form, e.g. atorvastatin free acid, atorvastatin lactone, atorvastatin salt, rosuvastatin free acid, rosuvastatin lactone, rosuvastatin salt, fluvastatin free acid, fluvastatin lactone, fluvastatin salt, simvastatin free acid, simvastatin lactone, or simvastatin salt.
Preferably compounds (Ia-If) can further be used for the preparation of any form of a statin salt in its amorphous or any polymorphic form.
The compounds of the present invention comprise in particular statin or statin intermediate structural element(s). The compounds of the present invention may encompass as common structural element a side-chain on the basis of a substituted heptenoic or heptanoic acid moiety, wherein the -COOH group may be for example present in free form or in the form of an ester, in particular in the form of a lacton. In particular, compounds of the present invention may have for example the following common structural side chain elements on the basis of heptenoic or heptanoic acid moieties:
As may be seen from the side chain formulas depicted above, these side chains differ only in so far as they comprise either a saturated or non-saturated C2 moiety remote from the -COOR 3 moiety. Also compounds of formula (Ie) or (If) have a related side chain structure on the basis of a substituted heptanoic acid moiety present in lactone form.
Particle size was determined by laser light scattering method using e.g. a Malvern Mastersizer 2000 Apparatus using water as the dilution medium.
The volume average particle diameter was determined by measuring the angular distribution of laser light scattered by a homogeneous suspension of particles.
In the following preferred embodiments of the process are described.
Brief Description of the Figures
Fig. 1 shows two photographs with amplification 400% and 1000% of ter/-butyl 2-((4R,6S)- 6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2-isopropyl-4-phe nyl-l//-pyrrol-l-yl)methyl)-2,2- dimethyl-l,3-dioxan-4-yl)acetate crystals obtained according to Examples 1 and 2.
Fig. 2 shows two photographs with amplification 400% and 1000% of ferf-butyl 2-((4R,6S)- 6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2-isopropyl-4-phe nyl-l//-pyrrol-l-yl)methyl)-2,2- dimethyl-l,3-dioxan-4-yl)acetate crystals obtained according to Comparative example 3.
Fig. 3 shows particle size distribution of tert-buty\ 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4- fluoroρhenyl)-2-isopropyl-4-phenyl-///-ρyrrol-l-yl)methyl) -2,2-dimethyl-l,3-dioxan-4- yl)acetate crystals obtained according to Examples 1 and 2.
Fig. 4 shows particle size distribution of tert-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4- fluorophenyl)-2-isopropyl-4-phenyl-l//-pyrrol-l-yl)methyl)-2 ,2-dirnethyl-l,3-dioxan-4- yl)acetate crystals obtained according to Comparative example 3. Detailed Description of the Invention
According to the invention there is provided a process for the crystallization of a compound of formula Ia:
wherein Ri, R 2 , and R 3 are as above, in the presence of an amphiphilic additive, preferably amine, more preferably quarternary amine salt, most preferarably cetyltrimethylammonium bromide (CTABr).
In one embodiment of the invention Ri and R 2 together represent isopropylidene and R 3 is a tertiary butyl.
The present invention provides an improved crystallization process for preparing the acetonide ester of atorvastatin (ferr-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4- fluorophenyl)-2-isopropyl-4-phenyl-l//-pyrrol-l-yl)methyl)-2 ,2-dimethyl-l,3-dioxan-4- yl)acetate). The acetonide ester is prepared with improved filterability of the crystallization mixture, high yield and a high level of purity.
Amphiphilic compounds which are used as crystallization additives, in particular in a process for the crystallization of a compound of formula Ia-If, may be custom made and may be chosen from the group of amines, branched or unbranched, unsubstituted or substituted, such as primary amines, secondary amines, tertiary amines or quarternary amine salts; alcohols, preferably C8-C28 alcohols; fatty acids, preferably C8-28 fatty acids; or their amphiphilic derivatives such as e g primary amides or salts with an inorganic or organic base Preferably, the amphiphilic additive is chosen from the group of amines, more preferably from the group of quarternary ammonium salts, alkyl ammonium chloride or bromide, most preferably cetyltπmethylammomum bromide (CTABr) In particular a quarternary amine salt can be a quarternary amine salt represented by formula
Rp-(NRqR 1 Rs) + Y " wherein Rq, R r , R s may be the same or different and are independently selected from the group consisting of methyl and ethyl, Rp is selected from straight chain alkyl groups having 14 to 18 carbon atoms, preferably 16 carbon atoms, and Y is selected from the group consisting of Br and Cl
The process of the present invention for the crystallization of a compound of formula Ia-If can comprise crystallizing this compound in the presence of an amphiphilic additive Said compound can be for example present in a mixture, preferably solution, comprising solvent and said compound, or can be present in a reaction mixture, in particular before or when starting crystallization of said compound
Solvents may be selected from any one or more of toluene or other aromatic hydrocarbons, tetrahydrofurane, or cyclic and acyclic ethers, ethyl acetate and other esters of alcohols with carboxyhc acids, 2- butanone, acetone, and other cyclic and acyclic ketones, methanol, etanol, z.rø-propanol, Λ-propanol, jso-butanol, sec-butanol, rc-butanol and other alcohols, acetonitπle, DMSO, DMF and other amides, hexane, heptane, and other acyclic and cyclic aliphatic hydrocarbons Aliphatic nitπles may also be used as solvents Binary mixtures of the above may also be used Preferably, the solvent is selected from isopropanol, ethyl acetate and mixtures thereof
The ratio between the compounds Ia-d dissolved and the solvents used is selected between lg/lmL to 1 g/30 mL, preferably, 1 g/2mL to Ig/ 10 mL, most preferably between 1 g/ 3 mL to 1 g / 6 mL
The weight percentage of the amphiphilic additive used with the regards to the compound I to be crystallized is 0 01% to 20%, preferably 0 01% to 10%, most preferably 0 01% to 1% In a first embodiment the amphiphilic additive may be added to the solvent together with compounds Ia-If, and heated to a temperature where all of the solute dissolves or the temperature of the reflux of the mixture, and than cooled to a temperature where most of the solute crystallizes.
In a second embodiment, the amphiphilic additive is added to a solution of compounds Ia-If already heated to a temperature where all of the solute dissolves or the temperature of the reflux of the mixture, and than cooled to a temperature where most of the solute crystallize.
In a third embodiment of the present invention, the amphiphilic additive is added already to the heated reaction mixture after compounds Ia-If had been synthesized and than cooled to a temperature where all of the solute dissolves or the temperature of the reflux of the mixture, and then cooled to a temperature where most of the solute crystallizes.
A process of the present invention can for example comprise a) providing a solution or mixture comprising a compound represented by any of formulas Ia-If and solvent or providing a reaction mixture comprising said compound, b) crystallizing said compound in the presence of an amphiphilic additive. As amphiphilic additive any of the amphiphilic additive described in detail before may be used. For example, it may be chosen from the group of amines, branched or unbranched, unsubstituted or substituted, such as primary amines, secondary amines, tertiary amines or quarternary amine salts; alcohols, preferably C8-C28 alcohols; fatty acids, preferably C8-28 fatty acids; or their amphiphilic derivatives such as e.g. primary amides or salts with an inorganic or organic base or may be any of the even more preferred amphiphilic derivatives as described supra. For example, said amphiphilic additive can be added to the solvent together with said compound or said amphiphilic additive can be added to said solution or mixture, said solution being heated to a temperature where all of the solute dissolves or to the temperature of reflux of said mixture, or said amphiphilic additive can be added to said reaction mixture, preferably said heated reaction mixture.
The average cooling ramp of the reactor jacket (dT/dt) may be chosen from 0.1 K/min to 2 K/min, preferably from 0.1 K/min to 1 K/min, most preferably from 0.1 K/min to 0.5 K/min.
The stirring speed may be chosen from 50 to 400 rpm, preferably from 50 to 300 rpm, most preferably from 100 to 250 rpm. The crystallized product is isolated by filtration, either by means of a centrifuge or a filter dryer, and dried at a temperature between 50 and 90 0 C, preferably between 50 °C and 80 °C, for 5 to 20 hours, preferably for 5 to 15 hours.
The relative filterability of the crystallization mixture in laboratory is determined and compared by means of the laboratory filtration test using Bϋchner funnel in a suction filtration.
The time needed for the filtration of 10 mL of suspension on a surface of 0.79 cm 2 of the crystallization mixture according to the present invention is between 8 and 15 seconds, while the time needed for the filtration of a comparable crystallization mixture without the use of an amphiphilic additive is between 70 and 120 seconds.
The chemical purity of the compound Ia obtained was determined with the following method:
HPLC analysis
Analyses were carried out on Agilent 1100 HPLC system, equipped with gradient pump, variable UV detector, thermostated autosampler and data handling system. Separation was performed on reversed phase C8 column using gradient elution with phosphate buffer pH 3.8 and a mixture of acetonitrile and tetrahydrofurane as organic modifier. Chromatograms were monitored at wavelength 248 nm.
LC-MS analysis
The analyses were carried out using a Agilent 1200series HPLC system (Agilent, USA) consisting of G1379B degasser, G1312B pump, G1367C autosampler, and a 6330 ion trap mass detector. The chromatographic separation was accomplished on a Cg column (Ascentis Express 75 mm χ 4.6 mm, 2,7μm, Supelco) at ambient temperature.
A gradient method was worked out, with acetonitrile content changing linearly during the analysis. The mobile phase A consisted of 5mM ammonium formiate, and mobile phase B consisted of acetonitrile. Gradient:
For quantification we used a ion trap mass detector with electrospray ionization in SIM mode (m/z=256).
Compound Ia crystallized by the present invention contained less than 0.10 % of Imp 1 and less than 0.10 % of Imp 2. The amphophilic additive used for crystallization of compounds I was present in a concentration less than 0.03 % (w/w) in the crystallized compound I.
The chemical purity of the compound Ie obtained was determined with the following method:
A.) PhEur method for related substances
HPLC method
Column: Zorbax SB-C8 , 3,5μm particles, 100 x 4.6 mm i.d.,
Eluent A: 0,1 % phosphoric acid
Eluent B: acetonitrile
Gradient:
Post time: 3 min
Flow-rate: 1.5 ml/min
Detection: UV, 238 nm
Injection volume: 5 μl
Column temperature: 25°C
Diluent: acetonitril Sample preparation:
Accurately weigh about 20 mg of sample into 50 ml volumetric flask, dissolve and dilute to volume with diluent.
Calculation:
External standard method
B.) USP method for dihidro lovastatin
HPLC method
Column: Zorbax SB-C8 , 5 μm particles, 250 x 4.6 mm i.d.,
Ehient A: 0, 1 % phosphoric acid
EIuent B: acetonitrile
Mobile phase: isocratic: acetonitril : 0.1 % H 3 PO 4 = 65 : 35
Flow-rate: 1.5 ml/min
Detection: UV, 200 nm
Injection volume: 10 μl Column temperature: 40 0 C Diluent: acetonitril
Sample preparation:
Accurately weigh about 25 mg of sample into 25 ml volumetric flask, dissolve and dilute to volume with diluent.
Calculation:
External standard method
The present invention is illustrated by the following Examples without being limited thereto. EXAMPLES
I.) Compound Ia
Example 1
The crystallization is carried out using 2-propanol as medium in a reactor with mechanical stirring. 25g of crude tert-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyi)-5-(4-fluorophenyl)-2- isopropyl-4-phenyl-li/-pyrrol-l-yl)methyl)-2,2-dimethyl-l,3- dioxan-4-yl)acetate is dissolved in 90 ml of 2-propanol at the reflux temperature of the mixture, 0.12 g of cetyltrimethyl ammonium bromide is added and the temperature is maintained for 30 minutes to allow all solid to dissolve. Then a linear cooling ramp -0.40 K/min of reactor jacket is applied and the mixture is cooled to 3 °C. The formed suspension is homogenized for 2 hours and the product is isolated using Buchner funnel in a suction filtration.
The time needed for the filtration of 10 mL of suspension on a surface of 0.79 cm 2 was approx. 10s, at a vacuum of about 80-100 mbar.
Example 2 (large-scale)
The crystallization is carried out using 2-propanol as a medium in a reactor with mechanical stirring. 180 kg of crude /erf-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2- isopropyl-4-phenyl-l//-pyrrol-l-yl)methyl)-2,2-dimethyl-l,3- dioxan-4-yl)acetate is dissolved in 650 L of 2-propanol at the reflux temperature of the mixture, 0.90 kg of cetyltrimethyl ammonium bromide is added and the temperature is maintained for 30 minutes for all solid to dissolve. Then a linear cooling ramp -0.40 K/min of reactor jacket is applied and the mixture is cooled to 3 0 C. The formed suspension is homogenized for 2 hours and the product is isolated using a filter-dryer.
Microscopic pictures of the product are shown in Figure 1, and particle size distribution in
Fig. 3.
Example 3 - comparative example
The crystallization is carried out using 2-propanol as a medium in a reactor with mechanical stirring. 25g of crude tert-butyl 2-((4R,6S)-6-((3-(phenylcarbamoyl)-5-(4-fluorophenyl)-2- isopropyl-4-phenyl-l//-pyrrol-l-yl)methyl)-2,2-dimethyl-l,3- dioxan-4-yl)acetate is dissolved in 90 ml of 2-propanol at the reflux temperature of the mixture and the temperature is maintained for 30 minutes to allow all solid to dissolve. Then a linear cooling ramp -0.40 K/min of reactor jacket is applied and the mixture is cooled to 3 °C. The formed suspension is homogenized for 2 hours and the product is isolated using Bϋchner funnel in a suction filtration.
The time needed for the filtration of 10 mL of suspension on a surface of 0.79 cm 2 was approx. 120 s, at a vacuum of about 80-100 mbar.
This example was performed in the same equipment and using the same parameters/ as Example 1 , only without the addition of CTABr.
Microscopic pictures of the product are shown in Figure 2, and particle size distribution in Fig. 4.
II.) Compound Ie
Example 4
The crystallization is carried out using ethylacetate and water as crystallization media in a reactor with mechanical stirring. 5 g of crude lovastatin, (lS,3R,7S,8S,8aR)-8-[2-[(2R,4R)-4- hydroxy-6-oxotetrahydro-2//-pyran-2-yl]ethyl]-3,7-dimethyl-l ,2,3,7,8,8a hexahydronaphthalen-1-yl (2S)-2-methylbutanoate), is dissolved in 25 ml of ethylacetate at the reflux. The solution is cooled to 65 0 C and 1 g of active carbon is added. The mixture isstirred at this temperature for the next 10 minutes. Then the active carbon is removed using filtration at the temperature of solution approximately 65 0 C. To the above prepared, hot solution 20 ml of distilled water (with the temperature approximately 70 "C) and 1 g of cetyltrimethylammonium bromide is slowly added. Then the crystallization mixture is cooled to 50 °C. At this temperature the seeds of pure lovastatin (50 mg) are added and the temperature is maintained for the next 30 minutes. Finally, the formed suspension is slowly cooled to the 10 0 C in the next 6 hours (dT/dt = -0.11 K/min). When the final temperature is reached the suspension is maintained at the temperature 10 0 C for the next two hours. The formed product is isolated using vacuum filtration and washed with 15 ml of distilled water with room temperature. Example 5 — comparative example
The crystallization is carried out using ethylacetate and water as crystallization media in a reactor with mechanical stirring. 5 g of crude lovastatin, (lS,3R,7S,8S,8aR)-8-[2-[(2R,4R)-4- hydroxy-6-oxotetrahydro-2//-pyran-2-yl]ethyl]-3,7-dimethyl-l , 2,3,7,8, 8a hexahydronaphthalen-1-yl (2S)-2-methylbutanoate), is dissolved in 25 ml of ethylacetate at the reflux. The solution is cooled to 65 °C and Ig of active carbon is added. The mixture is stirred at this temperature for the next 10 minutes. Then the active carbon is removed using filtration at the temperature of solution approximately 65 0 C. To the above prepared, hot solution 20 ml of distilled water (with the temperature approximately 70 0 C) is slowly added. Then the crystallization mixture was cooled to 50 0 C. At this temperature the seeds of pure lovastatin (50 mg) are added and the temperature is maintained for the next 30 minutes. Finally, the formed suspension is slowly cooled to the 10 0 C in the next 6 hours (dT/dt = -0.11 K/min). When the final temperature is reached the suspension is maintained at the temperature 10 °C for the next two hours. The formed product is isolated using vacuum filtration and washed with 15 ml of distilled water with room temperature.
III. Preparation of atorvastatin Ca
Example 6
Preparation of [R-(R* Jt*)1-2-(4-fluorophenyD-B,δ-dihydroxy-5-fl-methγlethyl) phenyl-
4-ffphenγlammo)carponvIl-l/f-pyrrole-l-heptanoic acid tertiary butyl ester
26,67 g of (4R-cis)-6-{2-[3-phenyl-4-(phenylcarbamoyl)-2-(4-fluoropheny l)-5-(l- methylethyl)pyrrol-l-yl]ethyl}-2,2-dimethyl-[l,3]dioxane-4-y l acetic acid tertiary butyl ester (Ia) is suspended in 120 niL of acetonitrile, 23 mL of water and 6.3 mL of IM HCl. The reaction mixture is stirred at 20-25 C C until all (4R-cis)-6-{2-[3-phenyl-4-(phenylcarbamoyl)- 2-(4-fluorophenyl)-5-(l-methylethyl)pyrrol-l-yl]ethyl}-2,2-d imethyl-[l,3]dioxane-4-yl acetic acid tertiary butyl ester (Ia) is dissolved and the reaction is followed with HPLC method. After 24 h 267 mL of water was added. The solid precipitate is filtered off and the cake is washed with 100 mL of water unitll the pH value of the filtrate is 5-7. The wet cake is dried at 20-30 0 C on air for approximately 1 hour till constant weight, optionally granulated and dried for 4 hours at 40-50°C.
22,54 g of tertiary butyl ester [R-(R* ,R*)]-2-(4-fluorophenyl)-β,δ-dihydroxy-5-(l- methylethyl)phenyl-4-[(phenylamino)carbonyl]-l//-pyrrole-l-h eptanoic acid is isolated The purity of the obtained product is higher than 99.9%.
Example 7
Preparation of amorphous atorvastatin hemi-caleium
To the solution of 8,87 g [R-(R*,R*)]-2-(4-fluorophenyl)-β,δ-dihydroxy-5-(l- methylethyl)phenyl-4-[(phenylamino)carbonyl]-l//-pyrrole-l-h eptanoic acid tertiary butyl ester in 31 mL of methanol and 26 mL fert-butyl methyl ether, 0.60 g of NaOH and 30 mL of water are added. The reaction mixture is purged with nitrogen flow for cca. 5 minutes, heated to the reflux for 2-4 h, until the concentration of the starting compound [R-(R*,R*)]-2-(4- fluorophenyl)-β,δ-dihydroxy-5-(l-methylethyl)phenyl-4-[(ph enylamino)carbonyl]-l/f- pyrrole-1-heptanoic acid tertiary butyl ester is lower than 0.5 %, determinated by HPLC. The reaction mixture is allowed to cool to 20-25 0 C, and filtered over randalite in methanol. 3% (w/w) of active charcoal suspended in water are added, the reaction mixture is heated to 50 0 C, cooled back to room temperature and filtered. The pH is set to 8.0-8.2 with the addition of aqueous HCl. The reaction mixture is washed with 3 * 60 mL /ert-butyl methyl ether and aqueous parts are finally filtered. The reaction mixture is purged with nitrogen flow for cca. 5 min, and 1.66 g of CaC^ X6H 2 O) and 31 mL of water is added in a 15-20 min interval at 20- 25 0 C. After the complete addition of CaC^ to the reaction mixture, the reaction mixture is stirred for additional 15-30 min; and 250 mL of water is slowly added into the reaction mixture to provoke the solidification of the thick emulsion-like mixture. Hemi-calcium salt of atorvastatin is formed and filtered off. The wet cake is washed with a mixture of water and methanol and finally with water. The collected solid material is dried on air to obtain dry solid atorvastatin hemi-calcium.
The dry hemi-calcium salt of atorvastatin can optionally be additionally milled on a dry pearl mill. | {
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2,655,709,608,705,101,000 | Anne L. van de Ven
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The investigation of microcirculation is an important task in biomedical and physiological research because the microcirculation information, such as flow velocity and vessel density, is critical to monitor human conditions and develop effective therapies of some diseases. As one of the tasks of the microcirculation study, red blood cell (RBC) tracking(More)
Encapsulating bacteria within constrained microenvironments can promote the manifestation of specialized behaviors. Using double-emulsion droplet-generating microfluidic synthesis, live Bacillus subtilis bacteria were encapsulated in a semi-permeable membrane composed of poly(ethylene glycol)-b-poly(d,l-lactic acid) (mPEG-PDLLA). This polymer membrane was(More)
The therapeutic efficacy of systemic drug delivery vehicles is limited by their ability to evade the mononuclear phagocyte system, preferentially localize to the target tissue, and negotiate past the endothelial barrier. In order to create a delivery vehicle capable of all these functions, we developed a biomimetic functionalization of synthetic particles(More)
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-308,729,266,435,407,170 | N Cuende
Junta De Andalucía, Cádiz, Andalusia, Spain
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Publications (28)67.82 Total impact
• [Show abstract] [Hide abstract]
ABSTRACT: To evaluate the results of liver transplantation (OLT) performed for hepatocellular carcinoma (HCC) among a multicenter cohort of patients with predefined common inclusion and priorization criteria. Over a 5-year period (January 2002-December 2006), 199 HCC patients underwent OLT in four centers in Andalusia. The morphological (Milan) inclusion criteria were priorized in two consecutive periods, according to the Model for End-stage Liver Disease score: group I, 53 patients (HCC < 2 cm = 24 points; > or = 2 cm or multinodular = 29 points) and group II, 146 cases (HCC < 3 cm without priorization; HCC > or = 3 cm or multinodular = 18 points). Among the 199 HCCs, 186 (93.5%) subjects were transplanted and 13 (6.5%) were excluded. There were 18 cases (9.7%) where the diagnosis was incidental and 168 were known HCC cases; 144 (85.7%) complied with the Milan criteria (Milan+); 24 (14.3%) exceeded there criteria (Milan-). According to preoperative imaging, the number of nodules and tumor mean sizes among the excluded-Milan+ and Milan- groups-were 1.8/5.3 cm, 1.4/3.5 cm, and 2.3/6.7 cm, respectively (P < .001). Percutaneous treatment during listing was delivered to 55% of the excluded cases: 49% of Milan+ and 96% of Milan-. The median time on the list was 88 days for known HCC (53 days for group I, and 97 days for group II), and 172 days for the incidental HCCs. Staging (pTNM) was correct in 64% of cases: 23% were understaged and 13% were overstaged. Overall mortality within the first 90 days was 9%, and transplant patient survival at 5 years was 61%. No differences were observed in survival rates between both study periods, although there were differences between the Milan+ (65%) and Milan- (23%) groups (P < .04). In addition, the difference in the recurrence rates was also significant between the Milan+ (7%), Milan- (24%), and the incidental (25%) groups (P < .02). A common priorization policy of HCC for OLT based on morphological criteria results in a low exclusion rate on the waiting lists (6.5%). The Milan criteria are still a good cutoff to stratify the risk of recurrence, despite preoperative tumor staging being correct in only two-thirds of cases.
Transplantation Proceedings 04/2009; 41(3):1009-11. DOI:10.1016/j.transproceed.2009.02.028 · 0.95 Impact Factor
• Source
N Cuende, M Alonso
American Journal of Transplantation 10/2007; 7(9):2212-3. DOI:10.1111/j.1600-6143.2007.01911.x · 6.19 Impact Factor
• Source
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ABSTRACT: This study analyzed the effect of population aging on organ donation for transplants in 43 countries and on the effectiveness of the donation process by comparing the results between Spain and the United States. The percentage of the population aged 65 or over accounted for 33% of the difference in the donation rates between the countries and for 91% of the variation in the rates after age adjustment. However, the level of aging of the Spanish (16.5%) and American (12.3%) populations failed to account for the percentages of deceased donors 65 or over (28% vs. 10%), due to the different age-specific donation rates, much higher in Spain above 50 years. These differences lead to a higher effectiveness of the process in the United States (3.1 transplanted organs per donor vs. 2.5 in Spain), though at lower rates of transplant per million population (73 vs. 87). We conclude that older populations have a greater donation potential as donation rates are strongly associated with population aging. It should therefore be mandatory to adjust donation rates for age before making comparisons. Additionally, effectiveness decreases with older donors, so age should be considered when establishing standards relating to organ donation and effectiveness of the process.
American Journal of Transplantation 07/2007; 7(6):1526-35. DOI:10.1111/j.1600-6143.2007.01792.x · 6.19 Impact Factor
• Source
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ABSTRACT: Prioritizing the liver transplant waiting list (WL) is subject to great variability. We present the experience of four transplant centers in Andalusia (Southern Spain) with a new consensus model of WL management based on the Model for End-Stage Liver Disease (MELD) score. The initial criteria for local prioritizing were: a) cirrhosis with MELD score > or =24, and b) all hepatocellular carcinoma (HCC) admitted to the WL. Fourteen months later new criteria were established: a) cirrhosis with MELD score > or =18, and b) uninodular HCC between 3-5 cm or multinodular HCC (2-3 nodules <3 cm). Access to regional priority was scheduled after three months for patients with cirrhosis or six months for patients with HCC. We analyzed the WL mortality rate, posttransplant survival rate, and overall survival rate over three 14-month periods: A (before implementation of priority criteria), B (initial criteria), and C (current criteria). Priority was given to 36% of recipients in period B and 47% in period C. The WL mortality rate (including removals from WL) was 12.9%, 12.9%, and 10.7% in periods A, B, and C, respectively. One-year graft survival was 79.7%, 72.6%, and 81.2% in the same periods. The overall one-year survival rate for new cases on the WL was 74.9% in period A, 68.6% in period B, and 82.2% in period C. The allocation system and WL management with the current criteria resulted in lower waiting list mortality without reducing posttransplant survival, leading to better survival for all patients listed.
Transplantation 01/2007; 82(11):1429-35. DOI:10.1097/01.tp.0000244559.60989.5a · 3.78 Impact Factor
• Source
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ABSTRACT: The 2 main indications for emergency liver transplantation are severe acute hepatic insufficiency and emergency retransplantation. In Spain, since the creation of the National Transplant Organisation (NTO), known as "the Spanish model," there have been high rates of donation, with a mean of 33.9 donors per million inhabitants in 2003 and 34.6 donors per million inhabitants in 2004. According to data provided by the NTO, there were 169 liver emergencies in the 2-year period 2003-2004. The time on the waiting list in an emergency situation was limited; 82.8% of cases were resolved in less than 48 hours. During this 2-year period, there were 2077 liver transplantations, including 128 emergence patients, which accounted for 6.1% of transplantations.
Transplantation Proceedings 12/2005; 37(9):3878-80. DOI:10.1016/j.transproceed.2005.09.131 · 0.95 Impact Factor
• Source
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ABSTRACT: Organ availability is affecting the development of liver transplantation in its entirety, leading to transplant teams expanding the criteria for accepting organ donors. In these circumstances, analysis of the impact of the donor's characteristics on graft survival becomes mandatory. Fifty-two donor variables from 5,150 liver transplants performed in Spain between 1994 and 2001 were analyzed through a univariate analysis. Those with statistically significant impact on graft survival were entered in a Cox regression model with the recipients' characteristics and other factors linked to the graft technique. Several donor factors negatively affect graft survival: donor age, cause of death, body mass index, vasoactive drug administration, prolonged intensive care unit (ICU) stay, increased alkaline phosphatase and liver enzyme levels, low bicarbonate level, and antecedents of hypertension. However, only four can be mentioned as representing a risk for losing the graft when donor variables are controlled with recipient or technique variables in a Cox regression model: donor age, antecedents of hypertension, prolonged ICU stay, and low bicarbonate level. In the same analysis, norepinephrine administration has a relative risk less than 1. The multivariate analysis of the impact of 52 donor characteristics on liver graft survival showed the negative effect of an elderly donor, with hypertension combined with the presence of metabolic acidosis, or a prolonged ICU donor stay. The administration of norepinephrine alone during donor management showed a protective effect.
Transplantation 06/2005; 79(10):1445-52. DOI:10.1097/01.TP.0000158877.74629.AA · 3.78 Impact Factor
• Source
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ABSTRACT: The maintenance of an equitable system for access to transplantation is a matter of concern to all professionals involved in this field. Any national system must ensure equity. The rates of indication for liver transplantation have been reviewed for all Spanish regions. The time to transplantation was evaluated with respect to different recipient characteristics and donor rates. The indication rates for liver transplantation are similar in the different countries with liver transplant programs but are far from similar among different regions in Spain. This suggests that there is not equity in the access to liver transplantation. A review of the factors affecting the waiting times to transplantation after being registered for the waiting list shows that some groups of patients are currently waiting less time than others. Shorter waiting times occur in patients of the AB group, children, patients with hepatocarcinoma, and patients living in the zone of Valencia, despite similar organ donation rates in all transplant zones. Neither the rate nor the probability of liver transplantation is affected exclusively by the organ donation rate in Spain but also depends on the number of patients admitted to the waiting list. Despite the existence of an organ allocation system that is center-oriented, liver patients are receiving grafts mainly based on the severity of the illness, because clearance rates from the waiting list of both dead patients and grafted patients are the same.
Transplantation 12/2003; 76(9):1398-403. DOI:10.1097/01.TP.0000090283.77172.F2 · 3.78 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:28-31. · 1.44 Impact Factor
• Source
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ABSTRACT: During recent years organ donation in Spain has increased by 100%, with important changes seen in the donor profile. Mean age has increased by more than 10 years, being nowadays more than 33% of our donors over 60 years. Ten years ago road traffic trauma was the main cause of death, while now most of our donors die due to stroke and only 21% die in a traffic accident. This changes lead to an increase in the number of kidneys discarded for transplantation every year. Among the 2517 kidneys retrieved during 2001, 567 were discarded, mainly due to different glomerular, interstitial or vascular pathologic damage. The older is the donor the higher is the percentage of kidneys discarded. It has to be underlined that an increased number of livers from donors, whose kidneys could not be used, are being grafted (141 in 2001 over 281 donors from whom no kidney could be grafted and over a total number of 1335 donors). Only 5% of kidneys were discarded due to technical problems. An important number of kidneys were discarded due to malignancy suspicion or diagnosis (12.3%). Organ donation has improved but kidney transplantation did not in parallel, due to the increasing number of kidneys discarded for transplantation in close relation with the evolution of donor's characteristics. Organ donation rate is around 33 donors per million population while efficient organ donation rate is around 30 donors per million. Only from 67% of donors both kidneys can be grafted and from 20% of donors no kidney can be used. These data will not change our policy, at least by the moment, we will continue to evaluate every potential brain death donor with the aim of studying if organs can be used. It is true that in 50% of cases over 70 years no organ can be used after retrieval and microscopic exam, but in the other 50% we can proceed.
Annals of transplantation: quarterly of the Polish Transplantation Society 02/2003; 8(2):9-16. · 1.43 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:32-41. · 1.44 Impact Factor
• J F Cañón, N Cuende, B Miranda
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:42-9. · 1.44 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:50-62. · 1.44 Impact Factor
• J F Cañón, N Cuende, B Miranda
Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:63-7. · 1.44 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:1-5. · 1.44 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2003; 23 Suppl 5:68-72. · 1.44 Impact Factor
• Gastroenterología y Hepatología 01/2003; 26(6):355-75. · 0.83 Impact Factor
• Source
Gastroenterología y Hepatología 01/2003; 26(6). DOI:10.1016/S0210-5705(03)70373-2 · 0.83 Impact Factor
• Transplantation 05/2002; 73(8):1360. DOI:10.1097/00007890-200204270-00033 · 3.78 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2001; 21 Suppl 4:65-76. · 1.44 Impact Factor
• Nefrologia: publicacion oficial de la Sociedad Espanola Nefrologia 02/2001; 21 Suppl 4:111-8. · 1.44 Impact Factor | {
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-9,214,650,736,114,405,000 | wound
(redirected from GSW)
Also found in: Dictionary, Thesaurus, Medical, Legal, Acronyms, Wikipedia.
wound
1. any break in the skin or an organ or part as the result of violence or a surgical incision
2. an injury to plant tissue
Wound
a mechanical injury to organic tissues with disruption of the continuity of such structures as skin and mucous membranes. Wounds are characterized by three basic local symptoms: (1) separation of the edges of the wound, which varies with the extent, depth, and location of the wound, (2) pain, and (3) bleeding; the last two result from injury to nerves and blood vessels. In addition to causing anatomical and functional disturbances to tissues and organs, some wounds are dangerous because they may lead to acute anemia or shock as a result of heavy bleeding or to wound infections, including such anaerobic infections as gangrene and tetanus.
Wounds are classified according to the causes of the injury as surgical, accidental, or combat wounds, according to the type of injury to the tissues as incised, puncture, gash, contused, bite, flap, crushed, or gunshot wounds, according to the presence of a wound infection as aseptic or infected wounds (practically all accidental wounds become infected), and according to penetration into body cavities, such as the pleural, abdominal, cranial, or articular cavities, as penetrating or nonpenetrating wounds.
Penetrating wounds are dangerous because the cavity may become infected or the organs within the cavity, for example, the lungs, liver, stomach, or intestine, may be injured. Puncture wounds are often quite deep, which may result in the trauma of organs and blood vessels located deep in the wound. A large number of crushed nonviable tissues and blood clots that encourage infection (especially anaerobic infection) are characteristic of contused, lacerated, and gash wounds. Wounds caused by bites may be complicated by the development of a severe infection; rabies, for example, is caused by pathogenic flora entering the wound from the mouth of the diseased animal.
The healing of a wound depends on the nature of the wound and on the presence or absence of infection. A linear incised wound that is not infected heals by first intention if the gap is corrected and the edges of the wound are brought together by sutures, clips, or strips of adhesive tape. The gap is filled with blood clots, fibrin, and the cells of injured and dead tissues; the last subsequently either tear away from the wound with discharges or undergo phagocytosis, which results in the wound cavity filling with special cells called fibroblasts. The blood capillaries start growing together from the edges of the wound at the end of the second day. By the fifth to seventh days, cicatricial tissue forms from the fibroblasts and new blood vessels and regeneration of the epithelium covering the tissue starts. The conversion of immature connective tissue into a permanent scar continues for several months.
Wounds that heal by second intention include wounds whose edges were not joined (that is, the cavity remained), as well as infected wounds and wounds complicated by suppuration. Healing by second intention is a longer process because it goes through a stage during which granulations develop; the granulations fill the wound cavity and gradually epithelialize from the edges of the wound. Severe systemic diseases, exhaustion, and hypovitaminoses cause even surgical wounds to heal by second intention.
First aid for wounds should be rendered immediately at the site of the accident by the victim himself or persons nearby. The purpose of first aid is to prevent the secondary contamination of the wound, to stop the bleeding, and to permit the wound to rest. The skin around the wound is cleaned with cotton or gauze moistened with water, ether, or alcohol (fluid must not enter the wound), and a sterile pad is applied to the wound and secured by a bandage, Kleol, or adhesive tape. Slight bleeding can usually be halted by applying a pressure bandage. In addition to a bandage, a tourniquet is applied on the part of the extremity above a wound if arterial bleeding is copious. If there is both a wound and a bone fracture, the extremity is immobilized.
Qualified first aid, or first surgical treatment, is provided by a surgeon, who removes nonviable tissues, blood clots, and foreign bodies from a wound, ligates bleeding vessels, excises the edges and bottom of contused, lacerated, and crushed wounds (which become incised wounds after treatment), and sews wounds up with interrupted sutures; all these procedures promote healing by first intention. A delayed suture can be applied (in two or three days) that draws the edges of an infected wound together, if it is not suppurating. Specific preventive measures are taken to prevent tetanus in cases of lacerated and contused wounds contaminated by dirt, prophylactic injections of anti-gangrene serum are made, and measures are taken to prevent posttraumatic sepsis.
Physical therapy, including ultraviolet irradiation treatment and treatment with ultrashort waves, and administration of antiseptics, hypertonic saline solutions, solutions of potassium permanganate, antibiotics, and sulfanilamide preparations, is used extensively in the case of suppurative wounds.
REFERENCES
Struchkov, V. I. Obshchaia khirurgiia. Moscow, 1966.
Kamaev, M. F. Infitsirovannaia rana i ee lecheme, 2nd ed. Moscow, 1970.
R. T. PANCHENKOV and A. G. KISSIN
What does it mean when you dream about a wound?
The term wound is often used as a metaphor for the impact of negative emotional experiences. The healing of old wounds may thus be indicated by this dream symbol.
References in periodicals archive ?
Using the aforementioned criteria, the study identified 111 patients with orthopaedic GSW injuries treated during 2012.
For people with SCI secondary to GSW, issues of access are magnified, as many of them experience additional disadvantages.
He cites a telecom installation project GSW Contracting recently completed successfully in Pennsylvania to document his contention.
The annualized crude rate for GSW injuries was 27 per 100,000 persons in large communities, compared with seven per 100,000 persons in small communities; however, the difference was greatest for violence-related GSWs (Table 2).
At the helm of GSW Worldwide, Deschamps grew the business three fold and oversaw its expansion into digital and global services.
Berth occupancy was observed at the port at fifty three percent on Wednesday where a total of eight ships namely ships CMA CGM Uruguany, Maersk Stepnica, Thai Binh Bey, Ping An Song, Unico Sienna, GSW Future, Ardmore Duntless and Sea Marshal are currently occupying berths to load/offload containers, rice, project cargo, fertilizer, chemicals, palm oil and furnace oil respectively during last 24 hours.
PO4 Virgel Villanueva, 84th SAC-Single GSW in the head inflicted during the firefight
57% of peer GSW Immobilien AGa[euro](tm)s (ETR:GIB) shareholders under its EUR1.
Advertising agencies such as GSW Europe and Junction 11 will operate as inVentiv Health Communications/Europe.
GSW general manager Zafer Jeha said the company aimed to become a reputed manufacturer of process equipment enjoying high demand and high margins in the GCC region.
The terms of the acquisition call for Cencosud to receive 100% of the stock in GSW SA, which operates the Grupo Wong supermarkets and shopping centers and which is 97 percent owned by the Wong family. | {
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7,362,587,838,863,455,000 | Skip to content
This Is Why You Should Get Nutrients From Food, Not Supplements
Experts weigh-in and explain why you should always try to get the majority of nutrients from food.
a spread of various vegetables, fruits, nuts and oats
There are many factors that go into leading a healthy lifestyle. Two pivotal aspects include eating a healthful diet and exercising. Not only can eating a diet rich in foods such as fruits, vegetables, legumes, and lean proteins help to sustain energy levels, but it can also help ward off illness. In some cases, nutrient deficiencies can make a person more susceptible to certain ailments. For example, vitamin D has been shown to prevent, or lower the risk of, contracting respiratory infections, including the common cold. Those who have low vitamin D levels may be prone to getting respiratory infections more often, too. So, it would make sense to reach for supplements to get some help, right?
See, sufficient intake of essential vitamins and minerals can typically be achieved through consuming a balanced diet. Often though, many people turn to supplements and vitamins for an added boost, as they provide additional nutrient support—but not all of it. In fact, taking too many supplements can be dangerous to your health. We consulted Kelli McGrane MS, RD for the food-tracking app Lose It!, as well as Tamara Bernadot, co-founder and chief nutrition officer at customized vitamin and supplement service Persona Nutrition, for more insight on the great supplements vs. food debate.
As an RD, why do you think it's better to get nutrients from food rather than in the form of supplements?
We know there are several vitamins out there that are marketed to consumers as containing equivalent nutrition as x-amount servings of vegetables and fruits, but we're not convinced that's the best way to receive vital nutrients.
"Compared to supplements, whole foods like fruits and vegetables are almost always a healthier option," says McGrane. "In addition to containing more overall nutrients, including macronutrients and micronutrients, whole foods also contain beneficial fiber and protective compounds, such as antioxidants, that aren't always present in supplements."
Why should someone take a multivitamin? What's the best way to find out if taking a multivitamin is necessary?
"While I'm an advocate for getting most of your nutrition through whole foods, there are times when supplements are necessary to ensure an individual is meeting his or her needs," says McGrane.
The registered dietitian says that multivitamins may be helpful for those who may have a restricted diet, struggle to eat a diversity of foods, or have a condition that makes it difficult to absorb nutrients from foods.
"While blood work can signal a nutrient deficiency, if an individual feels that his or her diet is restrictive or has noticed physical signs of deficiency, it's important to make an appointment with a registered dietitian or primary care physician prior to starting a multivitamin," she explains.
Why is it so important to not ingest an excessive amount of certain vitamins and minerals?
There are two main types of vitamins: those that are water-soluble, which are dissolved in the presence of water, and those that are fat-soluble, which can dissolve in fats and oils. Water-soluble vitamins are not stored in the body, making it even more important to hit daily requirements of these every day. In fact, the body excretes most water-soluble vitamins—which include vitamins B and C complex—through urine. In contrast, fat-soluble vitamins, including vitamins A, D, E, and K, are stored in the liver and adipose (fat) tissue and if consumed in excess, can reach toxic levels.
"Vitamin A, in particular, is concerning, as excess amounts can lead to dizziness, vomiting, fatigue, liver damage, bone loss, and hair loss," says McGrane. "At extreme doses, [it] can even be fatal. It's recommended that adults not exceed the upper limit of 10,00 IU (900 mcg) per day."
Iron is an essential mineral that could be dangerous if consumed in excess amounts. "Acute symptoms of iron poisoning include stomach pain, nausea, and vomiting. However, if iron intake continues to be excessive, iron can accumulate in internal organs and ultimately lead to fatal brain and liver damage," she says.
Taking too many vitamins and supplements can put you at risk of toxicity, so be sure to consult with your doctor or registered dietitian beforehand.
RELATED: Your guide to the anti-inflammatory diet that heals your gut, slows the signs of aging, and helps you lose weight.
How common are nutrient deficiencies?
"While many populations globally experience nutrient deficiencies that cause very serious health conditions (like rickets from a lack of vitamin D in the diet), the real concern in the U.S. is marginal deficiencies," says Bernadot. "Analysis of the National Health and Nutrition Examination Survey finds that nearly one-third of U.S. adults may be at risk of deficiency for at least one vitamin."
We need more or less of certain nutrients during different stages of life. For example, children between the ages of 9 and 18 need 1,300 milligrams of calcium per day to support bone growth. Men between the ages of 19 and 70 and women between 19 and 50 only require 1,000 milligrams of calcium per day. Pregnancy and lactation also require increased intake of specific vitamins and minerals.
"For instance, women who are pregnant need optimal levels of vitamin B9 (folic acid) to help support the growth and development of the baby and minimize the risk of neural tube defects," says Bernadot.
How do you determine which supplements to take, if any at all?
"The best way is to meet with a registered dietitian who can properly examine your diet for possible nutrient gaps, as well as perform a nutrition-focused physical assessment to look for possible signs of deficiencies," says McGrane. "Not only are dietitians trained in identifying deficiencies, but they'll also be able to give you personalized recommendations on which supplements to take, the proper dose, and trustworthy brands."
Is there anything to be cautious about when taking supplements?
"If your doctor or dietitian recommends taking supplements, it's important to remember that nutritional supplements aren't regulated by the FDA. As a result, it's essential to do your homework before purchasing," McGrane advises. "Look for brands with USP on the label, as it indicates that it's been tested for quality and is produced according to the FDA's Good Manufacturing Practices."
Cheyenne Buckingham
Cheyenne Buckingham is the news editor of Eat This, Not That!, specializing in food and drink coverage, and breaking down the science behind the latest health studies and information. Read more
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8,522,903,752,674,154,000 | Mixed Phenotype Acute Leukemias
[N A J Med Sci. 2012;5(2):119-122.] PDF File
Chen Gao, MD, PhD; Amy M. Sands, MD; Jianlan Sun, MD, PhD*
Mixed phenotype acute leukemia represents a small subset of acute leukemia that cannot be simply assigned as myeloid or lymphoid lineage, because of the ambiguous phenotype the leukemic cells exhibit. It encompasses leukemias containing separate populations of blasts of more than one lineage, or a single population of blasts co-expressing antigens of more than one lineage. The 2008 World Health Organization classification established strict criteria for diagnosis of mixed phenotype acute leukemia, emphasizing myeloperoxidase for myeloid lineage assignment, cytoplasmic CD3 for T lineage assignment, and CD19 and other B markers for B lineage assignment. A variety of cytogenetic lesions have been identified in this group of diseases, two of which, the t(9;22)(q34;q11) BCR-ABL1 translocation, and t(v;11q23) with MLL rearrangement are considered separate entities. Other categories include T/myeloid NOS, B/myeloid NOS and other rare types. Mixed phenotype acute leukemia is associated with poor outcome compared with other types of acute leukemias, particularly in those with Philadelphia chromosome, and clinically presents challenges in diagnosis and treatment.
Key Words: acute leukemia, acute leukemia of ambiguous lineage, acute leukemia, acute leukemia of ambiguous lineage, cytogenetics, diagnosis, mixed phenotype acute leukemia (MPAL)
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INTRODUCTION
Most cases of acute leukemia can be classified based on the lineage of the leukemic cells as myeloid, B-lymphoblastic (B-ALL) or T-lymphoblastic leukemia (T-ALL). However, there are uncommon cases in which the blasts show differentiation towards more than one lineage. In the 2008 World Health Organization (WHO) classification these cases are identified as mixed phenotype acute leukemias (MPAL), under the category of acute leukemias of ambiguous lineage.1 MPAL encompasses leukemias containing separate populations of blasts of more than one lineage (bilineal or bilineage), and a single population of blasts co-expressing antigens of more than one lineage (biphenotypic). Cases that can be classified in another category are excluded, including acute myeloid leukemia (AML) with recurrent translocations t(8;21), t(15;17) or inv(16), leukemias with FGFR1 mutations, chronic myelogenous leukemia (CML) in blast crisis, myelodysplastic syndrome (MDS)-related AML and therapy-related AML, even if they have MPAL immunophenotype.1 Of note, a diagnosis of MPAL should be reserved for patients who present with de novo acute leukemia.
Mixed phenotype acute leukemia is a rare disease, representing only 3 – 5% of acute leukemias of all age groups, and 2.4 – 3.7% in children.2,3 However, the true incidence is difficult to establish due to problems with definition, and perhaps variation between different laboratories. It affects both adults and children, more frequently adults and has slight male preference.4 The prognosis for MPAL is poor comparing to other acute leukemias, with an overall survival of 18 months.1,4
DIAGNOSIS
Before the publication of the 2008 WHO classification, the diagnosis and classification of MPAL were based on the scoring system proposed by the European Group for the Immunological Classification of Leukemias (EGIL).5 The EGIL classification scheme assigns score points to major antigens to determine if certain lineage is present. According to the original EGIL scoring system MPAL is defined when scores are over two points for both myeloid and T- or B- lymphoid lineages (Table 1). CD117 was assigned for 0.5 point in the original EGIL scoring system and later considered as a reliable marker for myeloid commitment, and scored higher (1 point).6 The EGIL criteria was very helpful in classification of MPAL. However, even the revised EGIL criteria can sometimes lead to an inaccurate classification. For instance, classical AML cases with t(8;21) frequently express multiple B-cell markers (CD19, CD79a and CD20), and cytoplasmic CD79a, considered to be specific in B-lineage determination, is positive in a significant percentage of T-ALL cases.
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Table 1. The European Group for the Immunological Classification of Leukemias (EGIL) scoring system.
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Table 2. 2008 WHO classification of acute leukemias of ambiguous lineage.
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The most recent 2008 WHO classification has established new and strict criteria for the diagnosis of MPAL (Table 2). The T lineage is recognized by the presence of specific T-lymphoid antigens, cytoplasmic CD3 (cCD3) or surface CD3. Cytoplasmic CD3 expression is best demonstrated by flow cytometry with antibodies to CD3 epsilon chain. It should be noted that polyclonal CD3 antibodies used in immunohistochemistry also react with the T-cell receptor zeta chain present in NK cells, and therefore considered not specific for T lineage. Surface CD3 is rare but indicative of the T-lineage. The myeloid lineage is demonstrated with the presence of myeloperoxidase (MPO) by flow cytometry, immunohistochemistry or cytochemistry, or monocytic differentiation (requiring at least two of the following: non-specific esterase (NSE), CD11c, CD14, CD64, lysozyme. Since there is no single marker sufficiently specific for B-cell lineage, multiple antigens are required, including strong expression of CD19 with one of the other B-cell markers (CD79a, cytoplasmic CD22, CD10), or weak CD19 expression with at least two of the other B-cell markers.1
Compared with the EGIL scoring system, the current 2008 WHO criteria applied less but more specific markers to define the lineage of the blasts, and incorporated the intensity of markers expression into the diagnostic algorithm. The 2008 WHO criteria also emphasize MPO in the diagnosis of MPAL. MPO can be negative in an AML with minimal differentiation, but it has to be positive in MPAL with myeloid lineage, unless the myeloid lineage proven to be monocytic differentiation by expressing at least two of the monocytic markers. Practically, diagnosis of MPAL largely relies on flow cytometric immunophenotyping. Other diagnostic methods such as immunohistochemistry and cytochemistry can be helpful.
The B/myeloid MPAL is the most common among MPALs, followed by T/myeloid, and other rare types of MPALs. A cohort of 100 patients diagnosed as MPAL using the 2008 WHO criteria showed 59% of cases are B/myeloid immunophenotype, and 35% are T/myeloid immunophenotype. A small portion of the cases are B+T-lymphoid imminophenotype or trilineage (B+T+myeloid) immunophenotype.4
Morphologically most cases of MPAL display a single population of leukemic cell, with 43% showing ALL morphology, and 42% showing AML morphology in a large cohort study.4 Majority of the cases with AML morphology are M1 (AML without maturation) or M5 (acute monoblastic and monocytic leukemia) according to the French-American-British (FAB) classification system, and rarely M2 (AML with maturation) or M4 (acute myelomonocytic leukemia).4
The new WHO classification emphasizes MPO expression in myeloid lineage assignment. This was supported by the report by Bene, et al. showing 98% of the MPAL cases expressing MPO in at least 5% of blasts, 76% of the cases with more than 20% of blasts expressing MPO. Majority of the cases have variable populations of blasts coexpressing MPO and lymphoid markers. Other myeloid markers are variably expressed, including CD13 (74%), CD33 (66%), and CD117 (52%), and frequently coexpressed with MPO. Expression of monocyte-associated markers include lysozyme (31%), CD15 (12%), and CD14 (8%).4
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There are four major categories listed under MPAL in the 2008 WHO classification: B/myeloid, NOS; T/myeloid, NOS; MPAL with t(9;22)(q34;q11. 2); BCR-ABL1; and MPAL with t(v;11q23); MLL rearranged.
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Figure 1. Wright-Giemsa-stained bone marrow smear from a patient with T/myeloid leukemia. Dimorphic populations of blasts are observed, one is small lymphoid appearing, the other has dispersed chromatin, prominent nucleoli and a moderate amount of pale cytoplasm, resembling myeloblasts, and positive for MPO.
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MPAL WITH t(9;22)(q34;q11.2); BCR-ABL1
This is the most frequent recurrent genetic abnormality occurring in MPAL and considered a distinctive entity. It accounts for 20% of all MPAL.1,4 It is a leukemia meeting the diagnostic criteria for MPAL with the blasts bearing the t(9;22)(q34;q11. 2) translocation or BCR-ABL1 rearrangement (Ph+) in patients with no history of CML. It occurs more often in adults than in children.4 Clinically, the patients present similarly as other patients with acute leukemias, with white blood cell counts likely to be high, resembling Ph+ ALL.
Majority of the cases occurring in adults have B/myeloid phenotype, while some show T/myeloid, B and T lineage, or trilineage leukemias. Morphologically many cases show a dimorphic blast population, one resembling myeloblasts and the other lymphoblasts. Some cases do not have distinguishing phenotypes.4,7,8
Cytogenetic abnormalities are identified by conventional karyotyping for t(9;22), or FISH or PCR for BCR-ABL1 translocation. Additional cytogenetic abnormalities are shown in many cases, including complex karyotypes. Ph+ is a poor prognostic factor for MPAL, with a reported median survival of 8 months in 12 patients, significantly worse than patients of all other types of MPAL.4
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Figure 2. T/myeloid leukemia with FLT3 mutation. Bone marrow section shows 100% cellularity with extensive replacement of marrow by sheets of blasts (A). Immunohistochemistry stains show a subset of blasts positive for CD3 (B), MPO (C), CD34 (D), TdT (E) and CD117 (F).
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MPAL WITH t(v;11q23); MLL REARRANGED
This is a leukemia meeting the diagnostic criteria for MPAL with blasts bearing a translocation involving the 11q23 breakpoint (MLL gene). MLL rearrangement is more often seen in patients with a precursor B-ALL with aberrant expression of myeloid markers, especially CD15 and CD65 but not MPO. These cases should not be considered MPAL.1,9
MPAL with MLL rearranged is rare and accounts for 8% of all patients with MPAL. It is more often seen in children and relatively common in infancy.1,4 The clinical presentation is similar to other patients with acute leukemias. High white blood cell counts are common as with other leukemia patients with MLL translocations. Commonly these leukemias display a biphenotypic blast population, with one resembling monoblasts and the other resembling lymphoblasts. The lymphoblast population often shows a CD19-positive, CD10-negative B precursor immunophenotype, frequently positive for CD15. Expression of other B markers is usually weak.1
The translocations involving MLL gene include t(4;11)(q21;q23), t(11;19)(q23;p13), and t(9;11)(p22;q23), with confirmed partner genes being AF4 on chromosome 4q21 and AF9 on 9p22.4 However, cases with chromosome 11q23 deletion should not be classified in this category. The prognosis for this type of leukemia is poor.1,4
MPAL B/MYELOID, NOS
This type of leukemia meets the diagnostic criteria for assignment to both B and myeloid lineages and lacks the above mentioned recurrent cytogenetic abnormalities. B/myeloid acute leukemia accounts for 59% of all MPAL4 cases and about 1% of all leukemias.1 It more commonly occurs in adults, but can be seen in children as well.
Morphologically, the blasts have no distinguishing features in most cases, with dimorphic populations, resembling lymphoblasts and myeloblasts, or a single population resembling ALL. CD19 is strongly expressed in greater than 90% of the cases, with majority positive in greater than 50% of the blasts. The blasts are also positive for CD10, cytCD22, and/or cytCD79a.4 Multiple different cytogenetic changes have been demonstrated, however none is proven to be specific in this subtype (will be discussed below).
MPAL T/MYELOID, NOS
This category meets the requirements for assignment to both T-lymphoid and myeloid lineages without recurrent cytogenetic abnormalities. It accounts for one third of MPAL and less than 1% of overall leukemias.1,4 It can occurs in both children and adults, but more commonly in children.
There are no distinctive clinical features in patients with T/myeloid acute leukemia. The blasts are composed of either a single population or dimorphic populations (Figure 1). Cytoplasmic CD3 is expressed in virtually all cases, with more than 20% of the blasts positive in majority of the cases. Other commonly expressed T-lineage markers include CD2, positive in 27-98% of the blasts in 67% of the cases, and CD7, positive in 24-99% of the blasts in 91% of the cases.4 Interestingly, the FMS-like tyrosine kinase 3 gene (FLT3) mutations is demonstrated to be specifically associated with T/myeloid lineage. The immunophenotypic profile of CD117(bright), terminal deoxynucleotidyl transferase (TdT), CD7, CD13 and CD34 is reported to be highly sensitive (100%) and specific (94%) for predicting FLT3 mutation in T-ALL and T/myeloid acute leukemia (Figure 2).10 Targeted therapy with FLT3 inhibitors has been developed and undergone clinical trials.11
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CYTOGENETICS
The incidence of cytogenetic abnormalities is high in MPAL, with only 13% of the cases showing a normal karyotype. About one third of the cases have a complex karyotype with three or more structural chromosome abnormalities, and 27% have other abnormalities. The most commonly involved chromosomal abnormalities include del(6)(q11-21), 7q-, -7, t(2;7), del(5q) or -5, trisomy 4, and hyperdiploid karyotype. ETV-6-RUNX1 rearrangement has been reported.12 Except for t(9;22), MLL rearrangement, and FLT3 mutation, there is no significant correlation between the other cytogenetic abnormalities with age, sex, morphology, FAB subtype or immunophenotype.4
PROGNOSIS
Young age, normal karyotype and ALL induction therapy are associated with favorable survival, and Ph+ is a predictor for poor prognosis. Study shows median survival is 139 months for children versus 11 months for adults, 139 months for patients with normal karyotype, versus 8 months for Ph+, and 139 months for patients receiving ALL regimens, versus 11 months for those receiving AML schedules.4
In summary, MPAL is a rare disease with poor prognosis. In order to establish the diagnosis, a panel of markers are suggested including: MPO, CD3 (cytoplasmic and surface), CD19 plus three other B-lineage markers (CD22, CD79a, CD10), and two or three monocytic markers. Adult and Ph+ patients have worse prognosis, and bone marrow transplantation should be considered in first remission in these patients.1,4
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_____________________________________________________________________________________________________________________________
Chen Gao, MD, PhD; Amy M. Sands, MD; Jianlan Sun, MD, PhD*
Department of Pathology, Buffalo General Hospital, State University of New York at Buffalo, 100 High Street, Buffalo, NY B
*Corresponding Author: Department of Pathology, Buffalo General Hospital, State University of New York at Buffalo, 100 High Street, Buffalo, NY 14203. Tel: 716-859-2140.
(Email address: jianlan. sun@gmail.com)
CONFLICT OF INTEREST
None.
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_____________________________________________________________________________________________________________________________
REFERENCES
1. Borowitz M, Bene MC, Harris NL, Porwit A, Matutes E. Acute leukemias of ambiguous lineage. In: Swerdlow SH, Campo E, Harris NL, et al, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2008:150-155.
2. Rubnitz JE, Onciu M, Pounds S, et al. Acute mixed lineage leukemia in children: the experience of St Jude Children’s Research Hospital. Blood. 2009;113(21):5083-5089.
3. Al-Seraihy AS, Owaidah TM, Ayas M, et al. Clinical characteristics and outcome of biphenotypic acute leukemia in children. Haematologica. 2009; 94(12):1682-1690.
4. Matutes E, Pickl WF, Van’t Veer M, et al. Mixed phenotype acute leukemia (MPAL): clinical and laboratory features and outcome in 100 patients defined according to the WHO 2008 classification. Blood. 2011;117(11):3163-3171.
5. Bene MC, Castoldi G, Knapp W, et al. Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias (EGIL). Leukemia. 1995;9(10):1783-1786.
6. Bene MC, Bernier M, Casasnovas RO, et al. The reliability and specificity of c-kit for the diagnosis of acute myeloid leukemias and undifferentiated leukemias. The European Group for the Immunological Classification of Leukemias (EGIL). Blood. 1998;92(2):596-599.
7. Carbonell F, Swansbury J, Min T, et al. Cytogenetic findings in acute biphenotypic leukaemia. Leukemia. 1996;10(8):1283-1287.
8. Killick S, Matutes E, Powles RL, et al. Outcome of biphenotypic acute leukemia. Haematologica. 1999;84(8):699-706.
9. Attarbaschi A, Mann G, Konig M, et al. Mixed lineage leukemia-rearranged childhood pro-B and CD10 negative pre-B acute lymphoblastic leukemia constitute a distinct clinical entity. Clin Cancer Res. 2006;12(10):2988-2994.
10. Hoehn D, Medeiros LJ, Chen SS, et al. CD117 expression is a sensitive but nonspecific predictor of FLT3 mutation in T acute lymphoblastic leukemia and T/myeloid acute leukemia. Am J Clin Pathol. 2012;137(2):213-219.
11. Levis M, Ravandi F, Wang ES, et al. Results from a randomized trial of salvage chemotherapy followed by lestaurtinib for patients with FLT3 mutant AML in first relapse. Blood. 2011;117(12):3294-3301.
12. Gerr H, Zimmermann M, Schrappe M, et al. Acute leukaemias of ambiguous lineage in children: characterization, prognosis and therapy recommendations. Br J Haematol. 2010;149(1):84-92.
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_____________________________________________________________________________________________________________________________
3693 stat all 5 stat today | {
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-1,239,144,893,618,829,600 | Ask an Expert: I Don’t Want to Get ‘Big’ So Should I Skip the Weights?
We asked a trainer if women should really lift weights.
It looks harder than it is. Woman weightlifting photo via Shutterstock.
It looks harder than it is. Woman weightlifting photo via Shutterstock.
In the February issue of Boston, Lisa Liberty Becker wrote about the stigma of women lifting at the gym. She lifted weights and the pounds dropped. Can this be true for everyone? We asked a personal trainer, should women lift weights?
Our answer comes from Ali Arnow, a personal trainer at Equinox on Franklin St. Ali’s been training for 13 years and holds multiple certifications.
Q: Why should women lift weights?
A: When women skip the weight room they lose out on the ultimate flab melter. Gaining muscle can pay off in a long term boost to your metabolism and can keep a woman’s body lean and sculpted. Although doing cardio burns calories, pumping iron can slash more in the long term. A cardio session burns calories during the sweaty time you’re on the treadmill, but a strength training session can slash more calories in the 24 hours after the workout. There is another benefit to lifting weights; muscle is metabolically active tissue. Muscle chews up calories even when you aren’t in the gym!
But torching calories isn’t the only benefit from lifting weights. You can actually stop and reverse bone loss using strength training. Weight-bearing exercise increases bone mass. Weight training can also decrease your risk of injury in sports and everyday activities. Women have a higher incidence of knee injuries, such as ACL tears and women can decrease their risk of these injuries by lifting weights.
Training with weights can boost you stamina and the way you function in your everyday activities. More muscle will make daily chores easier. Everything from lifting your 3-year-old daughter (gasp!) to shoveling snow will seem easier. You will have more energy to do the laundry, go grocery shopping, or dance all night.
You can turn back the clock with weight training. As we age we start losing eight to 10 percent of our strength. The fast twitch muscle fibers that keep you moving like a young person are the first to go. These are the muscles that help you catch your balance when you start to fall. Women who work their muscles retain significantly more strength as they get older.
Last but not least, strength training increases self-esteem and confidence. When you feel strong you feel empowered and this affects all areas of our lives from careers to relationships.
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-9,141,143,073,022,714,000 | Home Discussion Topics Dictionary Almanac
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Lesion
Lesion
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Encyclopedia
A lesion is any abnormality in the tissue of an organism (in layman's terms, "damage"), usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.
Types
Because the definition of a lesion is so broad, the varieties of lesions are virtually endless. They are subsequently classified by their features. If a lesion is caused by a tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
it will be classified as malignant
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
versus benign. Lesions may be classified by the shape they form, as is the case with many ulcers, which can have a bullseye
Bullseye (target)
The bullseye, or bull's-eye, is the centre of a target , and by extension the name given to any shot that hits the bullseye...
or 'target' appearance. Their size may be specified as gross or histologic depending on whether they are visible to the unaided eye or require a microscope to see.
An additional classification that is sometimes used is based on whether or not a lesion occupies space. A space-occupying lesion, as the name suggests, occupies space and may impinge on nearby structures, whereas a non space-occupying lesion is simply a hole in the tissue, e.g. a small area of the brain that has turned to fluid following a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
.
Some lesions have specialized names, like the Gohn lesions in the lungs of tuberculosis victims. The characteristic skin lesions of a varicella-zoster virus (VZV) infection are called chickenpox
Chickenpox
Chickenpox or chicken pox is a highly contagious illness caused by primary infection with varicella zoster virus . It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring...
. Lesions of the teeth are usually called dental caries
Dental caries
Dental caries, also known as tooth decay or a cavity, is an irreversible infection usually bacterial in origin that causes demineralization of the hard tissues and destruction of the organic matter of the tooth, usually by production of acid by hydrolysis of the food debris accumulated on the...
.
Finally, lesions are often classified by their location. For example, a 'skin lesion' or a 'brain lesion'.
Causes
Lesions are caused by any process that damages tissues. Lesions can also be caused by metabolic processes, like an ulcer or autoimmune activity, as in the case with many forms of arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
.
Lesions are sometimes intentionally inflicted during neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
, such as the carefully placed brain lesion used to treat epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
and other brain disorders. (See Ablative brain surgery
Ablative brain surgery
Ablative brain surgery is the surgical ablation by burning or freezing of brain tissue to treat neurological or psychological disorders. The lesions it causes are irreversible....
.)
Note that lesions are not limited to animals or humans; damaged plants are said to have lesions.
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7,215,981,378,300,370,000 | How to Get Smaller Shoulders
Broad shoulders present fashion challenges and can make you feel self-conscious, but the size of your shoulders is based on genetics. Unless you're overweight, shrinking your shoulders is nearly impossible. Even if you lose weight and your body shrinks, the inverted triangle shape of your torso will remain because you lose weight proportionally. You can't exercise away a certain body part. Once you're at a healthy weight, create the illusion of smaller shoulders by emphasizing other body parts with muscle development and your clothing.
Spot Training Is a Myth
You can't make a body body part smaller, be it your abs, legs or butt, by exercising it or eating certain foods. Fat covering muscles and bones doesn't melt away when you work the area. A study published in a 2013 issue of the Journal of Strength and Conditioning Research showed that participants who did up to 1,000 leg presses on one leg three times per week for 12 weeks experienced no change in the fat on that leg compared to the one that wasn't exercised. This confirmed research published in a 1971 issue of the Annals of Internal Medicine showing that tennis players' strong, oft-used dominant arms do not have less subcutaneous fat than their nondominant arms.
Your body does use fat for energy, but only when it's been converted to glycerol and free fatty acids that circulate in your blood stream. Where in your body the fat is broken down and metabolized at any given moment varies. It's dependent on the genetic way your body stores and loses fat. You can't direct your body to remove fat from your shoulders only.
A Shoulder's Tissue Makeup
The shoulders aren't typically a place you store a lot of fat tissue. They're mainly made up of bones, which have a genetically determined size, as well as connective tissue and muscle. Some subcutaneous fat lies right under the skin, and when you lose weight, it may help your shoulders reduce in size along with the rest of your body.
You build broad shoulders by growing the muscle tissue with moves such as lateral shoulder raises, military presses, pushups, front-arm raises and rear deltoid flyes. If you've built a lot of muscle mass in your shoulders, it will atrophy if you shift your workout program to lift lighter weights and less often. Don't skip training your upper body for fear of making your shoulders larger, though. Overall body health requires you to strength train all the major muscle groups, including the chest, shoulders and back, at least twice per week with one set of eight to 12 repetitions.
If you don't weight train and are of a healthy weight, the size of your shoulders isn't due to extensive muscle mass or fat tissue, but to the bone structure in your upper body. You can't change your bones.
Weight Loss for Smaller Shoulders
If you need to lose fat to help your shoulders trim down along with the rest of your body, adopt a low-calorie meal plan along with regular cardiovascular exercise. Determine your daily calorie burn by using an online calculator that takes into account your size, age, gender and level of activity. Then, create a deficit of 500 to 1,000 calories per day by eating less and moving more; this daily deficit helps you lose 1 to 2 pounds per week.
A simple way to trim calories is to reduce your intake of sugary soft drinks and refined grains, such as white bread or pasta. These foods offer little nutritional value and lots of extra calories. Design your meals and snacks so they contain moderate portions of lean proteins, whole grains and vegetables instead. Choose low-fat yogurt, fresh fruit and nuts as snacks instead of processed foods.
Create the Illusion of Smaller Shoulders
What you wear can accentuate broad shoulders -- especially strapless dresses and tops. Skip highly fitted blazers that pull across your back or ones with shoulder pads. Wearing a skirt or dress with a cinched waist calls attention to the width of your shoulders. Opt instead for tanks with wide straps and shirts with scoop- or V-necks. These break up your upper body so it appears less broad. Full skirts and wide-leg pants give your body a proportional look.
Physically, you can do little to change the inverted triangle shape of your upper body. But, you can focus on building muscle and definition in your lower body so that it balances out your physique. As part of your comprehensive training plan, perform exercises such as squats, deadlifts, step ups and lunges to build the muscles in your legs and backside. When you fill this area out with healthy muscle mass, you create a solid physique so your shoulders don't appear out of balance. | {
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5,780,372,833,906,478,000 | Lab Dept:
Microbiology/Virology
Test Name:
CMV Rapid FA
General Information
Lab Order Codes:
RCMV
Synonyms:
CMV Shell vial culture; Cytomegalovirus Rapid FA
CPT Codes:
87254 x2 - Virus isolation; shell vial, includes identification with immunofluorescence stain, each virus
Test Includes:
Shell vial isolation technique with immunofluorescent staining of CMV early nuclear antigen. Viral culture must be ordered with this test. Refer to Viral Culture
Logistics
Lab Testing Sections:
Virology
Phone Numbers:
MIN Lab: 612-813-5806
STP Lab: 651-220-6555
Test Availability:
Daily, 24 hours
Turnaround Time:
1 - 2 days
Special Instructions:
Do Not use calcium alginate swabs.
Requisition must state specific site of specimen and date/time of collection.
Specimen
Specimen Type:
Urine, throat, bronchoalveolar lavage, bronchial washings, appropriate autopsy and biopsy specimens, blood, bone marrow, tracheal aspirates, respiratory sources
Container:
Viral transport media (available in Microbiology), sterile container, swab transport system, Lavender top (EDTA) tube
Volume:
Whole blood: 5 mL
Urine: 5 mL
Washings/aspirates: 1 - 2 mL
1 swab
Aspirate or sputum: 0.5 mL
Collection:
BLOOD:
Venipuncture for patients greater than 26 weeks gestation OR greater than 2 weeks of age:
Prep with CloraPrep Sepp® Applicator with 2% CHG
1. Disinfect the stopper of the Lavender top tube (EDTA) with 70 % alcohol. Allow to dry. 2. Break the Sepp® ampule to release the 2% CHG. 3. Apply the CloraPrep® solution using a back-and-forth friction scrub for 30 seconds. 4. Allow the area to dry for 30 seconds. 5. If the site must be touched during venipuncture, disinfect the gloved fingers. 6. Collect 5 mL of blood and aseptically inoculate the Lavender top tube (EDTA). 7. Gently invert the tube 4-5 times to mix contents. 8. Forward unprocessed whole blood promptly at ambient temperature only.
Prep with CloraScrub™Swab with 3.15% CHG
1. Disinfect the stopper of the Lavender top tube (EDTA) with 70 % alcohol. Allow to dry. 2. Open the Chlorascrub™Swab package, do not unfold wipe. 3. Apply the Chlorascrub™ wipe using a back-and-forth friction scrub for 15 seconds. 4. Allow the area to dry for 30 seconds. 5. If the site must be touched during venipuncture, disinfect the gloved fingers. 6. Collect 5 mL of blood and aseptically inoculate the Lavender top tube (EDTA). 7. Gently invert the tube 4-5 times to mix contents. 8. Forward unprocessed whole blood promptly at ambient temperature only.
Venipuncture for patients less than 26 weeks gestation AND less than 2 weeks of age:
Prep with 2% tincture of iodine:
1. Disinfect the stopper of the Lavender top tube (EDTA) with 70 % alcohol. Allow to dry. 2. Scrub venipuncture site with 70% alcohol for 1 minute using the Frepp® applicator. Allow to dry. 3. Using the Sepp® applicator, apply 2% tincture of iodine to site starting at the center and moving outward in concentric circles. Allow to dry, approximately 30 seconds. 4. If the site must be touched during venipuncture, disinfect the gloved fingers. 5. Collect 5 mL of blood and aseptically inoculate the Lavender top tube (EDTA). 6. Gently invert the tube 4-5 times to mix contents. 7. Forward unprocessed whole blood promptly at ambient temperature only. 8. Following collection, remove the iodine using the Frepp® applicator or an alcohol pad.
Line Draw (All ages):
1. Prep catheter port by scrubbing the hub for 30 seconds using chlorhexidine gluconate (CHG) and allowing to dry. 2. Aseptically collect 5 mL of blood through the injection port. Blood may be collected without first drawing a discard. 3. Aseptically inoculate the Lavender top tube (EDTA). Forward unprocessed whole blood promptly at ambient temperature only.
Bone Marrow:
Place 1 – 5 mL of bone marrow in Lavender top (EDTA) tube(s). Invert several times to mix bone marrow. Do Not centrifuge. Send in original Vacutainer tube. Forward unprocessed bone marrow promptly at ambient temperature only.
Throat Swab:
1. Depress the tongue with a tongue depressor so the swab does not touch the tongue. 2. Sample the posterior pharynx, tonsils, and inflamed areas with a sterile swab. 3. If specimen cannot be transported to the lab immediately, place swab in transport media and refrigerate.
Tissue:
Submit specimen in a screw capped, sterile container.
Urine:
Males:
1. Clean glans with soap and water. 2. Rinse area with wet gauze pads. 3. While holding foreskin retracted, begin voiding. 4. After several mL have passed, collect a minimum of 5.0 mL without stopping flow of urine. 5. Maintain sterility and forward immediately to the Microbiology Lab. Refrigerate.
Females:
1. Thoroughly clean urethral area with soap and water. 2. Rinse area with wet gauze pads. 3. While holding labia apart, begin voiding. 4. After several mL have passed, collect a minimum of 5.0 mL without stopping flow of urine. 5. Maintain sterility and forward immediately to the Microbiology Lab. Refrigerate.
Bronchoscopy:
1 – 2 mL of specimen obtained by physician through the biopsy channel of the bronchoscope.
Transfer specimen into a luki tube. Transport to the Microbiology Laboratory immediately.
Nasopharyngeal swabs:
1. Obtain 2 swabs using NP flexible wire swabs. 2. Gently insert swab through nose into posterior nasopharynx. 3. Gently rotate swab slowly for 5 seconds to absorb secretions. 4. Collect a second swab in the same manner. 5. Maintain sterility and forward promptly at ambient temperature. 6. If specimen cannot be transported to the lab immediately, place swabs in transport media and refrigerate.
Nasopharyngeal Washings:
1. Tilt patient’s head back at a 70° angle. 2. Insert rubber bulb syringe containing 1 – 2 mL of sterile saline until it occludes the nostril. 3. Collect specimen (Minimum: 1 mL) with one complete squeeze and release bulb. 4. Repeat in other nostril. 5. Place aspirate in container and forward promptly. 6. If specimen cannot be transported to the lab immediately, place swabs in transport media and refrigerate.
Nasal Aspiratation:
1. Prepare suction set up on low to medium suction. 2. Wash hands and put on protective barriers (e.g., gloves, gown, mask). 3. Place child supine and obtain assistant to hold child during procedure. 4. Attach luki tube to suction tubing and #6 French suction catheter.| 5. Insert catheter into nostril and pharynx without applying suction. 6. Apply suction as catheter is withdrawn. If necessary, suction 0.5 – 1 mL of normal saline through catheter in order to clear the catheter and increase the amount of specimen in the luki tube. 7. If specimen cannot be transported to the lab immediately, place swabs in transport media and refrigerate.
Special Processing:
Extract swabs into viral transport media (VTM) by swirling and pressing the swab against the inside of the vial, then discard swab; add 3.0 - 5.0 mL urine to urine VTM; place washings/aspirates into VTM; place tissue into VTM. Refrigerate.
Transport/Storage:
Onsite collections: Transport to the laboratory immediately.
Offsite collections:
Swab specimens: Place in VTM and refrigerate.
Blood: Do Not refrigerate. Store and ship at room temperature. Do not refrigerate. Do Not centrifuge.
Specimens must be promptly transported to the laboratory, with the next available courier, not to exceed 24 hours from the time of collection. However, delayed transport causes a delay of test results.
Sample Rejection:
Specimen not submitted in appropriate transport container; improperly labeled specimen; insufficient volume; external contamination. If an unacceptable specimen is received, the physician or nursing station will be notified and another specimen will be requested before the specimen is discarded.
Interpretive
Reference Range:
No Cytomegalovirus detected by rapid fluorescent antibody.
Critical Values:
Positive results in systemic infections will be called to the physician or nursing unit.
Limitations:
● Urine and blood can be toxic to cell cultures and can result in inconclusive results. ● CMV antigenemia or molecular techniques are more sensitive tests for the detection of CMV in blood.
Methodology:
Shell vial culture with immunofluorescence
Additional Information:
● CMV infections are very common in normal individuals and are usually asymptomatic. However, CMV infections are frequently severe and life threatening in immunocompromised patients, including organ recipients and AIDS patients. CMV is the major viral pathogen following renal transplantation. Blood cultures positive for CMV predict progression. Knowledge of CMV infection is of utmost importance so that ganciclovir can be started as soon as possible.
● CMV is the most frequent cause of congenital viral infections in humans and occurs in about 1% of all newborns. Approximately 90% have no clinical symptoms at birth. Ten percent to 20 % of these infants will develop complications before school age. Congenital infection may occur as a result of either primary or recurrent maternal infection.
References:
Cook, JH, and M Pezzlo (2010) Specimen receipt and accessioning. Section 1. Aerobic bacteriology, 1.2.1-4. In HD Isenberg (ed) Clinical Microbiology Procedures Handbook. American Society for Microbiology, Washington DC
Miller, J Michael (1999) A Guide To Specimen Management in Clinical Microbiology, American Society for Microbiology, Washington DC
Miller, J Michael, and HT Holmes (1999) Specimen Collection, Transport, and Storage In PR Murray et al, (ed), Manual of Clinical Microbiology, 7th edition, American Society for Microbiology, Washington DC, pg 33-104
Griffiths, PD, and VC Emery (2002). Cytomegalovirus In DD Richman et al., (ed.), Clinical Virology, 2nd edition, American Society for Microbiology, Washington DC, pg 447-449
Updates:
11/20/14: Offsite information added.
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All About Vision
Kids' Vision & Learning
There’s More To Children’s Learning Than Just 20/20 Vision
children rely on good eyesight to do schoolwork
Even if your child doesn’t need corrective lenses, he or she may be experiencing vision problems. These eye conditions can cause learning problems and substandard educational results. A child’s visual acuity (how well s/he can see the wall chart) is an essential aspect of good vision but there are other factors which may prove more important. You may already be aware that a nearsighted child has little trouble reading or that good grades in school can be acquired even if much of the teacher’s board cannot be seen by the student.
Questions Related to Eyesight and Learning
Eye movement skills:
Do your child’s eyes move across the page in a book smoothly and accurately?
Eye focusing abilities:
Does your child change focus from near to far and back again – between reading text from a far-away white or black-board and writing on paper?
Eye teaming skills:
Are your child’s eyes working together as a focus unit – do they come together for proper eye alignment for reading?
Binocular vision skills:
Are your child’s eyes blending visual images from both eyes into a single, three-dimensional image?
Visual perceptual skills:
Does your child identify and understand what s/he sees, co-relating importance, connecting with previous visual memorized information?
Visual-motor integration:
Is the quality of your child’s eye-hand coordination balanced? Visual-motor integration is important not only for legible handwriting and the ability to efficiently copy written information from a book or board but also for sports. Deficiencies in any of these can be detrimental to a child’s learning ability and/or school performance.
Vision Problems Do Affect Kids Learning
Undetected learning-related vision problems in children are common. A child with an untreated vision problem may be misdiagnosed with behavior problems or ADHD/ADD when in reality they have a vision problem. Vision problems, in extreme cases, ignored or misdiagnosed, can become the true root cause of a child becoming the victim or aggressor in a school bullying tragedy.
Left untreated, vision problems will hinder your child’s learning in school. Studies have shown that at least 13% of children between the ages of nine-thirteen suffer from moderate to severe convergence insufficiency, the ability to bring one’s eyes together, which is crucial for good reading. Studies demonstrate clearly that 1 out of 4 school-age children suffer from at least one learning related vision problem.
Learning-Related Vision Problems
Signs and Symptoms
Some of the most common roadmap symptoms of learning-related vision disorders are:
• Double vision, particularly during or after reading
• Poor handwriting
• Hyperactivity or recklessness during class
• Word and letter reversals
• Easily distracted during reading
• Poor reading comprehension
• Poor overall school performance
• Circumventing of reading
• Blurred vision, especially after reading or working closely
• Eye Strain or frequent headaches
Call us to schedule a comprehensive child’s vision exam if your child exhibits one or more of these signs or symptoms and is exhibiting these types of problems in school.
Comprehensive Child Vision Exam
A comprehensive child’s vision exam includes tests performed in a routine eye exam, plus specific additional tests for detecting learning-related vision problems.
Extra tests would include accommodation, binocular vision, and ocular motility testing. In addition to these, depending on the type of problems your child is displaying, we may recommend other testing, either in our office or with a child’s vision and/or vision development specialist.
Vision Therapy
Special reading glasses or vision therapy may help your child if s/he has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses. Vision therapy entails eye exercises and other activities specifically tailored for each patient to improve vision skills.
Learning Disabilities and Vision
Although children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom, vision therapy is a treatment for vision problems; it does not correct a learning disability. A child’s learning ability and school performance may indicate learning disabilities and/or vision problems.
Once your child’s comprehensive vision exam is completed, our doctor will advise you about whether a program of vision therapy could be helpful. We will refer you to a children’s vision or education/learning specialist if we do not provide the specified additional services your child needs.
Orthokeratology (CRT & VST)
Pretty, young Ortho K Lenses brunette
Orthokeratology, commonly called ortho-k, is a method used to correct myopia (nearsightedness) or astigmatism by wearing rigid gas permeable contact lenses overnight, so that no corrective lenses are needed during daytime hours.
Gas permeable (GP) lenses specialized for ortho-k are inserted at bedtime and worn as you sleep. Throughout the night, the lenses reshape your cornea gently so that your vision becomes clear on the following morning. The correction is temporary, and ideally no eyeglasses or contact lenses will be needed on the next day or two. In order to maintain sharp visual acuity on a daily basis, you need to wear the ortho-k reshaping lenses every night.
At present, three brands of orthokeratology contact lenses are approved for use by the FDA. Euclid Emerald, usually prescribed for myopia control, Paragon Vision Sciences, who produces “Corneal Refractive Therapy” (CRT), and Bausch and Lomb, who manufactures “Vision Shaping Treatment” (VST).
Candidates for Ortho-K
Ortho-k is very suitable for nearsighted people who are not appropriate candidates for vision correction surgery, such as children. Individuals of all ages with healthy eyes can try ortho-k, namely because it can be discontinued at any point without permanent effects to the eyes.
People who require vision correction and engage regularly in sports or work in extremely dusty, dirty environments will also appreciate the convenience of ortho-k.
Vision Results from Orthokeratology
Success rates for ortho-k are generally higher for more mild vision prescriptions. The ideal goal is to provide 20/20 vision without any need for eyeglasses or contacts during the day.
According to FDA trials conducted on both CRT and VST lenses, more than 65% of ortho-k patients achieved 20/20 visual acuity. A whopping number of more than 90% of ortho-k patients achieved 20/40 vision or better (this is the legal requirement for driving without vision correction in most states). Consult with your eye doctor to find out if your vision prescription is within range for successful ortho-k treatment.
Note that although improvement in vision is generally reported within a day or two of wearing ortho-k overnight, the full effects may not be experienced until the lenses are worn for a few weeks. During this transition period, your vision will probably not be as crisp as it was with regular contacts or eyeglasses, and glare or halos around lights may be visible. Until ortho-k works fully, a temporary pair of eyeglasses may be required for specific actions, such as driving at night.
How Does Ortho-k Feel?
Although some people have trouble wearing regular gas permeable contact lenses during the day, ortho-k GP lenses are worn while sleeping – so discomfort and awareness of the lenses in your eyes is generally not an issue.
Is Ortho-k expensive?
Professional fitting for ortho-k requires a series of visits to your eye doctor. A number of pairs of contact lenses are also generally needed. GP lenses that are special for ortho-k are more costly than standard contacts. In sum, the fees for ortho-k add up to a higher total than regular contact lenses.
LASIK after Ortho-k
Some consider Ortho-K to be a non-surgical alternative to LASIK. Nonetheless, refractive surgeries, such as LASIK, are possible after treatment with ortho-k lenses. Yet because ortho-k works to reshape your cornea, you are required to stop wearing the lenses for approximately several months before undergoing LASIK. This allows your eyes to return to their original shape.
It’s important to inform your LASIK surgeon if you’ve been wearing ortho-k lenses, and you will be advised as to how long of a wait is necessary before having the laser procedure.
Eye Exams for Children
According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning can be affected. This also goes for infants who develop and learn about the world around them through their sense of sight. To ensure that your children have the visual resources they need to grow and develop normally, their eyes and vision should be checked by an eye doctor at certain stages of their development.
According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school, and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed or lazy eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly. Children’s eyes can change rapidly as they grow.
Eye Exams in Infants: Birth – 24 Months
A baby’s visual system develops gradually over the first few months of life. They have to learn to focus and move their eyes, and use them together as a team. The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. With the development of eyesight, comes also the foundation for motor development such as crawling, walking and hand-eye coordination.
You can ensure that your baby is reaching milestones by keeping an eye on what is happening with your infant’s development and by ensuring that you schedule a comprehensive infant eye exam at 6 months. At this exam, the eye doctor will check that the child is seeing properly and developing on track and look for conditions that could impair eye health or vision (such as strabismus(misalignment or crossing of the eyes), farsightedness, nearsightedness, or astigmatism).
Since there is a higher risk of eye and vision problems if your infant was born premature or is showing signs of developmental delay, your eye doctor may require more frequent visits to keep watch on his or her progress.
Eye Exams in Preschool Children: 2-5
The toddler and preschool age is a period where children experience drastic growth in intellectual and motor skills. During this time they will develop the fine motor skills, hand-eye coordination and perceptual abilities that will prepare them to read and write, play sports and participate in creative activities such as drawing, sculpting or building. This is all dependent upon good vision and visual processes.
This is the age when parents should be on the lookout for signs of lazy eye (amblyopia) – when one eye doesn’t see clearly, or crossed eyes (strabismus) – when one or both eyes turns inward or outward. The earlier these conditions are treated, the higher the success rate.
Parents should also be aware of any developmental delays having to do with object, number or letter recognition, color recognition or coordination, as the root of such problems can often be visual. If you notice your child squinting, rubbing his eyes frequently, sitting very close to the tv or reading material, or generally avoiding activities such as puzzles or coloring, it is worth a trip to the eye doctor.
Eye Exams in School-Aged Children: Ages 6-18
Undetected or uncorrected vision problems can cause children and teens to suffer academically, socially, athletically and personally. If your child is having trouble in school or afterschool activities there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but also the ability of your eyes to work together. Children that have problems with focusing, reading, teaming their eyes or hand-eye coordination will often experience frustration, and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal, so they aren’t able to express that they need help.
In addition to the symptoms written above, signs of vision problems in older children include:
• Short attention span
• Headaches
• Frequent blinking
• Avoiding reading
• Tilting the head to one side
• Losing their place often while reading
• Double vision
• Poor reading comprehension
The Eye Exam
In addition to basic visual acuity (distance and near vision) an eye exam may assess the following visual skills that are required for learning and mobility:
• Binocular vision: how the eyes work together as a team
• Focusing
• Peripheral Vision
• Color Vision
• Hand-eye Coordination
• Tracking
The doctor will also examine the area around the eye and inside the eye to check for any eye diseases or health conditions. You should tell the doctor any relevant personal history of your child such as a premature birth, developmental delays, family history of eye problems, eye injuries or medications the child is taking. This would also be the time to address any concerns or issues your child has that might indicate a vision problem.
If the eye doctor does determine that your child has a vision problem, they may discuss a number of therapeutic options such as eyeglasses or contact lenses, an eye patch, vision therapy or Ortho-k, depending on the condition and the doctor’s specialty. Since some conditions are much easier to treat when they are caught early while the eyes are still developing, it is important to diagnose any eye and vision issues as early as possible.
Following the guidelines for children’s eye exams and staying alert to any signs of vision problems can help your child to reach his or her potential.
Eye Exams for Contact Lenses
Contact lenses are a great alternative to wearing eyeglasses. An often unknown fact is that not all patients wear contact lenses as their primary source of vision correction. Each patient is different, with some patients wearing contact lenses only on weekends, special occasions or just for sports. That is the beauty of contact lens wear, the flexibility it gives each individual patient and their lifestyle.
If you decide to opt for contact lens wear, it is very important that the lenses fit properly and comfortably and that you understand contact lens safety and hygiene. A contact lens exam will include both a comprehensive eye exam to check your overall eye health, your general vision prescription and then a contact lens consultation and measurement to determine the proper lens fit.
The Importance of a Comprehensive Eye Exam
Whether or not you have vision problems, it is important to have your eyes checked regularly to ensure they are healthy and that there are no signs of a developing eye condition. A comprehensive eye exam will check the general health of your eyes as well as the quality of your vision. During this exam the eye doctor will determine your prescription for eyeglasses, however this prescription alone is not sufficient for contact lenses. The doctor may also check for any eye health issues that could interfere with the comfort and success of contact lens wear.
The Contact Lens Consultation
The contact lens industry is always developing new innovations to make contacts more comfortable, convenient and accessible. Therefore, one of the initial steps in a contact lens consultation is to discuss with your eye doctor some lifestyle and health considerations that could impact the type of contacts that suit you best.
Some of the options to consider are whether you would prefer daily disposables or monthly disposable lenses, as well as soft versus rigid gas permeable (GP) lenses. If you have any particular eye conditions, such as astigmatism or dry eye syndrome, your eye doctor might have specific recommendations for the right type or brand for your optimal comfort and vision needs.
Now is the time to tell your eye doctor if you would like to consider colored contact lenses as well. If you are over 40 and experience problems seeing small print, for which you need bifocals to see close objects, your eye doctor may recommend multifocal lenses or a combination of multifocal and monovision lenses to correct your unique vision needs.
Contact Lens Fitting
One size does not fit all when it comes to contact lenses. Your eye doctor will need to take some measurements to properly fit your contact lenses. Contact lenses that do not fit properly could cause discomfort, blurry vision or even damage the eye. Here are some of the measurements your eye doctor will take for a contact lens fitting:
Corneal Curvature
In order to assure that the fitting curve of the lens properly fits the curve of your eye, your doctor will measure the curvature of the cornea or front surface of the eye. The curvature is measured with an instrument called a keratometer to determine the appropriate curve for your contact lenses. If you have astigmatism, the curvature of your cornea is not perfectly round and therefore a “toric” lens, which is designed specifically for an eye with astigmatism, would be fit to provide the best vision and lens fit. In certain cases your eye doctor may decide to measure your cornea in greater detail with a mapping of the corneal surface called corneal topography.
Pupil or Iris Size
Your eye doctor may measure the size of your pupil or your iris (the colored area of your eye) with an instrument called a biomicroscope or slit lamp or manually with a ruler or card. This measurement is especially important if you are considering specialized lenses such as Gas Permeable (GP) contacts.
Tear Film Evaluation
One of the most common problems affecting contact lens wear is dry eyes. If the lenses are not kept adequately hydrated and moist, they will become uncomfortable and your eyes will feel dry, irritated and itchy. Particularly if you have dry eye syndrome, your doctor will want to make sure that you have a sufficient tear film to keep the lenses moist and comfortable, otherwise, contact lenses may not be a suitable vision option.
A tear film evaluation is performed by the doctor by putting a drop of liquid dye on your eye and then viewing your tears with a slit lamp or by placing a special strip of paper under the lid to absorb the tears to see how much moisture is produced. If your tear film is weak, your eye doctor may recommend certain types of contact lenses that are more successful in maintaining moisture.
Contact Lens Trial and Prescription
After deciding which pair of lenses could work best with your eyes, the eye doctor may have you try on a pair of lenses to confirm the fit and comfort before finalizing and ordering your lenses. The doctor or assistant would insert the lenses and keep them in for 15-20 minutes before the doctor examines the fit, movement and tearing in your eye. If after the fitting, the lenses appear to be a good fit, your eye doctor will order the lenses for you. Your eye doctor will also provide care and hygiene instructions including how to insert and remove your lenses, how long to wear them and how to store them if relevant.
Follow-up
Your eye doctor may request that you schedule a follow-up appointment to check that your contact lenses are fitting properly and that your eyes are adjusting properly. If you are experiencing discomfort or dryness in your eyes you should visit your eye doctor as soon as possible. Your eye doctor may decide to try a different lens, a different contact lens disinfecting solution or to try an adjustment in your wearing schedule.
Your Comprehensive Eye Exam
Your eyes are one of the most complex organs in your body. A comprehensive eye exam to assess your visual system and eye health involves a number of different of tests. Unlike a simple vision screening, which only assesses your vision, a comprehensive eye exam includes a battery of tests in order to do a complete evaluation of the health of your eyes and your vision.
The tests that you will undergo in a comprehensive eye examination may vary from eye doctor to eye doctor but here are are some common exams that you may encounter:
Patient Background and History
One of the most important parts in a comprehensive eye exam is your patient health history. This information will alert your doctor to any conditions that should be monitored closely, such as an allergy to any medications, current or family history of systemic or eye pathology or environmental conditions that could be affecting your vision or eye health. This will also help your doctor to determine any preventative eye care measures that are relevant to keep your eyes healthy for years to come.
Visual Acuity
Visual acuity is a measurement of your vision using an eye chart, the Snellen Eye Chart. In this test the patient is seated at a standard distance and is asked to read letters or symbols of various sizes, which get smaller as you move down the chart. The results are the familiar ratio of 20/20, 20/40 etc. which is a comparison of your vision compared to the average person with good vision, which is typically 20/20. For example, a patient that has 20/40 vision, can only see at 20 feet what the normal person can see from a distance of 40 feet. This test is a preliminary test of how clearly you are seeing in each eye but it does not give you a prescription for corrective lenses.
Refraction
Those who don’t have 20/20 vision have what is referred to in most cases as a “Refractive Error.” The patient may have nearsightedness, farsightedness, astigmatism or other eye conditions that prevent the patient from seeing 20/20. A refraction will tell the doctor which prescription lenses will correct your eyesight to achieve 20/20 vision or whichever amount your vision is correctable to.
A refraction may include a couple of steps.
Retinoscopy
Retinoscopy is a test that allows the doctor to obtain an approximate prescription for eyeglasses. In this test the doctor uses a hand-held instrument called a retinoscope that shines a light into the patient’s eye. The doctor then analyzes the reflex of the light from the patient’s eye to determine the patient’s prescription for glasses.
An instrument called a phoropter is something most patients associate with an eye exam. This space age appearing instrument, positioned in front of the patient’s face during the eye exam, gives the doctor the ability to determine the patient’s focusing ability as well as their eye alignment. The phoropter also determines which, out of the hundreds and hundreds of potential eyeglass prescriptions, will help the patient see as clear as possible. Using the phoropter, the doctor will ask the patient which series of lenses makes their vision the clearest.
While retinoscopy is quite effective for children and nonverbal patients, there are now a number of computerized or automated instruments available today to help doctors accurately determine a patient’s eyeglass prescription.
Autorefractors and Aberrometers
Autorefractors and aberrometers are computerized machines that are able to measure your refractive error to determine your prescription for glasses or contact lenses. These instruments are usually used in addition to testing described earlier:
– An autorefractor is similar to retinoscopy, which electronically analyses the light reflex from the patient’s eye.
– An aberrometer measures distortions or aberrations in the cornea and lens of the eye that disrupt proper focus of light on the retina. Using wavefront technology, the instrument measures the rays of light as they pass through your eye to look for imperfections which may indicate a refractive error.
Eye Focusing and Eye Teaming Tests
During the comprehensive eye exam, your eye doctor will also want to test how your eyes function individually and together from a mechanical perspective. In order to see clearly and comfortably, your eyes need to work together as a team.
Eye Health
The final and most important aspect of a comprehensive eye exam is a check of your overall eye health. These tests (below) are done to identify any eye conditions or diseases, both inside the eye as well as the external parts of the eye, that could affect your vision and general health.
Slit Lamp Test
The slit lamp or biomicroscope is an instrument that allows the doctor to examine the internal and external parts of the eye in detail, such as the conjunctiva, iris, lens, cornea, retina and the optic nerve. The patient rests their forehead and chin on a headrest to stabilize the head, while the doctor looks into the eye with the slit lamp microscope, which is magnified with a high-intensity light. A slit lamp test enables the doctor to evaluate the eyes for signs of normal aging and eye pathology, such as conjunctivitis, cataracts, macular degeneration or retinal detachment. Early diagnosis and treatment of eye diseases are essential for preventing vision loss.
Tonometry
Tonometry is a test to detect glaucoma by measuring the pressure inside your eye or IOP (intraocular pressure). Glaucoma can cause vision loss and even blindness if the IOP in the eye is too high and damages the optic nerve.
The applanation tonometer, typically attached to a slit lamp, is one of the most common instruments used to measure the pressure in the eye. Prior to doing this test the doctor will numb the patient’s eyes using an anesthetic, before gently applanating (putting pressure on) the patient’s cornea to measure the pressure in the eye.
Pupil Dilation
During your comprehensive eye exam, your doctor may decide to do a dilated eye exam. In this test, your doctor will instill dilating drops in each eye, which would enlarge your pupils to give the doctor a better view of certain parts of the back of the eye. Dilation is done at the discretion of the doctor, with some patients dilated every year and others at specified intervals; the frequency of dilation will vary for each patient.
Typically the drops take around 20 to 30 minutes to take effect and may last up to several hours following the exam; each patient is different. Since more light enters your eyes when your pupils are dilated, you will be more sensitive to bright light, especially sunlight. Although your doctor may provide disposable sunglasses, you may want to bring a pair of sunglasses to wear after the exam to make it more comfortable until the drops wear off.
A comprehensive eye exam is an important part of your overall general health maintenance and should be scheduled on a regular basis. The findings from your comprehensive eye exam can give your doctor important information about your overall health, particularly diabetes and high blood pressure.
Preparing for an Eye Exam
For both adults and children, an eye exam is a critical part in maintaining your overall health and well-being, and therefore, regular eye exams should be incorporated into your health routine. Comprehensive eye exams assess your vision and the health of your eye, looking for early signs of disease that may not have obvious symptoms. You should not wait until you experience a vision problem or symptoms of an eye condition to schedule a routine exam.
Depending on your age, family history, general health and eye health, it is recommended to have an eye exam every one to two years. Of course if you experience any serious symptoms that affect your eyes or your vision, you should contact your eye doctor immediately.
The Difference Between an Optometrist (OD) and an Ophthalmologist (MD or DO)
Confusion about the difference between optometrists and ophthalmologists is common, and many people are not aware of how the two eye care professionals differ.
Optometrists
Optometrists or Doctors of Optometry attend optometry school which is usually at least four years of graduate level training. They are able to perform eye exams, provide prescriptions for eyeglasses and contact lenses, and diagnose and treat eye diseases as as glaucoma, dry eyes, or eye infections that may require medication or drops. They can consult with and co-manage patients in pre- or post-op surgical care, however they do not perform surgery.
Ophthalmologists
Ophthalmologists are medical doctors that attend medical school and later specialize in ophthalmology. They are able to do all of the services mentioned above but also perform eye surgeries such as cataract surgery, refractive surgery such as LASIK and deal with more urgent eye conditions such as retinal detachment.
Infant and Child Eye Exams
According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.
Adult Eye Exams
Healthy adults under 40 with good vision and who do not wear eyeglasses or contact lenses are recommended to have an eye exam at least every two years. Those that do use vision correction or have a health issue such as diabetes, high blood pressure or another health condition that can have an impact on your eye health should schedule a yearly exam, unless the eye doctor recommends more frequent visits.
Once you reach 40, you become susceptible to a number of age-related eye conditions such as presbyopia, cataracts or macular degeneration, therefore annual or bi-annual exams are strongly recommended.
As you continue to age, particularly after age 55, the risks of eye disease increase, and early detection can be critical to preventing significant vision loss or blindness. Scheduling a yearly eye exam can make all the difference in maintaining your independence and quality of life.
How to Prepare for Your Exam
Prior to your exam you should decide whether you will be seeking special services such as a contact lens exam or LASIK consultation. These services may cost extra. Check with the doctor’s office or your insurance provider to see if they cover any of the exam expenses.
You need to know if you have medical insurance, vision plan coverage or both. Medical insurance usually does not cover “wellness/refractive” exams for glasses or contact lenses. Vision plans will cover exams for glasses or contacts, but usually cannot be used for red eyes, floaters, or other medical eye health problems. Please bring your insurance cards with you.
In addition to bringing your current pair of glasses or contacts if applicable, it is important to be aware of your personal and family history and to have a list of medications or supplements you are currently taking. Your pupils will probably be dilated as apart of your exam, so plan accordingly.
Why are Eye Exams Important?
For both adults and children alike, eye exams are an important part of one’s general health maintenance and assessment. Your eyes should be checked regularly to ensure that you are able to see as best as possible. Regular eye health exams will also check for signs of eye disease or conditions that can affect not only your vision but your overall health. Vision and eye health is such a critical part in learning and development, therefore, we highly recommend eye exams for infants and children.
Vision Screening vs. an Eye Exam
When we recommend regular eye exams, this should not be confused with a vision screening. A vision screening is a basic test that indicates if you have difficulty seeing and require further assessment and corrective measures. It can be performed by anyone, whether it is a school nurse, a pediatrician or even a volunteer at a vision clinic. A vision screening usually only checks vision, it does not check eye health. Also, most vision screenings for kids only check for nearsightedness (when you can not see far), but what happens when the majority of children are farsighted? Most of the time many of these kids get overlooked.
A comprehensive eye exam on the other hand, can only be performed by an eye doctor as it requires special knowledge and equipment to look around and into your eye to check your eye and vision health. Such an exam can assess whether there are underlying causes for vision problems and whether there are any signs of disease which can threaten your site and the health of your eye. A comprehensive eye examination can also diagnose symptoms of diabetes, high blood pressure, high cholesterol, tumors, cancer, autoimmune disorders, and thyroid disorders. A comprehensive eye examination will also provide an accurate prescription for eyeglasses or contact lenses.
Eye Exams for Eye Health
Eye exams are critical because many vision threatening eye diseases such as glaucoma, macular degeneration, cataracts, or diabetic retinopathy have no or minimal symptoms until the disease has progressed. In these cases, early detection and treatment is essential to halting or slowing down the progression of the disease and saving eyesight. During a comprehensive eye examination, your eye doctor will be looking for initial signs of these diseases. If a problem with your eyes arises such as red eyes, eye allergies, dry eyes, eye swelling,eye pain, always seek an eye doctor as your first doctor to call since they are specifically trained to treat eye diseases.
Eye Exams and Children
If your child is having developmental delays or trouble in school there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but your eyes functioning together. Children that have problems with focusing or hand-eye coordination will often experience frustration and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal so they aren’t able to express that they need help. Many conditions are much easier to treat when they are caught early while the eyes are still developing, so it is important to diagnose any eye health and vision issues as early as possible.
Eye Exams Over 40
Just like the rest of our bodies, our eyes begin to weaken as we age. There are a number of common age-related eye conditions such as presbyopia, cataracts, and age-related macular degeneration that can begin to affect your vision and your daily life. While some of these conditions are more of an inconvenience, others could lead to vision loss and dependency.
In addition to regular yearly eye exams, it is important to be aware of any changes in your eye health and vision. Also know your potential risk factors as well as your family ocular and medical history. Over half of the vision loss worldwide is preventable with proper treatment and care.
Computer Eyestrain
Digital eye strain is an increasingly common condition as digital devices become more ingrained into our daily lives. Digital eye strain, eye fatigue and computer vision syndrome (CVS) are conditions that result from extended exposure to digital screens such as computers, smartphones, tablets and televisions from a combination of factors including the blue light radiation emitted from the devices and the pixelated content that is difficult for our eyes to focus on.
Symptoms of computer or digital eyestrain tend to be noticed after someone has used a digital device for as little as 2 hours a day. Studies show that 60% of people spend more than 6 hours a day in front of a digital device and 70% of adults report some symptoms of computer vision syndrome (CVS) which include:
• Eyestrain
• Headaches
• Blurred or double vision
• Physical and mental fatigue
• Dry or watery eyes
• Red or irritated eyes
• Difficulty focusing
• Sensitivity to light or
• Neck, shoulder or back pain (caused by compromised posture to adjust to vision difficulty).
Digital eye strain also impacts your ability to focus and lessens productivity. Most people do nothing to ease their discomfort from these symptoms because they are not aware of the cause.
Protecting Your Eyes from Digital Eye Strain and Blue Light
There are a number of options for reducing digital eye strain and your exposure to blue light which include workspace ergonomics, computer glasses, specialized lenses and protective coatings. The first step is to get a comprehensive eye exam, making sure you speak to your eye doctor about how often you use a computer and digital device. This will help your doctor to get the full picture of your eye and vision needs in order to determine which option is best for you. It was also help the doctor to identify any underlying issues that could be worsening your symptoms.
Alleviating Digital EyeStrain
Workspace Alterations
Proper Lighting and Screen Brightness: You want the screen to be as bright as the surrounding environment or the brightest object in the room (depending on what is most comfortable for you). Therefore interior lighting or sunlight from the outdoors should be dimmed or blocked. Use fewer light fixtures or lower voltage light bulbs and close curtains or blinds when possible. Adjust the brightness and contrast of your monitor to the levels that are most comfortable.
Reduce Glare: Glare is a significant cause of computer eyestrain so it is important to minimize it as much as possible. Set up your computer where glare from windows won’t affect your screen or cover windows when this is not possible. Glare can also reflect from walls and shiny finishes on desks and other surfaces. An anti-glare screen on your monitor or an anti-reflective (AR) or anti-glare coating applied to your eyewear can also help to minimize glare and the strain it causes to your vision.
Screen size and distance: You want to make sure you are using a high quality (such as a flat LCD) screen that has a relatively large display (look for a diagonal screen size of at least 19 inches) and is located directly in front of your line of vision. Your viewing distance should be about an arm’s length away with the top of the monitor at about eye level or slightly below.
Eye Care
Keep Eyes Moist: When viewing a digital screen or monitor for an extended period of time, we tend to blink less frequently (about ⅓ as often as we should). Blinking however, is critical for keeping the eyes moist, which allows them to remain clear and comfortable and to avoid dry eyes, irritation, blurry vision or eye fatigue.
Focus on blinking by setting a timer for every 20 minutes and slowly closing and opening your eyes 10 times. Keep a bottle of artificial tears handy to use when your eyes are feeling dry.
Give Your Eyes a Break: Schedule and take frequent breaks from your screen. Follow the 20-20-20 rule; every 20 minutes, look at something 20 feet away for 20 seconds. Take this time to stand up and stretch your back, neck and legs as well.
Computer Eyewear
Computer glasses reduce eye strain by adjusting the focus slightly so your eyes feel like they are focusing on something further away. They also have a tint to remove the glare and block blue light from entering into your eyes. There are a number of options for computer eyewear, both if you need prescription eyewear and not. Speak to your eye doctor about what the best options are for you.
Learn more about computer glasses here.
It is important to know that both adults and children alike are susceptible to computer eye strain from computers and digital devices. With the growing use of such devices in our everyday lives it is important to start educating ourselves and our children on how to combat the negative effects of these habits.
Children and Computer Vision Syndrome
The use of computers, tablets and other digital devices has become so commonplace in the daily lives of children that a report by The Vision Council in 2015 showed that close to 25% of children spend more than 3 hours a day using some sort of digital device. These numbers are only expected to grow. As these devices are becoming integrated into schools and becoming more common for use at a younger age, many experts and parents are wondering how the use of these devices can affect children’s eyes in the short and long term.
Computer Vision Syndrome (aka Digital Eye Strain)
Just like adults, children are susceptible to computer vision syndrome (CVS), also called digital eye strain, after extended use of computers or digital devices. Symptoms of CVS include eye fatigue and eye strain, dry eyes, headaches, blurred vision, and neck and shoulder pain.
Staring at a computer screen is a stress for the eyes, particularly for children whose eyes and visual system are less developed. This is because the computer-generated, pixelated images which appear on the screen are not what our eyes are accustomed to and therefore can cause the eye to strain after extended viewing. Some children find it uncomfortable to view screens for long periods because they simply don’t have the focusing power to spend extended amounts of time looking at these pixelated images.
Children don’t always have the self control to limit computer use or the awareness to know when they are experiencing eye fatigue or other symptoms of CVS. Because of this, they are more likely to overuse digital devices which can make symptoms worse.
Screen Use and Myopia
Myopia or nearsightedness is a growing concern as studies show the incidences of the condition are growing exponentially. In the past it was thought that myopia was primarily genetic, however recent research indicates a correlation between environmental factors and the growing exposure to and use of digital devices, particularly in children. As children increase their computer use and time spent on screen, the likelihood of developing myopia seems to also be increasing. According to a study done at the University of California at Berkeley School of Optometry which researched the incidence of myopia in 253 children between 6 years old and 10 years old showed a link with the amount of time spent on a computer.
The Effects of Blue Light
Blue light or high-energy visible (HEV) light is emitted from digital devices and is causing greater and greater concerns about long term exposure. It is already known that blue light can affect sleep and concentration but studies are also indicating that it can cause long term retinal damage, particularly in kids whose young eye have more sensitivity to environmental influences.
How to Protect Your Children from CVS
With the increasing use of and dependence upon digital devices it is important to teach your children good habits to protect their eyes while they are young. Understanding the risks and dangers of prolonged screen time should be taught at an early age. Here are some tips for safe computer and digital device use to reduce digital eye strain and prevent the negative effects it can have on your children’s eyes and vision.
1. Limit Screen Time: When possible limit screen time to one or two hours a day, particularly for little children who don’t require computers for school work.
2. Optimize Your Children’s Work Station: Ensure that children are positioned properly and that lighting is appropriate so that they do not have to bend or stretch in unnatural ways to see the screen adequately. The monitor should be slightly below the child’s eye line and about 18 – 28 inches away. The chair should also be adjusted so that the child’s arms comfortably rest on the desk and his or her feet touch the floor (when possible).
3. Have Regular Eye Exams: Monitor your child’s eyesight, particularly an assessment of their near vision skills.
4. Follow the 20-20-20 Rule: Every 20 minutes, take 20 seconds to look at something at least 20 feet away.
5. Get in the Habit of Stretching: At regular intervals stretch the back, arms, shoulders and neck to relieve tension and reduce strain or soreness.
6. Consider Computer Glasses: Computer glasses are made to help the eyes focus more easily on the computer screen. If your child already wears prescription eyewear, prescription computer glasses are available as well.
7. Anti-glare: Anti-glare screens or coatings on eyeglasses can reduce glare and eye strain.
8. Look for signs of eye or vision problems such as blurred vision or eye rubbing, redness or a stiff neck. If you notice any lasting vision problems see your eye doctor for an examination.
Computer Glasses
Digital devices have impacted our world in so many positive ways, allowing us to connect, work, play, and get information at the speed of light. In fact, many people have a hard time when they “disconnect.” But all of this good brings with it a measure of concern: Digital Eye Strain or Computer Vision Syndrome.
Nearly 70 percent of U.S. adults experience digital eye strain as a result of the growing use of computers and digital devices. Adults aged 18 to 34 report feeling eye strain at a higher rate (45%) than their older counterparts. New research also suggests that overexposure to blue light, also referred to as high-energy visible or HEV light, may contribute to vision problems such as cataracts and age-related macular degeneration (AMD). Implications are just now being studied, but the short-term impact of digital eye strain affects individuals on a daily basis. Eye care providers are noting a steady rise in the incidence of myopia as well, which research suggests could be correlated to the increase of screen time and near focusing.
Symptoms of Digital Eye Strain include:
• Headaches
• Blurred or double vision
• Sore eyes
• Dry or watery eyes
• Sensitivity to light
• Neck, shoulder or back pain
In addition to these symptoms, emerging research shows that blue light from digital devices causes sleep disturbances by interfering with the REM cycle of sleep.
As people move from their computer to their tablet to their phone, more and more of these symptoms are being seen, and in younger and younger people. Computer glasses offer a solution to reduce the strain on your eyes and your exposure to blue light radiation.
How Computer Glasses Work
Computer glasses reduce eye strain by adjusting the focus slightly so that your eyes feel like they are focusing on something further away. They also have a tint to remove the glare and block blue light from entering into your eyes.
Finding the Right Pair
There are a number of companies that make computer glasses, some that are designed for device users without a prescription or that would wear the glasses with contact lenses. Other manufacturers provide options to incorporate vision prescriptions into the lens.
When shopping for computer glasses you want to make sure you find the right pair. The eyewear should sit nicely on your face and provide a comfortable tint. Here are some of the options available:
• Single Vision Computer Glasses: Provide the optimum lens power and field of view for viewing your computer screen without straining or leaning in to reduce symptoms of CVS. These are ideal for when the computer is at a fixed working distance, and work well if the user needs to view multiple screens at the same working distance.
• Office Lenses or Progressive Lenses: No-line multifocal eyewear that can be made to correct near, intermediate and some distance vision with a larger intermediate zone for computer vision if indicated. Perfect for those with presbyopia which is the gradual loss of focusing ability that occurs naturally with age. Office lenses work like progressive lenses but provide a wider field of view for intermediate (1-3 m) viewing distance and near working distance (about 40 cm).
• Blue-Blocking Lenses: Definitely recommended for this electronic age, blue-blocking lenses block blue light emitted from computer screens that is associated with glare, eye strain and possible sleep disturbances.
• Anti-glare and filtering coatings (treatments): Eliminate reflections from the surfaces of your lens to reduce eye strain and discomfort from glare. Some coatings can also block blue light emitted from computer screens.
While all of these are good options for protecting your eyes, the 20/20/20 rule still applies – after every 20 minutes of near tasks, look at something beyond 20 feet away for at least 20 seconds…it’s a good time to stretch the rest of the body too.
Eye exams are important to test your focusing ability, and to ensure that both eyes are working and focusing at the same place. Many people do not have the same prescription in each eye.
Children and Computer Glasses
Children are using digital devices more than ever and this trend will only continue as smartphones take over and tablet and computer-based learning increases. Their use extends well beyond the school day , as they use computers for homework and gaming and smartphones to text with their friends.
Computer glasses should be used for children proactively before eye strain begins to keep their eyes healthy longer and prevent nearsightedness. | {
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7,033,243,953,241,090,000 | Results: Both nebulizers were able to successfully aerosolise
\n\nResults: Both nebulizers were able to successfully aerosolise 1.5 mL of liposome suspension in a short period of time. The diameter and zeta-potential of the liposomes was preserved upon nebulization, and the calcein retention was above 70% in all cases.\n\nConclusions: It can, hence, be concluded that both systems, the Aeroneb Pro and the AeroProbe, are
well suited for the pulmonary delivery of liposomal formulations, with the AeroProbe having the additional advantage of allowing targeted delivery into the select regions of the lungs with a high degree of efficiency Quizartinib order and control.”
“Sociocultural phenomena, such as exogamy or phylopatry, can largely determine human sex-specific demography. In Central Africa, diverging patterns of sex-specific genetic variation have been observed between
mobile hunter-gatherer Pygmies and sedentary agricultural non-Pygmies. However, their sex-specific demography remains largely unknown. Using population genetics and approximate Bayesian computation approaches, we inferred male and female effective population sizes, sex-specific migration, and admixture rates in 23 Central African Pygmy and non-Pygmy populations, genotyped for autosomal, X-linked, Y-linked, and mitochondrial markers. We found much larger effective population sizes and migration rates find more among non-Pygmy populations than among Pygmies, in agreement with the recent expansions and migrations of non-Pygmies and, conversely, the isolation and stationary demography of Pygmy groups. We found larger effective sizes and migration rates for males than for females for Pygmies, and vice versa for non-Pygmies. Thus, although most Pygmy populations have patrilocal customs, their sex-specific genetic patterns resemble those of matrilocal populations. In fact, our results are consistent with a lower prevalence of polygyny and patrilocality in Pygmies compared with non-Pygmies and a potential female transmission of reproductive success in Pygmies. Finally, Pygmy populations showed
variable admixture levels with the non-Pygmies, with often much larger introgression from male than from female lineages. Social discrimination against Pygmies triggering complex movements of spouses in intermarriages https://www.selleckchem.com/products/fosbretabulin-disodium-combretastatin-a-4-phosphate-disodium-ca4p-disodium.html can explain these male-biased admixture patterns in a patrilocal context. We show how gender-related sociocultural phenomena can determine highly variable sex-specific demography among populations, and how population genetic approaches contrasting chromosomal types allow inferring detailed human sex-specific demographic history.”
“Cells of the inner ear face constant metabolic and structural stress. Exposure to intense sound or certain drugs destroys cochlea hair cells, which in mammals do not regenerate. Thus, an endogenous stress response system may exist within the cochlea to protect it from everyday stressors.
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-2,489,210,723,885,984,300 | fbpx
• Home
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• Get Back Into Balance
Get Back Into Balance
Your physical therapist can play a big role in helping you maintain or improve your balance as you age. Unfortunately, falls are becoming increasingly common in adults age 65 and over. Just because they’re common, doesn’t mean they’re inevitable though. Research shows that falls are caused by a variety of factors, and many of them can be improved. Let’s take a look at some of them and some tips to help you get back into balance.
Lower Body Weakness
As we age, without resistance training we lose muscle mass every year. Weakness in your lower body has been shown to increase your fall risk. A physical therapist can design an exercise program to help you strengthen your legs and lower body safely.
Inactivity
Another reason we lose muscle mass and our balance decreases is inactivity and deconditioning. People who have fallen in the past often have a fear of falling again, which leads them to do less. As their activity levels decrease, they get weaker and even more fearful of falling.
This downward spiral can be stopped with balance training from a physical therapist to build your confidence on your feet and allow you to become more active.
Group exercise classes are another great way to become more active, work on your balance and meet new friends at the same time. Ask your PT for recommendations for a class near you.
Vision Problems
Many people don’t realize that your body uses your vision for balance. If you want to prove this to yourself, try standing with your feet together with your eyes open, then compare that to doing it with your eyes closed. Visual problems can also make you miss things like bumps and changes in the surface you’re walking on, or objects that you could trip over.
If you’re having problems with your vision, see your eye doctor for an exam and recommendations on what can be done.
Medications
Certain medications can increase your risk of falling and impact your balance by making you sleepy, slowing your reactions, or causing weakness. Some examples of medications that can increase fall risk are certain types of antidepressants, blood pressure medications, and water pills.
Your physical therapist can help you work with your doctor or pharmacist to review your medications and consider changes to improve your balance and reduce your risk of falling.
When it comes to helping you improve your balance, and reduce your risk of falling, your physical therapist is an important part of the team. They can evaluate you to determine where your problem areas are, and design an individualized program for you. They can also refer you to other professionals who can help like your eye doctor and your pharmacist. If you’re starting to feel out of balance, your PT can help you stop falls before they start. | {
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3,318,166,400,297,097,700 | If you need a more accessible version of this website, click this button on the right.Switch to Accessible Site
Pierre Dentist | Pierre dental care | SD | Root Canal (Endodontics)
Patrick R. Hermanson, DDS, PC
Brent A. Swenson, DDS
Erick M. Rath, DDS, PhD, PC
433 S Central
Pierre SD 57501
Phn: (605) 224-5966
Root Canal (Endodontics)
Endodontics is the dental specialty that deals with the nerves of the teeth. Root canals are probably the most notorious procedure in dentistry and the most common procedure relating to endodontics. When a tooth becomes infected it is usually related to the nerves in the root of the tooth. The infected nerves need to be removed. If left untreated an infection can turn into an abscess, which is a much more serious problem that includes bone loss in the jaw.
The area around the tooth is numbed with a local anesthetic to start the procedure. The dentist will then drill down into the tooth to create an opening into the canal. They will then be able to remove infected tissue and clean the canal. After the infection has been removed, the space if filled with a sealant called gutta percha. It is highly recommended that a tooth that has undergone a root canal is fitted with a crown. This will improve the appearance of the tooth, and will also make it much more likely that the root canal is successful.
"Root canal" has become a scary term for dental patients to hear, but the benefits of the procedure and advances in dental technology have made it much less "scary". Local anesthetics and proper pain medication allow the procedure to be performed with little to no pain in most cases. There may be some soreness following the procedure, but that is normal for most dental procedures. Over the counter painkillers are usually enough to relieve any pain afterwards, but your dentist may prescribe medication. The procedure will also relieve you from pain caused by the infection allowing you to enjoy all the foods you love without any pain from heat, cold, or biting too hard. If you are experiencing pain consult your dentist today.
Patrick Hermanson, DDS - Brent Swenson, DDS - Erick Rath, DDS, PhD
[email protected]
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7,847,077,371,794,612,000 | Menopause Guide: Dr. Marie Savard Answers Your Questions
VIDEO: Dr. Marie Savard offers helpful advice for staying well during menopause.PlayABCNEWS.com
WATCH Straight Talk About Menopause
Every woman goes through menopause, but there are some common misconceptions about "The Change."
ABC News medical contributor Dr. Marie Savard appeared on "Good Morning America" today with information to bust the menopause myths and help women keep themselves healthy during menopause.
Savard tackles the most intimate questions women have about the female reproductive system in her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions."
You Asked, We Answered
Note: Some questions have been slightly edited for clarity and to ensure anonymity for the submitter.
Joni asked: I'm 52 and have already gone through menopause. I have been through it about a year and a half. Is there anything that can help with hot flashes/night sweats. I know that caffeine and alcohol are to be avoided or restricted. It doesn't seem to matter what I do, the hot flashes/night sweats just don't stop. I am hesitant taking HRT. Are the hot flashes/night sweats going to be with me forever?
Savard answered: You are not alone. About 80 percent of women will experience hot flashes to some degree at menopause and unfortunately for some women they can last years. I have a few patients who took small amounts of estrogen for their lifetime just to dampen their hot flashes. But for most women they will eventually disappear. Unfortunately the other effects of low estrogen such as bone loss and urinary and vaginal dryness will get worse with time. There are ways to minimize the symptoms, but studies have shown that there is nothing better than estrogen to relieve hot flashes and night sweats. A large analysis of alternative therapies found that nothing else worked -- except perhaps for soy foods and the herb black cohash (which can effect the liver and is only advised for up to 6 months of use). Unfortunately the decision to start estrogen is a big one -- but well worth a consideration if you are losing sleep and the hot flashes are impacting your life. Most experts now agree that for women in the throws of menopause, taking estrogen in the smallest dose to relieve symptoms is safe and quite effective. I take a small dose of an estrogen patch which minimizes any bad effects of estrogen pills and helps yet is enough to help me with sleep and dry vaginal tissues. If you have a uterus, you would need to add progesterone each month as well to balance out the estrogen. I take a natural progesterone capsule that comes as a prescription. I would recommend however that you work with your practitioner to make this decision. Women with a history of breast cancer and blood clots are generally not advised to take estrogen. If living a healthy lifestyle, which it sounds like you are trying to do, is not enough then perhaps just a short period of a year or so of estrogen may make all the difference. You can stop estrogen at any time.
Lana asked: For many women, menopause begins long before we become grandmothers. Could you please explain a bit about peri-menopause? When does it begin, at what age, and what are the signs and symptoms to look for?
Savard answered: As I mentioned in the segment on GMA today, a woman's ovary can begin to slow down production of eggs and the hormones estrogen and testosterone over a 5-10 year period. As the hormone levels become more erratic and decline, women can experience irregular and often heavier periods, reduced libido or sex drive, night sweats, and even mood changes and palpitations. Dry vaginal and urinary tissues tend to come later. Every women is different. The average age for most women to be at menopause (meaning no period for 12 months) is about 51. If your mother and grandmother went through earlier menopause -- you may as well. On the other hand environmental factors like smoking can bring on menopause about 2 years early. With the onset of perimenopause it is a good time to adopt as many good health habits as possible including adding extra calcium and vitamin D to your diet to minimize the inevitable bone loss -- and ask your practitioner to review your heart risks as well.
More Menopause Questions
Janet from Va., asked: I'm 48 and still getting normal periods. Right before my period I get extremely agitated with a racing/fluttering heart. I sometimes worry that maybe I am having a heart atttack, but am pretty convinced it is a pre-menopausal condition. Are agitation and heart racing a condition of pre-menapause?
Savard answered: The quick and easy answer is YES -- agitation and heart palpitations are common symptoms in women going through menopause. HOWEVER, as I am sure you know, heart disease is also a big concern in 48-year-old women and often can get missed. Before simply assuming your symptoms are all hormonal, I would have your regular physician do a complete check up including test of thyroid function, blood pressure check and a heart assessment.
Madeline from Calif., asked: I went into early and haven't had a period since I was 37. I was on Prempro for 5 years. I am now 47. I was wondering if since I haven't had a period for ten years, and since I went into menopause early will I age more quickly? I no longer have night sweats and hot flashes as I did for about 2 years. I also would like to know what I can do or take to enable a healthy life after menopause.
Savard answered: You experienced what we now cause premature menopause. Heredity and autoimmune conditions such as thyroid disorders and chemotherapy can lead to ovaries reduced function and menopause. Women who go through early menopause before age 40-45 should consider hormone therapy -- which you did. The two years of hormones likely helped you. Hormones help preserve bone mass and reduce future risk of heart disease and even reduced life expectancy for young women. I would recommend that you get a bone density test to evaluate your bone mass and to have your practitioner review your heart risk factors such as blood pressure, lipid levels, etc. Depending on the results you will want to reduce any risk factors as much as you can. We do know that extra calcium and vitamin D with exercise can minimize bone loss ? and a healthy diet, exercise and avoiding smoking and stress can reduce heart risk. Also look to your family history and lifestyle as the biggest clues to your future health. Your age at menopause is only one factor.
Patti asked: If you are on estrogen replacement, how long do you need to stay on it? Is it for the rest of you life or just for a certain time period?
Savard answered: Although for many years we believed that many women could benefit from lifelong estrogen treatment, we no longer think this way. Most research suggests that the increased risk of breast cancer is very small if any after the first few years but rises somewhat after 4-5 years on estrogen. On the other hand, once you stop estrogen, progressive bone loss and dry vaginal tissues will continue. Some women try to taper off estrogen slowly after a few years and see how they feel. If hot flashes don't come back, they then stop altogether and use other means to improve their bone strength and minimizes vaginal dryness.
Carolyn asked: Is it normal to have a little spotting ten years after your last period?
Savard answered: It is not normal to have any spotting or bleeding 10 years after your last period unless you are on hormones. If you are on hormones, some typical bleeding pattern or spotting may be seen, but even then you should alert your doctor to your bleeding pattern. Although a common reason for spotting is dry atrophied vaginal tissues and spotting after painful sex, a worrisome cause would be cancer of the lining of the uterus. All women who spot after they go through menopause should have a thorough gynecologic exam and a uterine ultrasound and or uterine biopsy. I have had both and can assure you they provide great peace of mind and can be done in a doctor's office. Only if something suspicious is found will you be advised to have a surgical procedure. Please don't hesitate or be afraid of getting checked out by a gynecologist.
Ann asked: I'm 50 years old. My periods have been irregular and appear to have stopped. My doctor did a blood test and followed up that my hormone levels are consistent with menopause and that if I have any bleeding I should come. I really have no symptoms that are unbearable -- a few hot flashes -- more like small panic attacks. I don't sleep as well at night, etc., but nothing that warrants taking medication for. Do I need to do anything besides my annual checkup, eating right and getting exercise? Also when filling out other forms, such as for an X-ray of my shoulder, how do I answer the question: "Date of last period?"
Savard answered: Not until your period has stopped for 12 months can you say you are definitely in menopause. Your blood test (the FSH test) may be high consistent with menopause, but it is not precise and may still be fluctuating. Until it has been a full 12 months I would answer that you are in the perimenopausal period. So far it sounds like you can avoid estrogen for now. As long as you are living a healthy lifestyle, have good bone density and low heart risk, you don't need to do anything more. Don't forget a colon cancer and breast cancer screen too however. By age 50, all adults need some colon cancer screening.
Kathleen from Pa., asked: I hear all these women my age telling me the problems they are having with menopause. I'm 50 and have no symptoms. I hope this continues. But, maybe I have not started it yet. When does menopause start and how long does it last?
By age 50 your ovaries have surely begun to reduce hormone production however some women have absolutely no symptoms and their period abruptly and permanently stops. Congratulations if that is you. Don't count yourself through menopause until you have gone 12 months without a period.
Roberta asked: I'm 55 and have been struggling the last three years with menopausal symptoms. I finally gave in and started taking hormone treatment last May (2009). I suffered from night sweats, insomnia, hot flashes, mood swings, you name it up to the point it was overwhelming and interfering with my day-to-day life. My doctor put me on Angeliq, a pill that is a combination of estrongen and progesterine. The first months were great -- it was like a miracle pill! My symptoms vanished. However, one problem was that I was bleeding constantly. My doctor ordered vaginal ultrasounds and even a uterine biopsy (very unpleasant) to rule out medical issues. But now, many months later, I have my symptoms back and the bleeding issue continues. I am told by my doctor I only have one other alternative and that is to take a different hormone for the first 25 days of the month, then go off, have my period and the at the first of the month go back on the pills. I am not convinced this is best for me. I still take the Angeliq, but I know it is what is causing my bleeding. Before the pills, I was barely ever having a period. Please give me some advise. Should I see a different doctor? My doctor is good, but his practice centers around his OB patients more than those in my situation.
Savard answered: Angelique is a newer hormone therapy that combines the traditional estrogen (in the form of estradiol) and a progestin (a newer chemical called drosperinone which is promoted to be safer on the heart, but not proven so) in one pill that you take continuously. I'm generally opposed to taking continuous hormones as the risk of spotting and irregular bleeding can sometimes persist for up to a year or more and the theoretical risk to the breast is greater with continuous treatment. There is no long term safety information on the use of this particular combination in postmenopausal women. Your doctor is correct to recommend as an alternative: take estrogen daily each month and add 10 -12 days of a progestin to balance out the estrogen and bring on a period. In this case, the period is often light, predictable, and may eventually disappear. On the other hand, many women eventually stop bleeding on Angelique or the combination hormones if they give it enough time. I talk about the precise hormone treatment that I take in the book -- and why that makes sense for me.
Gail from Ill., asked:I've been on the pill for years and years. I'm now 54 and the doctor wants me to go off of it. I'm scared. Should I go off or stay on? What affect is it having on me and going through menopause?
Savard answered: As I mentioned on GMA today, birth control pills are up to 10 times stronger than postmenopausal hormone therapy and obviously much more than you need to be healthy. There are potential risks to continued use of birth control pills including blood clots and high blood pressure ? and possibly breast cancer. It is not uncommon for women to take low dose birth control pills up until they go through menopause and beyond. Unless you stop the pill there is no way to know whether your ovaries have stopped functioning. Just because you got a period on the pill doesn't mean your ovaries were still working. As women approach the menopause age, most doctors will suggest a woman stop the pill and then check a blood test about 5 days into the next cycle. If the FSH is very high in menopause range, this is a clue that menopause may have occurred. By age 54, you are likely near if not already through menopause. The pill will not hasten or postpone menopause -- it simply gives you the hormones you need to suppress an egg (if you are still premenopausal) and will cause regular bleeding for any women regardless of her menopause status. As I mentioned in my book, my blood pressure went up on the low dose pill that I was taking to regulate my heavy periods before menopause. I am glad I discovered it and stopped the pill as my blood pressure is now fine on a low dose estrogen patch.
Carole from Wash., asked: I'm 75 yrs old and still having hot-flashes. Mostly at night, so I guess they are called "night sweats." Is this normal? And what can I do for this problem? My gynecologist (many years ago when I stopped taking hormones), said they could stop tomorrow and could continue forever. Don't really enjoy the "forever."
Savard answered: About 80 percent of women will experience hot flashes to some degree at menopause and unfortunately for some women (such as you) they can last years. I have a few patients who took small amounts of estrogen for their lifetime just to dampen their hot flashes. But for most women they will eventually disappear. Unfortunately the other effects of low estrogen such as bone loss and urinary and vaginal dryness will get worse with time. I presume you have experienced these problems to some degree. There are ways to minimize the symptoms, but studies have shown that there is nothing better than estrogen to relieve hot flashes and night sweats. A large analysis of alternative therapies found that nothing else worked -- except perhaps for soy foods and the herb black cohash (which can effect the liver and is only advised for up to 6 months of use).
Most doctors would not begin estrogen at age 75 because the risks would outweigh the benefits. Other medications that doctors have tried successfully include a low dose of some of the antidepressants, a blood pressure pill (clonidine) or gabapentin (a sedating pain and seizure medication). For some reason, these pills can be effective but I would only recommend if the hot flashes were incapacitation.
Menopause and Sex Drive Questions
Chris from Fla., asked: My wife has been going through menopause for a couple years now and as a husband I do have a question or two. She is also suffering from severe bone loss due to the menopause. With all these problems, sex between us has come to a complete stop. I have tried to be a completely understanding husband of 39 years, but is there anything I can do to make life a bit easier? I truly love her and intend to remain a completely loyal and understanding husband. Is there anything I can do? Pleasse advise and thank you in advance!
Savard answered: Not that it helps to say this, but you are not alone. I would first recommend that your wife have a good working relationship with a practitioner who can help her diagnose and treat all the potential medical problems she is having -- including giving her a low dose of vaginal or patch estrogen if she can safely take it. On the other hand, there are so many reasons why women have a reduced interest in sex at menopause that I hesitate to suggest that estrogen alone will solve the problem. Estrogen does not improve the libido. Sometimes stress, lack of sleep, worry about all sorts of things can make matter worse. Perhaps once she has had any possible medical things treated (including any depression, thyroid disease, dry vaginal tissues, etc.) -- perhaps you can both ask her physician to refer you to a kind sex therapist. They can be of tremendous help.
Paula asked: I'm 58 years old and going through menopause. My main concern is I have little or no libido. Can hormone replacement help? Is there anything that can help with this problem. My husband would so appreciate your help. Thank you.
Savard answered:I will answer you as I have answered previously: Not that it helps to say this, but you are not alone. I would first recommend that you have a good working relationship with a practitioner who can help you diagnose and treat any potential medical problem you may be having, including trying a low dose of vaginal or patch estrogen if you can safely take it. On the other hand, there are so many reasons why women have a reduced interest in sex at menopause that I hesitate to suggest that estrogen alone will solve the problem. Estrogen does not improve the libido. It is testosterone, which also goes down by 50 percent at menopause, that is important for libido. Typical hormone replacement does not include testosterone although there is one prescription that does. "Bioidentical" hormones often have testosterone as part of the mix, but you need to find a special physician to prescribe and I am not totally convinced of the long term safety of the hormones with added testosterone. Studies have shown in women that testosterone patch can help but there are safety concerns including possible increased breast cancer risk. Sometimes stress, lack of sleep, worry about all sorts of things can make matter worse. Perhaps once you have any possible medical things treated (including any depression, thyroid disease, dry vaginal tissues, etc.) -- perhaps you can your physician to refer you to a kind sex therapist. They can often be of tremendous help.
CLICK HERE to read an excerpt from Dr. Marie Savard's new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions."
Click here to return to the "Good Morning America" website. | {
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1,594,187,673,810,357,000 | Quick Answer: Is Being Skinny Healthy?
Do Skinny People live longer?
In a newly published study, people who were underweight and those who were extremely obese died the earliest.
People who were overweight, but not obese, actually lived longer than people whose weight was considered normal, based on body mass index (BMI)..
Can you be naturally skinny?
Nobody is “naturally” skinny, it’s just what and how much they eat in a day that determines how they are.
What is it called when you eat a lot but stay skinny?
Anorexia nervosa (anorexia) is a mental illness that affects how you feel about your body and how you eat. You think that your body is much bigger than it actually is, and may be very scared of gaining weight. You may also believe that you’d be a better person if you were thin.
Is being skinny at 14 normal?
Many guys and girls are skinny until they start to go through puberty. The changes that come with puberty include weight gain and, in guys, broader shoulders and increased muscle mass.
How can I gain weight quickly?
Here are 10 more tips to gain weight:Don’t drink water before meals. This can fill your stomach and make it harder to get in enough calories.Eat more often. … Drink milk. … Try weight gainer shakes. … Use bigger plates. … Add cream to your coffee. … Take creatine. … Get quality sleep.More items…•
Can being too skinny cause health problems?
There are certain health risks associated with being underweight or having poor nutrition. These risks include: malnutrition, vitamin deficiencies, or anemia. osteoporosis from too little vitamin D and calcium.
What makes a person skinny?
Causes. A person may be underweight due to genetics, improper metabolism of nutrients, lack of food (frequently due to poverty), drugs that affect appetite, illness (physical or mental) or the eating disorder anorexia nervosa.
What weight is too skinny?
You will recall that you calculate your BMI by dividing your weight in kilograms by the square of your height in metres. For adults, a BMI under 18.5 is considered dangerously thin, 18.5-25 is the healthy weight range, 25-30 is overweight, and 30 or over is obese.
What weight is considered skinny for a girl?
Women with a BMI of less than 18.5 are considered underweight. The average woman’s height is 5 feet, 4 inches. If you weigh 107 pounds or less at this height, you are considered underweight with a BMI of 18.4. A healthy weight range for that woman would be 108 to 145 pounds.
Is it healthier to be a little overweight or underweight?
FRIDAY, March 28, 2014 (HealthDay News) — It’s said you can never be too rich or too thin, but new research suggests otherwise. People who are clinically underweight face an even higher risk for dying than obese individuals, the study shows.
Why do I never gain weight?
One of the most important factors has nothing to do with body type, metabolism, or performing a spell during the full moon: It’s perception. Many people who appear to eat whatever they like without gaining weight aren’t actually eating more than the rest of us, Melanson said.
How can skinny person gain weight?
Here are some healthy ways to gain weight when you’re underweight:Eat more frequently. When you’re underweight, you may feel full faster. … Choose nutrient-rich foods. … Try smoothies and shakes. … Watch when you drink. … Make every bite count. … Top it off. … Have an occasional treat. … Exercise. | {
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-659,524,373,091,842,200 | plantar wart closeup
1 / 21
What Are They?
These small, noncancerous growths appear when your skin is infected with one of the many viruses of the human papillomavirus (HPV) family. The virus triggers extra cell growth, which makes the outer layer of skin thick and hard in that spot. While they can grow anywhere you have skin, you're more likely to get one on your hands or feet. The type of wart depends on where it is and what it looks like.
Swipe to advance
biting nails
2 / 21
Who Gets Them?
Because each person's immune system responds differently to the virus, not everyone who comes in contact with HPV will get a wart. And if you cut or damage your skin in some way, it's easier for the virus to take hold. That's why people with chronic skin conditions, such as eczema, or who bite their nails or pick at hangnails are prone to getting warts.
Swipe to advance
teen with doctor
3 / 21
Your Body Plays Defense
Kids and teens get more warts than adults because their immune systems haven't built up defenses against the many types of HPV. People with weakened immune systems -- like those with HIV or who are taking biologic drugs for conditions like RA, psoriasis, and IBD -- are also more susceptible to getting warts because their body may not be able to fight them off.
Swipe to advance
hanging towels
4 / 21
How They Spread
Warts are highly contagious and are mainly passed by direct skin contact, such as when you pick at your warts and then touch another area of your body. You can also spread them with things like towels or razors that have touched a wart on your body or on someone else's. Warts like moist and soft or injured skin.
Swipe to advance
spotted frog
5 / 21
Fairy Tales Are Wrong
You can touch or kiss all the frogs and toads you like because they won't give you warts.
Having a wart on your nose -- or anywhere else, for that matter -- doesn't make you a witch, either.
Swipe to advance
wart on finger
6 / 21
Common Warts
These flesh-colored growths are most often on the backs of hands, the fingers, the skin around nails, and the feet. They're small -- from the size of a pinhead to a pea -- and feel like rough, hard bumps. They may have black dots that look like seeds, which are really tiny blood clots. Typically they show up where the skin was broken, perhaps from biting your fingernails. (This can also transfer the virus from your hands to your face.)
Swipe to advance
plantar warts
7 / 21
Plantar Warts
Does it feel like you have pebbles in your shoe? Check the soles of your feet. These warts got their name because "plantar" means "of the sole" in Latin. Unlike other warts, the pressure from walking and standing makes them grow into your skin. You may have just one or a cluster (called mosaic warts). Because they're flat, tough, and thick, it's easy to confuse them with calluses. Look for black dots on the surface.
Swipe to advance
flat warts
8 / 21
Flat Warts
The upside of these warts is that they're smaller (maybe 1/8 inch wide, the thickness of the cord that charges your phone) and smoother than other types. The downside? They tend to grow in large numbers -- often 20 to 100 at a time. Flat warts tend to appear on children's faces, men's beard areas, and women's legs.
Swipe to advance
filiform warts
9 / 21
Filiform Warts
These fast-growing warts look thread-like and spiky, sometimes like tiny brushes. Because they tend to grow on the face -- around your mouth, eyes, and nose -- they can be annoying, even though they don't usually hurt.
Swipe to advance
genital warts
10 / 21
Genital Warts
As you might expect, you get these by having sex with someone who has them. They may look like small, scattered, skin-colored bumps or like a cluster of bumps similar to a little bit of cauliflower on your genitals. And they can spread, even if you can't see them. Don't try to get rid of genital warts yourself; they can be hard to treat.
Other types of HPV that could cause cancer may be passed sexually, too, including through oral and anal sex.
Swipe to advance
day calendar
11 / 21
How Long They Last
Over time, your body will often build up a resistance and fight warts off. But it may take months or as many as 2 years for them to disappear. In adults, warts often stick around even longer, perhaps several years or more. Some warts won't ever go away. Doctors aren't sure why some do and others don't.
Swipe to advance
multiple warts
12 / 21
To Treat or Not to Treat?
Most warts are harmless, and you don't need to do anything -- unless, of course, they're painful or embarrassing. Waiting for warts to go away could backfire, though: A wart might get bigger, new warts may appear, or you could give them to someone else. The best treatment depends on your age and health and the type of wart. But there's no cure for HPV, so some of the virus might stay in your skin after the wart is gone and reappear later.
Swipe to advance
wart treatment
13 / 21
Peeling Products
Over-the-counter gels, liquids, and pads with salicylic acid work by peeling away the dead skin cells of the wart to gradually dissolve it. For better results, soak the wart in warm water, then gently sand it with a disposable emery board before you apply the product. Be sure to use a new emery board each time. Be patient -- it can take several months.
Swipe to advance
gray duct tape
14 / 21
Duct Tape
Yes, you may be able to get a remedy for warts at the hardware store! Study results are mixed, but covering warts with duct tape may peel away layers of skin and irritate it to kick-start your immune system. Soak, sand, and put duct tape on the area (use silver stuff because it's stickier). Remove and re-do the process every 5-6 days until the wart is gone. If it works for you, the wart should be gone within 4 weeks.
Swipe to advance
medical wart removal
15 / 21
When to See the Doctor
If you're not sure your skin growth is a wart (some skin cancers look like them), it doesn't get better with home treatment, it hurts, or you have a lot of them, check with your doctor. If you have diabetes or a weakened immune system, you should have a doctor take a look before you treat a wart yourself.
Swipe to advance
Cryotherapy
16 / 21
Cryosurgery
For adults and older children with common warts, your doctor will likely want to freeze them off with liquid nitrogen. (Because the nitrogen is so cold, it can cause a stabbing pain for a little while, which is why it's not used for small children.) You'll probably need more than one session. It works better when you follow up with a salicylic acid treatment after the area heals. Cryosurgery can cause light spots on people who have dark skin.
Swipe to advance
liquid wart removal
17 / 21
Cantharidin
"Painting" a wart with this liquid makes a blister form underneath it, lifting it off the skin. When the blister dries (after about a week), the wart comes off with the blistered skin. Cantharidin is often the way to treat young children because it doesn't hurt at first, though it may tingle, itch, burn, or swell a few hours later.
Swipe to advance
doctor cutting wart
18 / 21
Burning and Cutting
Doctors may use one or both of these methods after they numb the area.
Electrosurgery burns the wart with an electric charge through the tip of a needle. It's good for common warts, filiform warts, and foot warts. Your doctor could also use a laser.
Curettage is scraping off the wart with a sharp knife or small, spoon-shaped tool. Another option is excision, slicing the wart off or cutting it out with a sharp blade.
Swipe to advance
prescription cream
19 / 21
Prescription Creams
For stubborn warts, peeling creams with glycolic acid, stronger salicylic acid, or tretinoin could do the trick. Diphencyprone (DCP) and imiquimod (Aldara) irritate your skin to encourage your immune system to go to work there. 5-Fluorouracil is a cancer medicine that may stop your body from making extra skin cells the same way it stops tumors from growing.
Swipe to advance
wart injection
20 / 21
Injections
Your doctor may use a needle to put medicine into the wart to help get rid of it. Bleomycin, a cancer drug, may stop infected cells from making more. Interferon boosts your immune system to better fight the HPV, typically for genital warts.
These usually aren't the first things your doctor will try, and you may need to use salicylic acid or duct tape on your wart, too.
Swipe to advance
rinsing feet
21 / 21
Stop the Spread
There's no way yet to prevent warts, but you can lower your chances of getting or spreading them:
• Don't touch, pick, or scratch your warts, or touch someone else's.
• Wash your hands after treating warts.
• Keep foot warts dry.
• Wear waterproof sandals or flip-flops in public showers, locker rooms, and around public pools.
Swipe to advance
Up Next
Next Slideshow Title
Sources | Medically Reviewed on 09/26/2017 Reviewed by Nayana Ambardekar, MD on September 26, 2017
IMAGES PROVIDED BY:
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SOURCES:
American Academy of Dermatology: "Warts: Overview," "Dermatologists share tips to treat common warts," "Where warts come from."
UpToDate: "Cutaneous warts (common, plantar, and flat warts)," "Patient education: Skin warts (Beyond the Basics)."
Mona Gohara, MD, clinical professor of dermatology, Yale School of Medicine.
Institute for Quality and Efficiency in Health Care: "Warts: Overview."
JAMA Dermatology: "Witches and Warts."
Cleveland Clinic: "Plantar Warts."
FamilyDoctor.org: "Warts."
University Health Service, University of Southampton: "Curettage and shave excision of raised skin lesions."
DermNet New Zealand: "Bleomycin and the skin."
BMC Infectious Diseases: "Interferon for the treatment of genital warts: a systematic review."
Reviewed by Nayana Ambardekar, MD on September 26, 2017
This tool does not provide medical advice. See additional information.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911. | {
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3,354,228,663,011,404,000 | Article Text
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Homozygosity for a frequent and weakly penetrant predisposing allele at the RET locus in sporadic Hirschsprung disease
1. A Pelet1,
2. L de Pontual1,
3. M Clément-Ziza1,
4. R Salomon1,
5. C Mugnier1,
6. F Matsuda2,
7. M Lathrop2,
8. A Munnich1,
9. J Feingold1,
10. S Lyonnet1,
11. L Abel3,
12. J Amiel1
1. 1Unité de Recherches sur les Handicaps Génétiques de l’Enfant INSERM U-393 and Département de Génétique, Hôpital Necker-Enfants Malades, Paris, France
2. 2Centre National de Génotypage, Evry, France
3. 3Laboratoire de Génétique Humaine des Maladies Infectieuses, INSERM U-550, Hôpital Necker-Enfants Malades, University Paris 5 Medical School, Paris, France
1. Correspondence to:
Stanislas Lyonnet
Département de Génétique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 15, France; lyonnetnecker.fr
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Hirschsprung disease (HSCR), the most common malformation of the hindgut (1/5000 live births), is a single-field neural crest derived malformation characterised by the absence of enteric ganglia along a variable length of the intestine.1 The genetics of HSCR are complex, considering a skewed sex ratio in favour of females (1/4) and recurrence risk figures whose values depend on the length of the aganglionic segment as well as the gender of affected individuals (mean value of 4%, ranging from 1 to 30%).2,3 All genetic and functional evidence points to the RET proto-oncogene as the major disease causing locus in HSCR. In particular, almost all HSCR families co-segregate with markers of chromosome 10q11.2 where the RET gene locus has been mapped,4–6 although modifier genes are involved.7,8 Nonetheless, in most series worldwide, a mutation within the RET gene coding sequence can be detected in only 40% and 10–20% of familial and sporadic cases, respectively.9–11 These data led to speculation that a frequent hypomorphic allele(s) must exist at the RET locus. To address this question, several groups have used linkage disequilibrium mapping, mostly in case control studies,12–17 taking advantage of single nucleotide polymorphisms (SNPs) scattered along the vast genomic domain encompassing the RET locus (55 kb). These studies consistently indicated that a predisposing haplotype is located in the 5′ region of the RET gene, whatever the ethnic background, with some functional data favouring the role of promotor variants.18,19 In order to refine the mapping of predisposing allele(s) at the RET locus and to characterise its genetic behaviour, we used a transmission disequilibrium test (TDT) across the RET gene, in a series of HSCR cases divided according to family type (sporadic or multiplex) and the presence/absence of a RET gene mutation. We found strong association between the disease phenotype and SNPs located 5′ to the RET locus; we also observed highly significant over-transmission of a predisposing SNP haplotype extending over 23 kb from the promoter region to exon 2 and encompassing the large intron 1. Over-transmission was not significant when considering cases with classical RET gene mutations. Conversely, the majority of sporadic HSCR cases with no RET gene mutation showed homozygosity for a low-penetrance predisposing haplotype, suggesting its major involvement in the commonest form of HSCR and its dosage-sensitive effect on the RET signalling pathway. The variable prevalence of the HSCR predisposing RET haplotype in the general population may account for the ethnic dependant prevalence of the disease.
METHODS
HSCR families
A total of 81 non-syndromic HSCR families, whose parents were available for study, were included. The series was divided into 66 single cases (46 males and 20 females), denoted as sporadic, and 15 one-generation families with at least two affected sibs (a total of 31 affected individuals including 18 males and 13 females), denoted as multiplex. Altogether, short segment and long segment HSCR was found in 45 and 29 cases, respectively, while the length of the aganglionic segment was not known in 23 cases.
Key points
• The genetics of Hirschsprung disease (HSCR), the most common malformation of the hindgut, are complex.
• Studies have consistently indicated that a predisposing haplotype is located in the 5′ region of the RET gene.
• A transmission disequilibrium test across the RET gene was used in a series of 81 HSCR cases divided according to the presence/absence of a RET gene mutation and family type (sporadic or multiplex).
• A strong association was found between the disease phenotype and single nucleotide polymorphisms (SNPs) located 5′ to the RET locus. Highly significant over-transmission of a predisposing SNP haplotype was also observed, extending over 23 kb from the promoter region to exon 2 and encompassing the large intron 1.
• Most sporadic HSCR cases with no RET gene mutation showed homozygosity for a low-penetrance predisposing haplotype, opposite to HSCR cases harbouring a RET gene mutation.
RET mutation screening
Blood samples were obtained with informed consent and DNA was extracted according to standard protocols. Probands were sequenced for the coding regions of the RET gene (list of primers is available on request). When a RET gene mutation was identified in the proband, all family members were sequenced for the appropriate exon in order to define their molecular status regarding the mutation.
SNP genotyping
All affected individuals and their parents were also sequenced for regions containing known polymorphisms. We subsequently focused on four SNPs encompassing the 5′ region of the RET locus from the proximal promotor at -5 (SNP-5, G/A, rs109000296) and -1 (SNP-1, C/A, rs109000297), over intron 1 (SNP IVS1, C/T, rs2435357) to exon 2 (G/A, SNP exon 2, rs1800858). All SNPs showed a variant allele with a frequency of at least 25% (table 1) and were tested for Hardy-Weinberg equilibrium.
Table 1
Transmission disequilibrium of RET 5′ SNPs in non-mutated HSCR families
Statistical methods
The role of common RET polymorphisms in susceptibility to HSCR was investigated with a family based association study, which avoids possible confounding of gene-phenotype associations due to inappropriately chosen controls or population substructures. We used the TDT20 to search for a distortion of the transmission of alleles from parents to affected offspring. Data were mainly analysed by the family based method implemented in the FBAT haplotype program.21 This method allows the use of an empirical variance-covariance estimator, which is consistent when sibling marker genotypes are correlated (for example, when the analysis includes multiplex families), and provides valid significance levels for tests of association.22 Data were also analysed by means of conditional logistic regression as described by Schaid and Rowland23. This analysis allowed estimation of odds ratios (ORs) and testing for homogeneity of the regression coefficients associated with RET polymorphisms according to some binary criteria such as gender of affected child, gender of transmitting parent, or family type (sporadic/multiplex). All analyses were performed under an additive model, and ORs correspond to the odds of presenting HSCR for 1-2 children versus 2-2 children, or for 1-1 children versus 1-2 children, in which 1 stands for the predisposing allele and 2 for the protective allele. To test for heterogeneity of the sample according to a binary criterion (for example, sporadic/multiplex families), the analysis was performed on the whole sample (for example, 66 families with no RET gene mutation) and separately on the two subsamples (57 sporadic and nine multiplex families). According to the hypothesis of homogeneity, twice the difference between the likelihood of the whole sample and the summed likelihoods of the two subsamples is distributed as a χ2 with 1 degree of freedom.
RESULTS
RET gene mutation detection
Direct DNA sequencing of the RET coding sequences detected a mutation in 15/81 (18.5%) HSCR index cases. The mutation detection rate is thus as low as reported in previous studies and as expected according to the hypothesis of a frequent hypomorphic mutation at the RET locus. Along the same lines, the mutation detection rate was dependent on family type with 6/15 (40%) and 9/66 (13.6%) in familial and sporadic cases, respectively.
In familial cases, mutations co-segregated with the HSCR phenotype and were mostly missense mutations (G93S, L452P, C620R, M1064T). Of two conservative changes, one has been shown to impair RET function through aberrant splicing (I647I), while the other (P399P) is likely to do so based on prediction programmes. Inherited mutations originated mainly from the mother (4/6 maternal transmissions), in accordance with the lower HSCR penetrance observed in females. In sporadic cases, mutations were either missense (R287M, R330Q, A487T, R873Q, E921K, N1059S) or splicing mutations (IVS-8 -1 G/A, IVS-7 -5 C/T, IVS-10 +1 G/A). Interestingly, 6/9 mutations occurred de novo.
Mutation screening allowed us to further split our sample into two groups: (i) 66 non-mutated families including 57 sporadic cases (38 males and 19 females) and nine multiplex families (all families with two affected children) and (ii) 15 mutated families (nine sporadic cases, four families with two affected children, and two families with three affected children).
SNP and haplotype studies
No SNP marker showed a significant deviation from the Hardy-Weinberg equilibrium. We concentrated statistical analyses on four SNP markers in a region encompassing 23 kb of the RET genomic domain from the proximal promotor region to exon 2, where the highest association has been reported15–17 and confirmed in the present study. No significant association was found in the 15 HSCR families with a RET gene mutation (nine sporadic, six multiplex), although a trend was observed in favour of a predisposing role of the less common variants of the three SNPs -5, IVS1, and exon 2.
Conversely, in the 66 HSCR families with no RET gene mutation, results were highly significant for the four SNPs (table 1) with ORs up to 8.3 (95% CI 4.0 to 17.2) for SNP-5 (p<10−6). In that sample, homogeneity tests did not show evidence for heterogeneity taking into account neither the gender of the affected child nor the sex of the transmitting parent. However, this test provided evidence for heterogeneity according to family type (sporadic v multiplex; p<0.03 for SNP-5), justifying splitting the sample between non-mutated multiplex and sporadic cases for further analyses.
In the nine non-mutated multiplex HSCR families (table 1), ORs, although greater than 1, were only suggestive of the role of the four SNPs, probably due, at least in part, to the small number of informative families. In contrast, the analysis of SNP transmission in the 57 non-mutated sporadic cases showed a striking over transmission of the rarer alleles of SNP-5, SNP IVS1, and SNP exon 2 with ORs of 18 (5.6–57.5), 13.7 (4.9–37.1), and 7.4 (3.1–17.2), respectively (table 1). A detailed analysis of SNPs -5 and IVS1 showed an overwhelming transmission of the rarer alleles: allele A for SNP-5 and allele T for SNP IVS1, for 54/57 and 55/59 transmissions, respectively (table 2). Moreover, for both these SNPs, each of the children born to heterozygous parents was found to be homozygous for the rare allele (17/17 and 18/18 cases for SNP-5 and SNP IVS1). Accordingly, in contrast with other HSCR sub-groups, no difference could be established between paternal and maternal transmission in this series of 57 non-mutated sporadic cases (table 2).
Table 2
Transmission of alleles at SNP-5 (G/A, rs109000296) and IVS1 (C/T, rs2435357) to affected child according to genotype in non-mutated simplex families
Based on single-loci SNP genotyping, we studied the most frequent haplotypes composed of the highest associated marker loci (table 3). The three SNPs -5, IVS1, and exon 2 are in very strong linkage disequilibrium and have similar allele frequencies, so that they define only two main haplotypes, A-T-A and G-C-G. SNP-1 has a different frequency from the three other SNPs and association with common allele C of this SNP is very likely due to linkage disequilibrium (allele C is almost always with the predisposing A-T-A haplotype, but due to higher frequency it is also sometimes with the G-C-G haplotype explaining the lower association of SNP-1 with HSCR). When focusing on the three SNPs with similar frequencies, the A-T-A haplotype of rarer alleles conferred a very high predisposition to HSCR in non-mutated sporadic cases (p = 9.10−6). The main effect was due to SNP-5 and SNP IVS1, since the analysis of haplotypes divergent for SNP exon 2 (table 3, upper rows) clearly showed that the A-T haplotype, extending over 10 kb from the promotor to mid-intron 1, was highly predisposing by itself. However, the analysis of haplotypes composed only of the two SNPs -5 and IVS1 did not allow any conclusions to be drawn about a predominant role of either one of these two SNPs (table 3, bottom rows).
Table 3
Haplotype analysis in the 57 non-mutated HSCR sporadic cases
DISCUSSION
As expected in a condition with a complex pattern of inheritance, genetic variations at the major locus RET in HSCR may be of low penetrance, are frequent in the general population, and may lie in non-coding sequences, all features opposite to what is observed for mutations in pure Mendelian traits. This would explain why screening in the RET coding sequences failed to demonstrate mutations in more than 15–20% of sporadic cases. In order to refine the mapping of such alleles and characterise their genetic behaviour, we investigated a series of 81 HSCR families using TDT across the vast 5′ genomic domain of the RET locus, from the promotor to exon 2. Our data agree with the hypothesis of a frequent hypomorphic mutation of the RET gene, with the greatest impact in the subgroup of patients with no RET gene mutation identified within the coding sequence (p<10−6). Haplotype studies suggest that this allele is more likely to map 5′ to exon 2 of the RET gene, from the proximal promotor to mid-intron 1.
The vast majority of informative sporadic HSCR cases were found to be homozygous for the predisposing RET gene 5′ haplotype. It is worth remembering that segregation meta-analysis in short segment HSCR, the most represented form in sporadic cases (80%), showed that the best fit were either the autosomal recessive or the multifactorial models.2 We thus propose that the frequent hypomorphic RET allele, located in the 5′ region, results in a dosage-sensitive impairment of the RET signalling pathway, and that homozygosity for that variant is the molecular basis for HSCR in most patients with no coding sequence mutation. Accordingly, the higher penetrance of severe RET gene mutations might explain their higher prevalence in multiplex HSCR families.
The genome-wide scan performed in HSCR sib pairs showed a parent of origin effect at, and only at, the RET locus, with a greater number of maternal transmissions than expected in sibs sharing one allele identical by descent (IBD1).8 In this series, we observed homozygosity for the A-T-A haplotype among non-mutated sporadic cases. We can hypothesise that over maternal IBD1 sharing at the RET locus holds true only among HSCR patients who inherited a classical RET gene mutation as it is more frequently maternal in one-generation familial cases. Conversely, it is striking that a mutation of the coding sequence of the RET gene occurs de novo in over 50% of sporadic HSCR cases (this series and Attié et al9).
Homozygotes for the A-T haplotype at the RET locus are estimated to be 4% of the general population. Homozygosity for the predisposing A-T haplotype may, therefore, be a necessary (although not sufficient) prerequisite for HSCR to occur in most non-mutated sporadic cases. According to both the 100% heritability of HSCR and the observations made in our previous sib-pair study,8 co-inheritance of frequent autosomal dominant predisposing alleles at modifier genes mapping to chromosome 3p21 and 19q12 may be necessary to explain the 1/5000 prevalence of HSCR in Caucasians. Along these lines, it is tempting to speculate that the variable prevalence of HSCR across different ethnic backgrounds may result from the variable frequency of the A-T predisposing haplotype, as suggested by linkage disequilibrium studies at the RET locus.24
Acknowledgments
We thank the Association Française de la maladie de Hirschsprung for support and participation in the study.
REFERENCES
View Abstract
Footnotes
• This work was supported by European Union grants 2001-01646 and grants from GIS Maladies Rares INSERM-AFM.
• Competing interests: none declared
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1,897,062,162,362,108,200 | Top
20
Doctor insights on: Fruit Ripening
Share
4
4
Is red dragon fruit safe to eat during pregnancy?
Is red dragon fruit safe to eat during pregnancy?
Dragon Fruit: Dragon fruit (pitahaya or pitaya) which is native to south ; central america is a healthy food to eat during pregnancy. A 100 gram serving contains 1 mg of fiber, 1 mg of iron as well as magnesium, potassium ; calcium. It also contains vit c ; b vitamins. It is a rich source of lycopene (helps to lower blood pressure ; helps to prevent cancer. ...Read more
See 1 more doctor answer
5
5
Does gentle pasteurized juices remove allergenic properties of fruits?
Does gentle pasteurized juices remove allergenic properties of fruits?
No: Processed juices will still contain allergens. If you are allergic to a fruit then you should also avoid the juice. ...Read more
6
6
Is stevia, splenda, or nectresse (erythritol, sugar, monk fruit extract, molasses) or aspartame safe during pregnancy?
Is stevia, splenda, or nectresse (erythritol, sugar, monk fruit extract, molasses) or aspartame safe during pregnancy?
Generally yes: There is no specific problem w/aspartame in pregnancy according to the nih. It does not cross the placenta, and is not a risk to you unless you have phenylketonuria - a rare genetic disorder. However, it is always prudent to limit all meds, supplements and the like during pregnancy except as instructed by your ob>. ...Read more
9
9
Is it normal for 7 month baby to eat 200gr of fresh fruit porridge (banana, apple, medlar, cherry, cherry plum, peach) between meals?
Is it normal for 7 month baby to eat 200gr of fresh fruit porridge (banana, apple, medlar, cherry, cherry plum, peach) between meals?
Childhood Obesity: Nope. Not at all. That is 800 calories. You are the parent. You are responsible for the health of your child. This is obscene and to me child abuse to allow your child to become grossly obese. If they are not obese they soon will be at that rate. 800 calories in a 7 month old between regular meals? That is extremely unhealthy. ...Read more
10
10
Are passion fruit seeds okay during pregancy?
Are passion fruit seeds okay during pregancy?
Some recommend : Avoiding passion flower during pregnancy because some substances it contains may cause uterine contractions (per medline plus) http://www.Nlm.Nhid.Gov/medlineplus/druginfo/natural/871.Html. ...Read more
11
11
What distinguishes eating fruit from having fruit juice?
What distinguishes eating fruit from having fruit juice?
Big difference: Eating fruits gives you a lot of fiber which is healthful for your bowel functions. Juices have too much sugar and will make you eat more as high sugar leads to increased hunger due to high Insulin levels which follow after consuming sugary drinks. ...Read more
12
12
How much vit c is in lge glass of fresh beetroot, lemon, apple, parsley, carrot juice?
How much vit c is in lge glass of fresh beetroot, lemon, apple, parsley, carrot juice?
Hard to know: This is hard to determine without the concentration of each component and the exact amount of the components in the mixture. ...Read more
13
13
Is passion fruit good during pregnancy?
Passion Flower: Passion flower is not recommended during pregnancy because some substances it contains may cause uterine contractions (per medline plus) http://www.Nlm.Nih.Gov/medlineplus/druginfo/natural/871.Html. ...Read more
See 1 more doctor answer
14
14
Is it ok to eat organic sprouted wheat berry and sprouted flaxseed bread during pregnancy?
Is it ok to eat organic sprouted wheat berry and sprouted flaxseed bread during pregnancy?
OK if no gluten-sens: This is ok unless you are among the 1% of people with celiac disease or the 10-20% who have non-celiac gluten sensitivity. See http://abt.Cm/1dopk3o some nutritionists advise everyone limit intake of grains, even whole grains, as too much starch is not healthy for anyone, but i feel sprouted bread is a healthy choice for most people in moderation. See http://bit.Ly/gagviu for further discussion. ...Read more
15
15
Are sprouted grains safe to eat during pregnancy?
Are sprouted grains safe to eat during pregnancy?
Controversial: There have been so many cases of sprouts contaminated by e. Coli or other pathologic bacteria, it's difficult to advise. If you know the producer of the sprouts is fastidious about their handling & preparation, they should be ok but if there is any doubt, don't risk them. ...Read more
See 1 more doctor answer
16
16
Which is healthier? boiled egg or fried egg?
Which is healthier? boiled egg or fried egg?
No joking here: There is no such medical list or answer to your question. If you include the calories from the oil or other product the egg was 'fried' in they you could maybe have a conversation. But, an egg is an egg is an egg is an egg. The calories are the same. ...Read more
See 2 more doctor answers
17
17
Allergy to organic trail mix. Throat closed. Which ingred likely? Raisin, sunflower seed, pumpkin seed, cashew, apples, almonds, cranberries, cane syrup
Allergy to organic trail mix. Throat closed. Which ingred likely? Raisin, sunflower seed, pumpkin seed, cashew, apples, almonds, cranberries, cane syrup
Food allergy: An allergist can help diagnose and treating this particular problem. Allergy testing either by blood or skin test can give us information of which food is likely the one that cause such symptom. Throat closing is dangerous. I would advise you seek specialist medical advice soon. ...Read more
18
18
Is monk fruit extract (monk fruit in the raw) a healthy sweetener to add to my coffee?
Is monk fruit extract (monk fruit in the raw) a healthy sweetener to add to my coffee?
Probably Acceptable: Monk Fruit In The Raw® is a zero-calorie sweetener made from monk fruit, a vine-ripened fruit native to Asia. The monk fruit extract, which is about 300 times sweeter than cane sugar, is blended with dextrose, a bulking agent, so that it can be conveniently measured, poured and used as a substitute for sugar or other caloric sweeteners. *Each packet contains less than 3 calories per serving, ...Read more
20
20
Drank homemade fruit drink w kale, pineapple , strawberry, banana & tbsp of flax seed now having fast heart beat and sensitivity to light?
Drank homemade fruit drink w kale, pineapple , strawberry, banana & tbsp of flax seed now having fast heart beat and sensitivity to light?
not related: It's hard to imagine how that could be related. If your hr is >120 at rest, proceed immediately to an er to get an ekg. Sensitivity to light can be due to many causes including eye issues. Do you have a headache? (suggesting migraine?). ...Read more | {
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Hidden diabetes: what is it, symptoms, tests during pregnancy
Hidden diabetes is a violation of the metabolism of carbohydrates, which is detected for the first time during pregnancy. The disease develops more slowly than type 1 diabetes. Sometimes it is mistakenly defined as type 2 diabetes. It is always a non-insulin-dependent form that develops in people with antibodies to the decarboxylase-glutamic acid.
During gestation, another endocrine organ is formed in the body - the placenta. It produces hormones (prolactin, progesterone and others) that reduce the susceptibility of the tissues of the mother's body to insulin. Antibodies to insulin receptors are being actively created, and the breakdown of hormones in the placenta occurs. This leads to increased metabolism of ketone bodies, glucose begins to be spent on the needs of the fetus.
Normally, the development of insulin resistance is the impetus for increasing blood glucose after a meal. Consumption of carbohydrates leads to slight hypoglycemia.With the prerequisites for the development of diabetes, the insular apparatus does not stand up. This leads to the formation of pathology.
Symptoms
Hidden diabetes can be assumed if there is:
• feeling tired;
• nebula in the head;
• dizziness;
• feeling hungry after eating;
• inability to quench thirst;
• frequent urination.
As the disease progresses, a person�s ability to produce insulin gradually decreases. This can lead to a sharp decline in vision and convulsions. Therefore, it is important to identify the signs at the earliest stage.
In the risk group, latent diabetes mellitus includes women:
• overweight;
• over 30 years old;
• with burdened heredity;
• with a dysfunctional obstetric history.
Often the problem occurs at 6-7 months of pregnancy. Diagnosis is often difficult due to asymptomatic leakage. Sometimes the latent form is found by chance during laboratory tests.
Diagnostics
When a pregnant woman gets registered, the level of glucose is determined. To do this, take venous blood. In healthy women, it ranges from 3.26-4.24 mmol / l. About diabetes, you can say, if the fasting indicator is higher than 5.5 - 6 mmol / l.
Additionally, a study on glycated hemoglobin is being conducted.The method allows you to set the status of the exchange for the last 2 months. Normally, the rate is 3-6%. With an increase of 8% and above, they speak about the development of diabetes.
Determining the presence of latent diabetes is achieved by studying the elevated levels of autoantibodies to the pancreatic profile. For this, an antibody test for glutamate decarboxylase is performed. They provide an opportunity to identify the hidden form of the disease, to predict the rate of progression of pathology.
The second test is a blood test for C-peptide. However, this study does not show the problem at an early stage.
Glucose Tolerance Test
The study is conducted three times:
1. The sugar level is measured on an empty stomach. If its level is 5.1 mmol / l and above, the diagnosis is confirmed, the test is terminated.
2. If the study continues, a pregnant woman drinks a glass of sweet water in five minutes.
3. After 60 and 120 minutes. Samples are taken from the woman. If after the second test revealed latent diabetes, the study is terminated.
The study takes 3-4 hours. At this time, you can not eat, walk and stand. An hour after taking a liquid, glucose should be no less than 10 mmol / l, and after 2 hours it should be less than 8.5 and more than 7.8 mmol / l.
This test has contraindications:
• individual glucose intolerance;
• gastrointestinal tract diseases;
• manifest diabetes.
The analysis allows you to start treatment on time, choose a diet. If, when registering, the level of glucose in the blood is normal, then the test is carried out once for 24-28 weeks of pregnancy. In identifying suspicions of the disease, the study is done earlier. In this case, a single positive result does not allow to make a diagnosis. Data is rechecked again.
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206,819,724,877,151,140 | Top
20
Doctor insights on: Doctor's Note
Share
1
1
New to the us. Doctor says I have enteritis. Please comment.?
New to the us. Doctor says I have enteritis. Please comment.?
Maybe: Enteritis is an inflammation of the bowel. Without knowing what type of enteritis or its cause it is difficult to know if you should be overly concerned. Some causes dissipate spontaneously, others are quite easily treated, and some forms of enteritis may be chronic and prone to the development of complications. Find out more about your illness and ask again. ...Read more
2
2
How would you read a doctor who refers you to urologist, who recommends biopsy for any psa 2.5+..My dr. Told of latter says, "buyer be aware." ?
How would you read a doctor who refers you to urologist, who recommends biopsy for any psa 2.5+..My dr. Told of latter says, "buyer be aware." ?
Unclear: My training focused on a change from baseline rather than a specific number. For instance if your psa has been 1.0 or close for a few years and in jumps up by .75 in one year, that is worth an ultrasound. Then depending on those findings a trip to the urologist for potential biopsy. Any other thoughts from collegues? ...Read more
See 2 more doctor answers
3
3
Saw doctor's notes about papilledema or something, is that serious?
Saw doctor's notes about papilledema or something, is that serious?
Papilledema : Papilledema is a serious condition where the optic nerves are swollen due to high spinal fluid pressure in the brain. If untreated can lead to vision loss. Work-up includes at CT or MRI scan of the brain and a spinal tap. ...Read more
Dr. Liawaty Ho Dr. Ho
2 doctors agreed:
4
4
New to the us. Doctor says I have anemia. Please comment.?
Dr. Liawaty Ho Dr. Ho
2 doctors agreed:
New to the us. Doctor says I have anemia. Please comment.?
Anemia: Anemia is decrease level of hemoglobin below the normal range. It is very common condition. Now, the important part is to find the cause. Because, once you know the cause you can treat anemia. It can be caused by bleeding, decrease production of red blood cells- eg. Iron or vit deficiency, or if there is destruction of blood. See your doctor and get some test. In a complex case-see a hematologist. ...Read more
See 1 more doctor answer
6
6
New to the us. Doctor says I have bedbugs. Please comment.?
New to the us. Doctor says I have bedbugs. Please comment.?
You don't have...: ...Bedbugs, your apartment does. Get an exterminator, and the bites will go away. ...Read more
See 1 more doctor answer
7
7
The doctor has given me alegra with no results. What should I do.?
The doctor has given me alegra with no results. What should I do.?
See your Doctor: If one is prescribed a medication that is not working for a particular set of symptoms or a certain disease then follow up with the prescribing physician is the most appropriate nest step.. ...Read more
See 2 more doctor answers
9
9
What are effects of mi at 92 yo? Always worse condition afterwards? Er doctor just told us so. Would like to see and share studies, your experiences.
What are effects of mi at 92 yo? Always worse condition afterwards? Er doctor just told us so. Would like to see and share studies, your experiences.
Extent o muscle loss: Mi implies occlusion of an artery that bring blood supply to the heart muscle and an infarction or death of the heart muscle. So if the the infarction size is small, and preferably if the rest of the heart muscle is supplied with adequte blood supply, there should not be too many side effects after one recovers from an mi. At 92, other factors, cardiac reserve, additonal disease etc contribute. ...Read more
11
11
What should a doctor's excuse say for someone with asthma?
What should a doctor's excuse say for someone with asthma?
Honest answre: Just say pt with acute exacerbation of br asthma. ...Read more
12
12
What should someone with mononucleosis expect from a doctor? What would a doctor say to them?
What should someone with mononucleosis expect from a doctor? What would a doctor say to them?
Depends on symptoms: Mono is caused by Epstein-Barr virus. Depending on symptoms and physical findings, there may be medicines that can help. The Dr. will advise resting for a few weeks. Anything else depends on exam and symptoms. ...Read more
See 2 more doctor answers
13
13
If a doctor exam you does the doctor have to tell you what the doctor found?
Doctor exam: yes the doctor needs to tell you what was found during the examination. If he is doing further testing he should explain what that is for and what he is looking for or what he is trying to rule out. Unless you are felt to be incompetent for some reason then this would be explained to a guardian. ...Read more
14
14
Is everybody in doctor's office entitled to know about my medical history?I only wanted my doctor to know, not the staff.I get calls from others too.
Is everybody in doctor's office entitled to know about my medical history?I only wanted my doctor to know, not the staff.I get calls from others too.
Obviously not: Everyone, such as the janitor. But everyone who is involved in your medical care is entitled to know, for your safety if nothing else. For example, if you are allergic to a certain med, you would want the nurse to know about it. If you want to keep certain information confidential, inform your doctor who will then take appropriate steps. ...Read more
See 2 more doctor answers
15
15
New to the us. Doctor says I have diabetes and pregnancy. Please comment.?
New to the us. Doctor says I have diabetes and pregnancy. Please comment.?
Gestational diabetes: It means you need to check with your doctor further. Have blood sugars monitored every day, initially an attempt to controll them will be with diet. If nu success medication will be added and your pregnancy will become a high risk pregnancy. Best advice: keep your appts with your doctor. ...Read more
See 1 more doctor answer
17
17
Hi, if you have an STD such as chlamydia can your doctor call or send a letter to your partner telling them about it?
Hi, if you have an STD such as chlamydia can your doctor call or send a letter to your partner telling them about it?
With Permission: Most states require your permission though some allow partners to be informed without reveling who, that someone they have been with is being treated for an std so they should be checked. I'm not sure if you are afraid to tell them, don't want them to know, or what, but consider that if you might have an std that is treatable but could cause issues left untreated, wouldn't you want to know? ...Read more
18
18
My wife's doctor wants her to see an endocrinologist. Is there something wrong?
My wife's doctor wants her to see an endocrinologist. Is there something wrong?
Maybe: An endocrinologist treats hormonal issues. So, the doc might want to see if she in in menopause, had diabetes, etc. And then help. Peace and good health. ...Read more
19
19
If my doc tells me one thing about a medication, and the leaflet that comes with the prescription says another, who is right? Why do they sometimes contradict?
If my doc tells me one thing about a medication, and the leaflet that comes with the prescription says another, who is right? Why do they sometimes contradict?
Sometimes a doctor: may offer information that is anecdotal. A doctor might tell you not to worry about having a certain side effect whereas a drug company may reveal that it has been reported but is very rare. Drug companies aren't supposed to be advertising their product's off -label uses whereas a physician can. There are many other issues as well. ...Read more
20
20
If I think someone has an anxiety disorder, should I ask the person to read up on it and see if he agrees with the symptoms/diagnosis?
If I think someone has an anxiety disorder, should I ask the person to read up on it and see if he agrees with the symptoms/diagnosis?
Yes: It's always worthwhile to try to get people to learn more about themselves. Your friend may be more likely to take seriously what he/she reads. ...Read more
See 4 more doctor answers | {
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-1,919,914,488,287,548,700 | Health Tip: Sleep Study
How much sleep do you need?
Children, teens, and adults alike are plagued with the question: How much sleep do I really need?
We all know the importance of sleep. It lays the foundation of your mood and attentiveness for the day. Students need the proper amount of sleep to do well on tests or perform their best for sports. The health risks sleep deprivation are, as quoted from WebMD, ” high blood pressure, inflammation, weight gain, and diseases associated with these risk factors, such as diabetes and heart disease.” But the question still remains: What is the right amount of sleep for me?
This is a topic of hot debate in the health field, but it boils down to your own personal needs as an individual.
How much sleep do you really need?
The sleep foundation set these guidelines for sleep
Using the chart as a reference point, you can determine the estimated amount of sleep you need per night. Of course, your individual lifestyle will determine whether you need more sleep or less of it. Try sleeping for different amounts in-and-around the guideline for your age group for your personalized sleep amount.
However, if you feel that you have a sleep problem, talk to your doctor, who may refer you to a specialist. You may be suffering from a sleeping disorder.
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One thought on “Health Tip: Sleep Study
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-497,027,422,944,696,600 | What should you workout on Monday?
What muscles should I workout on Monday?
Instead of exercising your whole body, you work one or two muscle groups each day, for example: Monday you work your back and biceps, Tuesday you focus on chest and triceps, Wednesday you rest, Thursday is leg day, Friday you work your shoulders, and on the weekend your rest.
What body parts to work on what days?
Day 1: chest, shoulders, triceps, forearms. Day 2: calves, hamstrings, quadriceps, glutes. Day 3: biceps, back, abdominals, traps, lats.
Which exercise to do on which day?
Day 1: Chest and triceps. Day 2: Back and biceps. Day 3: Rest.
What is the best workout weekly schedule?
Here’s What a Perfectly Balanced Weekly Workout Schedule Looks…
• Monday: Upper-body strength training (45 to 60 minutes) …
• Tuesday: Lower-body strength training (30 to 60 minutes) …
• Wednesday: Yoga or a low-impact activity like barre, light cycling, or swimming (30 to 60 minutes) …
• Thursday: HIIT (20 minutes)
How long should you workout a day?
As a general goal, aim for at least 30 minutes of moderate physical activity every day. If you want to lose weight, maintain weight loss or meet specific fitness goals, you may need to exercise more. Reducing sitting time is important, too. The more hours you sit each day, the higher your risk of metabolic problems.
IT IS IMPORTANT: Question: Is plyometric training hit or HIIT?
What day is leg day?
It’s Leg day on the 2nd of October.
Is working out 6 days a week too much?
… go the gym five to six days per week.
You don’t have to spend all your time on cardio machines or in aerobics class to lose weight. Dedicating two or three days to resistance training will tone and strengthen your muscles while burning calories.
What is the ideal workout schedule?
If you’ve also decided the same then here’s what an ideal schedule should include – three days of strength training and two days of cardio followed by two days of rest. On the other hand, if you want to tone muscles, then you can cut one day of cardio and focus on strength training for four days.
What exercises are OK to do everyday?
Keep the fuss to a minimum and stick with the basics.
• Lunges. Challenging your balance is an essential part of a well-rounded exercise routine. …
• Pushups. Drop and give me 20! …
• Squats. …
• Standing overhead dumbbell presses. …
• Dumbbell rows. …
• Single-leg deadlifts. …
• Burpees. …
• Side planks.
How many pushups should I do a day?
There is no limit to how many push-ups one can do in a day. Many people do more than 300 push-ups a day. But for an average person, even 50 to 100 push-ups should be enough to maintain a good upper body, provided it is done properly. You can start with 20 push-ups, but do not stick to this number. | {
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-5,199,605,127,344,144,000 | Men: Eat Right, Stay Healthy
Health
Man eating
Men, are you paying attention to your health? Compared to your female counterparts, you’re more likely to smoke and drink, make unhealthy choices, and put off regular checkups and medical care. But you need to pay just as close attention to your lifestyle as women do. One of the most important aspects of your lifestyle is what you put on your plate. Good nutrition is critical for good health. Eating well not only gives your body the nutrients it needs. It also helps keep weight under control. Being overweight can increase your chances of developing certain chronic conditions, including:
• heart disease
• type 2 diabetes
• high blood pressure
• stroke
• metabolic syndrome
• colon, kidney, liver, and gallbladder cancers
• osteoarthritis
So you’ve got to learn how to eat right to stay healthy all life long.
Are you overweight?
Doctors use several measurements to determine whether or not your weight is in a healthy range. One is called the body mass index (BMI). Plug your height and weight into an online BMI calculator.
• If your BMI is less than 18.5, it falls within the underweight range.
• If your BMI is 18.5 to 24.9, it falls within the normal or healthy weight range.
• If your BMI is 25.0 to 29.9, it falls within the overweight range.
• If your BMI is 30.0 or higher, it falls within the obese range.
You can also use waist and hip measurements to calculate body fat. To correctly measure waist circumference:
• Stand and place a tape measure around your middle, just above your hipbones.
• Make sure tape is horizontal around your waist.
• Keep the tape snug around your waist, but don’t compress the skin.
• Breathe out and take the measurement.
If your waist circumference is more than 40 inches you could be at a higher risk for developing the health conditions mentioned above.
Path to improved health
You may think that what you eat doesn’t matter that much. Or that whatever is lacking in your diet, you can make up with vitamin and mineral supplements. But a growing body of scientific evidence shows that nutrients work best in combination. So that it’s not one food, or one nutrient in isolation that helps you prevent disease and live a longer, healthier life. It’s the interaction among different foods, and the cumulative effect that the foods have on your body that helps. In other words, one single nutrient isn’t the key to good health. It’s your overall eating pattern that matters. So, what do you need to eat in order to stay healthy? First, estimate how many calories you should eat in a day. This number will vary, depending on your age, weight, activity level, and whether you’re trying to gain, maintain, or lose weight. Now that you know how much you should eat, what should you be eating to fill that calorie need? Your daily diet should include:
• Vegetables. Make sure you include a wide variety covering all of the five vegetables subgroups. That’s dark green (spinach, lettuce), red and orange (peppers), legumes (beans, peas), starchy (corn), and others. You can feast on them fresh, frozen, canned, and dried. Choose low-salt varieties when buying frozen and canned.
• Fruits, at least half of which are whole fruits. These include fresh, canned, frozen and dried. Fruit juices are okay but they lack fiber and drinking too many can add calories. Choose 100% fruit juice without added sugars.
• Whole grains. This includes grains by themselves, like rice, oatmeal and popcorn, as well as foods that contain grains like breads and cereals. At least half of your grains should come from whole grains. Limit the amount of refined grains and products made with refined grains. Foods like cookies, cakes and certain snack foods have been processed to remove the brain and germ, which removes dietary fiber, iron, and other nutrients.
• Fat-free and low-fat dairy products. These include milk, yogurt, cheese, and fortified soy beverages. Do not include other “milks” made from plants (like almond, rice or coconut milk) in this group.
• Protein foods. You should eat a variety in nutrient-dense forms. Incorporate foods from both animal and plant sources. These include seafood, meats, poultry, eggs, nuts, seeds, and soy products. Legumes (beans and peas) go in this group (as well as the vegetables group).
• Healthy oils. They should have a high percentage of monounsaturated and polyunsaturated fats and be liquid at room temperature. These include canola, corn, olive, peanut, safflower, soybean, and sunflower oils. Oils are also naturally present in nuts, seeds, seafood, olives, and avocados.
Things to consider
Your daily diet should limit:
• Added sugars, including syrups and other caloric sweeteners. These include brown sugar, corn sweetener, dextrose, fructose, high-fructose corn syrup, and honey. They should make up less than 10% of your calories per day. An added note: Replacing added sugars with high-intensity sweeteners (like saccharin or aspartame) may reduce your calorie intake in the short run. However, data has not proven that using these fake sugars helps in overall weight management.
• Saturated fats. Strong scientific data shows that replacing saturated fats with unsaturated, especially polyunsaturated fats, is associated with reduced blood levels of total cholesterol and of low-density lipoprotein-cholesterol (LDL-cholesterol). It’s also associated with a reduced risk of heart attacks and cardiovascular disease-related deaths. Foods high in saturated fats include red meat, poultry with skin, and dairy products such as cream, butter, and cheese. Saturated fats should make up no more than 10% of your calories per day.
• Trans fats. These are artificial fats created by a process that adds hydrogen to liquid vegetables oils to make them more solid. They’re found in margarines, certain snacks foods (like frozen pizza and microwave popcorn), and prepared desserts. A number of studies have shown an association between increased intake of trans fats and increased risk of cardiovascular disease. Therefore, trans fats should be limited to as few as possible.
• Sodium. You should consume less than 2,300 mg per day. If you have high blood pressure, you might benefit from lowering your intake to 1,500 mg per day. Americans are currently averaging 3,440 mg per day.
• Alcohol. If you do drink, do it in moderation. That means up to two drinks a day for men up to age 64 and one drink a day for men older than that. One drink would be 12 fluid ounces of regular beer, 5 fluid ounces of wine, or 1.5 fluid ounces of standard 80-proof liquor. The risk of various types of cancer, such as liver cancer, appears to increase with the amount of alcohol you drink and the length of time you’ve been drinking. | {
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8,604,343,191,583,796,000 | Often asked: How Many Scoops Of Pre Workout Should I Take?
How much pre workout should I take a day?
The recommended dose for improving exercise performance is 4–6 grams per day ( 13 ). Based on existing research, this dose is safe to consume. The only known side effect is a tingling or “pins and needles” feeling on your skin if you take higher doses. four minutes.
How much is 1 scoop of pre workout?
scoop is equal to 1/3 cup, lightly packed. By actual measurement. 5 of 5 found this helpful.
Can I take 2 scoops of c4?
Do not exceed 2 scoops per day. During your workout, it is recommended that you drink plenty of water or performance beverage such as Cellucor Alpha Amino to stay hydrated. Do not exceed recommended daily intake.
How much before workout should I take pre workout?
However, it can also be consumed in food or pill form. As the name suggests, pre-workout should be taken before a workout, and although many people drink it on their way to the gym or during their workout, it should be taken at least 30 to 60 minutes prior to hitting the weights or cardio machines.
You might be interested: FAQ: Why Do I Get Dehydrated When I Drink Pre Workout?
Is it OK to take pre-workout everyday?
How Much Pre Workout Should You Take? For healthy adults, it’s safe to consume about 400 milligrams (0.014 ounces) per day. When you’re measuring out your pre workout supplement, be sure to also factor in how much caffeine it contains per scoop and how much you’ve consumed before your workout.
Why is C4 banned?
C4 is banned in many sports because of an ingredient that C4 contains, synephrine, which may give athletes an edge over their opponent (Corpus Compendium, 2013).
Is pre-workout bad for you?
Pre-workout formulas are popular in the fitness community due to their effects on energy levels and exercise performance. However, you may experience side effects, including headaches, skin conditions, tingling, and stomach upset.
Do you take pre-workout with water?
Most pre-workout powders consist of a blend of amino acids, B vitamins, caffeine, creatine, artificial sweeteners, and other ingredients. Most products instruct users to mix the powder with water and claim to help enhance performance.
How many protein scoops a day?
A commonly recommended dosage is 1–2 scoops (around 25–50 grams) per day, usually after workouts. It’s recommended that you follow the serving instructions on the packaging. Keep in mind that if your protein intake is already high, adding whey protein on top of your current intake may be completely unnecessary.
How many scoops of C4 is too much?
DO NOT EXCEED 2 SCOOPS PER DAY. DO NOT USE THIS PRODUCT WITHIN 6 HOURS OF INGESTING ANY OTHER SOURCE OF CAFFEINE OR OTHER STIMULANTS. During your workout, it is recommended that you drink plenty of water or performance beverage such as Cellucor Alpha Amino® to stay hydrated.
You might be interested: FAQ: Jym Pre Workout Why Wait?
How long does a C4 pre workout last?
Caffeine is the feature ingredient in C4 Energy, C4 Smart Energy and C4 Ultimate that delivers the explosive energy you feel right away. On average, humans absorb 99% of caffeine ingested within 45 minutes and caffeine’s half-life lasts around 5 hours.
Does C4 build muscle?
C4 original combines incredible ingredients & flavors, to provide explosive support for energy, pumps, and muscular endurance. Includes clinically studied and patented CarnoSyn® Beta-Alanine to help your muscles endure a tough workout.
Does pre-workout help lose weight?
While a pre-workout formula like Ladder Pre-Workout can be part of a fitness and healthy eating plan that helps you lose weight, it doesn’t directly influence weight loss, says Trevor Thieme, CSCS, director of fitness and nutrition content at Openfit.
How long before workout should I take protein?
Ideally, a person should eat a meal rich in complex carbohydrates and protein around 2–3 hours before exercising. Waiting a few hours after eating allows the body enough time to digest the meal.
Is coffee a good pre-workout?
Sometimes you need an extra boost of energy before a workout. While options abound, one of the most popular pre-workout drinks is coffee. High in caffeine and low in cost, coffee makes for an effective beverage to enhance exercise performance.
Leave a Reply
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-5,325,195,529,688,911,000 | Category:
What Factors Affect Baclofen Dosage?
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The factors that most affect baclofen dosage are the way the drug is administered and the individual’s response to the medication. A patient’s medical condition also influences the amount that is needed, and any kidney damage may lower the dose or contraindicate the drug, entirely. Dosage is also governed by the philosophy that the lowest effective amount of the medication is given to avoid more significant side effects. Moreover, drug amounts almost always start small, and the medicine must be discontinued slowly.
Baclofen treats painful spasms that occur in multiple sclerosis or are associated with paralysis. It may also be prescribed to treat chronic hiccups or to aid in the initial recovery of alcohol addiction. The highest baclofen dosage is often employed for alcohol recovery, whereas lower doses tend to be used for the other conditions mentioned.
There are two ways that baclofen can be administered. It can be taken in a pill form, which melts in the mouth and doesn’t require water to swallow. Alternately, it can be given intrathecally. This delivery method is an injection of the drug into a permanent catheter that feeds into the spine.
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Intrathecal baclofen dosage is in much lower amounts than oral doses. Initial injections may contain 50 micrograms (mcg), 75 mcg or 150 mcg, but if a patient responds well to 50 mcg then he might continue to receive this amount three times per day. Some people are assisted with an even lower dose, but typical amounts used are between 300-800 mcg daily. The intrathecal delivery method is generally only employed for people with multiple sclerosis or paralysis.
Oral baclofen doses are much larger. In the first few days 15 milligrams (mg) per day are given, and this amount may increase as needed up to 80 mg. Some patients respond positively on relatively low doses. As mentioned, for alcohol addiction, the higher 80 mg amount is sometimes required.
Since baclofen is processed in the kidneys, there is concern about giving this medication to patients with severe renal damage. The drug might still be so helpful that its use is considered. If it is prescribed for a patient with compromised kidneys, baclofen dosage is usually halved. Physicians may also need to give consideration to other medications a patient might take that could adversely react with this drug.
Medications like baclofen may have severe side effects like seizures, hallucinations, and irregular heart rhythms. Minor but uncomfortable adverse reactions include diarrhea or constipation, general tiredness and fatigue, or difficulty sleeping. These side effects are more likely to occur as the dose increases. Therefore, patient response is carefully monitored, and the goal is to find the lowest effective baclofen dosage. Sometimes, patients may require increased doses if they use the drug for longer periods.
Another consideration with baclofen dosage is that the drug does create some dependency. Just as the medication is carefully initiated, it must also be cautiously discontinued. Stopping baclofen abruptly may cause withdrawal symptoms.
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4,625,446,489,118,307,000 | Can I Have Silikon Injections to Add Volume Below the Nose Tip?
I had a bad rhinplasty which left me with many iregularaties, i have depressions just below the tip, can silikon 1000 be used to add violume in the columella region? My scar did not heal after open rhinoplasty and left a rough edge, can silikon 1000 be used to add volume here? Also how do surgeons prevent accidental over injection? Do you have special needles? Thanks
Doctor Answers 2
Silikon to Correct Nasal Shape
Silicone injections into the nose can be performed but I typically use a temporary filler first, to make sure the result is what the patient wants. If the patient is happy with the result and wants a permanent filler Silikon can be used in many instances. There are potential risks with permanent fillers that your physician will need to discuss with you however. Best of Luck Dr Harrell
Miami Plastic Surgeon
4.9 out of 5 stars 49 reviews
Silicone to Correct Nasal Tip Irregularities
Silicone can be used to correct irregularities you are describing. It is a great filler for the non-surgical rhinoplasty as it is precise and permanent. There are only a handful of board-certified physicians experienced in using silicone as a filler and make sure to consult with one of them. Your questions about preventing over-injection and needles can be answered during a consultation.
Channing R. Barnett, MD
New York Dermatologist
4.1 out of 5 stars 8 reviews
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship. | {
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3,244,837,933,871,602,700 | GoodArticles.ORG
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620,711,682,233,364,100 | Epstein-Barr Virus
From MicrobeWiki, the student-edited microbiology resource
Revision as of 22:40, 27 July 2015 by Jordan.S.Abney-1 (talk | contribs) (Other Diseases/Cancers)
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University of Oklahoma Study Abroad Microbiology in Arezzo, Italy[1]
Epstein-Barr budding in a B cell From: msdiscovery.org [2]
Etiology
Taxonomy
| Order = Herpesvirales | Family = Herpesviridae | Subfamily = Gammaherpesvirinae | Genus = Lymphocryptovirus | Species = Human Herpesvirus 4
NCBI: [3] Genome: [4]
Description
The Epstein-Barr virus (EBV) is one of the two human host-specific viruses in the subfamily Gammaherpesvirinae, along with Kaposi's Sarcoma, a virus normally associated with lesions in AIDS patients. It is the most common virus among the human population. More than 95% of the human population contain EBV antibodies, meaning that they have come into contact with the virus at some point in life and it is lying latent. Many people are asymptomatic when infected, but under certain stresses, diseases, such as mononucleosis, can arise. EBV was found to be the main virus responsible for Burkitt's Lymphoma in 1964, and later on was found to be correlative with Hodgkin's Lymphoma and nasopharyngeal carcinoma. EBV is not the sole cause of these cancers, but it does play an important role in their development. A defining marker of a virus is that it requires a host to replicate and survive, and when EBV was discovered, it was very difficult to grow on any medium.
Herpesviruses are characteristically icosahedral, 20-sided, and 70-100 microns in diameter, which led Epstein to characterize EBV with this family, however because he could not run standard tests of the other herpesviruses at the time, he concluded it must be a new strain [1].
Genome
EBV is a double-stranded DNA virus, making it more stable and less likely for mutations than RNA viruses. EBV is 184 kb pairs in length. The genome shows around 70 predictable open reading frames and there are two different strains. The strains differ in their latent proteins, but they are not associated with any specific disease. Analyzing repeat genes can be used in studying outbreaks [2]. The genome codes for latent and lytic proteins, and there are RNA transcription proteins whose functions are still unknown. It is an enveloped herpes virus, which means it can cause a life-long latent infection. EBV is very large for a herpesvirus and is surrounded by an outer layer comprised of cellular membranes from infected cells, adding an extra 50-100 nm to its size. The envelope is necessary for infectivity and sensitivity.
Pathogenesis
Transmission
Infectious Dose and Incubation
Epidemiology
Frequency
Diseases
Virulence Factors
Clinical Features
Clinical features can be hard to discern as most immunocompetent patients are asymptomatic [3]. In immunocompetent individuals, symptoms will mainly correspond to infectious mononucleosis (IM) in young adults, though these symptoms could also presuppose leukemia or lymphoma. In immunocompromised patients, EBV may exacerbate their autoimmunity; this results in high morbidity and mortality rates. Most symptoms in IM and other diseases caused by EBV are a direct result of cytotoxic T cells attacking the EBV in B cells.
Symptoms
Infectious Mononucleosis
The symptoms of IM can begin quickly and develop rapidly. The main, specific, symptoms to IM are sore throat and neck swelling, though there are non-specific symptoms such as vague discomfort, headaches, chills, and fever [2]. Spleen tenderness and rashes are some of the more commonly serious symptoms to suggest IM. EBV replicates in B cells and epithelial cells and the sore throat is usually caused by lysis of the oropharyngeal epithelial cells. The swollen neck is due to enlarged lymph nodes as the infected B cells replicate to normal cells. IM can be caused by a variety of pathogens, however EBV is the cause of over 90% of reported cases. Teenagers are at the highest risk of IM when exposed to EBV for the first time. Primary exposure of EBV in infants is usually accompanied by flu-like or no symptoms whatsoever. Chronic Fatigue Syndrome was once thought to be associated with EBV, but as of recent research, no correlation has ever been found [4]. IM caused by EBV has been shown to be a risk factor for those with Chronic Fatigue Syndrome, but EBV itself does not cause CFS.
Other Diseases/Cancers
EBV is an aggressor and stimulator of other, more serious and life-threatening, diseases and cancers. There is not always a direct correlation between EBV and these symptoms, but they can be worsened if EBV becomes lytic. Most of these ailments are found in the lymphatic system, as that is where the infected B cells reside.
• Burkitt's Lymphoma: EBV is found in nearly all endemic patients in Africa. Chronic malaria is thought to reduce resistance to EBV, allowing it to cause tumors, mostly around the jaw and facial bones. This is one of the first cases of viral infections being correlated to cancers [5].
• Hodgkin's Lymphoma: Being infected with IM increases your chance of contracting this cancer, but a precise correlation cannot be found. Symptoms include enlarged lymph nodes, spleen, and liver, as well as back pain and weight loss. This is a serious cancer that usually possesses a survival rate of 5 years, though treatments are always improving [6].
• Nasopharyngeal Carcinoma: There are a variety of factors that can be attributed to this cancer, and the main viral component is associated with EBV. As stated previously, this is the most common virus among the human population, so there are many reasons this virus could be found in many cancer patients. EBV may aggravate the cancer, but it has not been proven to be a direct cause. Studies have only shown that patients produce a higher level of antibodies towards EBV, and this can be used as a marker for NPC [7]. Once again, main symptoms include swollen lymph nodes, a soft palate, pain, and hearing loss.
• Autoimmune Complications:
• Hairy Leukoplakia-This is a white lesion that cannot be scraped off in the oral cavity. It is directly caused by EBV and is usually seen in HIV or otherwise immunocompromised patients [8].
• Multiple Sclerosis-Neurological functions are severely compromised, making everyday tasks challenging. It has been found that those infected with EBV during adolescence are more likely to develop MS than those exposed during childhood or not at all. Some hypothesize that MS could be a serious complication of IM, though there are some outlying patients that test negative for EBV. EBV has a mechanism that prevents infected B cells from being killed, and some of these errant cells could make it to the central nervous system, where antibodies could mistake the myelin sheath for EBV. Though much research still needs to be done to determine specific pathways that could link EBV to MS [9].
• Pretty much any disease that can cause swelling in the lymph nodes could be associated with EBV in some way. Symptoms are relatively similar across these various diseases, and because so much of the population is infected with EBV, correlations are prevalent, but suspicious.
Diagnosis
Treatment
Prevention
Host Immune Response
References
1. Cancer Virus: The Story of Epstein-Barr Virus
2. Principles and Practice of Clinical Virology
3. Routine Epstein-Barr Virus Diagnostics
4. CDC Chronic Fatigue Syndrome
5. Burkitt's Lymphoma, Malaria, and Epstein-Barr
6. Hodgkin's Disease and Epstein-Barr Virus
7. Relationship Between Epstein-Barr and Nasopharyngeal Carcinoma
8. Managing HIV/AIDS
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9,221,417,385,890,556,000 | The Largest Contribution Of Chiropractic Physician To Mankind.
A chiropractic practitioner can be extremely helpful to have. Chiropractic practitioners deal especially with problems connecting to the bone and joint framework of the body. Their primary purpose is to either ease pain or boost working by changing the spinal column and other components.
A chiropractic doctor can be very useful to an individual that has suffered a sports injury. For instance, if a golfer’s swing has actually been off kilter for time, he or she might want to attempt readjusting the joint where the golf club has struck in order to decrease the unexpected force that it gives off. Additionally, if a person has been utilizing a muscle or joint to help push him or her around a certain sphere, an adjustment to that joint can help in reducing the effect of the effect on the sphere. By adjusting the joint, the athlete or golfer will not really feel as much discomfort from the hit, but will certainly be able to carry out the activity at its finest for a far better result. The chiropractic specialist might likewise advise other modifications to the individual, such as those to the neck or back. chiropractor Kelowna BC best
Abrupt, serious, and unanticipated pain is typically the outcome of imbalance in the spinal column. As an example, if there is a problem with one vertebra and the pain emits down with the butts, it could show a trouble with the legs or hips. A chiropractic doctor can recognize troubles related to the legs or hips, make spinal adjustments, and give treatment. However, they can likewise deal with a patient using gentle methods, such as normal spinal modifications.
If the root cause of a problem involves the joints and also the muscles, then the chiropractic physician can deal with the whole body, consisting of the face and also head. This is called a complete body approach. This type of therapy is extra reliable than simply concentrating on the spine. Although the chiropractic physician will certainly concentrate on these specific areas, various other areas of the body can be impacted by misalignment also.
Chiropractic care is based on the understanding that the nerves regulates most of the features of the body, which consists of the musculoskeletal system. Actually, neuromusculoskeletal problems commonly involve the spine, which is regulated by the mind and also worked with by the muscle mass. As people age, the spine becomes much less steady, as well as the results can be a loss of muscular tissue strength, reduced range of motion, pins and needles in the hands and feet, and neck pain. Neuromusculoskeletal disorders can impact the whole body, not simply the spine. Therefore, chiropractic care therapies may be used to deal with issues in various other parts of the body also.
Chiropractic treatment has several advantages, yet among the most important is the prevention of severe injury from spine manipulation. Most individuals consider chiropractic treatment when there is a nerve injury or an imbalance of the spine, but all people must seek normal chiropractic care even if they do not have signs of a specific illness. Back adjustment can be performed to aid maintain the proper positioning of the spinal column, which can reduce the threat of injury and discomfort. Individuals may likewise discover that chiropractic doctor help them manage their position, given that correct posture can protect against the development of health problems. Chiropractic care can offer alleviation for lots of common conditions, consisting of aching joints, stance troubles, back pain, migraines, migraines, and extra. chiropractic top rated
Chiropractic doctors focus on dealing with various problems related to the skeletal system of the body. Their main goal is to ease discomfort and improve feature. They do refrain from doing surgical procedure or prescribe medications. Rather, they manipulate or readjust the back and other inner parts of the body to obtain them right into the appropriate position, or ideal placement. It is their suggestion that you look for treatment with a chiropractic physician, for a number of factors.
One of the ways chiropractics physician make use of spine control is by straightening the joints. These consist of the neck and back. By straightening the bones around your spinal joints, it offers the muscular tissues, ligaments as well as tendons an opportunity to loosen up, as well as lower rigidity. The chiropractic physician can also straighten your scapula, the leading part of your bone on each side. This will certainly help in reducing or eliminate troubles with your shoulders, back, and also neck.
Another reason you could look for therapy from a chiropractic doctor is due to the fact that you are experiencing pain. A chiropractic doctor can assist determine which muscle mass teams are tight, weak or swollen, which ones you can exercise to boost flexibility and also strength, and which muscular tissues are constantly overworked. Via adjusting the spine, the chiropractor can likewise massage and also enhance soft cells such as the nerves, glands, lymph nodes, and also the joints. Some chiropractors will certainly also make use of massage treatment to target a certain pain or pain problem. Various other times, the chiropractic physician will merely carry out spine modifications to alleviate muscular tissue tension, release pain as well as advertise raised wheelchair.
Chiropractic programs might likewise include making use of therapeutic devices, like whirlpool baths, heating units, stretching devices and also weights. In some cases, your chiropractic doctor might suggest that you take part in physical treatment or a gym program. In this case, the program may entail gentle stretching workouts to raise versatility, variety of activity, stamina, as well as endurance. The chiropractic program may additionally involve an intense, single experience, in which the chiropractic physician manipulates details joints or the back at really high speeds.
When you initially meet with your chiropractic doctor, he will ask a series of inquiries about your medical history. He will need to know concerning any kind of injuries, diseases, surgeries, drug, or conditions that might have been affecting your health. Your chiropractic specialist will likely begin with fundamental x-rays or other diagnostic examinations to make sure that your spinal column is healthy and balanced as well as your discomfort is not caused by something that could be easily determined and dealt with. If you do not feel well, your chiropractic practitioner will assist you identify if there is a hidden cause for your pain. In some cases, if the trouble can not be appropriately determined, a doctor will certainly need to make a medical diagnosis or treatment on his very own. chiropractic top rated
Chronic headaches may consist of the problem of reduced pain in the back, however they can likewise entail problems with the neck and also shoulders. Most of the problems that can be dealt with through chiropractic care back control are those that involve the soft cells, joints, muscles, and nerves. This type of care is an efficient means to ease pain. If you do obtain some pain from time to time, your chiropractor will be able to help you solve the underlying reason as well as reinforce your body so it can endure future spells of discomfort.
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831,054,721,591,871,700 | Mesenchymal Stem Cells Modified with a Single-Chain Antibody against EGFRvIII Successfully Inhibit the Growth of Human Xenograft Malignant GliomaReportar como inadecuado
Mesenchymal Stem Cells Modified with a Single-Chain Antibody against EGFRvIII Successfully Inhibit the Growth of Human Xenograft Malignant Glioma - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.
Background
Glioblastoma multiforme is the most lethal brain tumor with limited therapeutic options. Antigens expressed on the surface of malignant cells are potential targets for antibody-mediated gene-drug delivery.
Principal Findings
In this study, we investigated the ability of genetically modified human mesenchymal stem cells hMSCs expressing a single-chain antibody scFv on their surface against a tumor specific antigen, EGFRvIII, to enhance the therapy of EGFRvIII expressing glioma cells in vivo. The growth of U87-EGFRvIII was specifically delayed in co-culture with hMSC-scFvEGFRvIII. A significant down-regulation was observed in the expression of pAkt in EGFRvIII expressing glioma cells upon culture with hMSC-scFvEGFRvIII vs. controls as well as in EGFRvIII expressing glioma cells from brain tumors co-injected with hMSC-scFvEGFRvIII in vivo. hMSC expressing scFvEGFRvIII also demonstrated several fold enhanced retention in EGFRvIII expressing flank and intracranial glioma xenografts vs. control hMSCs. The growth of U87-EGFRvIII flank xenografts was inhibited by 50% in the presence of hMSC-scFvEGFRvIII p<0.05. Moreover, animals co-injected with U87-EGFRvIII and hMSC-scFvEGFRvIII intracranially showed significantly improved survival compared to animals injected with U87-EGFRvIII glioma cells alone or with control hMSCs. This survival was further improved when the same animals received an additional dosage of hMSC-scFvEGFRvIII two weeks after initial tumor implantation. Of note, EGFRvIII expressing brain tumors co-injected with hMSCs had a lower density of CD31 expressing blood vessels in comparison with control tumors, suggesting a possible role in tumor angiogenesis.
Conclusions-Significance
The results presented in this study illustrate that genetically modified MSCs may function as a novel therapeutic vehicle for malignant brain tumors.
Autor: Irina V. Balyasnikova, Sherise D. Ferguson, Sadhak Sengupta, Yu Han, Maciej S. Lesniak
Fuente: http://plos.srce.hr/
DESCARGAR PDF
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-100,767,934,517,183,860 | I have Rh-blood type, why is it dangerous for the fetus?
Most of us know common blood types including A, B, AB, O. In each blood type there is a plus-minus blood type system. Each person at birth has inherited genetics from parents, so there is one of the eight blood groups mentioned above and does not change throughout life.
1. I have Rh-blood type, why is it dangerous for the fetus?
The plus sign of each blood type in turns out that the person's bloth surface has rh antigen, fully written as Rh(D)+ in the first case or without rh antigen, written in full as Rh(D)- in the second case.
In Vietnam, up to 99.96% of people belong to Rh+ blood type (either O+ or B+ or A+ or AB+, according to the decreasing rate) but only 0.04%-0.07% of people belong to blood type Rh- (either O- or B- or A- or AB-). Blood type with a rate of less than 0.1% is a rare blood type and less than 0.01% is a very rare blood type. People with rh-rare blood type in our country belong to the community of people with rare blood groups, statistics show that in 10000 people only 4-7 people have Rh-blood type.
Belonging to a rare blood type causes one person to face a much higher risk than others for some of the following reasons:
• When urgent blood transfusions are required in cases of accidents, emergency surgery … this blood type is not always available for transmission in hospitals and medical facilities.
• In case you have Rh-blood type, you have Rh+ blood type, according to genetic rules, at least 50% of babies born will have Rh+ blood type like dad. At the first pregnancy, the rh+ blood type of rh+ like dad develops normally until birth if the process of pregnancy is not hurt. However, at the second pregnancy, if the child still has rh+ blood type, there will often be a blood type disagreement with the mother's blood type rh-. The mother's body makes antibodies that pass through each other against rh+ antigens in the blood type of the child causing red blood cells, also known as hem soluble. The consequences can cause miscarriage, still still life, premature birth, babies born with intellectual disability, hem soluble, frequent blood changes …
• For women with Rh- blood type during pregnancy with Rh+ blood type, there may be a blood transfusion accident at the first Rh+ blood transfusion.
What is Blood Type Rh-
This Blood Type Rh- is not always available for transmission in hospitals and medical facilities
It can be said more about the case of the person carrying the blood type Rh- that is, the body does not have antigens of the blood type Rh, so it is impossible to fight the antigen of the Rh group. The body may be hypersensitive to this blood type. The obvious specific manifestation in the pregnant mother who received a blood transfusion will give birth to antibodies against Rh+. From the second blood transfusion with the Rh+ group, in the human body there will be a reaction between antibodies and Rh antigens and cause hemoma.'
In a more understandable way, the mother has a blood type Rh- has never received a blood transfusion, during pregnancy, often has the same blood type as rh+, the red blood cells of the child carrying the blood type Rh+ penetrate into the mother's blood type, stimulating the mother's body to give birth to anti-Rh+ antibodies. During the 2nd pregnancy, this antibody can be transmitted into the fetus, against the baby's red blood cells, causing accidents such as fetal edema, hemoma in babies.
2. How to prevent danger to the fetus due to RH- blood type?
gourd
Need to know what blood type you carry, if you belong to rare blood groups, you need to be psychologically ready to prepare the worst case when you need a blood transfusion
The seriousness of the disagreement between the Rh+ and Rh- group obliges us to understand and take measures to prevent and minimize the risk of danger to the fetus during pregnancy. It is necessary to know what blood type you carry, if you belong to rare blood groups, you need to be psychologically ready to prepare the worst case when you need a blood transfusion. Especially for women with Rh blood type, pregnancy monitoring should be managed closely and properly. Pregnant mothers with Rh-blood type need anti-D prevention if the husband has RH+ blood type. Use of immunosymed antibodies D should be carried out under the advice of a doctor:
Monitoring fetal anemia and the effectiveness of anti-D immuno antibodies every 2 weeks for obstetrics and gynecology; negative anti-D immunos antibody values, periodically prevent it with anti-D.
The use of anti-D is as follows: During pregnancy: there are 2 uses and the same effect;
• Method 1: 2 doses of anti-D IgG 500 IU – 625 IU at the 28th and 34th weeks of pregnancy (If an anti-D injection is given at week 28, week 34 can always be injected with anti-D without re-testing the price of immunosed antibodies).
• Option 2: inject 1 single dose of anti-D IgG 1500 IU at the 28th week of pregnancy.
In addition, post-birth prevention is also required, anti-D IgG 500IU – 1500 IU injection within 72 hours after birth (if the child is bornwith a positive Rh(D) blood type).
By having rh blood type on the pregnant mother, it will minimize the risk of danger to the fetus, ensuring the safety and development of the fetus.
At Share99 International Health Hub, there is a full maternity service as a solution to help pregnant mothers feel secure because there is a team of doctors throughout the pregnancy. When choosing a full-service maternity, a pregnant woman can:
• The process of pregnancy is monitored by a team of specialists
• Regular examination, early detection of abnormalities
• Package maternity for the convenience of childbirth
• Babies receive comprehensive care.
For direct advice, please click hotline number or register online HERE. In addition, you can register for remote consultation HERE
SEE MORE:
• What do you know about the rarest blood types?
• How to categorise blood type
• What happens if there is a blood type disagreement between mother and child?
About: Minh Quynh
b1ffdb54307529964874ff53a5c5de33?s=90&d=identicon&r=gI am the author of Share99.net. I had been working in Vinmec International General Hospital for over 10 years. I dedicate my passion on every post in this site.
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AEC (Absolute Eosinophil Count) Test
Absolute eosinophil count is a blood test that analyses the number of a type of white blood cell called eosinophils. The eosinophils become very active when you have certain allergic diseases, infections, and other medical conditions.
Tests done
10,00,000+
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Rated 4.9/5
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on Google
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NABL
Accredited
What is AEC (Absolute Eosinophil Count) test?
An AEC (Absolute Eosinophil Count) is a blood test that measures the number of eosinophils in your body. Eosinophils are a type of disease-fighting white blood cells (WBCs) that become active in the case of an infection, allergic disease, or drug reaction.
Eosinophil levels beyond normal can be indicative of an autoimmune disease, seasonal allergies, asthma, and parasitic infections. An abnormally low eosinophil count may be the result of intoxication from alcohol or the excessive production of cortisol. Low values of eosinophils are generally not a concern.
What are the other names for the AEC (Absolute Eosinophil Count) test?
The other names are: AEC, Absolute Eosinophil Count.
What are the test parameters included in the AEC (Absolute Eosinophil Count) test?
There is only one parameter.
What does the AEC (Absolute Eosinophil Count) test measure?
Absolute Eosinophil Count test measures the number of eosinophils present in the blood. Eosinophils, a type of white blood cells, help in fighting diseases. These come into action because they are said to be linked with certain infections and allergic diseases. The eosinophils are produced and mature in the bone marrow. Usually, they take about 8 days to mature and then are moved into the bloodstream.
The eosinophils have varied functions like physiological roles in organ formation, such as the development of the post-gestational mammary gland; facilitating movement to the areas of inflammation, trapping substances, killing cells, and bactericidal and anti-parasitic activity. It also helps in the treatment of immediate allergic reactions and modulation of inflammatory responses.
What’s the normal range of AEC test?
0.02 - 0.50 thou/mm3. (20 - 500 cells/cumm)
Who should get an AEC (Absolute Eosinophil Count) test?
An Eosinophil count may help to diagnose a few conditions that might have a high count:
• To diagnose the acute hypereosinophilic syndrome.
• If you have an allergic disorder like asthma or hay fever.
• Autoimmune conditions
• An infection caused by a parasite or a fungus.
• A reaction to certain medications
• Usually, the early stages of Cushing’s disease, a very rare condition that can happen if you have too much of a hormone called cortisol in your blood
• Eczema (itchy, inflamed skin)
• Leukaemia and other blood disorders
Are any preparations needed for the AEC (Absolute Eosinophil Count) test?
No special preparation is required. Fasting is not required for this test.
What is the cost of an AEC test?
What is the type of sample required?
This test requires a blood sample.
Who processes an AEC (Absolute Eosinophil Count) test?
A healthcare provider, who is also called a phlebotomist, usually performs blood draws, including those for Absolute Eosinophil Count tests, but any healthcare provider trained in drawing blood can perform this task. The samples are sent to a lab where a medical laboratory scientist prepares the samples and performs the tests on analysers or manually.
What should I expect during my AEC (Absolute Eosinophil Count) test?
You may expect to experience the following during the blood test or a blood draw:
• You have to sit comfortably on the chair, and a healthcare provider will check your arms for an easily accessible vein. This is the inner part of your arm on the other side of your elbow.
• Once the phlebotomist has located a vein, they will disinfect the area with an alcohol swab.
• They will insert a needle into your vein to draw a blood sample. This might feel like a small pinch.
• After the needle is inserted, the required amount of blood will be collected in a test tube.
• When they have drawn enough blood for the test, they’ll remove the needle and hold a cotton ball or gauze on the pricked site to stop any bleeding.
• They will apply a band-aid over the pricked site, and the blood collection is finished.
This process takes less than five minutes.
What should I expect after my AEC (Absolute Eosinophil Count) test?
Once the phlebotomist has collected the blood sample, it will be sent to the laboratory for processing or testing. When the results are ready, your healthcare provider will share the results with you.
What are the risks of an AEC (Absolute Eosinophil Count) test?
These blood tests are common, and they don’t carry any significant risks. You might have a slight pain like an ant bite when the needle gets inserted, and a small bruise can develop there.
When can I expect my AEC (Absolute Eosinophil Count) test results?
These test reports are available via email or WhatsApp within 6 hours of the collection of the blood sample.
What do the results of an AEC (Absolute Eosinophil Count) test mean?
Interpreting test results
Normal
A normal blood sample will contain fewer than 500 eosinophil cells per microliter of blood in adults. Children may have varying values depending on their age.
Abnormal
If there are more than 500 eosinophil cells per microliter, then it means that you have a disease or disorder known as eosinophilia. It can be classified as mild (500-1500 per microliter), moderate (1500–5000 per microlitre), or severe if it is greater than 5000 per microliter.
This can also be due to:
• Autoimmune disease
• Parasitic worm infection
• Allergic reactions that are severe
• Asthma
• Eczema
• Ulcerative colitis
• Scarlet fever
• Leukaemia
• Crohn's Disease
• Lupus
A low eosinophil count could be due to intoxication due to alcohol and an elevated level in the production of cortisol, such as with Cushing's disease.
What are normal AEC (Absolute Eosinophil Count) test results?
This normal absolute eosinophil count is less than 500 cells per microliter (cells/mcL).
The normal value ranges might vary slightly among different laboratories. Talk to your healthcare provider about the meaning of your specific test results.
What other tests might I have along with this test?
Complete Haemogram, Total IGE
How do I book an AEC (Absolute Eosinophil Count) test at home?
Log on to www.orangehealth.in and submit your details. Our highly trained, professional, and vaccinated eMedics will be at your doorstep within 60 minutes or at the time booked by you.
Order now & get your sample collected in 60 minutes
Good reports coming in ...
Certainly recommend them strongly for quick and accurate testing. They are the best we’ve come across in Bangalore in the last 41 years !!
K Srinivasan
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Superb experience overall. Everything was very well managed right from booking to confirming slots, to pick up and report generation.
Mridul Mimansa
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Very professional, efficient, and high-tech. The reports came blazing fast.
Saurabh Guru
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-3,061,365,341,433,645,000 | Chondromalacia patellae
From Wikipedia, the free encyclopedia
Jump to: navigation, search
This article is about certain forms of inflammation under the patella. For other uses, see Runner's knee.
Chondromalacia patella
Classification and external resources
ICD-10 M22.4
ICD-9 717.7
DiseasesDB 2595
MedlinePlus 000452
Patient UK Chondromalacia patellae
MeSH D046789
Chondromalacia patellae (also known as CMP) is inflammation of the underside of the patella and softening of the cartilage. Chondromalacia patella is more accurately referred to as patellofemoral pain syndrome. The cartilage under the kneecap is a natural shock absorber, and overuse, injury, and many other factors can cause increased deterioration and break down of the cartilage. The cartilage is no longer smooth and therefore movement and use is painful.[1] While it often affects young individuals engaged in active sports it also afflicts older adults who overwork their knees.[2][3]
Description[edit]
While the term chondromalacia sometimes refers to abnormal-appearing cartilage anywhere in the body,[4] it most commonly denotes irritation of the underside of the kneecap (or "patella"). The patella's posterior surface is covered with a layer of smooth cartilage, which the base of the femur normally glides effortlessly against when the knee is bent. However, in some individuals the kneecap tends to rub against one side of the knee joint, irritating the cartilage and causing knee pain.[5]
The condition may result from acute injury to the patella or chronic friction between the patella and a groove in the femur through which it passes during knee flexion.[6] Possible causes include a tight iliotibial band, neuromas, bursitis, overuse, malalignment, core instability, and patellar maltracking.
Pain at the front or inner side of the knee is common in both young adults and those of more advanced years, especially when engaging in soccer, gymnastics, cycling, rowing, tennis, ballet, basketball, horseback riding, volleyball, running, combat sports, figure skating, snowboarding, skateboarding and even swimming. The pain is typically felt after prolonged sitting.[7] Skateboarders most commonly experience this injury in their non-dominant foot due to the constant kicking and twisting required of it.[citation needed] Swimmers acquire it doing the breaststroke, which demands an unusual motion of the knee. People who are involved in an active life style with high impact on the knees are at greatest risk. Proper management of physical activity may help prevent worsening of the condition. Athletes are advised to talk to a physician for further medical diagnosis as symptoms may be similar to more serious problems within the knee. Tests are not necessarily needed for diagnosis, but in some situations it may confirm diagnosis or rule out other causes for pain. Commonly used tests are blood tests, MRI scans, and arthroscopy.[8]
Treatment[edit]
In the absence of cartilage damage, pain at the front of the knee due to overuse can be managed with a combination of RICE (rest, ice, compression, elevation), anti-inflammatory medications, and physiotherapy.[9]
Usually chondromalacia develops without swelling or bruising. While treatment remains controversial,[citation needed] most individuals benefit from rest and adherence to an appropriate physical therapy program. Allowing inflammation to subside while avoiding irritating activities for several weeks is followed by a gradual resumption. Cross-training activities such as swimming[citation needed] can help to maintain general fitness until a physical therapy program emphasizing strengthening and flexibility of the hip and thigh muscles can be undertaken. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the swelling amplifying patellar pain. Treatment with surgery is declining in popularity due to positive non-surgical outcomes and the relative ineffectiveness of surgical intervention.[5]
See also[edit]
References[edit]
1. ^ "Chondromalicia patella". Mayo Clinic. Mayo Foundation for Medial Education and Research (MFMER). Retrieved 9 December 2013.
2. ^ Grelsamer, Ronald P (2005). "Patellar Nomenclature". Clinical Orthopaedics and Related Research (436): 60–5. doi:10.1097/01.blo.0000171545.38095.3e. PMID 15995421.
3. ^ "Isolated patellofemoral arthritis often overlooked". Academy News. The American Academy of Orthopaedic Surgeons. February 6, 1999.
4. ^ Schindler, Oliver S. (2004). "Synovial plicae of the knee". Current Orthopaedics 18 (3): 210–9. doi:10.1016/j.cuor.2004.03.005.
5. ^ a b Cluett, Jonathan (June 14, 2011). "Chondromalacia". About.com.
6. ^ Shiel, William C.; Cunha, John P. (June 27, 2012). "Chondromalacia Patella". MedicineNet. Retrieved May 19, 2013.
7. ^ Gauresh. "Knee Cap Pain". [unreliable medical source?]
8. ^ "Chondromalacia patellae". Health Information Patient.co.uk. Egton Medical Information Systems Ltd. Retrieved 9 December 2013.
9. ^ Jenkins, Mark A.; Caryn Honig (2005-06-02). "Patello-Femoral Syndrome". Retrieved 2008-10-06. [unreliable medical source?]
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6,535,044,566,248,046,000 | August
12
19:18
Children // Childhood diseases
Asphyxia
Asphyxia
Such a widespread phenomenon as asphyxia occurs in mild or severe in 70% of children who had just been born.The phenomenon of asphyxiation is very dangerous and a lack of child's spontaneous breathing, when the rest of the baby shows signs of life.
inability of the child to breathe leads to the development of oxygen starvation and the accumulation of excessive amounts of carbon dioxide into the child's body, which, in turn, is fraught with problems in the activities of children's central nervous system and respiratory system and blood circulation.
What is asphyxia in newborns?About
primary asphyxia say when it accompanies the birth of a child, secondary asphyxia can occur in infants during the first days after his birth.If mild asphyxia there is a particular danger to the baby's health, the severe form can lead to death.
Primary apnea is also called intrauterine and secondary - acquired, iearose after the appearance of a baby into the world.The most common secondary apnea is common among prematur
e infants, due to the lack of development of the respiratory system.
Article topic: fetal hypoxia
When a child experiences a mild asphyxia, it is expressed in a weakened breathing.A child makes his first breath of life, is not enough air, he gains his lungs, his muscle tone is weakened, in the nasolabial triangle can be seen bluish skin color.
asphyxia in high form newborn making first breath, starts breathing irregularly publishes a weak cry.Often children with asphyxia average form marked tachycardia and barikardiya reflexes weakened limbs and face covered by blue.
When the newborn is suffering from severe asphyxia, his breathing is very uneven, the child makes a moaning cry instead, pulse weak and slow, the skin has a pale color, mucous cyanotic, no reflexes. The heaviest option asphyxia - a clinical death, when it is taken for resuscitation to prevent the death of the baby.
What can cause asphyxia?
Primary apnea can be caused in the cases:
• intracranial injury, which occurred in the course of delivery;
• abnormalities in the child's development-related breathing problems;
• immunological incompatibility between mother and child;
• filling respiratory tract of the newborn amniotic fluid or mucus.
incorrectly occurring childbirth can cause primary asphyxia due to a series of anomalies of patrimonial activity, narrow pelvis mother, improper insertion of the head of the child, etc.
asphyxia often develop in newborns whose mothers were found extragenital disease, a severe form of iron deficiency anemia, late toxicosis, diabetes and cardiovascular diseases.This pathological condition often occurs in children born to women with a diagnosis of intrauterine hypoxia in acute or chronic forms.
Secondary asphyxia usually cause congenital abnormalities in the baby's health, including the main ones are: congenital pneumonia, a number of diseases of the central nervous system of the child, circulation problems in the newborn brain.
What are the consequences of asphyxia newborns?
Child Health asphyxiated, is under threat following complications:
• development of seizures;
• diencephalic deviation;
• hypo- and hyperexcitability;
• development hydrocephalic syndrome.
These effects usually develop when severe asphyxia.Timely and prompt action to treat it can prevent the threat to the health of the baby.The sooner taken intensive care to a child in a state of asphyxia, the lower the risk of developing complications.
What measures asphyxia in a newborn?
If a child is born with the signs of asphyxia, immediately pump out mucus or amniotic fluid from his airways, to eliminate any obstacles to the full mechanical breathing baby.
After the adoption of measures resuscitation character requires careful monitoring of the baby of life by tracking all of his vital parameters.Child retreaded after asphyxia breathing placed in the intensive care unit, where he must undergo special treatment in order to prevent it from swelling of the brain and to establish the normal functioning of the body.
To prevent the risk of asphyxiation of the child, his future mother should be checked regularly during pregnancy for the development of pathologies.In the process of childbirth can not prevent fetal hypoxia for a long time.
important that the child was asphyxiated after competent medical support with good oxygen therapy.Once a child with his mother to leave the walls of the hospital, the baby should be shown regularly pediatrician and neurologist in order to prevent the development of disease in the activities of children's central nervous system. | {
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521,260,653,734,428,740 | How to Manage Depression Triggers
4 months ago 32
Stress tin instrumentality a toll connected anyone. But if you person depression, you mightiness not bounce backmost from accent easily. The decease of a loved one, a occupation loss, oregon a divorcement could trigger symptoms specified arsenic guilt and hopelessness. But determination are steps you tin instrumentality to get better.
“You request to spot that you’re astir to spell down the rabbit hole, and instrumentality a measurement back,” says Jeannie Lochhead, MD, an adjunct objective prof of psychiatry astatine the University of California, Riverside School of Medicine. “Meditation, mindfulness, bully sleep, avoiding alcohol, spending clip with radical who really attraction astir you -- that’s what builds resilience. It’s not push, push, push. Try harder.”
You tin negociate your depression, nary substance what causes it. Here are immoderate communal triggers and adept tips connected however to instrumentality enactment to trim their interaction connected you.
Job Loss
You mightiness person a batch tied up successful your work. For starters, a occupation nonaccomplishment tin instrumentality you distant from an full web of people. “That unsocial causes societal isolation, which tin cause depression,” Lochhead says.
Advice: Try to summation immoderate power of the situation, says Tim Pearman, PhD, a prof of aesculapian societal sciences and psychiatry and behavioral sciences astatine Northwestern University Feinberg School of Medicine.
Pearman suggests you update your resume but enactment flexible. “There whitethorn beryllium a full clump of occupation opportunities disposable to you that you mightiness not adjacent deliberation astir extracurricular of your field,” helium says. “Maybe it’s clip to interruption the mold of however you self-identify successful presumption of your vocation way and see different options.” Casting a wider nett successful your occupation hunt whitethorn assistance you consciousness much successful power and little hamstrung by the caller occupation loss.
Rejection
No 1 likes to consciousness unwanted. But rejection, whether from a imaginable employer, a friend, oregon a important other, tin spark depression successful immoderate people. That includes those with rejection sensitivity dysphoria (RSD).
Advice: Use a method called benefit-finding. “The thought is fundamentally uncovering metallic linings,” says Kate Sweeny, PhD, a prof of science astatine the University of California, Riverside.
Sweeny studies strategies that assistance radical get done stressful oregon uncertain times. She says radical thin to consciousness little depressed erstwhile they deliberation astir affirmative things that mightiness travel retired of atrocious news, specified arsenic the nonaccomplishment of a occupation oregon relationship.
Marriage Problems oregon Divorce
The extremity of a narration is hard, whether you unrecorded with slump oregon not. That’s existent whether you’re the 1 who decides to permission oregon not. “It’s going to beryllium a bumpy ride,” Lochhead says. “People request to expect that. Even if they’re the ones who determine they privation the divorce.”
Advice: It’s important to program for your aboriginal and consciousness hopeful astir it. To bash that, Lochhead suggests you look to the things successful your beingness that fulfill you most. And don’t propulsion distant from your loved ones. “Avoiding societal isolation is truly important aft divorce,” she says.
A marriage and household counsellor tin beryllium a large help. Pearman says a couple’s therapist tin assistance you determine to enactment unneurotic oregon “make the splitting-up process arsenic non-traumatic arsenic possible.”
Family Troubles
All families person their ups and downs. But you don’t person to propulsion done and hole your problems connected your own.
Advice: As a parent, you person tons of outlets. Pearman says to scope retired to a household counselor, adjacent group, oregon friends and family. The aforesaid is existent for children and teens. “Kids who bash the best, successful presumption of their affectional health, are the ones who person a truly beardown societal network.”
Pearman suggests you caput disconnected household problems astatine the pass. Check successful with your kids each week. Ask them astir school, friends, and their likes and dislikes. “It tin beryllium successful the discourse of thing fun, similar going retired for ice cream oregon taking a walk,” helium says. “But if your kid knows you’re going to person that time, it tin truly unfastened the doorway for them to beryllium a small much communicative.”
Loss of a Loved One
It’s mean to consciousness bittersweet aft you suffer idiosyncratic adjacent to you. But slump and grief aren’t the aforesaid thing. “Active grief tends to beryllium a small spot much dramatic. It’s crying spells and not being capable to absorption connected thing due to the fact that you’re truthful torn isolated by it,” Pearman says. “With depression, a batch of what radical acquisition is simply a consciousness of numbness.”
Advice: Pay attraction to your symptoms. If you can’t absorption connected your enactment oregon get retired of bed, oregon you’ve been depressed for much than a fewer months, “at that point, it’s astir apt clip to question nonrecreational help,” Pearman says.
You tin question grief counseling earlier oregon aft your loss. A counsellor tin assistance you enactment done beardown emotions. Also, springiness yourself a interruption if you deliberation you’re “not grieving right.” Don’t bushed yourself up for grieving for excessively agelong oregon feeling excessively bittersweet oregon not bittersweet enough. “It’s not a linear process,” helium says.
The day of a nonaccomplishment tin besides beryllium tough. It tin assistance if you program thing for that day. “That tin beryllium arsenic elemental arsenic having a infinitesimal to bespeak connected what that idiosyncratic meant successful your life,” Pearman says. “Or it tin beryllium arsenic large a happening arsenic getting household oregon friends unneurotic to speech astir that person.”
Empty Nest
It’s mean to consciousness uncertain and lonely erstwhile your kids permission home. It’s a large change.
Advice: Lochhead astir ever suggests mindfulness meditation for soon-to-be bare nesters. It’s OK to beryllium upset for a small while. But, she says, you request to absorption much connected “accepting the alteration that’s astir to hap and letting the thoughts go.”
Pearman thinks it’s a bully thought to unpaid oregon instrumentality a people to larn thing new. This tin assistance capable that newfound clip and abstraction with thing that brings you joy.
Retirement
Your regular daily changes a batch erstwhile you don’t spell to enactment each day. That tin rise your hazard for slump triggers specified arsenic societal isolation, atrocious sleep habits, and deficiency of physical activity.
Without a job, your days tin consciousness arsenic if they suffer their structure. This tin unfastened your clip up to each kinds of atrocious habits if you’re prone to them. For example, Lochhead says, “You’re much apt to portion alcohol. If you usually portion lone connected the weekends, present you tin portion Monday, Tuesday, oregon Wednesday.”
Advice: Try to fig retired what it is astir retirement that mightiness trigger depression. Then larn however to negociate those cues. Lochhead says it’s each astir planning. For example, bash you consciousness debased without a regular and a afloat societal calendar? If so, make your ain docket and meetups with friends.
As with bare nest syndrome, Pearman suggests you unpaid oregon instrumentality a class. But helium says it’s besides the cleanable clip to get active. “Try a clump of antithetic things,” helium says. “And if 1 benignant of exercise doesn’t talk to you, effort thing else.”
Long-Term oregon Caregiver Stress
Depression tin sometimes beryllium a grounds of an ongoing illness. It’s casual to get mentally oregon physically overwhelmed if you’re sick oregon attraction for a loved 1 who’s ill.
Advice: You mightiness get the connection that you request to enactment positive. But it’s earthy to consciousness atrocious erstwhile atrocious things happen, Pearman says. “Let yourself consciousness that.”
But much importantly, helium says, is that you inquire for help. Be specific. Maybe you request meals a mates of times a week. Or possibly you privation idiosyncratic to enactment with your loved 1 portion you spell to the gym. Don’t interest astir being a burden. Friends and household usually privation to help. Pearman says it tin really “be a gift” if you archer them precisely what you need.
Holiday Stress
The holidays tin beryllium a clip for solemnisation with friends and family. But each that enactment tin beryllium hard to handle. The holidays often trigger slump for people. The stress of the holidays tin pb to anxiety, too. “If you person social anxiety, going to a vacation enactment whitethorn really beryllium incredibly stress-inducing,” Lochhead says.
Advice: It’s steadfast to bounds the clip you walk with definite people. That includes household members, friends, oregon co-workers. And don’t consciousness atrocious astir it. “Realize your ain request for abstraction and [figure out] however you tin get that,” Pearman says.
But if you bash commencement to announcement unhealthy thoughts oregon behaviors, “that’s wherever mindfulness and meditation tin beryllium precise helpful,” Lochhead says.
The holidays tin besides propulsion you disconnected your different steadfast routine. Keep an oculus connected your vacation slumber habits, eating patterns, carnal activity, and intoxicant intake. “All of those things interaction slump relapses,” she says.
Winter Blues
Many radical person caller oregon worse slump erstwhile the seasons change. That’s called seasonal affective disorder (SAD).
Advice: Talk to your doctor. They mightiness suggest airy exposure, talk therapy, oregon antidepressants. Physical enactment tin besides help. “Exercise is the fig 1 astir important strategy,” Pearman says. “It truly tin crook things around.”
Write down your feelings arsenic they happen. You mightiness spot that you’re much depressed successful the greeting oregon arsenic the time goes on. “It’s truly important to announcement those patterns, due to the fact that then, you tin really program for erstwhile you request to get things done,” helium says.
Hormonal Changes
Certain hormonal shifts tin impact your mood. For women, that includes earlier the commencement of your play and during oregon aft pregnancy oregon menopause. “It tin beryllium overwhelming to consciousness similar your emotions aren’t successful your control,” Lochhead says
Advice: No substance the cause, hormonal changes tin bring superior symptoms that impact your regular life. Lochhead suggests you inquire your doc astir medication oregon different treatments that tin assistance you consciousness better.
If you get premenstrual dysphoric disorder (PMDD), program for your symptoms. “Set an alarm 4 days earlier your rhythm that says, ‘Hey, warning, for the adjacent 4 days, you’re going to consciousness things overmuch much intensely,’” Lochhead says.
Substance Use
People with slump are much apt to usage drugs and alcohol. On the flip side, a substance usage upset (SUD) tin worsen your debased temper and different symptoms. This is what Pearman calls a “circular relationship.”
Advice: Keep way of your substance use. “People who regularly overuse alcohol, oregon who’ve had immoderate problems with addiction successful the past, should marque definite to support a grounds of their drinking to guarantee that it is staying wrong the limits they acceptable and not expanding implicit time,” Pearman says.
Seek nonrecreational assistance if you can’t power your cause oregon intoxicant use. Pearman suggests a certified intoxicant cause counsellor (CADC). They’ll assistance you negociate your slump and your substance use.
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-7,612,330,330,655,014,000 | Mastoidectomy and its Importance in Ear Infection Treatment
Mastoidectomy
Importance of Mastoidectomy in Ear Infection Treatment
Mastoidectomy is a surgical procedure that is commonly performed to treat chronic ear infections, specifically those that involve the mastoid bone located behind the ear. The mastoid bone is a part of the temporal bone, which is situated on the side of the skull and contains the middle and inner ear structures. When chronic ear infections persist and are not effectively treated with antibiotics or other conservative measures, mastoidectomy may be necessary to stop the infection in its tracks and prevent further complications.
Mastoidectomy: When is it Needed?
Mastoidectomy is typically indicated in cases of chronic otitis media, which is a middle ear infection that persists or recurs despite medical treatment. Chronic otitis media can cause inflammation and infection in the mastoid air cells, which are small, air-filled spaces within the mastoid bone. If left untreated, the infection can spread to nearby structures including the brain, leading to serious complications such as mastoiditis, abscess formation, or damage to the facial nerve or inner ear.
The Mastoidectomy Procedure: What to Expect after this ENT Surgery
The mastoidectomy procedure is typically performed by an ear, nose, and throat (ENT) specialist, also known as an otolaryngologist. The surgery is usually done under general anaesthesia, and the surgeon makes an incision behind the ear to access the mastoid bone. The infected mastoid air cells are then carefully removed, and any infected or damaged tissue is cleaned out. In some cases, the surgeon may also need to repair or reconstruct any damaged structures, such as the eardrum or middle ear bones. In some approaches the surgeon may incise from the front of the ear also- Endaural approach.
Mastoidectomy: Different Approaches for Different Cases
There are several different types of mastoidectomy, and the choice of approach depends on the severity and location of the infection, as well as the patient’s individual needs. Some common types of mastoidectomy include:
Simple Mastoidectomy: This is the most basic type of mastoidectomy, and involves removal of the infected mastoid air cells while leaving the middle ear structures intact.
Modified Radical Mastoidectomy: This involves removal of the infected mastoid air cells, as well as the middle ear structures (such as the eardrum and middle ear bones) if they are also infected or damaged.
Radical Mastoidectomy: This is the most extensive type of mastoidectomy, and involves removal of the entire mastoid bone, as well as the middle and inner ear structures. This type of mastoidectomy is rarely performed and is reserved for severe cases of infection or when other treatment options have failed or for ear malignancies.
Mastoidectomy – Recovery and Risks: What to Expect After the Mastoidectomy Surgery?
After mastoidectomy, patients may experience some pain, swelling, and drainage from the surgical site, which are typically managed with pain medications and antibiotics. The recovery period can vary depending on the extent of the surgery and the patient’s overall health, but most patients can expect to return to their normal activities within a few days.. It’s important to follow all post-operative instructions provided by the surgeon to ensure proper healing and minimize the risk of complications.
As with any surgical procedure, there are risks associated with mastoidectomy, including infection, bleeding, damage to nearby structures (such as the facial nerve or inner ear), and changes in hearing or balance. However, these risks are generally low and most patients experience successful outcomes with improved ear health and resolution of chronic ear infections.
Conclusion: The Importance of Mastoidectomy in Treating Chronic Ear Infections
Mastoidectomy is a valuable surgical procedure that plays a crucial role in the treatment of chronic ear disease, specially Unsafe CSOM, or the so called Atticoantral disease. | {
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8,909,712,736,518,987,000 | cord blood insurance | public cord blood banking toronto
However, the American Academy of Pediatrics strongly encourages umbilical cord donations for general research purposes. Donors are encouraged to contact a cord blood bank by the 35th week of pregnancy.
Unlike other banks, CBR uses a seamless cryobag for storage. The seamless construction decreases the potential for breakage that can occur in traditional, seamed-plastic storage bags. Prior to storage, each cryobag is placed in a second overwrap layer of plastic, which is hermetically sealed as an extra precaution against possible cross contamination by current and yet unidentified pathogens that may be discovered in the future. CBR stores the stem cells in vaults, called dewars, specially designed for long-term cryostorage. The cord blood units are suspended above a pool of liquid nitrogen that creates a vapor-phase environment kept at minus 196 degrees Celsius. This keeps the units as cold as liquid nitrogen without immersing them in liquid, which can enable cross-contamination. Cryopreserved cord blood stem cells have proven viable after more than 20 years of storage, and research suggests they should remain viable indefinitely.
Donating cord blood to a public bank adds to the supply and can potentially help others. Donating to a public bank is especially important for ethnic minorities, who are not well represented in cord blood banks. Public cord blood donation increases the chance of all groups finding a match.
Chemotherapy and radiation therapy generally affect cells that divide rapidly. They are used to treat cancer because cancer cells divide more often than most healthy cells. However, because bone marrow cells also divide frequently, high-dose treatments can severely damage or destroy the patient’s bone marrow. Without healthy bone marrow, the patient is no longer able to make the blood cells needed to carry oxygen, fight infection, and prevent bleeding. BMT and PBSCT replace stem cells destroyed by treatment. The healthy, transplanted stem cells can restore the bone marrow’s ability to produce the blood cells the patient needs.
The immune system has a way to identify foreign cells; it’s what allows the body to defend itself. So although transplants were proving successful after the first in 1956, they were limited to twins because their shared genetic makeup made them 100 percent compatible. This took a turn in 1958, when scientists discovered a protein present on the surface of almost all cells that lets the body know if the cell is one of its own cells or a foreign cell. In 1973, we finally learned enough about these compatibility markers (called human leukocyte antigens or HLAs) to perform the first unrelated bone marrow transplant.
First isolated in 1998, there is a lot of controversy around acquiring embryonic stem cells. Thankfully, we can also acquire the stem cells that form just a little bit later down the road, like in the umbillical cord tissue. These stem cells, known as adult stem cells, stay with us for life. (Later, we will learn why not all adult stem cells are equal.) Adult stem cells are more limited in the types of cells they can become, something known as being tissue-specific, but share many of the same qualities. Hematopoietic stem cells (Greek “to make blood” and pronounced he-mah-toe-po-ee-tic) found in the umbilical cord’s blood, for instance, can become any of the different types of blood cells found in the body and are the foundation of our immune system. Another example is mesenchymal (meh-sen-ki-mal) stem cells, which can be found in the umbilical cord tissue and can become a host of cells including those found in your nervous system, sensory organs, circulatory tissues, skin, bone, cartilage, and more.
Much research is focused on trying to increase the number of HSCs that can be obtained from one cord blood sample by growing and multiplying the cells in the laboratory. This is known as “ex vivo expansion”. Several preliminary clinical trials using this technique are underway. The results so far are mixed: some results suggest that ex vivo expansion reduces the time taken for new blood cells to appear in the body after transplantation; however, adult patients still appear to need blood from two umbilical cords. More research is needed to understand whether there is a real benefit for patients, and this approach has yet to be approved for routine clinical use.
There are over 130 public cord blood banks in 35 countries. They are regulated by Governments and adhere to internationally agreed standards regarding safety, sample quality and ethical issues. In the UK, several NHS facilities within the National Blood Service harvest and store altruistically donated umbilical cord blood. Trained staff, working separately from those providing care to the mother and newborn child, collect the cord blood. The mother may consent to donate the blood for research and/or clinical use and the cord blood bank will make the blood available for use as appropriate.
After a baby is born, the umbilical cord and placenta are no longer needed and are usually thrown away. However, the blood left in the umbilical cord and placenta contains blood-forming cells. (These cells are not embryonic stem cells.) By collecting and freezing this blood, the healthy blood-forming cells can be stored and may later be used by a patient who needs them.
Pro: It gives you that peace of mind that if anything did happen to your child, the doctors would have access to their blood. This could potentially be a great benefit, and you would have no idea what would have happened if it weren’t for this blood.
The second question concerns “storing” the newborn’s cord blood for the child’s future use or a family member’s future use. The American Academy of Pediatrics has issued a policy statement saying that, “Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use.” They state: “No accurate estimates exist of the likelihood of children to need their own stored cord blood stem cells in the future. The range of available estimates is from 1 in 1000 to more than 1 in 200000.51 The potential for children needing their own cord blood stem cells for future autologous use is controversial presently.” Read the complete statement here.
The main reason for this requirement is to give the cord blood bank enough time to complete the enrollment process. For the safety of any person who might receive the cord blood donation, the mother must pass a health history screening. And for ethical reasons, the mother must give informed consent.
Though uses of cord blood beyond blood and immunological disorders is speculative, some research has been done in other areas.[17] Any such potential beyond blood and immunological uses is limited by the fact that cord cells are hematopoietic stem cells (which can differentiate only into blood cells), and not pluripotent stem cells (such as embryonic stem cells, which can differentiate into any type of tissue). Cord blood has been studied as a treatment for diabetes.[18] However, apart from blood disorders, the use of cord blood for other diseases is not in routine clinical use and remains a major challenge for the stem cell community.[17][18]
A stem cell has the potential to become one of many different types of cells. Stem cells are unique cells: They have the ability to become many different types of cells, and they can replicate rapidly. Stem cells play a huge part in the body’s healing process, and the introduction of new stem cells has always showed great promise in the treatment of many conditions. It wasn’t until we found out where and how to isolate these cells that we started using them for transplants. Although a person’s own stem cells are always 100 percent compatible, there are risks in using someone else’s stem cells, especially if the donor and recipient are not immediately related. The discovery of certain markers allows us to see how compatible a donor’s and host’s cells will be. The relatively recent discovery of stem cells in the umbilical cord’s blood has proven advantageous over acquiring stem cells from other sources. Researchers are currently conducting clinical trials with stem cells, adding to the growing list of 80 diseases which they can treat.
For the 12- and 24-month payment plans, down payment is due at enrollment. In-house financing cannot be combined with other offers or discounts. *Please add $50 to the down payment for medical courier service if you’re located in Alaska, Hawai’i or Puerto Rico. **Actual monthly payment will be slightly lower than what is being shown. For the length of the term, the annual storage fee is included in the monthly payment. Upon the child’s birthday that ends the term and every birthday after that, an annual storage fee will be due. These fees are currently $150 for cord blood and $150 for cord tissue and are subject to change.
The first cord blood banks were private cord blood banks. In fact, Cryo-Cell is the world’s first private cord blood bank. It wasn’t until later that the government realized the need to preserve cord blood for research and public welfare. As a result, 31 states have adopted a law or have a piece of pending legislation that requires or encourages OBGYNs to educate expectant parents about cord blood banking and many states now have publicly held cord blood banks. As a result, parents have the option of banking their baby’s cord blood privately for the exclusive use of the child and the rest of the family or donating the cord blood to a public bank so that it can be used in research or by any patient who is a match and in need.
In March 2004, the European Union Group on Ethics (EGE) has issued Opinion No.19[16] titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that “[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms.”[16]
Cord blood banks may be public or commercial. Public cord blood banks accept donations of cord blood and may provide the donated stem cells to another matched individual in their network. In contrast, commercial cord blood banks will store the cord blood for the family, in case it is needed later for the child or another family member.
Umbilical cord blood was once discarded as waste material but is now known to be a useful source of blood stem cells. Cord blood has been used to treat children with certain blood diseases since 1989 and research on using it to treat adults is making progress. So what are the current challenges for cord blood research and how may it be used – now and in the future?
^ a b Walther, Mary Margaret (2009). “Chapter 39. Cord Blood Hematopoietic Cell Transplantation”. In Appelbaum, Frederick R.; Forman, Stephen J.; Negrin, Robert S.; Blume, Karl G. Thomas’ hematopoietic cell transplantation stem cell transplantation (4th ed.). Oxford: Wiley-Blackwell. ISBN 9781444303537.
There are some diseases on the list (like neuroblastoma cancer) where a child could use his or her own cord blood. However, most of the diseases on the proven treatment list are inherited genetic diseases. Typically, a child with a genetic disease would require a cord blood unit from a sibling or an unrelated donor.
http://marketerslog.com/news/cord-blood-banking-stem-cell-research-pros-amp-cons-review-launched/0084102/
http://www.wmcactionnews5.com/story/38663417/cord-blood-banking-stem-cell-research-pros-cons-review-launched
http://www.hawaiinewsnow.com/story/38663417/cord-blood-banking-stem-cell-research-pros-cons-review-launched
http://www.wandtv.com/story/38663417/cord-blood-banking-stem-cell-research-pros-cons-review-launched
http://www.nbc12.com/story/38663417/cord-blood-banking-stem-cell-research-pros-cons-review-launched
https://www.youtube.com/channel/UCspc5xs7rmywaELYKBqCOAg
Phone 1-888-932-6568 to connect with a CBR Cord Blood Education Specialist or submit an online request. International callers should phone 650-635-1420 to connect with a CBR Cord Blood Education Specialist.
Just like other blood donations, there is no cost to the donor of cord blood. If you do not choose to store your baby’s blood, please consider donating it. Your donation could make a difference in someone else’s life.
BMT and PBSCT are most commonly used in the treatment of leukemia and lymphoma. They are most effective when the leukemia or lymphoma is in remission (the signs and symptoms of cancer have disappeared). BMT and PBSCT are also used to treat other cancers such as neuroblastoma (cancer that arises in immature nerve cells and affects mostly infants and children) and multiple myeloma. Researchers are evaluating BMT and PBSCT in clinical trials (research studies) for the treatment of various types of cancer.
The other way the body creates more cells is through its stem cells, and stem cells do things a little differently. They undergo what is called asymmetric division, forming not one but two daughter cells: one cell often an exact replica of itself, a new stem cell with a relatively clean slate, and another stem cell that is ready to turn into a specific type of cell. This trait is known as self-renewal and allows stem cells to proliferate, or reproduce rapidly.
Cancellations prior to CBR’s storage of the samples(s) are subject to an administrative fee of $150. If you terminate your agreement with CBR after storage of the sample(s), you will not receive a refund.
Anthony’s doctors found a match for him through the New York Blood Center’s National Cord Blood Program, a public cord blood bank. Unlike private banks, public banks do not charge to collect cord blood, they charge a patients insurance company when cells are used. And once it is entered in the public system, the blood is available to anyone who needs it.
^ a b c American Academy of Pediatrics Section on Hematology/Oncology; American Academy of Pediatrics Section on Allergy/Immunology; Lubin, BH; Shearer, WT (January 2007). “Cord blood banking for potential future transplantation”. Pediatrics. 119 (1): 165–70. doi:10.1542/peds.2006-2901. PMID 17200285.
* Annual storage fees will be charged automatically to the credit/debit card on file, on or around your baby’s birthday, unless you’ve chosen a prepay option and are subject to change until they are paid.
^ Reddi, AS; Kuppasani, K; Ende, N (December 2010). “Human umbilical cord blood as an emerging stem cell therapy for diabetes mellitus”. Current stem cell research & therapy. 5 (4): 356–61. doi:10.2174/157488810793351668. PMID 20528762.
When the collection is complete, we send a courier to your location to pick up your collection kit and transport it to ViaCord’s Processing Lab. Once at our lab, our lab specialist get to work processing the cord blood to get you the highest volume and quality of stem cells possible.
In some types of leukemia, the graft-versus-tumor (GVT) effect that occurs after allogeneic BMT and PBSCT is crucial to the effectiveness of the treatment. GVT occurs when white blood cells from the donor (the graft) identify the cancer cells that remain in the patient’s body after the chemotherapy and/or radiation therapy (the tumor) as foreign and attack them.
When a child develops a condition that can be treated with stem cells, they undergo transplant. A doctor infuses stem cells from cord blood or bone marrow into the patient’s bloodstream, where they will turn into cells that fight the disease and repair damaged cells—essentially, they replace and rejuvenate the existing immune system.
After all is said and done, the cost to collect, test, process and store a donated cord blood collection at a public bank is estimated to be $1,200 to $1,500 dollars for each unit banked. That does not include the expense for the regulatory and quality systems needed to maintain licensure, or the cost of collecting units that are discarded because they don’t meet standards.
Stem cells from cord blood can be used for the newborn, their siblings, and potetinally other relatives. Patients with genetic disorders like cystic fibrosis, cannot use their own cord blood and will need stem cells from a sibling’s cord blood. In the case of leukemia or other blood disorders, a child can use either their own cord blood or their sibling’s for treatment.
Cord Blood Registry is headquartered in South San Francisco, California. CBR owns their 80,000 square foot laboratory located in Tucson, Arizona. CBR’s laboratory processes cord blood collections seven days a week, 365 days a year. The state-of-the-art facility has the capacity to store the stem cell samples of five million newborns.
Cord blood holds promise for future medical procedures. Scientists are still studying more ways to treat more diseases with cord blood. At Duke University, for example, researchers are using patients’ own cord blood in trials for cerebral palsy and Hypoxic ischemic encephalopathy (a condition in which the brain does not receive enough oxygen). Trials are also under way for the treatment of autism at the Sutter Neuroscience Institute in Sacramento, California.
Umbilical cord blood is useful for research. For example, researchers are investigating ways to grow and multiply haematopoietic (blood) stem cells from cord blood so that they can be used in more types of treatments and for adult patients as well as children. Cord blood can also be donated altruistically for clinical use. Since 1989, umbilical cord blood transplants have been used to treat children who suffer from leukaemia, anaemias and other blood diseases.
We are genetically closest to our siblings. That’s because we inherit half of our DNA from our mother and half from our father, so the genes we inherit are based on a chance combination of our parents’. Our siblings are the only other people inheriting the same DNA.
* Disclaimer: Banking cord blood does not guarantee that treatment will work and only a doctor can determine when it can be used. Cord tissue stem cells are not approved for use in treatment, but research is ongoing.
Stem cells also may be retrieved from umbilical cord blood. For this to occur, the mother must contact a cord blood bank before the baby’s birth. The cord blood bank may request that she complete a questionnaire and give a small blood sample.
If a sibling of a child whose cord blood you banked needs a transplant, then your chances of a match will be far higher than turning to the public. However, the safest bet is to bank the cord blood of all your children, safeguarding them against a number of diseases and ensuring a genetic match if necessary.
Your baby’s newborn stem cells are transported to our banking facilities by our medical courier partner, and you can receive tracking updates. Each sample is processed and stored with great care at our laboratory in Tucson, Arizona. CBR’s Quality Standard means we test every cord blood sample for specific quality metrics.
Blood from the umbilical cord and placenta is put into a sterile bag. (The blood is put into the bag either before or after the placenta is delivered, depending upon the procedure of the cord blood bank.)
Private storage of one’s own cord blood is unlawful in Italy and France, and it is also discouraged in some other European countries. The American Medical Association states “Private banking should be considered in the unusual circumstance when there exists a family predisposition to a condition in which umbilical cord stem cells are therapeutically indicated. However, because of its cost, limited likelihood of use, and inaccessibility to others, private banking should not be recommended to low-risk families.”[11] The American Society for Blood and Marrow Transplantation and the American Congress of Obstetricians and Gynecologists also encourage public cord banking and discourage private cord blood banking. Nearly all cord blood transplantations come from public banks, rather than private banks,[9][12] partly because most treatable conditions can’t use a person’s own cord blood.[8][13] The World Marrow Donor Association and European Group on Ethics in Science and New Technologies states “The possibility of using one’s own cord blood stem cells for regenerative medicine is currently purely hypothetical….It is therefore highly hypothetical that cord blood cells kept for autologous use will be of any value in the future” and “the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options.”[14]
cord blood insurance | public cord blood banking toronto
Blood from the umbilical cord and placenta is put into a sterile bag. (The blood is put into the bag either before or after the placenta is delivered, depending upon the procedure of the cord blood bank.)
There are no health risks related to cord blood collection. Cord blood is retrieved from the umbilical cord after it has been cut, thus preventing any pain, discomfort, or harm. This process is completely safe.
The European Group on Ethics in Science and New Technologies (EGE) has also adopted a position on the ethical aspects of umbilical cord blood banking. The EGE is of the opinion that “support for public cord blood banks for allogeneic transplantations should be increased and long term functioning should be assured.” They further stated that “the legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service which has presently no real use regarding therapeutic options.”
The baby’s cord blood will be processed and stored in a laboratory facility, often referred to as a blood bank. The cord blood should be processed and stored in a facility that is accredited by the American Association of Blood Banks (AABB) for the purpose of handling stem cells.
Cord Blood Registry® (CBR®) is the world’s largest newborn stem cell company. Founded in 1992, CBR is entrusted by parents with storing samples from more than 600,000 children. CBR is dedicated to advancing the clinical application of cord blood and cord tissue stem cells by partnering with institutions to establish FDA-regulated clinical trials for conditions that have no cure today.
There are several cord blood banks that are accredited by the American Association of Blood Banks. Most offer information on cord blood banking and provide private cord blood banking services. With a little research, you should be able to locate a credible cord blood bank online.
Current applications for newborn stem cells include treatments for certain cancers and blood, metabolic and immune disorders. Additionally, newborn stem cell preservation has a great potential to benefit the newborn’s immediate family members with stem cell samples preserved in their most pristine state.
To prevent graft-versus-host disease and help ensure engraftment, the stem cells being transfused need to match the cells of the patient completely or to a certain degree (depending on what is being treated). Cord blood taken from a baby’s umbilical cord is always a perfect match for the baby. In addition, immediate family members are more likely to also be a match for the banked cord blood. Siblings have a 25 percent chance of being a perfect match and a 50 percent chance of being a partial match. Parents, who each provide half the markers used in matching, have a 100% chance of being a partial match. Even aunts, uncles, grandparents and other extended family members have a higher probability of being a match and could possibly benefit from the banked cord blood. Read more reasons why you should bank cord blood.
The immune system has a way to identify foreign cells; it’s what allows the body to defend itself. So although transplants were proving successful after the first in 1956, they were limited to twins because their shared genetic makeup made them 100 percent compatible. This took a turn in 1958, when scientists discovered a protein present on the surface of almost all cells that lets the body know if the cell is one of its own cells or a foreign cell. In 1973, we finally learned enough about these compatibility markers (called human leukocyte antigens or HLAs) to perform the first unrelated bone marrow transplant.
Women thinking about donating their child’s cord blood to a public bank must pass certain eligibility requirements. While these vary from bank to bank, the following list shows general health guidelines for mothers wanting to donate.
In New Zealand, a hopeful couple are participating in a study that will use one of their son’s cord blood stem cells to research treatment for another son’s cystic fibrosis. In Chicago, people are using their sibling’s stem cells to successfully treat sickle cell disease. And countless other families have banked their second child’s cord blood after their first child was diagnosed with leukemia. Many of those children are alive and well today thanks to their sibling’s stem cells. Since the first successful cord blood stem cell transplant on a sibling in 1988, over 30,000 cord blood transplants have been performed worldwide.
Banking cord blood is a new type of medical protection, and there are a lot of questions that parents may want to ask. The Parent’s Guide to Cord Blood organization even has questions it believes all parents should ask their cord blood banks. We have answers to these and other frequently asked cord blood questions in our FAQs. If you can’t find the answer for which you are looking, please feel free to engage one of our cord blood educators through the website’s chat interface.
Any and all uses of stem cells must be at the direction of a treating physician, who will determine if they are applicable and suitable, for treatment of the condition. Additionally, CariCord makes no guarantee that any treatments being used in research, clinical trials, or any experimental procedures or treatments, for cellular therapy or regenerative medicine, will be available or approved in the future.
Most public banks only work with selected hospitals in their community. They do this because they need to train the staff who will collect the cord blood, and they want the blood to be transported to their laboratory as quickly as possible. A parent who wants to donate should start by finding public banks in your country.
The umbilical cord blood contains haematopoietic stem cells – similar to those found in the bone marrow – and which can be used to generate red blood cells and cells of the immune system. Cord blood stem cells are currently used to treat a range of blood disorders and immune system conditions such as leukaemia, anaemia and autoimmune diseases. These stem cells are used largely in the treatment of children but have also started being used in adults following chemotherapy treatment.
From high school friend to the love of her life. Read about the real-life adventures of CBR mama Michelle—and why she’s so grateful for her husband and family this Mother’s Day. Read more on #TheCBRBlog blog.cordblood.com/2018/04/one-cb… … pic.twitter.com/EA4E73Rnv8
As most parents would like to bank their babies’ cord blood to help safeguard their families, it is often the cost of cord blood banking that is the one reason why they do not. Most cord blood banks have an upfront fee for collecting, processing and cryo-preserving the cord blood that runs between $1,000 and $2,000. This upfront fee often also includes the price of the kit provided to collect and safely transport the cord blood, the medical courier service used to expedite the kit’s safe shipment, the testing of the mother’s blood for any infectious diseases, the testing of the baby’s blood for any contamination, and the cost of the first full year of storage. There is then often a yearly fee on the baby’s birthday for continued storage that runs around $100 to $200 a year.
Private or family banks store cord blood for autologous use or directed donation for a family member. Private banks charge a yearly fee for storage. Blood stored in a private bank must meet the same standards as blood stored in a public bank. If you have a family member with a disorder that may potentially be treated with stem cells, some private banks will store the cord blood free of charge.
In March 2004, the European Union Group on Ethics (EGE) has issued Opinion No.19[16] titled Ethical Aspects of Umbilical Cord Blood Banking. The EGE concluded that “[t]he legitimacy of commercial cord blood banks for autologous use should be questioned as they sell a service, which has presently, no real use regarding therapeutic options. Thus they promise more than they can deliver. The activities of such banks raise serious ethical criticisms.”[16]
The body has two ways to create more cells. The first is usually taught in middle school science. Known as cell division, it’s where a cell replicates within its membrane before dividing into two identical cells. Cells do this as needed for regeneration, which we will touch on in a second.
Throughout pregnancy your baby’s umbilical nurtures life. It’s carries oxygen rich cells and nutrients from your placenta to your baby, and then allows your baby to pump deoxygenated and nutrient depleted blood back to your placenta. This constant exchange is protected by a special type of tissue that acts like a cushion, preventing twisting and compression to ensure that the cord blood flow remains steady and constant.
Tracey Dones of Hicksville, N.Y., paid to bank her son Anthony’s cord blood. But four months after he was born, Anthony was diagnosed with osteopetrosis, a rare disease that causes the body to produce excess bone, leads to blindness, and can be fatal if left untreated.
To explain why cord blood banking is so expensive in the United States, we wrote an article with the CEO of a public cord blood bank that lists the steps in cord blood banking and itemizes the cost of each one.
A bone marrow or cord blood transplant replaces diseased blood-forming cells with healthy cells. Cells for a transplant can come from the marrow of a donor or from the blood of the umbilical cord collected after a baby is born. Sometimes special qualities of umbilical cord blood make it a better choice of blood-forming cells for transplant.
Anthony’s doctors found a match for him through the New York Blood Center’s National Cord Blood Program, a public cord blood bank. Unlike private banks, public banks do not charge to collect cord blood, they charge a patients insurance company when cells are used. And once it is entered in the public system, the blood is available to anyone who needs it.
Cord blood in public banks is available to unrelated patients who need haematopoietic stem cell transplants. Some banks, such as the NHS bank in the UK, also collect and store umbilical cord blood from children born into families affected by or at risk of a disease for which haematopoietic stem cell transplants may be necessary – either for the child, a sibling or a family member. It is also possible to pay to store cord blood in a private bank for use by your own family only.
cord blood insurance | public cord blood banking toronto
Adverse effects are similar to hematopoietic stem cell transplantation, namely graft-versus-host disease if the cord blood is from a genetically different person, and the risk of severe infection while the immune system is reconstituted.[1] There is a lower incidence with cord blood compared with traditional HSCT, despite less stringent HLA match requirements. [1]
In addition to cord blood banking as an eligible FSA expense, you can also benefit from certain tax advantages to store your baby’s cord blood. As of 2013, if your child or a family member has a medical condition that might be expected to improve (through the use of cord blood), you can deduct your out-of-pocket expenses from your income taxes!
The mother signs an informed consent which gives a “public” cord blood bank permission to collect the cord blood after birth and to list it on a database that can be searched by doctors on behalf of patients. The cord blood is listed purely by its genetic type, with no information about the identity of the donor. In the United States, Be The Match maintains a national network of public cord blood banks and registered cord blood donations. However, all the donation registries around the world cooperate with each other, so that a patient who one day benefits from your child’s cord blood may come from anywhere. It is truly a gift to the benefit of humankind.
* Annual storage fees will be charged automatically to the credit/debit card on file, on or around your baby’s birthday, unless you’ve chosen a prepay option and are subject to change until they are paid.
Students who register to donate blood three or more times during their high school career earn a Red Cord to wear during graduation events. Seniors must complete the requirement by May 15 (or by the date of their school’s final blood drive of the year, whichever is later).
Estimated first minimum monthly payment. Future minimum payments will vary based on amount and timing of payments, interest rate, and other charges added to account. You may always pay more. The more you pay each month, the quicker your balance will be repaid and the lower your total finance charges will be. For more information about CareCredit’s healthcare payment plans, please visit carecredit.com. If minimum monthly payments are 60 days past due, the promotions may be terminated and a Penalty APR may apply. Standard terms including Purchase APR or Penalty APR up to 29.99% apply to expired and terminated promotions, and optional charges. Subject to credit approval by Synchrony Bank. Other terms and conditions may apply. Please see here for more details.
A bone marrow or cord blood transplant replaces diseased blood-forming cells with healthy cells. Cells for a transplant can come from the marrow of a donor or from the blood of the umbilical cord collected after a baby is born. Sometimes special qualities of umbilical cord blood make it a better choice of blood-forming cells for transplant.
It’s hard to ignore the ads for cord blood banks, offering a lifetime of protection for your children. If you’re an expectant mom, there’s information coming at you constantly from your doctor’s office, magazines, online, and perhaps even your yoga class.
The first cord blood banks were private cord blood banks. In fact, Cryo-Cell is the world’s first private cord blood bank. It wasn’t until later that the government realized the need to preserve cord blood for research and public welfare. As a result, 31 states have adopted a law or have a piece of pending legislation that requires or encourages OBGYNs to educate expectant parents about cord blood banking and many states now have publicly held cord blood banks. As a result, parents have the option of banking their baby’s cord blood privately for the exclusive use of the child and the rest of the family or donating the cord blood to a public bank so that it can be used in research or by any patient who is a match and in need.
Some brochures advertising private cord blood banking show children with cerebral palsy, a neurological disorder, who were treated with their own stem cells. In the case of Cord Blood Registry, the company lists all stem cell transplants conducted at Duke University. In a list of individuals treated in their “stem cell therapy data” cerebral palsy is listed. However, transplants were part of an early research study and studies of efficacy are just now underway.
It’s now possible to preserve up to twice the number of stem cells – exclusively available through cord blood banking with Americord®. With Cord Blood 2.0™, you now have the opportunity to treat your child into adolescence and even adulthood. Learn more >
STEM CELLS are found in cord blood, cord tissue, and placenta tissue. These cells are highly valuable to your baby, the mother, and possibly other family members. When you save these stem cells with Americord®, you ensure that they are securely stored for you and your family’s future needs. Learn more >
The first successful cord blood transplant (CBT) was done in 1988 in a child with Fanconi anemia.[1] Early efforts to use CBT in adults led to mortality rates of about 50%, due somewhat to the procedure being done in very sick people, but perhaps also due to slow development of immune cells from the transplant.[1] By 2013, 30,000 CBT procedures had been performed and banks held about 600,000 units of cord blood.[2]
Congratulations to the Marepalli family, this week’s winners of a free year of storage! CBR Clients: Enter for a chance to win by tagging a family photo with #CBRFamilyContest! #MyStemCellsLiveAtCBR pic.twitter.com/RLIx54bLqS
Georgia Regents University is conducting an FDA-regulated phase I/II clinical trial to assess whether an infusion of autologous stem cells derived from their own cord blood can improve the quality of life for children with cerebral palsy.
Cord Blood Registry (CBR) is a private bank that offers collection and long-term storage of both cord blood and cord tissue. With more than 700,000 stored units, CBR is one of the largest of the cord blood banks.
Most of the diseases on the proven treatment list are inherited genetic diseases. Typically, these treatments require a donor transplant, as from a sibling. In fact, research shows that treatments using cord blood from a family member are about twice as successful as treatments using cord blood from a non-relative.9a, 17 To date, over 400 ViaCord families have used their cord blood 56% were for transplant.1
Save by paying in advance for 21 years of storage through our long-term storage plan. This plan covers all the initial fees (collection kit, courier service, processing, and preservation) and the cost of 21 years of continuous storage. The 21-year plan is available with both our standard and premium processing methods. A lifetime plan is also available; call for details.
|| Payment Plan Disclosures for CareCredit 48-Month Plan – Availability subject to credit approval. $1,650 or as low as $46 per month. If you pay only the minimum amount it will take you 48 months to pay off the balance and $2,201 total. A 14.90% Extended Payment Plan for 48 Months on purchases of $1,000 or more with your CareCredit card. Fixed minimum monthly payments required. Penalty APR may apply if you make a late payment. On promo purchase, fixed monthly payments equal to 4.8439% of initial purchase balance for 24 months; 3.4616% of initial purchase balance for 36 months; 2.7780% of initial purchase balance for 48 months required, and interest charges will be applied to promo balance at a reduced 14.90% APR if (1) promo purchases paid in full in promotion duration as indicated, and (2) all minimum monthly payments on account paid when due. Purchase APR of up to 29.99% applies to expired promotions and optional charges.
Some parents-to-be are sold on the advertising that banking their child’s cord blood could potentially treat an array of diseases the child, or his siblings, could encounter in their lives. Other parents-to-be may find all the promises too good to be true.
Your cells didn’t start out knowing how to come together to form your bones, heart or blood; they begun with more of a blank slate. These completely undifferentiated cells can be found during gestation, or the time the baby is in the womb, and are called embryonic stem cells. These early stage stem cells are master cells that have the potential to become any type of cell in the body.
For these and other reasons, the American Academy of Pediatrics (AAP) and many physicians do not recommend private cord blood banking except as “directed donations” in cases where a family member already has a current need or a very high potential risk of needing a bone marrow transplant. In all other cases, the AAP has declared the use of cord blood as “biological insurance” to be “unwise.” [Read the AAP’s news release at http://www.aap.org/advocacy/archives/julcord.htm ]
Public cord blood banks store cord blood for allogenic transplants. They do not charge to store cord blood. The stem cells in the donated cord blood can be used by anyone who matches. Some public banks will store cord blood for directed donation if you have a family member who has a disease that could potentially be treated with stem cells.
Founded in 1992, CBR has stored more than 600,000 cord blood and cord tissue collections from 3,500 hospitals in over 100 countries and partnered with institutions to establish multiple FDA-regulated clinical trials. CBR has helped more than 400 families use their cord blood stem cells for established and experimental medical treatments, more than any other family cord blood bank. CBR’s goal is to expand the potential scope of newborn stem cell therapies that may be available to patients and their families.
Cancellations prior to CBR’s storage of the samples(s) are subject to an administrative fee of $150. If you terminate your agreement with CBR after storage of the sample(s), you will not receive a refund.
There are around 20 companies in the United States offering public cord blood banking and 34 companies offering private (or family) cord blood banking. Public cord blood banking is completely free (collecting, testing, processing, and storing), but private cord blood banking costs between $1,400 and $2,300 for collecting, testing, and registering, plus between $95 and $125 per year for storing. Both public and private cord blood banks require moms to be tested for various infections (like hepatitis and HIV).
Any and all uses of stem cells must be at the direction of a treating physician, who will determine if they are applicable and suitable, for treatment of the condition. Additionally, CariCord makes no guarantee that any treatments being used in research, clinical trials, or any experimental procedures or treatments, for cellular therapy or regenerative medicine, will be available or approved in the future.
Cord blood is the blood from the baby that is left in the umbilical cord and placenta after birth. It contains special cells called hematopoietic stem cells that can be used to treat some types of diseases.
Whole genome sequencing is the process of mapping out the entire DNA sequence of a person’s genome. This test can show what type of health concerns we might face and most importantly how we can improve our health and quality of life.
Umbilical cord blood is useful for research. For example, researchers are investigating ways to grow and multiply haematopoietic (blood) stem cells from cord blood so that they can be used in more types of treatments and for adult patients as well as children. Cord blood can also be donated altruistically for clinical use. Since 1989, umbilical cord blood transplants have been used to treat children who suffer from leukaemia, anaemias and other blood diseases.
As noted earlier, with better matching, there is a greater chance of success and less risk of graft-versus-host disease (GvHD) in any stem cell transplant. With cord blood, the baby’s own cells are always a perfect match and share little risk. When using cord blood across identical twins, there is also a very low chance of GvHD although mutations and biological changes caused by epigenetic factors can occur. Other blood-related family members have a 35%–45% chance of GvHD, and unrelated persons have a 60%–80% chance of suffering from GvHD.
^ a b c American Academy of Pediatrics Section on Hematology/Oncology; American Academy of Pediatrics Section on Allergy/Immunology; Lubin, BH; Shearer, WT (January 2007). “Cord blood banking for potential future transplantation”. Pediatrics. 119 (1): 165–70. doi:10.1542/peds.2006-2901. PMID 17200285.
The Leading the Way LifeSaving Ambassadors Club is a recognition program honoring sponsor groups for outstanding performance in reaching or exceeding blood drive collections goals. CBC presents a Leading the Way plaque to winning sponsors on an annual basis. The award is based on three levels of achievement:
Cord Blood Registry is a registered trademark of CBR® Systems, Inc. Annual grant support for Parent’s Guide to Cord Blood Foundation is made possible by CBR® through the Newborn Possibilities Fund administered by Tides Foundation. | {
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-4,307,482,546,044,461,000 | psychiatrist near me cigna Secrets
Overall health industry experts who will diagnose and deal with interest deficit hyperactivity dysfunction (ADHD) with medication include things like:
A vital A part of evaluation for ADHD is thinking about the types of difficulties due to the behaviors. Just how much do they have an effect on schooling and social habits? Checks for relevant challenges
Only All those therapies that most effective assist Regulate ADHD signs and symptoms with no producing Actual physical or emotional damage needs to be utilized.
Treatment depends upon the age of your child. Youngsters ages 4 to 5 yrs are treated initially with actions therapy. Your son or daughter's physician will check with you about medication if your child's indications don't increase. Small children ages six to eleven yrs are treated with drugs or behavior therapy or both equally. Youngsters ages 12 to 18 yrs are taken care of with drugs and usually also with habits therapy. Behavioral therapy allows coach mother and father, instructors, along with other adults to blame for a youngster who may have ADHD. These packages deal with developing routines and rules for habits and carefully viewing how a youngster responds.
Teens with ADHD may even have far more complications when they're driving cars. They get extra speeding tickets and possess significant car accidents additional normally. They need to be viewed intently by a certified adult when they are Mastering to drive.
Notice deficit hyperactivity disorder (ADHD) might be not easy to identify in a younger little one. It may be not easy to notify the distinction between typical actions and ADHD symptoms in younger small children.
If your child qualifies, you will fulfill with faculty personnel to discover aims and strategy an individualized education software (IEP). This usually implies that your university will get more test to accommodate your son or daughter's further requires. This can be as minimal as inserting your child within the front of The category. Or it may be as involved as offering classroom staff members that can help your son or daughter.
footnote 1 Whilst numerous dad and go to these guys mom believe that foods with sugar and food items additives make their small children a lot more hyperactive, these foods look at this web-site haven't been shown to trigger ADHD. footnote two Signs and symptoms
The precise explanation for interest deficit hyperactivity condition (ADHD) is not known. But it could operate in people. Ongoing study is focused on finding the genes that trigger a person for being more likely to get ADHD.
Stimulant medicines. These medicines may also help anyone emphasis greater. And they're able to support minimize hyperactivity and impulsivity.
Habits score scales or checklists for ADHD . These are generally used by moms and dads and lecturers to evaluate the child's symptoms.
The doctor will use rules through the American Psychiatric Affiliation to diagnose ADHD. The physician may additionally have a look at prepared reviews about the kid's conduct. Moms and dads, teachers, and Many others which have frequent connection with the child get ready these reviews. How can it be dealt with?
In preschool-age kids, signs in many cases are the same as regular habits for youthful kids. In young children involving the ages of 6 and twelve, indications of ADHD are more apparent than in other age teams.
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1,395,881,987,050,312,400 | Crystal-Dental-Centre-New-Delhi
NABH Accredited
CGHS empanelled
+91 70656 13333 |+911141603131
info@crystaldentalcentre.com
What are the type of dental implants?
Endosteal Implant / Subperiosteal Implant
Everyone wishes to have a beautiful and charming smile. The setting of teeth of a person is one of the main aspects of his or her beauty and almost everyone wishes to have a sparkly smile with properly set teeth. And if any of the teeth goes missing from the jawline due to various reasons then it is definitely a matter of concern. And for this reason then one has to visit the Dentist in order to get satisfactory help.
Dental Implants are delicate to handle and more difficult to carry out. The doctor has to be skilled enough in order to carry out a perfect dental implant. It is completely on the work experience of the dentist that the patient relies on. Faulty implant activity may give rise to a plethora of associated Denture problems which includes a change in facial appearance, defective smile, Pain on Chewing, tasting the food and even talking. Hence one has to be pretty careful while completing the task. Well, there are mainly two types of dental implants that can be performed in the jawline of a human. They are:
Endosteal Implant New Delhi
Endosteal Implants
These types of dental implanting way includes implanting the tooth directly into the jawbone with the help of a small surgery. The post or metallic cylinder is placed into the gum and then left for some months for it to heal completely and the jaw bones to surrounding the titanium cylinder. And when the tissue surrounding the gum has healed, the second part of the implantation surgery is performed which includes bridging. This is done to connect the post to the implant which is original. Then comes the third and the final part of the process which is placing an artificial tooth or teeth and attaching it to the metallic cylinder directly or sometimes grouped on a Bridge.
Subperiosteal Implants
These types of dental implanting way include fixing of a metal frame into the jawbone and just below the gum tissue. This again might take up considerable time and when the healing process of the gums completes, the metallic frame fixes to the jawbone properly. Then the third step includes the observation of the fact that the metallic posts, which are attached to the frame are protruding through the gums or not. If they are protruding then it is the ideal time to mount the artificial teeth to the posts. This is what the process includes.
Apart from an implantation surgery, a person should maintain the basic oral hygiene i.e. to brush the teeth twice a day and properly floss the teeth, avoid smoking and should avoid chewing the food very hard. Dental implants are available in different shapes and sizes. So whether it is a narrow gap or a wide one, opt for a dental implant and get back the best smile that you once had. The process is pretty cost friendly but an expert is needed to perform the task properly. So get your check up done now at Crystal Dental Centre, New Delhi, India and take expert advice from you’re best dentists.
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-873,251,848,150,303,200 | When to See a Doctor for Knee Pain Treatment in Chandigarh
Knee pain that develops gradually or as a result of more vigorous activities than normal can be treated at home. Knee pain caused by a mild injury can also usually be safely monitored for a day or two to evaluate if self-care approaches are effective. In case of long-term knee pain caused by arthritis, weight loss and exercises to strengthen the muscles around the joint can help.
Schedule an appointment with doctors for knee pain in Chandigarh if your knee pain was triggered by a particularly severe hit, or if it’s accompanied by significant swelling, redness, tenderness and warmth around the joint, fever and severe pain. Meet a doctor also if knee pain persists or develops to the point that it interferes with your daily activities or sleep.
You can take care of your knee pain by following some dos and don’ts and by undergoing certain treatments by doctors for knee pain in Chandigarh to bid your knee joint pain goodbye.
Contents:
1. Dos and Don’ts for Knee Joint Pain
2. Treatment for Knee Joint Pain
Dos and Don’ts for Knee Joint Pain
Healing Hospital Chandigarh For Knee Pain In Chandigarh
Dos:
1. Exercise: Exercising daily for at least 15 minutes is beneficial for the overall health of the body. Doing cardio exercises, weight training and stretching helps in increasing bone flexibility, strengthening the muscles and supporting the knees.
2. Consider acupuncture: Acupuncture is a form of treatment that involves inserting very thin needles into a person’s skin at different depths at specific points on the body. Studies have shown that acupuncture can relieve pain and get rid of a variety of other ailments too. Therefore, considering acupuncture for knee pain may also prove to be beneficial.
3. Apply heat/ice packs: Using a cold compress as a first-aid after a knee injury can reduce swelling and discomfort. Using it three to four times a day for 15 to 20 minutes per time may provide relief. After that, you may also take a warm bath, use a heating pad, or wrap yourself in a warm towel for 15 to 20 minutes.
4. Prevent from falling: A painful knee can increase the risk of a fall and cause more damage to the knee. This damage must be prevented at all costs. You may take some preventive measures for the same such as making your home well-lit, using handrails on staircases, using a ladder or stool to reach something on a high shelf, etc.
5. Wear appropriate shoes: Cushioned insoles may help to relieve knee pain. Orthopaedic doctors usually prescribe special insoles for shoes if you have knee osteoarthritis. Consult an orthopaedic doctor to determine the best insole for you.
6. Get expert advice: It is always best to know the reason behind the knee pain, and so consulting the doctor at the very initiation of the pain is advised.
Also Read: https://www.healinghospital.co.in/important-things-to-follow-after-total-knee-replacement/
Don’ts:
1. Don’t rest in excess: Resting too much can loosen your muscles and thus can increase knee joint pain. So, rest in moderation and involve yourself in an active lifestyle to reduce the pain.
2. Don’t stress your joints: Avoid strenuous exercises such as running, jumping, etc. if you have knee joint pain. Added stress on the knees may worsen the knee pain and may also cause injury.
Healing Hospital Chandigarh Treatments for Knee Joint Pain In Chandigarh
Treatments for Knee Joint Pain
1. Physiotherapy: Working with a physiotherapist can help in restoring knee strength and reduce pain in the joint. Your doctor may prescribe a certain home-based exercise regime, medicines and ice and compression for quicker recovery.
2. Injections: One of the most common injections for knee joint pain is Corticosteroid injection. Such injections can lubricate the joint and provide temporary relief. While the pain can be treated temporarily through these injections, they cannot heal the meniscus tear.
3. Anti-inflammatory medicines: Anti-inflammatory such as ibuprofen and aspirin can help in reducing swelling and cure the pain.
4. Knee Surgery: You may resort to surgery if the injury is serious or if symptoms persist even after nonsurgical procedures. Depending on your specific condition, you can undergo a partial meniscectomy to treat a meniscal tear or a complete knee replacement to relieve arthritis joint pain and regain knee function.
Looking for doctors for knee pain in Chandigarh? Click here to book an appointment: https://healinghospital.co.in/book-an-appointment/
Knee Pain Treatment Specialist in Chandigarh
Almost everyone experiences knee pain at some point of time. Knee pain is so common because it is led by a number of unavoidable factors apart from other preventable causes. But at the same time, knee pain is also easily treatable.
In this article, we’ll discuss about the factors contributing to knee pain, causes behind knee pain, its prevention and knee pain treatment in Chandigarh.
Contents:
1. Factors Contributing to Knee Pain
2. Causes of Knee Pain
3. Prevention from Knee Pain
4. Knee Pain Treatment in Chandigarh
Doctors For Knee Pain In Chandigarh
Factors Contributing to Knee Pain
A number of common factors can contribute to knee pain as follows:
• Age: Knee pain usually occurs with increasing age. It is common for joints to wear away after excessive use for so many years. Knee pain is very common after the age of 50 when the bone density and muscle efficiency decreases along with lack of physical activity.
• Weight: Obesity is one of the most common causes of knee pain across the world. High body weight puts excessive strain on the joints of the body, which can even lead to dislocation.
• Gender: According to many research studies, women are more likely to develop early knee pain in comparison with men. The primary reason for this is that women tend to have wider pelvises, which makes an injury more likely. Apart from this, some hormones in women also contribute to weaker leg muscles and ligaments.
• Tobacco consumption: Smoking has been linked to loss of cartilage which can contribute to osteoarthritis.
Knee Pain Treatment Specialist in Chandigarh Mohali
Causes of Knee Pain
• Injuries: A knee injury can affect ligaments, tendons, bursae, bones, and cartilage. Some of the common knee injuries are ACL Injury, Fractures, Torn meniscus, Knee bursitis, and Patellar tendinitis.
• Arthritis: Arthritis is one of the most common causes of knee pain. It is a chronic condition that causes inflammation and pain in the joints. There are more than 100 types of arthritis that affect the body. Some of the most common varieties of arthritis are Osteoarthritis, Rheumatoid Arthritis, Gout, Septic Arthritis, and Post-traumatic Arthritis.
• Meniscal tear: When a knee injury causes the cartilage to slit, it is called a meniscal tear. Cartilage is a tough and flexible tissue that covers the end of bones. Causes of meniscal tear can be a sudden twist or advancement of age.
• Bone tumour: When cells divide abnormally and excessively, they can form a lump of tissue. This lump is called a tumour. Presence of bone tumour can lead to extreme knee pain and needs to be treated immediately.
Also Read: https://www.healinghospital.co.in/are-ex-athletes-at-a-higher-risk-of-joint-pain-later-in-life/
Prevention from Knee Pain
Although it is not always possible to prevent knee pain, some precautions may be taken to prevent knee pain as far as possible.
• Maintain Healthy Weight: A healthy weight prevents the joints from bearing excessive weight which increases their life. Thus a healthy weight can prevent from osteoarthritis and other knee problems.
• Exercise smartly: Some people are of the perception that the more you exercise the more will your knees stay fit. On the contrary, you should exercise only as much as your body can handle. If you feel pain in your knees while exercising, stop at that instant and give yourself a break.
• Quit Smoking: As already mentioned above, smoking contributes to the wearing away of knee joints and can cause osteoarthritis. Therefore, you should quit smoking as soon as possible.
• Use kneepads to prevent injury: If you play a sport or are indulged in an activity that involves a lot of kneeling, it is best to wear kneepads to prevent bursitis.
• Do not forget to stretch: Stretching before and after physical activity can help prevent knee pain or pain in any joint to a great extent.
Knee Pain Treatment in Chandigarh
Knee pain can be caused by a variety of factors and causes as discussed. If your knee pain is causing you to change the way you live, it is time to visit your doctor. It is important to understand that you do not have to live with knee pain. Your orthopaedic doctor can provide you with the right kind of treatment to relieve your knee pain.
Treatment of Knee Pain begins with a diagnosis by the orthopaedic doctor through physical examination, imaging tests such as X-Ray, MRI, CT scan and Ultrasound, and Lab tests.
Treatment of Knee Pain depends on the cause of it. Depending on the cause, you may be treated through medications, physiotherapy, injections, or surgery. Nowadays, many doctors suggest Fast Track Knee Resurfacing for Knee Arthritis.
Book an appointment with doctors for knee pain in Chandigarh here: https://www.healinghospital.co.in/orthopedic/ | {
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-4,080,852,654,795,309,600 | What Are Biologic Drugs?
Understanding Biologic Drugs Which Are Used to Treat Certain Types of Arthritis
140089790.jpg
Stephen Smith/Photographer's Choice RF/Getty Images
In the late 1990s, the first biologic drug went on the market to treat rheumatoid arthritis. Enbrel (etanercept) was first, but it did not take long for other biologic drugs to be developed and marketed.
For more details on biologic drugs, read this excerpt from UpToDate—a trusted electronic reference used by many physicians and patients looking for in-depth and well-explained medical information. Then read on so you will have a full understanding of biologic drugs.
Biologic Drugs: Details from UpToDate
"Biologic response modifiers, also known as biologics, are medications that were designed to prevent or reduce the inflammation that damages joints. Biologics target molecules on cells of the immune system, joint, and the products that are secreted in the joint, all of which can cause inflammation and joint destruction. There are several types of biologics, each of which targets a specific type of molecule involved in this process (tumor necrosis factor, interleukin-1, and cell surface molecules on T and B lymphocytes)."
Biologic Drugs and Their Targets
• Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Simponi (golimumab), and Cimzia (certolizumab pegol) are biologic drugs that target tumor necrosis factor (TNF). They are commonly referred to as TNF blockers and, typically, one of the TNF blockers is the first biologic drug tried.
• Kineret (anakinra) inhibits interleukin-1. It is generally regarded as a less effective biologic than TNF blockers and not often prescribed.
• Orencia (abatacept) interrupts the activation of T cells. Usually, Orencia is reserved for patients with moderate to severe rheumatoid arthritis who are unable to manage their disease with methotrexate and a TNF blocker.
• Rituxan (rituximab) depletes B cells. Again, this drug is typically reserved for patients who have an unsatisfactory result with methotrexate and a TNF blocker.
• Actemra (tocilizumab) works by inhibiting the interleukin-6 receptor, thereby blocking interleukin-6.
Who Should Be Treated With Biologics?
Patients who have had an unsatisfactory response to DMARDs (disease-modifying anti-rheumatic drugs), either alone or in combination with other arthritis medications, are usually good candidates for biologics. Compared to DMARDs, biologics work more quickly. You should know whether you are responding within weeks of starting a biologic drug.
Who Should Not Be Treated With Biologics?
Unfortunately, there are patients who are not good candidates for treatment with biologic drugs. There are certain conditions where the risks would most likely outweigh the benefits of treatment with biologic drugs. For example, patients with a prior history of multiple sclerosis or lymphoma would not be good candidates. Patients with symptomatic congestive heart failure are also not good candidates. It's also too risky to use biologic drugs when a patient has a history of severe or recurring infections.
Which of the Biologics Should You Use?
Your doctor will help you choose the best biologic for you. Cost is certainly a consideration.
You and your doctor must determine if your health insurance will cover the drug you choose—or what your out-of-pocket expense will be. Be sure it is affordable for you.
Another consideration is convenience. How is the drug administered? Do you have to go to the doctor's office for treatment or would it be better for you to choose one of the biologic drugs that is administered as a self-injection? How often is the drug administered—once a week, twice a week, every two weeks, or monthly? What's your preference?
Is it important for you to choose a drug that has a good track record, in other words, one of the older, rather than newer, biologics?
These are all things to consider, because if you choose what suits you best, you will more likely remain compliant with your treatment.
Want to learn more?
See UpToDate's topic Patient Information: Rheumatoid Arthritis Treatment for additional in-depth medical information on rheumatoid arthritis treatment.
Source:
Maini RN and Venables PJW. "Patient information: Rheumatoid arthritis treatment" UpToDate. Accessed October 31, 2009.
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-7,006,820,337,074,999,000 | Champlain Primary Care Digest
Home » Articles posted by Dr. Taryn Taylor
Author Archives: Dr. Taryn Taylor
A Review of Running Shoes
We are often asked to comment on which shoes may be most suitable for a patient. While that answer is up for debate, an important step to answering that question is understanding what is available out there. Here we will briefly outline some of the characteristics of different categories of running shoes that you may encounter.
1.) Minimalistic shoes – attempt to approximate barefoot running
General Characteristics:
• Reduced/minimal cushioning
• thin soles, no heel lift (traditional shoes have 10-14mm heel lift)
• no arch support
• wide metatarsal area/toe box
• very flexible, generally very light
Example brands:
• Vibram Five Fingers.
• vivobarefoot
• Merrell Barefoot
• New Balance Minimus
• Nike Free
2.) Maximalist shoes – attempt to maximize cushioning and protection of foot
General Characteristics
• Thick cushioning
• Rigid sole
• Slightly reduced heel lift compared to regular shoes
• Wide base
• Lightweight for its size
Example brands:
• Hoka One One
• Merrell All Out Peak
• Mizuno Wave Sky
• Skechers GOrun Ultra R
• New Balance Fresh Foam 980 Boracay
3.) Zero-drop shoes – footwear where the heel is at the same height as the ball of the foot
General Characteristics
• Often overlaps with minimalistic shoes
• Variable structure, but the emphasis is that there is zero heel lift
Example Brands
• Altra Torin 3.0
• Merrell Vapor Glove 2
• Nike Flex Fury 2
• Vibram FiveFingers Bikila
There are many studies out there looking into the pros and cons of each type of shoewear and whether they are effective in reducing running injuries. The jury is still out but hopefully, this will cast some light on what your patients may be talking about!
Jim Niu MD, CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport Med
The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness
Jerrold Petrofsky, Lee Berk, Gurinder Bains, Iman Akef Khowailed, Haneul Lee, Michael Laymon
Clinical Journal of Sport Medicine, Volume 27, No. 4, July 2017
Delayed-onset muscle soreness (DOMS) is a relatively common phenomenon experienced by people who are new to exercise, or essentially anyone who exceeds their normal workout intensity. DOMS can range from mild irritation to severe pain that can form a significant barrier inhibiting performance, or exercise participation altogether. Furthermore, previous research has shown that DOMS is greater in intensity and duration in older individuals and individuals with diabetes, which is a particularly important patient population within family medicine. This cross-sectional repeated measure design study was performed to assess the impact on DOMS of heat applied for 8 hours immediately or 24 hours after exercise.
60 subjects aged 20-40 who were physically inactive for 6 weeks and had BMI’s less than 40 were divided randomly into 3 groups (control, ThermaCare heat wraps applied immediately after exercise, and ThermaCare heat wraps applied 24 hours after exercise). To provoke DOMS, the subjects completed squats in 3, 5-minute bouts with 3 minutes of rest in-between each bout. Visual analog pain scales, blood myoglobin, muscle strength, range of motion, and stiffness of the quads were the main outcome measures of the study.
The results revealed a significant reduction in soreness in the group that had the heap wraps applied immediately after exercise (P<0.01). This was corroborated by blood myoglobin, algometer and muscle stiffness data. In addition, there was some benefit to applying the heat 24 hours after exercise when compared to control.
In summary, low-level continuous heat wraps left for 8 hours after heavy exercise can reduce the effects of DOMS (assessed by both subjective and objective measures). Although cold therapy is commonly used after heavy exercise to reduce soreness, heat seems to have the added benefit of increasing flexibility of tissue and tissue blood flow. The authors note that for the purposes of reducing joint swelling, it is still probably better to use cold therapy.
Sean Mindra MD, CCFP
PGY3 – Sport and Exercise Medicine, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine
The Noisy Knee
Song, S. J., Park, C. H., Liang, H., & Kim, S. J. (2018). Noise around the Knee. Clinics in orthopedic surgery, 10(1), 1-8.
A common MSK question patients ask is “is it normal that my knee makes this sound?” While this review focuses on the knee, the approach can be generalized to any shoulder. Noise in the knee is common, and often patients are worried the noise is pathological.
Noise around the knee can be separated into physiologic and pathologic causes. This is defined by whether the sound is associated with pain, swelling, and abnormal range of motion. There are also many different types of sounds which are more likely to describe one cause than another. Crepitus is a vague descriptor used to represent a sound during a joint’s range of movement. Popping is a sudden explosive and well perceived sound, usually associated with injury such as meniscal, cruciate, or collateral ligament tears. Clunking is a loud singular noise due to release against resistance, often suggestive of something that was subluxed and now relocated. Clicking is a tiny, singular noise that occurs during one cycle of knee extension and flexion, this can be associated with various causes. Grinding and grating are used to describe continuous scratching sounds and are more associated with degenerative OA and patellofemoral pain syndrome.
Physiologic Sounds:
Not associated with any history of trauma, swelling, or pain.
Tend to be sporadic in nature
No aggravation of sounds and combined symptoms
Causes include:
• build up or bursting of tiny bubbles in the synovial fluid
• snapping of ligaments
• catching of the synovium or physiological plica
• hypermobile or discoid meniscus.
One way to distinguish between these causes is whether the joint sound occurs repeated during range of motion. If it happens repeatedly, it is usually due to anatomic structures rubbing against each other, such as ligaments/tendons or plica over a bony prominence. One common is the bicep femoris tendon at the lateral aspect of the knee. If the crack has a refractory period, it is likely due to air build up in the joint, and subsequent changes in joint pressure during range of motion cause cavity formation which creates a popping sound.
Management of physiologic noise involves reassurance and stretching and strengthening of affected musculotendinous structures.
Pathologic Sounds:
Can have history of trauma or injury
Tend to be higher pitch/frequency
observed consistently, has gradual aggravation
Causes:
• Degenerative changes
• Structural cause such as bony spurs and cysts, meniscal tears…etc
• Pathologic plica
• If a plica gets irritated, it can cause synovitis and pain
• Patellofemoral instability
• Due to hypermobility of patella or subluxation of patella
• Post-surgical
• Pathologic snapping knee syndrome
• Any extra or intra-articular structure that causes painful sounds, which can include ganglion cysts, lipoma, synovial nodules, fabella, osteochondromas, osteophytes
Management of these pathologic noises depends on the underlying cause.
Overall, noise around the knee is a common phenomenon, with one study suggesting 38.1% of women and 17.1% of men over 40. With this approach, careful evaluation of the noise can help prevent unnecessary diagnostic interventions and provide appropriate guidance for healthy patients experiencing physiologic noise.
Jim Niu MD, CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport Med
Chronic Exertional Compartment Syndrome – An Introduction
We have all heard of compartment syndrome. This is a medical emergency where increased pressures within a compartment can lead to rapid ischemia, muscle damage, and even potential amputation after a trauma or injury.
How many of us have heard of chronic exertional compartment syndrome (CECS)?
CECS is a cause of chronic exertional leg pain. Most often seen in young runners and elite athletes, it is a relatively unknown and underdiagnosed condition. Its incidence and pathophysiology are not well understood. One theory suggests a noncompliant fascia that cannot accommodate the expansion of muscle volume during exercise, causing increased intracompartmental pressures.
Suspect CECS with athletes who present with chronic anterior/lateral leg pain that worsens with prolonged use and resolves shortly upon cessation of activity. Most cases will occur in the anterior or lateral compartments. Classically, these athletes will be able to tell you that a specific time, distance, or intensity will bring on the symptoms, characterized as burning, aching, cramping, or pressure. It usually resolves fairly shortly if they stop the activity unless they continue to push through the symptoms for longer durations. It is fairly common to be bilateral. They may have some numbness/tingling in the dermatomal distribution of the nerve that runs through the compartment and weakness of those muscle groups.
Physical exam is often normal at rest. Some people will have visible painless fascial herniations. On physical exam immediately after exercise, there may be pain on palpation of the muscles involved, pain with passive stretching of the muscles, and the compartments may be quite firm. No imaging is necessary but will commonly be done to rule out other diagnoses such as a stress fracture. The diagnosis of CECS can be made clinically but given its non-specific nature, it can be confirmed using immediate post-exercise intracompartmental pressure testing. If confirmed, a surgeon may be consulted for an ELECTIVE fasciotomy.
The differential diagnosis includes medial tibial stress syndrome (shin splints), stress fractures, fascial defects, nerve entrapment syndromes, popliteal artery entrapment syndrome, and vascular or neurogenic claudication.
It is important to note that shin splints present with pain on the medial border of the tibia. Shin splints are NEVER lateral! A high level of suspicion is required for the diagnosis of ant/lat CECS as all imaging will be reported as normal.
While uncomfortable, there is no evidence to suggest that the pain from CECS indicates any muscle damage or has long-lasting implications. Modified activity is a reasonable treatment option. People may choose to avoid continuous running and opt to bike, swim, skate or play shorter shifts. Hopefully, this brief introduction sheds some light on the subject.
Jim Niu MD, CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport Med
First-Aid Treatment for Friction Blisters: “Walking Into the Right Direction?”
Lando Janssen, Nenltje A.E. Allard, Dominique S.M. ten Haaf, Cees P.P. van Romburgh, Thijs M.H. Eijsvogels, Maria T.E. Hopman. Clinical Journal of Sports Medicine, Vol 28, No. 1, January 2018.
Trauma-induced separation within the epidermis, or friction blisters, are frequently encountered by patients choosing to be physically active to improve their overall health and well-being. Although most blisters are benign entities, complications including antalgic gait patterns, exercise-related or overuse injuries, cellulitis or sepsis can result. Thus, from the primary care physician’s perspective, the goal of treatment remains to reduce pain, facilitate healing and prevent both infection and recurrence.
However, much of the advice provided to patients regarding this topic is not evidence-based. To date, very limited research has been conducted to examine different treatment regimens for friction blisters. Furthermore, each study on this topic is limited to studying a homogenous population (elite athletes, military personnel). The purpose of this study was to compare the efficacy of fixation dressing versus adhesive tape in the first-aid treatment of friction blisters. These 2 methods were evaluated based on 1) Time of treatment application, 2) effectiveness, 3) material satisfaction in a large group of participants of the Nijmegen Four Days Marches (4DM). In addition, this study included a 1 month follow-up period to evaluate blister healing and complications when comparing treatments with different blister-covering materials.
The major findings of this prospective observational cohort study were:
• Time of treatment application was significantly lower in the wide area fixation dressing group (41.5min, SD = 21.6min) compared to the adhesive tape group (43.4min; SD = 25.5min; P = 0.02).
• A significantly higher drop-out rate in the 4DM was observed in the fixation dressing group as compared with the adhesive tape group (11.7% vs. 4.0%, respectively, P = 0.048)
• There was no difference in pain intensity scores, infection rates, and the need for additional medical treatments. However, there was delayed blister healing in fixation dressing group (51.9% vs. 35.3%; P = 0.02) and a trend towards decreased satisfaction (P = 0.054) when compared to the adhesive tape group.
The authors conclude that despite a small, but significant reduction in the time of treatment application with wide area fixation dressings, these dressings resulted in delayed blister healing, a trend towards lower satisfaction, and a higher drop-out rate of in the 4DM. For these reasons, they do not recommend the use of wide-area fixation dressings in routine first-aid treatment for friction blisters and rather support the use of adhesive tape for this purpose.
Sean Mindra, MD, CCFP PGY3 – Sport and Exercise Medicine, University of Ottawa Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine
Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis
Enke, Oliver, et al. “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ 190.26 (2018): E786-E793.
Back pain is a common issue seen in the family medicine practice that can result in significant morbidity. There are many therapies and pharmacological options available for the treatment of back pain, but high-quality studies showing efficacy are lacking for many of these options. In 2012, a BMJ review showed treatment benefit of gabapentin for low back radicular pain based on one study, and a few although not all guidelines subsequently suggested a trial of anticonvulsants for patients with acute neuropathic pain. This has resulted in a significant increase in the use of anticonvulsants in the family practice setting for low back pain. This review examines the use of anticonvulsants (topiramate, gabapentin or pregabalin) to treat low back pain with or without radicular pain. 9 studies were examined for a total of 859 participants. Of note, however, this study was not able to perform any significant subgroup analysis, such as acute vs chronic low back pain.
1. Low back pain with or without radiating leg pain
1. Gabapentin
1. No effect for pain in short term. High-quality evidence.
2. No effect for pain in the intermediate term, low-quality evidence
2. Topiramate
1. Small clinically significant improvement pain in short-term, moderate evidence
2. No effect on disability in short-term
3. Lumbar radicular pain
1. Gabapentin or pregabalin
1. No effect on pain in intermediate term, high quality evidence
2. No effect on disability in short, intermediate, and long term, moderate evidence
2. Topiramate
1. No effect on pain or disability in short term. Low quality evidence
3. Adverse events
1. Higher in anticonvulsants compared to placebo, high quality evidence
2. Most common side effects: drowsiness, somnolence, dizziness, nausea
In summary, this review suggests that anticonvulsants do not appear to improve patients’ pain or disability with regards to back pain, with or without radicular pain. While there are many nuances, the key to treating back pain without red flags remains centred on patient education, exercise therapy, and getting a multidisciplinary treatment program involved whenever possible.
Jim Niu PGY3 Sport and Exercise Medicine Fellow
Advisor: Dr. Taryn Taylor, BKin, MSc, MD, CCFP (SEM), Dip Sport Med
Physical activity should be a focus from childhood
Article reviewed: Timing of the decline in physical activity in childhood and adolescence: Gateshead Millennium Cohort Study
Mohammed Abdulaziz Farooq,1,2 Kathryn N Parkinson,3 Ashley J Adamson,3,4
Mark S Pearce,3 Jessica K Reilly,4 Adrienne R Hughes,1 Xanne Janssen,1
Laura Basterfield,4 John J Reilly1
It has been well shown in research and preached in our world community that physical activity is an essential component to well being. Studies show a clear dose-response relationship between increased levels of physical activity and associated health benefits. Canadian guidelines for physical activity including those for children and adolescents encourage participation in a variety of physical activities that support their natural development and promote their well-being. The Canadian guidelines for physical activity note that health benefits will be felt by children and adolescents who do at least 60 minutes of moderate to vigorous physical activity (MCPA) on a daily basis. General consensus in previous studies has suggested that as we grow up, physical activity levels decline. In particular, it is a common belief amongst those involved in healthcare that in adolescent years this decline was the most drastic and important to target. It was also believed that this decline was more serious in girls than in boys. This article assessed the validity of these perceptions by reviewing the literature on this topic and by performing a longitudinal cohort study to assess physical activity decline over time from age 7 to 15.
On review of the evidence, the authors concluded that there was insufficient proof that both total volume physical activity and MVPA declines with the onset of adolescence nor to prove that this decline is more marked in girls than boys. The main reasons for this were a lack of objective measurements in the previously done research, the amount of follow-up and the lack of present-day applicability of the studies, which were mainly done before the year 2000.
The longitudinal cohort study included 545 individuals from the Gateshead Millennium Study over 8 years of follow-up, from North-East England. The cohort was studied at ages 7, 9, 12 and 15 years of age to assess the progression of their physical activity in terms of habitual total volume of physical activity and MVPA. To do this, they used an Actigraph accelerometer to get objective measures over 5–7 day intervals at each year of collection. The analysis of the cohort was done by looking at a trajectory of physical activity to be able to assess whether there was a significant drop in adolescence. As well this trajectory method of analysis allowed the authors to identify subgroups within the cohort who may have had different changes in physical activity over time.
Four trajectories of change in terms of total volume of physical activity and four trajectories as well for MVPA were identified for boys. There was one trajectory of change in the total volume of physical activity and three trajectories of change in MVPA for girls. All of these trajectories showed a decline from age 7 to the age of 15 years old in all the participants. There was no evidence of a steep decline starting in adolescence for both total volumes of physical activity and for MVPA.
This study showed that in all forms of objective data that were used as measurements showed declines in physical activity from as early as age 7. These measures are commonly used in similar studies. In recent years, since the beginning of this study, there have been other studies that fit the conclusion of these findings. These other studies either did not include childhood or failed to prove the previously held belief that physical activity begins to decline at adolescence more rapidly and declines more rapidly in girls than boys.
The strengths of this study were its longitudinal design, the size of the cohort, the objective nature of its results and the fact that it represents a contemporary sample of children. The fact that this study was located only in the North-East of England makes it possible that different results may be found in a different cohort living in a different part of the world with different physical activity policies and perspectives.
In conclusion, the present study contradicts the currently held belief that there is a significant decline in physical activity in adolescence as opposed to earlier in a child’s life. The main implication of these findings is that current policy is not founded in evidence-based findings. Thus, there is a need for future research and change in public health policy with a greater emphasis on the child rather than adolescent physical activity, and on both for boys and girls. Specifically, healthcare professionals including primary care physicians may need to consider their focus on promoting physical activity in early childhood for both sexes.
Dr. Mickey Moroz M.D.C.M. CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (CAC SEM), Dip Sport & Exercise Med
Marijuana and Its Effects on Athletic Performance: A Systematic Review
Kien V. Trinh, Dion Diep, Hannah Robson
Clinical Journal of Sport Medicine, Volume 28, No. 4, July 2018
Currently, many sporting organizations including the International Olympic Committee (IOC) prohibit the use of any substance that has an ergogenic (performance enhancing) effect, poses a risk to the use of the user’s health and safety, or violates the spirit of sport. The legalization of marijuana in Canada is tentatively set for October 2018, which may increase the use and normalization of the drug. Thus, it is vital that primary care physicians remain up to date regarding the rules and regulations surrounding marijuana use, as well as its effects on users. Much of the literature points to marijuana being more of an ergolytic drug, where it impairs rather than improves one’s physical performance, stamina, or recovery. Despite patient beliefs that that marijuana use can improve their performance, it’s ergogenic potential remains poorly understood. The purpose of this study was to determine the effects of marijuana on athletic performance.
This systematic review included any primary study of any design of any clinically or laboratory-relevant outcomes on athletic performance. Studies included both male and female participants of any athletic background, between the ages of 18 and 65 with no other comorbid conditions. All studies used marijuana cigarettes for the intervention group and all studies utilized a control group (participants that were not given marijuana cigarettes). Vital signs, pulmonary measures, physical work capacity, grip strength, and exercise duration were chosen to be relevant outcomes. After identifying and screening 929 citation postings, only 3 trials met the inclusion criteria.
The effects of marijuana on heart rate, blood pressure and exercise duration remains unclear. Low-quality evidence exists for marijuana having an ergogenic on effect on exercise by inducing bronchodilation and increasing FEV1 after exercise compared to inactive controls. There was no significant difference in grip strength between treatment, sham and inactive control groups. Additionally, there is low-quality evidence that suggests marijuana use is associated with decreased physical work capacity compared with sham and inactive control groups.
There are several limitations to this study. Firstly, there were only 3 trials (one observational, one crossover, and one crossover randomized control trial) that met the inclusion criteria. When comparing these 3 trials, clear heterogeneity is noted between study type, intervention, and outcomes. Thus, no meta-analyses were performed. Furthermore, despite various available forms of consumption (e.g. edible, vaporization, tinctures, oils), all studies only assessed smoked marijuana as their treatment. There is a clear paucity of current research on marijuana and its effects on athletic performance. The banning of substances in competition is a highly debated and ever-changing field. With its legalization in Canada looming, further research is warranted on marijuana and its effect on athletic performance to help investigate and justify current and future doping policy.
Sean Mindra, MD, CCFP
PGY3 – Sport and Exercise Medicine, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine
Different ways of promoting physical activity
Article reviewed:
Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis
Breanne E. Kunstler, MPhty, Jill L. Cook, PhD, Nicole Freene, PhD, Caroline F. Finch, PhD, Joanne L. Kemp, PhD, Paul D. O’Halloran, PhD, and James E. Gaida, PhD
As per the Canadian Institute for Health Information, in 2017, total health expenditures in Canada are expected to represent 11.5% of Canada’s gross domestic product (GDP). Physicians and health care professionals continue to promote preventative care as one way to tackle the ever-growing cost of health care. Primary prevention is generally low cost and has wide-reaching benefits. Specifically, physical activity has been shown to reduce the burden of disease and decrease the progression of many common non-communicable diseases (NCDs). In 2013, just over 2 in 10 adults and 1 in 10 children and youth in Canada met the Canadian Physical Activity Guidelines, which requires adults to achieve 150 to 300 minutes of moderate intensity of physical activity or 75 to 150 minutes of vigorous intensity physical activity, or an equivalent combination of both each week, as well as muscle-strengthening activities on at least 2 days each week. With so many people in Canada being physically inactive and with the rise in preventable diseases, primary care providers, including allied health professionals, have a critical role to promote physical activity and well-being. Physiotherapists are particularly well trained and positioned to promote physical activity in patients as their treatment plans often involve some type of physical activity.
This article did a systematic review of studies that assessed the efficacy of one-on-one, physiotherapist-led physical activity (PLPA) interventions at increasing physical activity levels among adults in clinic-based private practice, primary care, and outpatient settings. The eight studies that met this articles inclusion criteria looked at adults over the age of 18 who either had MSK injuries, risk factors for NCDs or who were suffering from NCDs. The studies either used subjectively (questionnaire) or objectively (accelerometry) quantified change in physically activity. A meta-analysis was conducted to look at the correlation of PLPA interventions at different follow-up times, as well as looking at success rates of PLPA interventions meeting minimum recommended physical activity levels. It also looked at the effect that the length of the therapy session had on the PLPA interventions success.
Looking at 3 out of the 8 studies included in the review, there was a significant finding that PLPA interventions were efficacious at assisting adults achieve the minimum recommended physical activity levels with an OR of 2.15. The other 5 studies included in the review showed a significant finding that PLPA interventions had only a small effect on patient’s physical activity level in short and medium term follow-up which was not seen past 1 year of follow-up. When comparing the length of intervention seen in the different studies there was no difference in efficacy of PLPA interventions on the improvement physical activity level. Overall, the improvement in PA seen by PLPA interventions ranged from increasing vigorous, moderate and low-intensity PA.
In this article, it was highlighted that there was a lack of analysis on the content as opposed to the length of the interventions. There was also no emphasis on the importance of maintaining the level of physical activity achieved over time. As it was shown, the benefits of the PLPA interventions were not seen in the majority of the studies in long-term follow-up. The one study that did use intervention techniques geared towards maintenance of PA improvements resulted in such maintenance. Even though there was improvement of PA in most patients who received PLPA, the benefits of preventative lifestyle changes such as PA is truly seen when maintained over time and integrated into a person’s weekly routine.
In summary, patients ultimately are responsible for the maintenance of their lifestyles. To help them integrate physical activity into their daily lives primary care providers can play an important role. This article shows that training physiotherapists and primary care health care professionals in behavioral changing counseling can help tackle the growing rate of inactivity and ultimately decrease the risks of NCDs.
1. Moroz M.D.C.M. CCFP
Sport and Exercise Medicine Fellow, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (CAC SEM), Dip Sport & Exercise Med
Return to Driving After Hip Arthroscopy
Amit M. Momaya, Despina Stavrinos, Benjamin McManus, Shannon M. Witting, Benton Emblom, Reed Estes
Clinical Journal of Sport Medicine, Volume 28, No. 3, May 2018
Hip arthroscopy represents one of the most common procedures performed to help alleviate hip pain and improve quality of life. Driving represents one of the most important topics that patients will ask physicians about, especially in the primary care setting after they have been discharged from hospital and are looking to get back to their daily routine. The purpose of this study was to use a modern driving simulator and assess patients’ braking performance after undergoing a right hip arthroscopy.
This prospective study involved 14 patients scheduled to undergo right hip arthroscopy (perfumed by a single surgeon at 1 institution) and a control group (healthy volunteers who denied musculoskeletal problems) of 17 participants to account for a potential learning phenomenon. The two groups did not differ in age, sex, height, weight, and driving experience as measured by years since licensure. The control group did not undergo any type of surgical procedure. All were between the ages of 16 and 60, licensed drivers, and regularly drove using automatic transmission. All participants drove in the simulator initially to establish a baseline, and then at 2, 4, 6, and 8 weeks post-operatively. The following variables were measured:
• Initial reaction time (IRT): time between stimulus and initiation of release of accelerator
• Throttle release time (TRT): time from initiation to full release of foot from accelerator
• Foot movement time (FMT): time between release of accelerator and initial contact with brake
• Brake travel time (BTT): time to apply 200N of force from initial brake press
• Braking reaction time (BRT): the sum of IRT + TRT + FMT
• Total braking time (TBT): the sum of BRT + BTT
The results of the study revealed that the experimental group exhibited significant improvements in INT, TRT, FMT, and BRT at between the pre-operative and 2 weeks post-operative driving sessions in the simulator, however there was no significant change thereafter. There was no significant change in BTT in the experimental group over the 8-week period. No learning phenomenon was noted in the control group.
This study, which was the first to address driving after hip arthroscopy, suggests that most patients may return to driving at the 2 week mark, as indicated by breaking performance. However, there are several limitations to this study. Perhaps the most obvious limitation is that the participants are operating in a simulation and not in an actual vehicle. In addition, despite the fact that all patients in the experimental arm underwent a hip arthroscopy, the procedures themselves differed with respect to degree of soft tissue and bony surgery. For example, an osteoplasty may affect braking performance significantly more than a simple debridement. The relatively small sample size was a barrier to attempt to look at whether these differences existed. Also, it is important to note that currently, there are no single legally mandated or universally accepted numbers for BRTs. While this study provides some evidence for driving after right hip arthroscopy, it is recommended that primary care physicians, surgeons and patients communicate openly with one another to create individualized timelines for safe return to driving.
Sean Mindra, MD, CCFP
PGY3 – Sport and Exercise Medicine, University of Ottawa
Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine | {
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Why You Shouldn’t Mix Energy Drinks and Alcohol (health.clevelandclinic.org)
If you’re planning on partying any time soon, you might be planning what sort of drinks to have. And one popular choice over the last several years has been to mix alcohol with caffeinated energy drinks.
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While this may seem like a good idea – the energy drink overpowering alcohol’s drowsiness effects – there are some negative side effects that warrant consideration.
Registered Dietitian Julia Zumpano, RD, warns the high caffeine content in energy drinks may get you to drink more than your limit. “Caffeine is a stimulant but once you come down from that high you want it again, just like coffee,” she says. “It’s a very addictive effect.”
We chatted with Zumpano to get the low-down on why you should avoid such a troubling mix, no matter what your situation is.
The alcoholic energy drink craze
In the late 2000s, brands flooded the market with canned beverages that packaged the two ingredients together, resulting in a wave of popularity for drinks like Four Loko and Sparks. But, in 2010, the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) sent warnings to several companies that produced these drinks.
According to the FTC, these drinks presented a risk to consumer health because, “Consumers – particularly young, inexperienced drinkers – may not realize how much alcohol they have consumed because caffeine can mask the sense of intoxication.”
Several drinks, like Four Loko, altered their drinks by dropping caffeine from their ingredients list. Other brands simply pulled their lines altogether.
Even with those specific drinks pulled from the market, though, the chance to mix energy drinks with alcohol remains an easy enough cocktail to make. Drinkers just have to make their own mix instead of relying on these pre-mixed formulas. And with that remains certain dangers.
Caffeine’s effect on intoxication
According to Zumpano, researchers have spent a lot of time over the years exploring the way in which energy drinks might reduce the sensation of intoxication — which may induce more drinking.
Researchers not only wanted to find out if energy drinks offset the sedating effects of alcohol, but they were also looking to determine if the reduced sensation of intoxication impairs judgment relative to risky behaviors, like drunk driving or binge drinking.
“Alcohol has this sedative effect. It makes you feel more relaxed” says Zumpano. “But it also has the residual effect of making you feel tired. Some people like being relaxed but not feeling tired so they add caffeine, a stimulant, to bring them back up, to enjoy the feeling of being relaxed without feeling tired.”
The problem, she says, is that the stimulation can mask how drunk you actually are, prompting you to overdrink. Additionally, she points out that because of the caffeine intake, you’ll have more energy through the night meaning you might be drinking longer and taking in more alcohol.
That syncs with the conclusions of multiple studies in the decade since that initial wave of popularity: yes, mixing alcohol with energy drinks does seem to increase the desire to consume more alcohol and could result in more alcohol-related injuries.
As for whether or not these drinks alter one’s perception of how intoxicated they are, the evidence has been less conclusive so far.
Issues with the heart
Another side-effect of consuming energy drinks is potential damage to the heart. As Zumpano notes, both caffeine and alcohol have their own separate effects on blood pressure and, when combined, can create even more havoc.
One 2018 study tested 44 non-smoking, healthy students in their 20s, exploring the impact one 24-ounce energy drink had on the function of their blood vessels. According to the study, “vessel dilation was on average 5.1% in diameter before the energy drink and fell to 2.8% diameter after, suggesting acute impairment in vascular function.”
And a 2016 study found that while acute energy drink consumption didn’t lead to a significant increase in heart rate, it did lead to a significant increase in both systolic and diastolic blood pressure. This is particularly bad for someone who already has elevated blood pressure, Zumpano says, but it can also lead to long-term problems if you don’t.
Given that it’s already been established that excessive amounts of alcohol can negatively impact your heart health, combining it with energy drinks could up that risk even more. “If you’re consistently drinking and combining caffeine and alcohol, forcing your blood pressure to be elevated, you’re increasing your risk of stroke, heart attack and heart disease,” she says. “And long term excessive alcohol use can negatively affect your kidneys and your liver, too.”
Caffeine and alcohol both stimulate atrial fibrillation (irregular heartbeat), Zumpano adds, noting that people who already suffer from it should be even more cautious when consuming alcohol, caffeine or both combined.
There’s also a question of sodium. “Some caffeinated/energy drinks could contain sodium which could further increase your blood pressure,” Zumpano adds.
And this is all further compounded by the way both alcohol and highly caffeinated drinks can drastically alter your sleep pattern which can lead to even more heart issues.
Loaded with calories
Besides all of these other issues, Zumpano says sugar-laden energy drinks will definitely put a big dent in your diet. And that, in turn, can still circle around to have a big negative impact on your heart health.
“Alcoholic drinks can range from 100 calories up to 500 calories per drink, depending on what you’re having. A traditional 9oz pina colada provides 500 calories and 63 grams of sugars,” she says.
And it’s not just mixed drinks; Zumpano points out that stout beers brewed with coffee, which have become increasingly popular over the years, carry plenty of calories and caffeine, too.
Beyond the caloric content of the alcohol, most of these energy drinks average between 250 to 300 calories, says Zumpano, so they add up very quickly. “If you have three of those drinks, now you’ve got a 900-calorie intake from those alone. If weight loss or weight management is a goal for you, that intake is going to adversely affect your goals.”
There’s also the issue of sugar, which is a common, loaded ingredient of the energy and caffeinated drinks. “High amounts of alcohol and simple sugars lead to elevated blood triglycerides,” she adds. “Triglycerides are fats in the blood that are separate from cholesterol but can still contribute to plaque formation in the arteries.”
That kind of consumption can lead to fatty liver disease or pancreatitis. Additionally, the alcohol-caffeine combo can also lead to elevated blood sugar and blood triglyceride levels which can lead to a higher risk of diabetes.
How to mitigate risks
Zumpano says the best way to make sure you don’t risk these health issues is simply to avoid mixing caffeine with alcohol, particularly when that includes energy drinks.
“If you do want to have alcohol but want to stay up later, try having a separate caffeine drink a few hours before,” she suggests. “And try avoiding high levels of caffeine. Instead of an energy drink, try a caffeinated tea, a small cup of coffee or a shot of espresso.”
If you do like mixed drinks, Zumpano recommends using a club soda, flavored water or seltzer as a mixer. She also suggests avoiding high sugar drinks. Besides the issue of sugar, people are more inclined to consume more sweet drinks and have them quicker which could lead to over-consuming.
Finally, she suggests including water between each alcoholic and/or caffeinated drink. Water will help you rehydrate, which can lessen the effects of a hangover the next day. Water between each alcoholic drink will also help you consume less alcohol, calories and sugar.
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Add a Few More Hours To Your Intermittent Fasting With Akimbo Fasting Fuel (www.mensjournal.com) | {
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I wonder if I am bipolar. I've been treated for severe
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I wonder if I am bipolar. I've been treated for severe depression before and am mildly depressed at intervals, lasting 1-3 weeks. Sometimes, less frequently mildly elated, irritable, even angry for hours, hypersexual, very creative, many thoughts, less sleep. What confuses me is duration - sometimes just elated for a few days, but it has been for weeks in the past. I spend more but don't get out of control with it. Olfactory hallucinations sometimes. Not on meds or drugs, & try not to drink too much. My brother seems worse than me. I'm 53.
Submitted: 7 years ago.
Category: Mental Health
Expert: Gina P replied 7 years ago.
Hi,
Thank you for using Just Answer. The symptoms you describe can be indicative of Bipolar Disorder. But, it sounds as if you are managing them fairly well. The onset of this disorder usually begins in the twenties. This could also be related to some hormonal imbalance or vitamin deficiency.
I would recommend you have a physical exam to rule out medical and if the symptoms persist, have an evaluation by a psychiatrist. Please let me know if you have other quesions. Thanks, Gina
Customer: replied 7 years ago.
Gina,
thanks for your reply. Actually I first experienced these symptoms when I was 16. It's only recently that I began to consider the possibility of bipolar disorder
Les
Expert: Gina P replied 7 years ago.
Hi Les,
As with any diagnosis, it would be impossible to diagnose on line. Please follow through with the medical and psychiatric exams so you can enjoy your life to the fullest. Gina
Gina P and other Mental Health Specialists are ready to help you | {
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Pertussis (whooping cough) is a very contagious disease caused by a type of bacteria called Bordetella pertussis. Among vaccine-preventable diseases, pertussis is one of the most commonly occurring ones in the United States (CDC).
What are the symptoms of whooping cough?
The early signs for pertussis are runny nose, coughing and sneezing just like the common cold and spreads through droplets in the air when infected people cough or sneeze. For infants less than 6 months old, the disease can be potentially very serious but the symptoms can be mild in older children and adults. In fact, approximately 83% of infants who contract pertussis are infected by a parent, older sibling, or other caregiver who didn’t know they were sick.
The ‘classic’ pertussis disease progression:
• Stage 1 (7-10 days): common cold-like symptoms 7-10 days
• Stage 2 (4 - 6 weeks): Cough is intense, often with a "whoop", and coughing spasms that can cause vomiting, rib fractures and may require hospitalization. For infants they can have a disruption in their breathing called apnea. Babies might turn reddish, purplish, or bluish. If your baby is having difficulty breathing they need to see a healthcare provider immediately
• Stage 3 (2 - 6 weeks): Symptoms gradually resolve during this stage but can occur for 6 months or longer.
So, what is considered ‘best practice’ for protecting your newborn?
Cocooning. This is the practice where the primary caregivers and anyone who will regularly be coming in contact with the baby gets vaccinated in order to provide a ‘cocoon’ of protection around the baby. This would be the baby’s parents, siblings, grandparents, day care workers, and healthcare providers. It is recommended that pregnant women get vaccinated in the third trimester in order to build up an immunity and pass that along to the fetus so that they’re better protected when they’re born.
The practice of cocooning showed remarkable results in California. In 2010, California had 9154 reported pertussis cases with infants less than 6 months contracting the disease at a rate of 435 per 100,000 people. 10 infants, all less than 3 months old, died of the disease. California implemented a cocoon vaccination plan and in 2011 the number of cases dropped to 2795 with no deaths from whooping cough. This was the first time since 1991 that there were no deaths from pertussis in California.
Talk to your doctor about getting a vaccine, especially if you’re pregnant, or if you will be in contact with a newborn.
Comments
Jennifer
Hi Natalie,
First of all, congratulations on your pregnancy!
The recommendation for pregnant women says, "Pregnant women who have not been previously vaccinated with Tdap should get one dose of Tdap during the third trimester or late second trimester. " (CDC)
By that recommendation, it sounds as though you would not be in need of a booster, but I would certainly ask your OB or primary care physician to be sure for your specific healthcare needs.
Sincerely,
Jennifer
4/13/2012 3:52:16 PM
Natalie
What is my husband and I got the vaccine 2.5 years ago? I'm currently pregnant and in my third trimester, should I get another booster to better build up an immunity to pass on to my baby?
4/13/2012 2:06:25 PM
Leave comment
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3,555,030,171,522,742,300 | Campuses: FH.com Home button
Hemophilia
Types of Hemophilia
There are many factors in the blood that are involved in the forming of clots to stop bleeding. A child with hemophilia is missing, or has a low supply of, one of the factors needed in order for the blood to clot. Two common factors that affect blood clotting are factor VIII and factor IX.
Hemophilia is classified by its level of severity. Hemophilia may be mild, moderate, or severe, depending on the level of the blood clotting factors in the blood.
The three main forms of hemophilia include the following:
• Hemophilia A--caused by a lack of the blood clotting factor VIII; approximately 85 percent of hemophiliacs have type A disease.
• Hemophilia B--caused by a deficiency of factor IX.
• Hemophilia C--some doctors use this term to refer to a lack of clotting factor XI
• von Willebrand disease--a part of the factor VIII molecule known as von Willebrand factor or ristocetin cofactor is reduced. The von Willebrand factor involves helping the platelets (blood cells that control bleeding) attach to the lining of a vein or artery. This missing factor results in prolonged bleeding time because the platelets are unable to attach to the wall of the vessel and form a plug to stop the bleeding. This disease is similar to hemophilia, but is not usually called by this name. It is more common and usually milder than hemophilia.
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7,367,513,015,862,740,000 | PunchNG Menu:
Walking and walking
Dr. Sylvester Ikhisemojie
Dr. Sylvester Ikhisemojie
The human body is designed for walking, among many other different types of movement that are possible. As one of the few mammals that can actually ambulate erect, it is little wonder that the features of any individual are so adept at providing the ability to walk. It is a common thing to see people in urban areas in many countries abandon this beneficial, natural means of communication for cars, buses and other motorised means of transportation even over short distances. Rather than take a walk down the street, for example, many people would hop on a motorcycle or hail a cab or drive. They are not likely to ride a bicycle which would make them sweat a bit and burn some calories. The result has been a steadily increasing waistline across several population groups in different countries. Obesity has become a problem and the diseases associated with that are an increasing health burden in many OECD countries, as well as among the affluent middle class in the developing countries.
The problems of arthritis, high blood pressure, diabetes and heart disease have become a major headache in some of these nations and there is none to blame than an increasingly sedentary lifestyle. Instead of driving down the street for example, you can walk. Rather than take an elevator in a multi-storey building, you can take the stairs.
Little deliberate things like these improve the overall strength of the muscles, sustain their bulk or even increase it. When the skeletal muscles benefit in this way, the cardiac muscles also do so. In some cases, especially when there have been associated changes in the diet, weight reduction might be achieved. Other benefits of walking include an improvement in the mood and better sleep. The regularity of this natural habit also has implications for our gait.
Other types of movement such as running and swimming are not regularly engaged in and are thus less important than the one type of movement that is common to most people. The erect posture of man, the ability to achieve most movements between two different points with the use of two legs mainly is an indication that this was the desire of a supreme being at the time of creation. However, the spiritual angle is not the purpose of this essay but rather the benefits that walking can bring to our health. Indeed, because walking is about the most natural thing a man can do, it is an exercise that makes sense even while being performed effortlessly.
Walking is an excellent way to keep the muscles bulky, healthy and well supplied with blood and oxygen. Muscles have a resting phase which occurs between activities and those movements help such muscles refresh themselves. That is particularly true of a muscle like the heart which is the busiest muscle in the entire body. As a result of the increase in metabolism that walking brings about, it is possible to keep fit by walking regularly in one’s neighborhood and elsewhere in the environment. It is estimated that in order to fully enjoy the benefits of walking an individual will require to take an average of 8000 steps a day. Walking, when done on a regular basis is of immense benefit to our cardiovascular health, which means that even the walls of the blood vessels stand to benefit. It is also of great importance to the maintenance of the heart’s health.
Walking also helps to burn belly fat. This is an absolutely important quality of this form of exercise because in those people who are overweight or obese, the larger their abdominal girth is, the more they suffer from the hormonal effects of having a large abdomen. The value of good regular exercise is in helping to keep this fat away. In the same manner, that sort of exercise helps to keep away the tendency to gain weight unduly. However, when the real aim is to lose weight, the pattern of walking is often recommended to be a cardio-exercise and should aim to deliver brisk walking for 30 to 90 minutes most days of the week. When this is achieved, then weight loss is possible. Besides, walking at a leisurely pace or a brisk pace is also good for the group of muscles on both calves that are known as the peripheral hearts. They have earned this appellation because these muscles are effective pumps in pushing blood back towards the heart during our daily activities. They squeeze and propel the blood along and when they do that effectively, the heart benefits greatly.
Walking is also good for the joints; it keeps them well lubricated by distributing the synovial fluid around evenly. With time, the joints will not give any form of discomfort unlike what happens often when the exercise routine is vigorous and regular such as you might find in an athlete or a professional footballer. Among those sorts of people, the wear and tear of many seasons of active play is sufficient in the end to cause osteoarthritis, tendon tears and muscle avulsions. These are serious injuries that usually take a long time to heal if they ever do so. Running may ultimately cause similar damage even when not done professionally but walking guarantees a sport that is least likely to bring about any associated injury occurring as a result of the engagement.
If an individual is taking up walking as a sport, it is better to start with short duration walks over a short distance. It should be done consistently because regularity helps to sustain burning the calories and also in improving the overall metabolism. As time goes on, both the duration of the exercise and the distance covered should become easier to increase so that a regular pattern is established. It is important to not make it a habit to skip more than one day at a time so that a certain kind of expectation can be built into the process. When you walk at a brisk pace for about 30 minutes, you can burn 100 and 300 calories. This can be doubled easily if you are able to walk like that for one hour. In the first 30 minutes of such brisk walking, the fuel used by the body is essentially stored sugar but this is soon all used up. When the exercise continues beyond this point, the body then calls up the fat stores and converts them into fuel for its use. Until the weight-watcher reaches this point, no reduction in weight is possible. So, since these fat stores are what any concerned person wants to get rid of, that remains the incentive to extend both the distance and the duration of the walk.
Questions and answers
Dear doctor, your article on Sunday, August 25, 2019 (The way we build) got me rolling on the floor. Nigeria for show. We are still living the life, adapting at all turns. God help us. xxx @xxx
God bless you also. Thank you so very much for your comments. Nigerian governments are getting to be able to build cities and towns cheaply…..they do not have to lay telephone wires, power lines, water mains, drain ducks, sewage mains, gas lines and others but they are not even able to provide much of what is outstanding.
Dear doctor, please clarify sir if irregular/abstinence from sex can lead to prostate cancer. God will bless you more. 0703xxxxxxx
Well, the relationship between both scenarios is not just straight forward like you asked it. What is known is that when a man abstains from sex or has irregular sex, he has got a higher chance of developing prostate cancer. That is thought to be possible because certain emissions that ought to go out of the body with the semen are not discharged leaving them to accumulate within the system and increase the chance of getting cancer of the prostate.
Dear doctor, I am 21 and I always forget things easily. Even when I read and read, I still forget. Please sir, what do I do? And I still want to go to school. Thanks a million sir. 0812xxxxxxx
I appreciate how you feel. It is a challenge without a doubt and I must say however, that I personally believe that even as you read, your mind is probably roaming over other things that are not of immediate concern or relationship to what you might be reading. In future, you may read up on something and then you make your own notes on what you just read, and read the notes you made yourself and let us see whether you will still forget. Gradually, your memory will improve and you will recall what you read.
Dear doctor, thank you for the wonderful advice and awesome works. I pray that God will continue to enrich you with wisdom. Sir, I am a 19-year-old female. I have some boils growing in my private parts and sometimes, it itches me. When it gets ripe, I press it and it is so painful. I don’t know what to do. It makes me uncomfortable. 0902xxxxxxx
Well, boils should not be pressed because they will cause pain when that is done. As a final solution, you should let a doctor see these boils just to be sure they are ordinary boils and prescribe the appropriate antibiotic to use. Anything else you do will merely be guess work and will only give you temporary relief.
Dear doctor, a friend of mine took family planning injection for three months. In the first two months she said that when she was menstruating, it was coming out only a little but for many days while in the third month, it did not come out at all. Now, it is going to three months and she has not menstruated and she is not pregnant. Please what could be the cause of the problem? Thank you sir. 0708xxxxxxx
It is a problem that you can often see when you take a hormone preparation for the purpose of family planning. It is not desirable for the injection to work like that but sometimes, this is what you will find. Sometimes, people will bleed from one period to the next and the only way you can tell the difference between menstruation and bleeding is that the menstruation sheds more blood. Your friend’s experience is unique because she has experienced both prolonged bleeding and no bleeding at all. In the majority of women, the period continues to happen normally. She is normal too and the only way out of this situation is to convert to another type of family planning.
Dear doctor. I am female, aged 25 and I do usually have a frequent runny nose and cold at night. People tease me with it. I sneeze at midnight when I wake up to urinate. When it is severe, I scratch my nose, even though the nostrils are blocked and develop sore throat. Please advise me sir. 0802xxxxxxx
This appears to be an allergy in which case the runny nose may be provoked by something you might have perceived or some kind of particle floating in the air that your body does not like. You have to see a doctor for treatment and if the problem persists, you could be further referred to an ear, nose and throat surgeon. Do not try to do self-medication.
Dear doctor, I appreciate your good works; your direct, uncomplicated responses. I am 58. I have discovered in the last two years that my erection is not as strong for purposes of long lasting intimacy with my wife. I do not suffer from high blood pressure, diabetes or any challenging ailment. Can I resort to the use of Viagra or any approved sex enhancing drugs without fear of attendant risks? Or should I just ride along like that? 0803xxxxxxx
Thank you so very much for your kind words. Viagra is available over the counter and can be bought and used without a written prescription. However, as a precaution, it is always useful to have your doctor check you to determine that you do not have some hidden problems which would prevent you from safely using it. Most of the time, it is people with poorly controlled high blood pressure or heart disease that need to worry.
Dear doctor. I am 63 years old. Since the past nine months, I have had gas bubbles in my stomach. Sometimes, I belch but most times, as often as 20 times a day, I fart while sitting, standing or bending down. I have stopped fizzy drinks in the last three months and I have limited my sugar intake to the minimum. The gas is odourless. What causes this and what medication can make it stop? Thanking you. Anonymous
This is not a disease. We all have gas bubbles in our stomach, belch and fart. Most people will fart about 14 times a day on the average and most of the time, it is odourless like yours. When we talk, laugh, sing and so on, we swallow air. When the food we eat is digested in the intestines, one of the side products is gas so that there is always gas in our system. If your fart smells, it would depend on what you ate but as for the frequency, that is the normal way to expel all the swallowed air in our intestines.
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All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.
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6,024,243,640,832,453,000 | This Clostridium Difficile Infection calculator determines the CDI rate of recurrence and the risk group based on patient age, disease severity and antibiotic use. There is in depth information on how lawyerfree.ru works below the form.
1
Age greater than 65
2
Severe or fulminant illness
3
Any non-CDI antibiotics used
How does this Clostridium Difficile Infection calculator work?
This health tool provides information on the recurrence rate and risk group for patients diagnosed with the bacterial Clostridium Difficile Infection. This condition is the most common cause of infectious diarrhea and colitis.
There are three criteria in the Clostridium Difficile Infection calculator:
■ Age greater than 65 – CDI is known to be of higher threat to elderly patients in health care facilities, especially those in long term hospitalization.
■ Severe or fulminant illness – the severity of CDI ranges from mild to fulminant pseudomembranous colitis. The greater the severity, the higher the risk group in which the patient is and the rate of recurrence.
■ Any non-CDI antibiotics used – this item refers to the fact that non-CDI antibiotics can be used as diagnosis criteria.
The presence of either of the above criteria means the score is added 1 point, therefore the final scores range between 0 and 3. The below table presents each score with their respective risk group and recurrence rate in percentage.
CDI score Risk group Recurrence rate
0 Low 0%
1 Low 33.3%
2 High 71.4%
3 High 87.5%
Clostridium Difficile Infection medical guidelines
This nosocomial and community-acquired pathogen occurs in 1/5 cases with antibiotic associated diarrhea. Given that new strains appear with antibiotic developments, in the past two decades, incidence has increased dramatically.
High incidence is also associated with the use of medication that suppresses gastric acid production, either by antagonization or pump inhibition.
Presentation is usually symptomatic with the following: watery diarrhea, fever, abdominal pain and nausea. However, the array of cases is between asymptomatic colonization and fulminant colitis which can complicate to toxic megacolon or perforation of the colon.
Main diagnosis method is the enzyme immunoassays for detection of the C. difficile toxin but stool culture (stool leukocyte and lactoferrin) is also practiced but with limited accuracy.
There is also a clinical prediction rule with the following four characteristics:
■ New onset of partially formed or watery stools (more than 3 in 24h);
Recent antibiotic exposure;
■ Abdominal pain;
■ Fever (up to 40.5 °C or 105 °F).
Antibiotic treatment for Clostridium Difficile Infection usually revolves around metronidazole, vancomycin or fidaxomicin. Oral rehydration therapy is also required. Severe cases may require colectomy.
Average recurrence rate is reported around 25%, but as revealed in the results above, it increases with the presence of certain severity factors. After the first recurrence after treatment, rates go up with every subsequent episode.
Prophylaxis methods focus on limitation of antibiotic use, probiotic use, hand washing and proper room cleaning in health facilities.
References
1) Burnham CA, Carroll KC. (2013) . Clin Microbiol Rev; 26(3):604-30.
2) Bartlett JG, Gerding DN. (2008) . Clin Infect Dis. 46 (Supplement 1): S12-S18.
3) Heinlen L, Ballard JD. (2010) . Am J Med Sci; 340(3): 247–252.
4) Fred C. Tenover FC, Baron EJ, Peterson LR, Persing DH. (2011) J Mol Diagn; 13(6): 573–582.
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-2,648,882,398,683,263,500 | • slide10
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Vision News
06 July 2020
Providing the New River Valley
with Quality, Comprehensive Eye Care...
Begin Booking an Appointment
Our top priority is the care of your eyes. We want to keep your eyes healthy through regular eye health evaluations, communication, and education. This page lists a few of the most common eye diseases. Select from the following list of topics or scroll to learn about the causes, symptoms, and treatments for:
Blepharitis
blepharitisThere are two types of blepharitis. Seborrheic blepharitis is often part of an overall skin condition called seborrhea, which may also affect the scalp, chest, back and the area behind the ears. The second form of blepharitis – staph blepharitis – is a more severe condition, caused by bacteria, that begins in childhood and may continue through adulthood.
Causes
Hormones, nutrition, general physical condition, and even stress may contribute to seborrheic blepharitis. Build-ups of naturally occurring bacteria contribute to staph blepharitis.
Symptoms
Blepharitis could be described as dandruff of the eyelids. Seborrheic blepharitis results in redness of the eyelids, flaking and scaling of eyelashes, and greasy, waxy scales caused by abnormal tear production. Staph blepharitis can cause small ulcers, loss of eyelashes, eyelid scarring, and even red eye.
Treatment
Careful cleaning of the eyelids can reduce seborrheic blepharitis. Application of hot packs to the eyes for 20 minutes a day can also help. Staph blepharitis may require antibiotic drops and ointments.
Top of Page
Cataracts
cataractA cataract is a cloudiness that occurs in the lens of the eye. The lens is made mostly of water and protein that is arranged to let light through. Sometimes the protein clumps, blocking light and making the lens appear cloudy.
Symptoms
A person with cataracts may encounter faded colors, problems with light (such as halos, or headlights that seem too bright), poor night vision, double vision, or multiple vision.
Treatment
Your eye doctor can detect the presence of cataracts through a thorough eye exam, including a visual acuity test and dilation of the pupils. Treatment is available to prevent or reduce cataracts.
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Conjunctivitis
conjunctivitisConjunctivitis, commonly called pink eye, is a redness of the eye. It is often accompanied by a discharge (clear, yellow, or white) and itching in the eye.
Causes
Pink eye may be caused by a bacterial infection or a viral infection, but it may also be caused by an allergic reaction. Viral pink eye is highly contagious.
Prevention and Treatment
To avoid spreading conjunctivitis, wash your hands often, do not touch the infected area with your hands, do not share wash cloths or towels, disinfect surfaces, and avoid using makeup which may become contaminated. A child with pink eye should be kept from school for a few days. Sometimes an eye doctor will need to prescribe antibiotic eye drops and ointments to clear up conjunctivitis.
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Diabetic Retinopathy
Diabetic retinopathy is a condition associated with diabetes. High levels of blood sugar may damage tiny blood vessels in your eye. New vessels may form to replace the damaged vessels. The new vessels can burst, resulting in blurred vision or even blindness.
Symptoms
• "Floaters” – small specks that pass across your field of vision, made up of cells floating in the transparent gel of your eyeball
• Difficulty reading or seeing things close-up
• Sudden loss of vision
• Flashes
• Blurred or darkened vision
Risk Factors and Treatment
If you have diabetes, make sure you control your blood sugar level. This will reduce your risk of getting diabetic retinopathy. If you are experiencing some of the symptoms listed above, give us a call. If diagnosed properly, diabetic retinopathy can be treated with a laser procedure or a vitrectomy.
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Dry Eye Syndrome
If your eyes are constantly itchy or dry, you may have dry eye syndrome, which affects almost 10 million Americans. Dry eye syndrome is caused by a lack of, or poor quality of, tears. Tears lubricate the outer layer of the eye called the cornea. If the tears are not composed of a proper balance of mucous, water, and oil, the eye becomes irritated.
Symptoms
Dry eye syndrome leads to a number of symptoms, including itchiness, irritation, burning, excessive tearing, redness, blurred vision that improves with blinking, and discomfort after long periods of watching television, using a computer, or reading.
Risk Factors
There are many factors that can contribute to dry eye syndrome. These include dry, hot, or windy climates; high altitudes; air-conditioned rooms; and cigarette smoke. Contact lens wearers, people with abnormally dry skin, and the elderly are more likely to develop dry eye syndrome. You may also be more at risk if you take certain medications, have a thyroid condition, a vitamin-A deficiency, Parkinson’s or Sjorgen’s disease, or if you are a woman going through menopause.
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Glaucoma
glaucGlaucoma is a very common eye disorder affecting millions of Americans. It is caused by too much pressure on the inside of the eye. The fluid in your eyes helps to nourish and cleanse the inside of your eyes by constantly flowing in and out. When the fluid is prevented from flowing out, the intraocular pressure builds and damages the optic nerve. This causes a gradual loss in peripheral vision.
Symptoms
Those suffering from open-angle glaucoma experience a type of tunnel vision, where their field of vision gradually decreases. It can eventually lead to blindness. Narrow-angle glaucoma, which is rare, carries symptoms of sharp pain in the eyes, blurred vision, dilated pupils, and even nausea or vomiting. It can cause blindness in a matter of days, and it requires immediate medical attention.
Risk Factors
Heredity seems to be a risk factor. Also, you may be at greater risk if you are over 45, of African descent, near-sighted, or diabetic. Finally, if you have used steroids or cortisone for a long period of time, or if you have suffered an eye injury in the past, you have a greater chance of developing glaucoma.
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Macular Degeneration
Macular degeneration is a disease which affects a small area of the retina known as the macula. The macula is a specialized spot on the retina that allows us to see the fine detail of whatever is directly in front of us. Macular degeneration occurs when the macula begins to deteriorate.
“Wet” vs. “Dry”
Most often, macular degeneration is accompanied by formation of yellow deposits, called “drusen,” under the macula, which dry out or thin the macula. This is called “dry” macular degeneration. In rare cases, abnormal blood vessels develop under the macula and leak fluid. This is called “wet” macular degeneration.
Causes
A number of uncontrollable factors contribute to macular degeneration, including age, sex, eye color, farsightedness, and race. Risk factors you can control include smoking, high blood pressure, exposure to harmful sunlight, and diet.
Symptoms
It is difficult to detect dry macular degeneration in its early stages. The most common symptoms, when detected, include a spot of blurry vision, dark vision, or distorted vision. Wet macular degeneration progresses much faster than the dry variety. Both forms of macular degeneration can cause blindness.
Treatment
Currently, there is no cure for macular degeneration, but treatment is available to slow the effects.
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Retinal Detachment
The part of the eye which collects light and transmits the light messages to the optic nerve and brain is the retina. It lines the inner back wall of the eye. When the retina separates from the back wall, it is known as retinal detachment. It is a serious condition which can cause permanent damage and vision loss if not treated quickly.
Symptoms
A retinal detachment often causes sudden defects in your vision. It may just cause a blind spot too small to notice, or it may cause a noticeable shadow which obscures your vision. An increase in “floaters,” which look like small particles or fine threads, may also be noticed. Finally, flashes of light are associated with retinal detachment.
Risk Factors
Eye injuries, tumors, and cataract surgery can cause retinal detachment. Near-sighted individuals and the elderly are at greater risk for spontaneous detachment. Also, diabetic retinopathy, a condition associated with diabetes, can cause bleeding which leads to retinal detachment.
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5,058,186,948,913,034,000 | Skip to main content
Effects of different types of fluid resuscitation for hemorrhagic shock on splanchnic organ microcirculation and renal reactive oxygen species formation
Abstract
Introduction
Fluid resuscitation is an indispensable procedure in the acute management of hemorrhagic shock for restoring tissue perfusion, particularly microcirculation in splanchnic organs. Resuscitation fluids include crystalloids, hypertonic saline (HTS), and synthetic colloids, and their selection affects the recovery of microcirculatory blood flow and reactive oxygen species (ROS) formation, which is often evident in the kidney, following reperfusion. In this study, the effects of acute resuscitation with 0.9 % saline (NS), 3 % HTS, 4 % succinylated gelatin (GEL), and 6 % hydroxyethyl starch (HES) 130/0.4 were compared in a hemorrhagic shock rat model to analyze restoration of microcirculation among various splanchnic organs and the gracilis muscle and reperfusion-induced renal ROS formation.
Methods
A total of 96 male Wistar rats were subjected to sham operation (sham group), hemorrhagic shock (control group), and resuscitation with NS, HTS, GEL and HES. Two hours after resuscitation, changes in the mean arterial pressure (MAP), serum lactate level and the microcirculatory blood flow among various splanchnic organs, namely the liver, kidney, and intestine (mucosa, serosal muscular layer, and Peyer’s patch), and the gracilis muscle, were compared using laser speckle contrast imaging. Renal ROS formation after reperfusion was investigated using an enhanced in vivo chemiluminescence (CL) method.
Results
Microcirculatory blood flow was less severely affected by hemorrhaging in the liver and gracilis muscle. Impairment of microcirculation in the kidney was restored in all resuscitation groups. Resuscitation in the NS group failed to restore intestinal microcirculation. Resuscitation in the HTS, GEL, and HES groups restored intestinal microcirculatory blood flow. By comparison, fluid resuscitation restored hemorrhagic shock-induced hypotension and decreased lactatemia in all resuscitation groups. Reperfusion-induced in vivo renal ROS formation was significantly higher in the GEL and HES groups than in the other groups.
Conclusion
Although fluid resuscitation with NS restored the MAP and decreased lactatemia following hemorrhagic shock, intestinal microcirculation was restored only by other volume expanders, namely 3 % HTS, GEL, and HES. However, reperfusion-induced renal ROS formation was significantly higher when synthetic colloids were used.
Introduction
Fluid resuscitation is often the sine qua non treatment in the acute management of hemorrhagic shock. However, even when a sufficient amount of fluid is administered for restoring hemodynamic stability, splanchnic organ injury may persist. This may be because different types of resuscitation fluid may differently affect the recovery of microcirculatory blood flow and reperfusion-induced reactive oxygen species (ROS) formation [1, 2]. During resuscitation, adequate organ perfusion is more strongly correlated with microcirculatory improvement than macrocirculatory improvement [3]. Accordingly, numerous clinical investigations have been conducted to clarify the microcirculatory effects of different types of resuscitation fluid, including crystalloids, hypertonic saline (HTS), and synthetic colloids, by observing sublingual microcirculation [1, 4]. However, because splanchnic microcirculation is partly compromised during hypovolemia, which may participate in the development of multiple-organ dysfunction syndrome [5], and the splanchnic microcirculatory response to fluid challenge may become dissociated from the sublingual microcirculatory response [6, 7], the effects of different types of fluid on the splanchnic microcirculation during resuscitation from hemorrhagic shock remain unclear. Accordingly, we previously used an experimental model to investigate the microcirculation among multiple splanchnic organs during hemorrhagic shock and 0.9 % saline resuscitation and observed that the intestinal microcirculation remained impaired despite the recovery of the macrocirculation [8]. Thus far, the microcirculatory effects of other volume expanders, such as HTS and synthetic colloids, among multiple splanchnic organs remain unexplored.
In addition to microcirculatory change, reperfusion after fluid resuscitation is another factor influencing organ injury. The kidney is one of the most sensitive splanchnic organs targeted in reperfusion-mediated oxidative tissue injury [9]. ROS formation is an early biomarker of reperfusion-induced oxidative stress and may be detectable in the acute phase of fluid resuscitation. Excess ROS formation is associated with systemic inflammation and can initiate cell death [2]; moreover, it is closely correlated to renal injury [9, 10] The extent of ROS formation after reperfusion may depend on the type of resuscitation fluid used [2], and fluid resuscitation using synthetic colloids is relevant to acute kidney injury [1113]. However, renal ROS formation during the acute phase of fluid resuscitation using synthetic colloids is less thoroughly investigated compared with that using other types of resuscitation fluid.
Therefore, in the current study, we used different types of resuscitation fluids, namely 0.9 % saline, 3 % HTS, 4 % succinylated gelatin (GEL), and 6 % hydroxyethyl starch (HES) 130/0.4, for acute resuscitation in a hemorrhagic shock rat model. The primary goal of this study was to determine the effects of different resuscitation fluids on the restoration of microcirculation in multiple splanchnic organs, using the laser spackle contrast imaging (LSCI) technique. The secondary goal was to calculate renal reperfusion injury-induced ROS formation by using an in vivo ROS assessment technique.
Methods
Experimental animals
A total of 96 male Wistar rats (body weight = 250 ± 30 g; Biolasco Taiwan Co., Taipei, Taiwan) were used. The rats were kept on a 12-h light–dark cycle and had a free access to water and food. All experimental procedures were approved by the Institutional Animal Care and Use Committee of National Taiwan University and were conducted in accordance with its guidelines.
Part I - changes of microcirculatory blood flow intensity in splanchnic organs
Anesthesia and surgical procedure
The rats were anesthetized and prepared as described in our previous study [8]. A tracheostomy was performed, and a 14G catheter (Surflo; Terumo Corporation, Laguna, Philippines) was inserted into the trachea to maintain spontaneous breathing. Anesthesia was maintained using 1.2 % inhaled isoflurane. Subcutaneous atropine (0.05 mg/kg in 10 mL/kg of saline) was injected to limit the rate of moisture evaporation from the surgical open wound and to prevent airway secretion. The body temperature of the rats was continuously monitored rectally, and a warmer pad was applied to maintain it between 36 and 37 °C. Polyethylene catheters (PE-50; Intramedic 7411, Clay Adams, Parsippany, NJ, USA) were inserted into the right common carotid artery and external jugular vein. The catheter in the right common carotid artery was used to continuously monitor macrocirculatory hemodynamics, including the mean arterial pressure (MAP) and heart rate (HR), and to withdraw blood for inducing hemorrhagic shock. The external jugular vein was used to infuse resuscitation fluid.
A long, midline laparotomy was performed to exteriorize splanchnic organs, including the liver, left kidney, and a segment of the terminal ileum (approximately 6–10 cm in length, proximal to the ileocecal valve). A 2-cm section was made on the antimesenteric aspect of the intestinal lumen by using a high-frequency desiccator (Aaron 900; Bovie Aaron Medical, St. Petersburg, FL, USA) for carefully exposing the opposing mucosa to study microcirculation. Furthermore, the nearby intestinal serosal muscular layer (at the midline of the antimesenteric aspect) and the central Peyer’s patch (identified by visualizing the lymph nodes) were identified to study microcirculation. Moreover, the right gracilis muscle was exposed for analyzing microcirculatory changes relative to the splanchnic organs. The exposed viscera and tissue were kept moist by treating them every hour with 0.5 mL of aerosolized saline, prewarmed to 37 °C.
Evaluation of microcirculatory blood flow
The microcirculation was assessed using the LSCI technique [14] and the setup was similar to that employed in our previous study [8]. A full-field laser perfusion imager (MoorFLPI; Moor Instruments, Ltd., Devon, UK) was used to continuously record the intensity of microcirculatory blood flow in the splanchnic organs, starting from the baseline. The imager uses LSCI, in which a random speckle pattern is generated when a tissue is illuminated by a laser light. The random speckle pattern changes when blood cells move within the regions of interest (ROIs). When the level of movement is high (high flow), the changing pattern becomes more blurred, and the contrast in that particular region declines accordingly. Therefore, low contrast is associated with high flow, and high contrast is associated with low flow. The contrast image is processed to produce a 16-color-coded image that is associated with the blood flow in the tissue (e.g., blue indicates low flow and red, high flow). The microcirculatory blood flow intensity of each ROI was recorded as a perfusion unit (PU), which is equal to the product of the average speed and concentration of red blood cells moving in the tissue sample volume (i.e., blood cell flux or perfusion). The images were recorded and analyzed in real time using the MoorFLPI Version 3.0 software (Moor Instruments, Ltd.). Six separate ROIs were defined on the liver, left kidney, intestinal mucosa, serosal muscular layer, Peyer’s patch, and right gracilis muscle (details on the selection of ROIs are listed in Additional file 1). The intensity of microcirculatory blood flow was recorded as an arbitrary PU.
Hemorrhagic shock and fluid resuscitation protocols
In total, 60 rats were randomly assigned to the following six groups (n = 10 in each group): (1) the sham group, in which the rats received all surgical procedures except blood withdrawal and fluid resuscitation; (2) the control group, in which the rats underwent hemorrhaging but no fluid resuscitation; (3) the NS group, in which the rats were resuscitated with 0.9 % saline; (4) the HTS group, in which the rats were resuscitated with 3 % HTS; (5) the GEL group, in which the rats were resuscitated with 4 % succinylated GEL (Gelofusine®, B. Braun, Taiwan); and (6) the HES group, in which the rats were resuscitated with 6 % HES 130/0.4 (Voluven®, Fresenius-Kabi, Bad Homberg, Germany).
Figure 1a shows a timeline of part I of the experiment. After completion of surgery, the rats were allowed to stabilize for 30 minutes before the baseline measurements were recorded (baseline condition was considered stable when all measurement values remained at 10 % for 15 minutes; defined as 0’ minutes; T0). At T0, the concentration of isoflurane was lowered to 0.7 % to prevent over-anesthesia in the rats without further surgical stimulation, and hemorrhagic shock was then induced through controlled blood withdrawal via a right carotid arterial cannula with total blood loss of 30 mL/kg from 15’ to 60’ (T1) minutes. Fluid resuscitation was administrated from 60’ to 90’ minutes, and the volume of fluid used for resuscitation was same as that of blood withdrawn. Two hours after fluid resuscitation, part I of the experiment was complete (T2; at 210’ minutes in the rats receiving fluid resuscitation and at 180’ min in the rats in the sham and control groups; Fig. 1a). Hemodynamic measurements of the macrocirculation and microcirculation were compared among the groups at T0, T1, and T2 (Fig. 1a). Because different organs may have different baseline values of the microcirculatory blood flow intensity, the percent changes in the microcirculatory blood flow intensity at T1 and T2 were compared with the T0 baseline values.
Fig. 1
figure 1
Timeline of the protocols for part I of the experiment for assessing splanchnic organ microcirculation (a) and part II of the experiment for calculating renal reactive oxygen species (ROS) formation after reperfusion (b). T0 baseline state, T1 complete of hemorrhagic shock, T2 end of measurement (2 h after shock (180’ minutes) or 2 h after resuscitation (210’ minutes)), MAP mean arterial pressure, HR heart rate
The first 0.2 mL of blood withdrawn at 15’ minutes and the final 0.2 mL of blood withdrawn at T1 were analyzed using arterial blood gas analysis as the baseline status and shock status, respectively. At the end of the measurement (T2), arterial blood gas analysis was repeated to evaluate the effects of fluid resuscitation.
Part II - formation of renal reactive oxygen species in vivo
For investigating kidney ROS activity in vivo, 36 rats underwent the same hemorrhagic shock and fluid resuscitation procedures (n = 6 rats in each group) as did the rats used for investigating microcirculatory changes in the splanchnic organs with two changes. First, the rats were anesthetized with a subcutaneous urethane injection (1.2 g/kg) instead of volatile anesthesia because in vivo measurement was conducted in a closed box that did not allow the entry of a volatile anesthesia breathing circuit. In addition, volatile anesthesia may mask ROS formation because of its antioxidant properties [15]. Second, pilot experiments showed that rats receiving anesthesia with subcutaneous urethane could survive only if the volume of blood loss was lowered. Therefore, hemorrhagic shock was induced by withdrawing a lesser amount of blood (20 mL/kg; Fig. 1b).
The method for detecting chemiluminescence (CL) from the organ surface after intrarenal arterial infusion of a superoxide anion probe, 2-methyl-6-[4-methoxyphenyl]-3,7-dihydroimidazo-[1,2-a]-pyrazin-3-one hydrochloride (MCLA) (TCI-Ace; Tokyo Kasei Kogyo Co. Ltd., Tokyo, Japan) [16, 17], was adapted to demonstrate ROS production in kidneys subjected to ischemia reperfusion. For excluding photon emission from sources other than the kidney, the rats were housed in a dark box with a shielded plate. Only the renal window was left unshielded and was positioned under a reflector, which reflected the photons from the exposed kidney surface onto the detector area. A single dose of N,N9-dimethyldiacridium (1 mM in 0.1 mL) (lucigenin; Sigma) or a continuous infusion of MCLA (0.2 mg/mL per h) was administered through an intrarenal arterial catheter. The lucigenin- or MCLA-enhanced CL signal from the kidney surface was measured continuously during administration using a CL analyzer (CLD-110, Tohoku Electronic Industrial Co., Sendai, Japan). The ROS response was directly evaluated from the kidney surface through intrarenal arterial infusion of MCLA (0.2 mg/mL/h) [16]. At T2, the increased ROS formation from baseline was compared.
Statistical analysis
Analysis was performed using statistical software (MedCalc Inc., Mariakerke, Belgium) and SigmaPlot for Windows, Version 12 (SAS Institute, Cary, NC, USA). Data are presented as the median (interquartile range) in tables and the mean (standard error of the mean) in figures. According to our previous report [8], the sample size was estimated to be six rats in each group to detect a difference in the mean microcirculatory blood flow of 200 PU. Mean differences and percent differences at different time points among the six groups were investigated using repeated measurement analysis of variance (ANOVA) with the factors of time and group, followed by the Bonferroni test. A p value <0.05 was considered statistically significant.
Results
Part I - changes in microcirculatory blood flow intensity in splanchnic organs
Microcirculatory blood flow changes
Table 1 shows a summary of changes in the sequential absolute values of the intensity of microcirculatory blood flow during the measurement period. The rats in the sham group had no significant changes in the intensity of microcirculatory blood flow in all investigated organs (Table 1; Figs. 2a and 3af). The microcirculatory blood flow in the liver and gracilis muscle did not significantly change after hemorrhagic shock and fluid resuscitation (Table 1; Fig. 3a, f). Hemorrhagic shock significantly lowered the intensity of microcirculatory blood flow in the kidney and intestine (including the mucosa, serosal muscular layer, and Peyer’s patch; Figs. 2b and 3be).
Table 1 Microcirculatory blood flow intensity changes after hemorrhagic shock and fluid resuscitation in part I of the experiment
Fig 2
figure 2
Example of laser speckle contrast imaging of the microcirculatory blood flow intensity in the sham (a), control (b), 0.9 % saline (c), hypertonic saline (d), gelatin (e), and hydroxyethyl starch (f) groups at time (T)2. The regions of interest were the liver (1), kidney (2), intestinal mucosa (3), serosal muscular layer (4), Peyer’s patch (5), and gracilis muscle (6)
Fig 3
figure 3
Percent changes in the microcirculatory blood flow intensity at time (T)1 and T2 compared with T0 in the liver (a), kidney (b), intestinal mucosa (c), serosal muscular layer (d), Peyer’s patch (e) and gracilis muscle (f). *Value in a fluid resuscitation group significantly different from that in the control group with p <0.05. #Value in a fluid resuscitation group significantly different from that in the 0.9 % saline group with p <0.05. ^Value in a fluid resuscitation group significantly different from that in the sham group with p <0.05. NS 0.9 % saline, HTS hypertonic saline, HES hydroxyethyl starch, GEL gelatin
The intensity of microcirculatory blood flow in the kidney was restored after fluid resuscitation in the NS, HTS, GEL, and HES groups at T2 (Figs. 2cf and 3b). Fluid resuscitation by NS induced significantly improved intestinal mucosal and Peyer’s patch microcirculatory blood flow compared with that in the control group (Fig. 3c and e). However, the microcirculation of the intestine (including the mucosa, serosal muscular layer, and Peyer’s patch) in the NS group remained significantly impaired compared with that in the sham group at T2 (Figs. 2c and 3ce). By comparison, the intensity of microcirculatory blood flow in the intestine in the HTS (Figs. 2d and 3ce), GEL (Figs. 2e and 3ce), and HES (Figs. 2f and 3ce) groups significantly improved relative to that of the control group and was comparable with that of the sham group at T2. The difference in microcirculatory blood flow in the serosal muscular layer between the HTS and the NS groups at T2 was also statistically significant (Fig. 3d).
Macrocirculation and arterial blood gas analysis
The macrocirculatory changes after hemorrhagic shock and fluid resuscitation in part I of the experiment are summarized in Table 2. The repeated measurement ANOVA showed that there were significant differences in MAP change between the control and other groups (Table 2; p <0.001). The hemorrhagic shock induced a significant reduction in the MAP from 115 (100–118) mmHg at T0 to 56 (46–67) mmHg at T2 in the control group (p <0.001). Fluid resuscitation restored the MAP to 80 (76–85) mmHg, 89 (70–102) mmHg, 89 (82–93) mmHg and 85 (72–99) mmHg at T2 in the NS, HTS, GEL and HES groups, respectively (compared to the control group, each p <005; Table 1). Significant changes in heart rate were not found between groups.
Table 2 Macrocirculatory changes after hemorrhagic shock and fluid resuscitation in part I of the experiment
Hemorrhagic shock induced significant decreases in arterial pH value at T1 in each group. The respiratory parameters including the arterial partial pressure of oxygen (PaO2)/inspired fraction of oxygen (FiO2) ratio and arterial partial pressure of carbon dioxide (PaCO2) were comparable between each group. Hemorrhagic shock induced anemia in each group such that the hemoglobin level and hematocrit decrease from 13.0 (12.5–13.8) g/dL and 39 (38–41) % at T0 to 10.0 (8.6–10.2) g/dL and 30 (26–30) % at T2 in the control group. The absolute hemoglobin and hematocrit values at T2 were higher in the GEL group than those in the other groups, but the changes in values from T0 to T2 were comparable between each group (Table 3). Hemorrhagic shock induced lactatemia in each group such that the serum lactate level increased from 0.6 (0.5–0.9) mmol/L at T0 to 4.3 (3.0–5.8) mmol/L at T2 in the control group. (Table 3). The serum lactatemia at T2 was comparably decreased in all resuscitation groups (Table 3).
Table 3 Arterial blood gas analysis in part I of the experiment
Part II formation of renal reactive oxygen species in vivo
Hemorrhagic shock induced a significant increase in renal ROS formation in vivo (551 (322–955) vs. 155 (155–303) CL counts/10 s in the control and the sham groups respectively; p <0.05). Fluid resuscitation also significantly increased in vivo renal ROS formation in the NS, HTS, GEL, and HES groups compared with the sham group at T2 (277 (189–480), 1644 (1065–2344), 3918 (2596–4610), and 3119 (1880–9298) CL counts/10 s, in the NS, HTS, GEL, and HES groups, respectively; p <0.05 compared with the sham group; Fig. 4). Reperfusion-induced renal ROS formation was higher in the HTS, GEL, and HES groups than in the control group. Specifically, the GEL and the HES groups had significantly higher in vivo renal ROS formation compared with that in the HTS and other groups at T2 (Fig. 4). The amount of renal ROS formation was comparable between the GEL and HES groups at T2.
Fig 4
figure 4
Comparison of the amount of reperfusion-induced formation of renal reactive oxygen species in vivo after fluid resuscitation. *Value in a fluid resuscitation group significantly different from that in the control group with p <0.05. #Value in a fluid resuscitation group significantly different from that in the other fluid resuscitation group, including the 0.9 % saline (NS) and hypertonic saline (HTS) groups with p <0.05. ^Value in a fluid resuscitation group significantly different from that in the sham group with p <0.05. CL chemiluminescence, GEL gelatin, HES hydroxyethyl starch
Discussion
In the current study, we compared commonly used resuscitation fluids, namely a crystalloid (0.9 % saline), HTS, and synthetic colloids (GEL and HES), in the acute management of hemorrhagic shock. The major findings are that first, we observed that although fluid resuscitation with the crystalloid restored the MAP and decreased the serum lactatemia, intestinal microcirculation was effectively resuscitated only after using the HTS or synthetic colloids; second, fluid resuscitation using the synthetic colloids was associated with the greatest formation of renal ROS in vivo after reperfusion.
Different splanchnic organs may have heterogeneous microcirculatory responses to fluid therapy. For instance, we recently observed that the intestinal microcirculation was more vulnerable to hemorrhaging and had poorer responses to NS resuscitation compared with the liver, kidney, and gracilis muscle [8]. In support of our previous findings, we also observed that during the resuscitation period, the intestinal microcirculation had a more positive response to fluid resuscitation using HTS, GEL, or HES than to that using NS. Our previous and current studies have indicated that the acute microcirculatory response to fluid therapy in susceptible organs such as the intestine is affected not only by volume effects but also by the biochemical composition. Hypertonic fluid and plasma substitutes, especially synthetic colloids, are the most common compositions for correcting hypovolemia in addition to the crystalloid. HTS was proposed to correct microcirculatory dysfunction and inflammatory effects in a hypovolemic state [1] and has been in clinical use for resuscitating hypovolemic and brain injury patients [18]. It was also reported to improve both macrocirculation and microcirculation in comparison with NS and HES during fluid resuscitation in septic shock patients [19]. In previous experimental studies, HTS has improved myocardial blood flow in a pig model of cardiopulmonary resuscitation [20], increased cerebral blood flow in a rat model of cardiac arrest [21], and reduced mesenteric microcirculatory dysfunction in a rat model of strangulated small bowel obstruction [22]. We additionally found that the microcirculatory blood flow in the serosal muscular layer was the most restored in the HTS group (Figs. 2d and 3d), probably because HTS is more effective in increasing superior mesenteric arterial blood flow [23] and in improving intestinal perfusion with selective vasodilation of precapillary arterioles [24] after hemorrhagic shock. Synthetic colloids have been widely used clinically, and their therapeutic effects on microcirculation have gained substantial attention in human studies [1]. GEL was reported to improve splanchnic perfusion in patients who underwent abdominal aortic aneurysm repair [25] and in hypovolemic septic patients [26]. In addition, HES improved gastric mucosal perfusion in patients who received abdominal aortic surgery [27] or liver surgery [28] and improved sublingual microcirculation during early goal-directed therapy for septic patients [29]. However, the effects of synthetic colloids on the microcirculation among multiple splanchnic organs have been less frequently investigated. Our results are in accordance with those of clinical reports indicating that splanchnic microcirculatory blood flow improved after synthetic colloid resuscitation. Synthetic colloids may exert this effect by inducing a decrease in erythrocyte aggregation, thereby reducing the low-shear viscosity of the blood [30]. Despite the microcirculatory advantages of fluid resuscitation using synthetic colloids, concerns remain about the safety of both GEL [13] and HES [11, 12], mainly an increased risk of acute kidney injury, especially in critically ill patients who are vulnerable to oxidative stress. Moreover, we determined that increased reperfusion-induced renal ROS formation may be a mechanism underlying the risk of kidney injury during fluid resuscitation using synthetic colloids.
An ideal resuscitation fluid should not only be effective in restoring both macrocirculation and microcirculation but also cause less reperfusion injury [31]. Recently, Chen and colleague reported that fluid resuscitation with HES 130/0.4 after hemorrhagic shock was associated with lesser oxidative stress and a less severe inflammatory response in the liver, intestine, lungs, and brain compared with GEL and HES 200/0.5 [32]. By contrast, in the current study, increased formation of renal ROS was evident after fluid resuscitation using GEL and HES for hemorrhagic shock. The differences are likely related to two aspects. First, the comparison among resuscitation fluids was not limited to synthetic colloids in the current study; particularly, HTS was included in the comparison. Second, the target organ was different. ROS formation in the kidney was emphasized in the current study because infusion of GEL and, particularly, HES is associated with acute kidney injury [1113, 33]. ROS have an extremely short lifetime, and there are various antioxidants in vivo. Therefore, a general method for detecting the products of lipid peroxidation, such as malondialdehyde, in tissue may be insufficiently sensitive for detecting acute changes in ROS during reperfusion through fluid resuscitation. In the current study, to evaluate ROS production, we used an enhanced CL method that is highly sensitive for detecting acute changes in ROS [34]. Greater reperfusion-induced ROS formation than that induced by ischemia may be inevitable after effective microcirculatory restoration; accordingly, greater ROS formation was observed in the HTS, GEL, and HES groups than in the control and NS groups. However, the higher reperfusion-induced ROS may not be completely explained by more effective microcirculatory restoration, because HTS was comparably effective in restoring splanchnic microcirculation but did not induce higher renal ROS formation than the synthetic colloids. It may be because of the anti-inflammatory properties of HTS. Studies have reported that using HTS is associated with less neutrophil activation [22] and less expression of genes implicated in leukocyte–endothelium interaction [35]. However, our results should be cautiously applied to clinical scenarios, because there are differences in susceptibility to oxidative challenge between rats and humans [36]. Rodents may be more resistant to the pathological effects of nitrosative stress, but humans may have evolved counter-regulatory mechanisms [37]. Additional investigations may be warranted for understanding the extent of renal ROS formation caused by using synthetic colloids in clinical settings.
In hemorrhagic shock, stabilization of macrocirculatory hemodynamic parameters, such as the MAP, is likely to occur at the expense of splanchnic microcirculatory perfusion. For instance, Dubin and colleagues reported a dissociation between macrocirculation, sublingual and intestinal microcirculation during hemorrhaging; the MAP and arterial pH were significantly modified only at the final stage of bleeding, but microcirculation decreased at the first stage of bleeding [38]. In the current study, we found that the intestine was the most vulnerable splanchnic tissue during the dissociation between macrocirculation and microcirculation by conducting a multiple organ model, which may be the major difference in the current study compared to other experimental models. The simultaneously monitoring of microcirculation among multiple organs was performed using LSCI. The LSCI enables full-field imaging with multiple ROIs and investigating multiple organs in near real time. Furthermore, because a larger ROI can be set, LSCI reduces inter-site and inter-individual variability and can provide comparable or even improved reproducibility of microcirculation compared with other techniques, such as sidestream dark-field imaging [39]. However, sidestream dark-field imaging enables direct visual observation of red blood cells flowing through individual capillaries and can depict heterogeneity between capillaries.
This study has certain limitations. The major limitation is the brief period of observation, because the long laparotomy for exposure of multiple splanchnic organs is associated with significant injury and stress. Therefore it was focused on the period of acute resuscitation; long-term outcomes, such as a survival rate, were less appropriate to evaluate. The improvement of outcomes after fluid resuscitation may be associated with other factors in addition to microcirculatory response and reperfusion injury. For instance, the outcome of resuscitation using HTS was reported to be non-significantly more favorable than that of resuscitation using NS in patients receiving out-of-hospital resuscitation for traumatic hemorrhagic shock [40]. Second, this study compared the microcirculatory responses of various splanchnic organs to different resuscitation fluids. Thus, the euvolemic model was applied. Therefore, the results of the current study may not be generalizable to other methods of treatment such as hypotensive resuscitation, which may improve survival after hemorrhagic shock [31]. Third, the microcirculation plays a crucial role in acute kidney injury [41]. LSCI may enable detection of the heterogeneity in reperfusion dynamics in renal microvascular perfusion [42], but we did not correlate this heterogeneity with renal ROS formation after synthetic colloid resuscitation in the current study. Because the primary goal of the current study was to evaluate the microcirculatory changes among multiple splanchnic organs, heterogeneity in a specific single organ was not examined. However, because the LSCI perfusion distributions of reperfusion correlated to the changes in the mean value of the entire kidney [42] and the renal ROI in the current study was close to that of the entire kidney, the changes in the mean microcirculatory blood flow presented in this study may still correlate to reperfusion-induced microvascular heterogeneity. Fourth, the current study examined two severities of hemorrhagic shock (30 mL/kg and 20 mL/kg). Most investigators attempt to recreate hemorrhagic shock by inducing blood volume loss of more than 40 % [43] because this level of shock is strongly correlated to outcomes. In the current study, this extent of blood loss was reached only in part I of the experiment because volatile anesthesia could not be used during the in vivo ROS measurement. However, it is rational to assume that more reperfusion-induced renal ROS formation occurs when more blood is withdrawn and more fluid is used for resuscitation. Finally, the serum hemoglobin level calculated through arterial blood gas analysis at T2 was higher in the GEL group than in the other groups. Although the values obtained using an arterial blood gas analyzer are reliable for use in detecting serial serum lactatemia changes [44], the obtained hemoglobin values should be interpreted with caution and confirmed using standard venous samples [45].
Conclusions
Our study suggested that even though fluid resuscitation with a crystalloid effectively restored the MAP and decreased serum lactatemia and kidney microcirculation in hemorrhagic shock, the intestinal microcirculation was restored only by other volume expanders, 3 % HTS and synthetic colloids (GEL and HES). In addition, reperfusion-induced formation of renal ROS in vivo was significantly increased in rats resuscitated with the synthetic colloids. Our result supports the clinical literature proposing that fluid resuscitation may increase the risk of kidney injury.
Key messages
• Hemorrhagic shock induced heterogeneous splanchnic microcirculatory derangement in the kidney and, particularly, the intestine; by contrast, the liver was less affected
• Fluid resuscitation with 0.9 % saline, 3 % saline, and synthetic colloids effectively restored microcirculation in the kidney, blood pressure and serum lactate levels in hemorrhagic shock
• The intestinal microcirculation was restored using 3 % saline and synthetic colloids, but not 0.9 % saline
• Fluid resuscitation using the synthetic colloids was associated with significantly increased reperfusion-induced formation of renal reactive oxygen species in vivo
Abbreviations
ANOVA:
analysis of variance
CL:
chemiluminescence
GEL:
gelatin
HES:
hydroxyethyl starch
HR:
heart rate
HTS:
hypertonic saline
LSCI:
laser speckle contrast imaging
MAP:
mean arterial pressure
MCLA:
2-methyl-6-[4-methoxyphenyl]-3,7-dihydroimidazo-[1,2-a]-pyrazin-3-one hydrochloride
NS:
0.9 % saline
PaCO2 :
arterial partial pressure of carbon dioxide
PaO2/FiO2 :
ratio of arterial partial pressure of oxygen/inspired oxygen fraction
PU:
perfusion unit
ROI:
region of interest
ROS:
reactive oxygen species
T0 :
time zero
T1 :
15–60 minutes after time zero
T2 :
2 h after fluid resuscitation
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Acknowledgements
This work was supported in part by a grant from the National Taiwan University Hospital (NTUH 104-A125). We thank Roger Lien (MicroStar Instruments CO., Ltd., Taipei, Taiwan) for providing technical assistance during full-field laser perfusion imager examinations. We also thank all NCMMR participants.
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Correspondence to Yu-Chang Yeh or Chiang-Ting Chien.
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The authors declare that they have no competing interests.
Authors’ contributions
CYW participated in the design of the study, performed the experiments (carried out the microcirculatory measurement) and prepared and revised the manuscript. KCC prepared the manuscript drafting and revision, acquisition of data and performed the experiment (carried out the in vivo renal ROS formation measurement). YJC performed the statistical analysis (including statistical revision) and interpretation of data and also participated in the design of the study. YCY participated in the design of the study and prepared the manuscript (revising it critically for important intellectual content) and also coordinated the research group. CTC participated in the design of the study, performed the experiment (carried out the in vivo renal ROS formation measurement) and prepared the manuscript (revising it critically for important intellectual content). All authors read and approved the final manuscript.
Yu-Chang Yeh and Chiang-Ting Chien contributed equally to this work.
Additional file
Additional file 1:
The protocol of setting regions of interest and its' intra- and inter-observer's agreement. (DOCX 357 kb)
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Wu, CY., Chan, KC., Cheng, YJ. et al. Effects of different types of fluid resuscitation for hemorrhagic shock on splanchnic organ microcirculation and renal reactive oxygen species formation. Crit Care 19, 434 (2015). https://doi.org/10.1186/s13054-015-1135-y
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Keywords
• Mean Arterial Pressure
• Hemorrhagic Shock
• Fluid Resuscitation
• Reactive Oxygen Species Formation
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-1,704,521,065,381,949,400 | Peds Ophtho Case 2: Diagnosis & Conclusions
Diagnosis: Accommodative Esotropia
This is a case of strabismus, specifically acccommodative esotropia.
Strabismus, or ocular misalignment of the eye, is a common pediatric condition. It arises when the eye muscles do not work together to produce a single image. When eye deviation occurs, the brain will try to compensate by ignoring the visual input from the deviated eye. This can lead to amblyopia, which refers to poor development of visual acuity from causes such as ocular misalignment, significant refractive error, or structural abnormalities. With strabismic amblyopia, the eye can be structurally normal but will not achieve 20/20 vision because brain is suppressing the image received from the eye due to ocular misalignment.
Why is amblyopia important? Amblyopia can be reversible if the underlying cause is corrected while the patient is young (<13 years of age). Once the patient reaches visual maturity (>13 years old), the visual pathways are less adaptable and the brain suppression of the eye may become permanent. If a patient with accommodative esotropia has amblyopia of one eye from misalignment, prompt correction of the misalignment can help to reverse the amblyopia. Once the eyes are realigned, the brain no will longer suppress the eye and vision can continue to develop. However if the esotropia is addressed at an older age, correcting the strabismus may not improve the amblyopia because the visual pathway has matured, resulting in permanent decreased vision.
strabismus diagramStrabismus can be classified by the direction of the deviation: hypertropia, hypotropia, exotropia, or esotropia, and can be further classified by the cause and onset. In this case, the patient has accommodative esotropia of the right eye. Accommodative esotropia is an acquired form of esotropia that typically presents between the ages of 2-4 years. It will often begin intermittently and then quickly become constant. The pathophysiology is related to an imbalance between the medial recti (converging) muscles and ciliary body (accommodation). The patient will have difficulties with near vision (hyperopia) and will try to increase accommodation (focusing power) in order to see the close-up object more clearly. In certain patients, this can lead to excessive convergence and subsequent eye crossing. It is important to remember that it is normal for pediatric patients to have some degree of hyperopia. However, patients with severe hyperopia (greater than +2.00D) can develop this particular form of strabismus. (Upper left image credit: CC BY-SA 4.0).
The other most common types of strabismus include congenital esotropia and intermittent exotropiaCongenital esotropia occurs at birth or within six months of age and patients will typically have a very large angle of deviation (>30 PD). The deviation is constant. Intermittent exotropia tends to arise between the ages of 10 months and 4 years. Because the eye deviation happens infrequently, it can be difficult to detect. The exotropia will typically only arise when seeing objects far away. A classic sign is closing, or “squinting” of the bad eye when looking into the sun.
Of note, strabismus should be distinguished from pseudostrabismus. In pseudostrabismus, the eyes may appear falsely misaligned due to large epicanthal folds or a wide nasal bridge. In pseudostrabismus the corneal light reflex, cover, and alternating cover tests are normal. Furthermore, normal newborns can have physiologic intermittent strabismus. This can be present as early as birth but will typically resolve by 2 months. Any child with intermittent crossing after two months of age, or persistent crossing at any age should be referred immediately to a pediatric ophthalmologist.
General risk factors for strabismus include family history, preterm birth or premature weight, history of ocular conditions that obstruct the visual axis (i.e ptosis, cataracts, retinoblastoma), developmental abnormalities (Down’s syndrome, hydrocephalus) and neuromuscular conditions (Graves’ disease or cerebral palsy).
Strabismus is a clinical diagnosis and thus a thorough history and physical exam are warranted. The physical exam should include tests such as the corneal light reflex test, cover-uncover test, alternate-cover test, and cycloplegic refraction. Cycloplegic refraction allows for the full refractive error to be measured without be confounded by accommodation. Further work-up should be conducted if there is concern that the strabismus is secondarily caused (e.g. retinoblastoma).
Treatment
Treatment for strabismus includes correction of the underlying cause of the misalignment in order to restore binocular vision. Strategies include prescription glasses to correct refractive error, occlusion therapy (covering the normal eye), pharmacologic therapy (i.e. atropine to impair sight of the normal eye), and surgery to realign the eyes. Surgical techniques for horizontal ocular deviations commonly include recessions or resections of the eye muscles to achieve ocular alignment.
References and Additional Resources:
1. Boyd K.“Strabismus in Children.” Lipsky SN, Turbert D. (Eds). Eye Health A-Z. December 2020 .Available at: https://www.aao.org/eye-health/diseases/strabismus-in-children.
2. Leuder G. “Chapter 9. Strabismus in Infants.Pediatric Ophthalmology. St. Louis, McGraw-Hill Medical, 2011.
3. Mestre C, Otera C, Diaz-Douton F et al. “An automated and objective cover test to measure heterophoria.PloS One. 2018;13(11)e0206674.
4. Coats D, Payasse EA, Olitsky SE, Armsby C. “Evaluation and management of strabismus in children.” Olitsky SE, Armsby C. (Eds). UptoDate. Available at: https://www-uptodate-com.eresources.mssm.edu/contents/evaluation-and-management-of-strabismus-in-children?search=stabismus&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3.
5. Ferris J. Amblyopia: AtropineClinical Education: Basic Skills Video. October 2015. Available at: https://www.aao.org/basic-skills/amblyopia-atropine.
6. Helveston EM. Understanding, detecting, and managing strabismus. Community Eye Health. 2010;23(72):12-14.
7. “Accommodative Esotropia.” American Association for Pediatric Ophthalmology and Strabismus: Eye Terms and Conditions. March 2019. Available at: https://aapos.org/glossary/accommodative-esotropia.
8. Heidar K, Miller AM, Kozak A, et al. “Accommodative Esotropia” Grigorian AP (Eds). American Academy of Ophthalmology: EyeWiki. February 2021. Available at: https://eyewiki.aao.org/Accommodative_Esotropia.
9. Clarke WN. Common types of strabismus. Paediatr Child Health. 1999;4(8):533-535.
Case 2 Index
Peds Ophtho Case 2 Index
Peds Ophtho Case 2: Introduction
Peds Ophtho Case 2: Additional History
Peds Ophtho Case 2: Physical Exam
Peds Ophtho Case 2: Ophtho Visit
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1,340,264,461,192,829,400 | Community Academic Profiles
Richard I. Mazze
Publication Details
• Reproductive and teratogenic effects of sufentanil and alfentanil in Sprague-Dawley rats.
Fujinaga M, Mazze RI, Jackson EC, Baden JM. Anesth Analg. 1988; 67 (2): 166-9
The reproductive and teratogenic effects of sufentanil and alfentanil were studied in a total of 168 Sprague-Dawley rats in two separate experiments. Either sufentanil (10, 50, or 100 micrograms.kg-1.day-1) or alfentanil (8 mg.kg-1.day-1) were administered continuously from day 5 through day 20 of pregnancy using subcutaneously implanted osmotic minipumps. Cesarean sections were performed on day 20 of pregnancy, reproductive indexes were determined, and the 1484 fetuses were examined for external, visceral, and skeletal abnormalities. No significant adverse reproductive or teratogenic effects were observed with either narcotic.
PubMedID: 2963565
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Stavrou, S., Nicolaides, N. C., Papageorgiou, I., Papadopoulou, P., Terzioglou, E., Chrousos, G. P., … Charmandari, E. (2016, July 31). The effectiveness of a stress-management intervention program in the management of overweight and obesity in childhood and adolescence. Journal of Molecular Biochemistry, 5(2), 63–70. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996635/
“Most people who have been lean their whole lives have a much better understanding of proper portion size than people who are overweight,” says Deborah Riebe, Ph.D., a professor in the department of kinesiology at the University of Rhode Island. “If they go out to eat, they’re much more likely to ask for a doggie bag right away or to leave food on their plate rather than cleaning it up.”
Or skip your favorite early-morning show—whatever it takes to grab a few more minutes of sleep each day. When researchers at the University of Chicago studied men who were sleep-deprived, they found that after just a few days, their bodies had a much harder time processing glucose in the blood—a problem common in overweight diabetics. When the individuals returned to a more normal seven to eight hours of sleep a night, however, their metabolisms returned to normal.
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Sometimes, to whip your body into shape, you have to get a little nutty. While nuts are high in fat, it's that very fat that makes them such powerful weapons in the war against a ballooning belly. In fact, a study published in Diabetes Care revealed that study participants who consumed a diet rich in monounsaturated fats, like those in nuts, over a 28-day period gained less belly fat than their saturated fat-consuming counterparts while improving their insulin sensitivity.
Be choosy about carbs. You can decide which ones you eat, and how much. Look for those that are low on the glycemic index (for instance, asparagus is lower on the glycemic index than a potato) or lower in carbs per serving than others. Whole grains are better choices than processed items, because processing removes key nutrients such as fiber, iron, and B vitamins. They may be added back, such as in “enriched” bread.
I am on day four and I am very discouraged. I don't feel as if I am losing any weight at all. I encourage you to complete the seven days. Don't be too disappointed if you don't lose all ten pounds. Everybody and metabolism is different. Do be careful, however, to follow the diet exactly. Don't eat less food than is recommended in your effort to lose weight as that will throw off the diet's chemistry.
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Publication numberUS3437088 A
Publication typeGrant
Publication dateApr 8, 1969
Filing dateDec 1, 1966
Priority dateDec 1, 1966
Publication numberUS 3437088 A, US 3437088A, US-A-3437088, US3437088 A, US3437088A
InventorsBielinski Leonard J
Original AssigneeBielinski Leonard J
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Apparatus for measuring motility of body organs
US 3437088 A
Images(1)
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Description (OCR text may contain errors)
April 8, 1969 L. J. BIELINSKI APPARATUS FOR MEASURING MOTILITY OF BODY ORGANS Filed Dec. 1, 1966 FIG.4
INVENTOR LEONARD J. BIELINSKI RONALD E. BARRY Attorney United States Patent 3,437,088 APPARATUS FOR MEASURING MOTILITY F BODY ORGANS Leonard J. Bielinski, 812 E. 18th St., Marshfield, Wis. 54449 Filed Dec. 1, 1966, Ser. No. 598,427
Int. Cl. A61b /10; G011 7/00; A61m 25/00 U.S. Cl. 128-2 5 Claims This invention relates to devices used to test the operation of the various functional systems of the human body and more particularly to a device for making esophageal motility studies.
The esophageal motility test is performed on patients who exhibit symptoms which could be related to diseases in the esophagus or the valves or sphincters at either end. These tests are based on the pressures, lengths and speed of the peristaltic waves which pass down the esophagus after each swallow. There has been some confusion in the interpretation of the results of the tests limiting their value to the diagnosis of only four to six easily diagnosed diseases. This confusion seems to be related to the limited information presently being obtained from such devices.
One of the primary objects of the present invention is to provide an improved device for making esophageal motility studies and motility studies in other suitable body organs.
Another object of the present invention is to provide a device which can be manufactured at low cost for making motility studies.
A still further object is to provide an improved device for making motility studies which can be accurately located in the patient.
A still further object of the present invention is to provide an improved motility device that will provide accurate indications of the motion and pressure of the peristaltic waves in the esophagus of the patient.
Another object of the present invention is to provide a device for making motility studies which is unefi'ected by foreign pressures.
These objects are attained by embedding a number of catheters in a semi-rigid flat tape with one end of each catheter terminating in an opening in one surface of the tape. The openings are each spaced at predetermined distances along the tape and are approximately eight times as large as the opening in the catheters. The opposite ends of the catheters are each connected to a transducer that responds to pressure fluctuations of the peristaltic waves or sphincters. These responses are amplified and seen on an oscilloscope and recorded on a photographic recorder. The tape is calibrated throughout its length so that the distance of the openings in the tape to the patients incisors is always known. A common reference point is marked on the tape and is aligned with the incisors of the patient. The distance of the Opening from the incisors will then be known and recorded on the oscilloscope and a recorder for each test. The tape is then removed and a second set of distances recorded. Another test is then run. This procedure can be repeated any number of times until a pattern for the peristaltic waves in the entire esophagus and sphincter areas and their pressures has been established.
The tape is swallowed by the patient sitting up, with the openings or wells down. After the tape has been swallowed approximately 60 to 70 centimeters, the patient is instructed to lie on his back. The test is performed in this position. The wells will then be upright preventing any draining of the catheters during the test, and also preventing air bubbles from entering the catheters which would result in dampening of pressures.
Other objects and advantages will become more readily 3,437,088 Patented Apr. 8, 1969 apparent from the following detailed description when read in connection with the accompanying drawings, in which:
FIGS. 1a and 1b are top views of the esophageal motility device broken at line 1-1.
FIG. 2 is an enlarged cross-sectional view taken on line 2-2 of FIG. 1.
FIG. 3 is an enlarged cross-sectional view taken on line 33 of FIG. 1 showing one of the wells or openings.
FIG. 4 is an enlarged view of the side of the device with part of the tape broken away.
Referring more particularly to the drawings, the esophageal motility device includes a number of hollow tubular catheters 10, 12, 14 and 16 embedded in a latex rubber tape 18. The ends 11, 13, 15 and 17 of the catheters terminate in wells or openings 20, 22, 24 and 26, respectively, which are formed on one surface of the tape. Each of the wells consists of a ring 21, 23, 25 and 27 embedded in the surface of the tape which defines the openings for the wells. The ends of the catheters are sealed in the bottom of the wells flush with the surface in the bottom of the well. Each of the wells or openings has a crosssectional area equal to approximately eight times the cross-sectional area of the opening in the ends of the catheters. When the tape is placed in position and filled with liquid, pressure fluctuations caused by the peristaltic waves or sphincters will be sensed by the fluid in the well or opening and transferred to the liquid in the catheter.
The opposite ends of the catheters 40, 42, 44 and 46 are connected to transducers 48, 50, 52 and 54 which are in turn connected to amplifiers, an oscilloscope and a photographic recorder (none of which are shown). Pressure fluctuations which are sensed in the wells will then be transferred to the transducers, converted to electrical energy in the transducers and amplified for delivery to the oscilloscope and photographic recorder.
Referring again to FIG. 1a, it should be noted that each of the wells or openings is located a predetermined distance a from the next Well. The last well is located a predetermined distance b from a reference scale 70 near the other end of the tape.
In operation the tape is swallowed by the patient until a known point on the reference scale 70 is located opposite the incisors in the mouth of the patient. The patient should be sitting up and the tape swallowed with the wells down. The catheters and well should be filled with a liquid such as water. The patient is then instructed to lie down so that the wells will be upright. When the patient swallows, the duration, pressure and length of the peristaltic wave as it passes each well will be seen and recorded. A pattern of waves will then be seen on the oscilloscope and recorder on the photographic recorder indicating the pressure, length and duration of each wave or high pressure area as it passes the well or opening. The tape is then moved until the reference point 70 is located at a known point. The photographic recorder is again marked to indicate the distance of the wells from the known point. The pattern of peristaltic waves seen on the oscilloscope will indicate the responses of the wells or openings at the new location. This procedure is repeated a number of times until a complete peristaltic wave pattern for the entire esophagus and sphincter areas and their pressures has been established for the patient.
Using a semi-rigid tape which is flat assures that the tape will not twist after it has been swallowed by the patient. The wells or openings will then always be in the same vertical position in the patient. With the catheters embedded in a semi-rigid tape the introduction of foreign pressures such as biting on the tube, tongue movement or body movements into the wave form is prevented.
Although only one embodiment of the invention has been shown and described it should be apparent that vari- 3 ous changes and modifications can be made herein without departing from the scope of the appended claims.
What is claimed is:
1. A device for making esophageal motility studies comprising,
a flat semi-rigid tape, having a number of spaced openings in one surface,
a number of tubular members embedded in the tape,
each of said tubular members having an open end which terminates in one of said openings,
the other end of each of said tubular members being connected to a transducer means which responds to pressure variations in said openings,
said openings being spaced at predetermined distances along said tape whereby the length, pressure and duration of peristaltic waves and sphincter areas can be determined.
2. A device according to claim 1 wherein said openings have a cross-sectional area approximately eight times as large as the cross-sectional area of the openings in the end of the tubular members.
3. A device according to claim 1 including a reference means located a predetermined distance from one of said openings whereby the location of said openings can be determined at any time within the patient.
4. A device for recording the characteristics of peristaltic waves in the human body comprising,
a number of elongate tubes,
a fiat semi-rigid tape for holding said tubes in a fixed relation,
a number of spaced wells located on one surface of said tape,
each of said tubes having an open end terminating in one of said wells,
a liquid in said tubes and wells, and
transducer means connected to the other end of said tubes to indicate pressure fluctuations on the liquid in said well.
5. A device according to claim 4 wherein the cross- 10 sectional area of said wells is approximately eight times as large as the cross-sectional area of the openings in said tubes.
References Cited UNITED STATES PATENTS RICHARD A. GAUDET, Primary Examiner.
K. L. HOWELL, Assistant Examiner.
US Cl. X.R.
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Referenced by
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Classifications
U.S. Classification600/593, 604/118
International ClassificationA61B5/11, A61B5/03
Cooperative ClassificationA61B5/1126, A61B5/037
European ClassificationA61B5/11W, A61B5/03H2 | {
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-257,552,701,377,422,940 | The Facts About Erectile Dysfunction
For many men, the term erectile dysfunction creates instant panic. However, this doesn't have to be the case. Find out the causes of erectile dysfunction, and what you can do to support healthy testosterone, and improve sexual ability - without opting for that 'little blue pill'.
For many men, the term erectile dysfunction creates instant panic, leading to dreaded thoughts of the end of youth and sexual satisfaction.
An estimated 5 percent of 40-year-old men and close to 35 percent of 65-year-old men experience ED on a long-term basis.
And while erectile dysfunction – often called ED in advertising to dull the impact – may seem like one of the worst diagnosis in the world, it doesn’t have to be. There are many reasons behind problems with ‘raising your main sail’, and in most cases, those problems are easily solved, putting you back in the game and restoring your confidence.
Causes of erectile dysfunction
There are a variety of reasons that you could be experiencing problems with erections, according to WebMD.com, and many of them can be addressed without the popular – but risky – little blue pill. (Ref. 1)
Some things to look at include:
• Depression. Nothing kills libido like chronic depression. But if you have depression and are being treated for it, research the drug or drugs you are taking. Some can have negative effects ‘downstairs’, while others make it more difficult to achieve an orgasm.
• Poor blood flow to the penis. If you suffer from diabetes or heart disease, your blood vessels including those leading to the penis, could be damaged from high blood glucose, which slows blood flow and ultimately results in the inability to initiate and maintain an erection.
• Drinking too much. Cutting back on the beer, Bordeaux or bourbon will help kick things up a notch when you want your romantic side to come out.
• Low testosterone. There are a wide range of symptoms that accompany low testosterone, including being overweight or obese. Causes may include being under stress, not getting enough sleep and too much BPA – a common plastic compound found in water bottles and microwave containers - in your diet. Low testosterone levels can have a negative impact on your abilities in the bedroom.
• A chronic illness. If you are not in the best of health, your medication regimen or the complications from the illness itself can cause erectile dysfunction. In this case, eating better and working out when you can, will help build up strength and may help you fight off the illness and regain your confidence.
Tips to boost testosterone, blood flow
Testosterone is the main building block behind achieving and maintaining an erection, because erections require the release of nitric oxide, which plays a big role in vascular health, and supports the heart while improving the ability to achieve and maintain an erection. Nitric oxide, however, is not released if testosterone is not around to send it a signal.
Nitric oxide is produced by the cells that line our arteries when cued by testosterone, so if both levels are low, neither coordinating function can perform its duties, leading to ED.
That means finding ways to boost testosterone is vital. While reducing stress, getting a good night’s sleep and erasing small amounts of plastics from your diet is a good first step. Weight training and resistance exercise also helps trigger testosterone production. (Ref. 2)
Foods to support testosterone production
If you eat foods that help support testosterone levels, you crowd out estrogen, allowing testosterone levels to stay healthy.
Some foods to include:
1. Vitamin D. Tuna, salmon and eggs contain vitamin D, but you can also acquire it by spending some time in the sun. Studies have shown that men with higher levels of vitamin D have higher testosterone levels as well.
2. Oysters. Oysters have long been considered an aphrodisiac because oysters contain zinc, which plays a role in supporting healthy hormone levels. Not really immediate miracle generators of erections but at least they contain good levels of zinc to help contribute to the overall support of testosterone in your body.
3. Eating foods rich in nitric oxide. Some of the best foods to boost nitric oxide include members from the green family, including spinach, kale, Swiss chard, arugula and collard greens, and beets also help boost blood flow. (Ref. 3)
Having optimum levels of nitric oxide can help improve your ability to achieve and maintain an erection, so both you and your partner can again have the satisfying sex life you deserve without having to take prescription drugs, such as that little blue pill.
A Word From Our Chairman…Warren Matthews
“A major cause of ED for older men are those taking statin drugs to lower cholesterol. Lower levels of cholesterol inhibit the production of the sex hormones including testosterone. Another major problem for men as they get older, is that their bodies tend to convert testosterone to estrogen. It is possible to boost testosterone levels with the support of a number of ingredients which we have in both Total Balance Men's and Male Rejuvenator. For example, we include Chrysin which helps support increased testosterone levels and arouses sexual desire”.
References
1. http://www.webmd.com/men/erectile-dysfunction-13/slideshow-causes-of-ed
2. http://www.muscleandfitness.com/workouts/workout-tips/8-ways-be-alpha-male-tomorrow
3. http://www.healthline.com/health-slideshow/testosterone-boosting-food
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1,685,062,941,292,183,000 | Facebook Pixel
Infertility: How Endometriosis Happens
By HERWriter
Rate This
Endometriosis affects up to 15 percent of all women at some point. Mild cases cause pain and time off work. Severe cases can cause crippling pain and infertility.
Endometrium is tissue that lines the uterine cavity. Problems arise when endometrium doesn't stay where it belongs.
Endometriosis lesions or implants (endometrium tissue) can set up camp in every organ of a woman's pelvis, including reproductive organs, urinary system and the bowel.
Endometriosis is epitomized by severe pelvic pain which gets worse before a woman's period, becoming excruciating during her period and diminishing after the period ends. Intercourse and bowel movements can bring on more pain.
The type of pain will depend in part on how much of this tissue there is and where the lesions have spread to. Hormone stimulation causes lesions to break down and bleed.
The body then covers this area with adhesions or scar tissue. But the endometriosis lesions under the adhesions create greater pain and feeling of pressure.
If an organ like an ovary becomes covered with adhesions, its blood supply suffers and a cystic mass can form. These endometrioma can range in size from very small to as large as a softball.
Severe cases essentially freeze organs in place. Organs become stuck together, rather than being able to move in the pelvis. In situations where organs would normally have some movement, like sexual intercourse, ovulation, or moving of the bowel, pain explodes.
Some doctors believe that lower estrogen levels can reduce the risk of endometriosis. They recommend avoiding alcohol and caffeine, maintaining healthy weight and getting regular exercise.
Oral contraceptives are sometimes used successfully for endometriosis.
Prostaglandins are oil-based hormones secreted by healthy endometrium and most other body tissues. Prostaglandins are integrally involved in body processes such as pregnancy, ovulation, and menses (menstrual cycle).
More prostaglandins are produced in the uterine endometrium than anywhere else in the body. Problems arise when prostaglandins are released at the wrong times or in the wrong places.
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-5,613,652,642,955,190,000 | Animal Health Research Reviews
Research Article
Passive and active components of neonatal innate immune defenses
Matthew A. Firtha1, Patricia E. Shewena1 and Douglas C. Hodginsa1 c1
a1 Department of Pathobiology, University of Guelph, Guelph, ON, Canada NIG 2W1
Abstract
Innate immune defenses are crucial for survival in the first days and weeks of life. At birth, newborns are confronted with a vast array of potentially pathogenic microorganisms that were not encountered in utero. At this age, cellular components of the adaptive immune system are in a naïve state and are slow to respond. Antibodies received from the dam are essential for defense, but represent a finite and dwindling resource. Innate components of the immune system detect pathogen-associated molecular patterns (PAMPs) on microorganisms (and their products) by means of pattern-recognition receptors (PRRs). Soluble mediators of the innate system such as complement proteins, pentraxins, collectins, ficolins, defensins, lactoferrin, lysozyme etc. can bind to structures on pathogens, leading to agglutination, interference with receptor binding, opsonization, neutralization, direct membrane damage and recruitment of additional soluble and cellular elements through inflammation. Cell-associated receptors such as the Toll-like receptors (TLRs) can activate cells and coordinate responses (both innate and adaptive). In this paper, accumulated knowledge of the receptors, soluble and cellular elements that contribute to innate defenses of young animals is reviewed. Research interest in this area has been intermittent, and the literature varies in quantity and quality. It is hoped that documentation of the limitations of our knowledge base will lead to more extensive and enlightening studies.
(Received September 01 2005)
(Accepted October 22 2005)
Correspondence:
c1 *Corresponding author: Email: dhodgins@uoguelph.ca
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-5,096,943,281,399,069,000 | Institut for Biomedicin
Lars Bolund
Transgenic Wuzhishan minipigs designed to express a dominant-negative porcine growth hormone receptor display small stature and a perturbed insulin/IGF-1 pathway
Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review
DOI
Growth hormone (GH) is an anabolic mitogen with widespread influence on cellular growth and differentiation as well as on glucose and lipid metabolism. GH binding to the growth hormone receptor (GHR) on hepatocytes prompts expression of insulin growth factor I (IGF-1) involved in nutritionally induced compensatory hyperplasia of pancreatic β-cell islets and insulin release. A prolonged hyperactivity of the IGF-1/insulin axis in the face of insulinotropic nutrition, on the other hand, can lead to collapse of the pancreatic islets and glucose intolerance. Individuals with Laron syndrome carry mutations in the GHR gene resulting in severe congenital IGF-1 deficiency and elevated GH serum levels leading to short stature as well as perturbed lipid and glucose metabolism. However, these individuals enjoy a reduced prevalence of acne, cancer and possibly diabetes. Minipigs have become important biomedical models for human conditions due to similarities in organ anatomy, physiology, and metabolism relative to humans. The purpose of this study was to generate transgenic Wuzhishan minipigs by handmade cloning with impaired systemic GHR activity and assess their growth profile and glucose metabolism. Transgenic minipigs featuring overexpression of a dominant-negative porcine GHR (GHR(dm)) presented postnatal growth retardation and proportionate dwarfism. Molecular changes included elevated GH serum levels and mild hyperglycemia. We believe that this model may prove valuable in the study of GH functions in relation to cancer, diabetes and longevity.
OriginalsprogEngelsk
TidsskriftTransgenic Research
Vol/bind24
Nummer6
Sider (fra-til)1029-42
Antal sider14
ISSN0962-8819
DOI
StatusUdgivet - dec. 2015
Se relationer på Aarhus Universitet Citationsformater
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5,767,391,861,951,712,000 | | | Birth Control and Athletic Performance
Author / Leah Kay
In this country, 62% of women are using some form of contraceptive. Of those, almost 50% are using a type of hormonal method such as the patch, an injectable or, the most popular form, the pill. While many women use the pill as an oral contraceptive, it is also frequently prescribed for irregular menstrual cycles, acne, severe PMS or other hormonal imbalances.
Many potential side effects for women on the pill include blood clots, weight gain or breakthrough bleeding. While these are often taken into consideration before use, many athletes are woefully ignorant of other detrimental effects that can be brought about by prolonged pill usage. As strength and conditioning coaches, this presents us with some unique challenges regarding our female athlete population.
Oral contraceptives cause deficiencies in:
• Vitamin: B6, Folate, B12
• Mineral: Zinc, Selenium, Magnesium, Phosphorus
• Antioxidants
This can lead to performance losses in several ways. B vitamins are utilized in the body to convert carbohydrates to energy, produce red blood cells, synthesize DNA, and repair tissue and cells. More specifically, B12 deficiencies cause significant fatigue. So instead of chasing PR’s, your athletes will just want to chase Zzz’s.
Magnesium is utilized in over 300 reactions in the body including ATP production in the mitochondria. Yes, over 300 reactions. Low levels of magnesium is like watching the movie “300” without any Spartans–ain’t nothing badass going to happen anytime soon. And speaking of mitochondria, those little cellular powerhouses are not invincible. They rely heavily on antioxidants to neutralize any free radicals within the body whether they came from the good stuff (exercise) or the bad stuff (pollutants, pesticides). Only problem is, hormonal birth control depletes those antioxidants so there’s less (wo)manpower to fight off the junk and protect those cells!
The brutal results from this multitude of contraceptive driven deficiencies are increased fatigue, lowered motivation and impaired recovery. We all know that recovery is more important than training itself, so that combo can be truly devastating to the female athlete.
Now, one could assume that aggressive supplementation of these deficient nutrients MIGHT neutralize the negative effects mentioned so far. However, there’s one major influence that the pill has on the body that cannot be fixed with supplementation. And this effect might just be the most detrimental to athletic performance of all: the increased production of sex hormone binding globulin (SHBG).
SHBG is a special kind of protein that binds to testosterone and renders it inactive. If you read that sentence and dropped to your knees screaming “No! Dear God, NOOOOO!!!!”, pat yourself on the back because that was the appropriate response. The reduction of excess testosterone is precisely one of the reasons the pill is prescribed for acne. This might be good news for your skin, but bad news for your muscles and a lot of other things! You see, female athletes already have naturally lower levels of testosterone than their male counterparts.
With testosterone’s role in increasing muscle mass, bone mass, competitive drive, and sex drive one could see how an increased binding of this small amount of testosterone could cause serious problems for female athletes, especially those whose sport has a very large strength, power or weightlifting bias. I’m looking at you Power Athletes!
Even worse, women using oral contraceptives also tend to have lower levels of the hormone DHEA (a testosterone pre-cursor) and higher levels of the stress hormone cortisol which is very catabolic in nature. That’s a triple whammy! And excessive cortisol production can often lead us down the slippery slope of HPA-axis dysfunction (commonly referred to as adrenal fatigue) You see your brain is responsible for talking to your adrenals and signaling them to produce hormones on a regulated basis. This constant introduction of estrogen from birth control dysregulates that communication creating an environment of chronic cortisol production and inflammation which is seriously bad news for any athletes that are looking to compete at the highest level (think CF Games!).
So where does this leave us with empowering our female power athletes? The solution to this problem is going to be different for each individual. There are a lot of low hanging fruits that need to be examined before diving down this rabbit hole.
For many Power Athlete Ladies the stress of possible unwanted pregnancy, irregularity, PMS etc is enough to warrant keeping the hormonal birth control that they are using. If that’s the case, I’d highly suggest making sure their sleep is ON POINT! Next up, I’d examine their nutrition and make sure they’re getting optimal levels of flesh building nutrients. Then I’d really work on optimizing rest and recovery techniques. Lastly, they’d benefit from some targeted supplementation to minimize the common deficiencies discusses above.
But, if you are coaching a seasoned female athlete (or are one) who is seeing a slow, unexplained drop in performance and have already optimized their low-hanging fruit, a change could be in order whether that be switching to a non-hormonal birth control method or ditching it all together. It’s a choice nobody can make for them, but, hopefully, now they’ve got a little more knowledge to make that decision.
Sources
Guttmacher Institute (2015, October) Contraceptive Use in the United States. Retrieved August 22, 2016, from https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
Lee, C.W., M.A. Newman, and S.E. Riechman. 2009. Oral Contraceptive Use Impairs Muscle Gains in Young Women (Abst. 955.25). Experimental Biology 2009, New Orleans (April 21).
Panzer C., et al. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med 2006 Jan; 3(1): 104-13.
Zal F, et al. Effect of vitamin E and C supplements on lipid peroxidation and GSH-dependent antioxidant enzyme status in the blood of women consuming oral contraceptives. Contraception. 2012 Jul;86(1):62-6.
Akinloye O, et al. Effects of contraceptives on serum trace elements, calcium and phosphorous levels. West Indian Med J. 2011 Jun;60(3):308-15.
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AUTHOR
Leah Kay
Former collegiate volleyball player and 7 year competitive CrossFitter. 6x CF regional qualifier and 1x CF Games qualifier. Began coaching CrossFit in 2009 while working towards a Bachelor's in Nursing. Studied functional medicine through the American Academy of Anti-Aging in 2013 with specific emphasis on nutrition and hormone regulation. Continues to blend love of coaching and wellness as Head Trainer and Co-Owner of CrossFit Katy and Functional Nutritionist at Specialty Healthcare and Wellness in Houston, TX.
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2,144,845,385,546,434,000 | Publications
Hepatology. 2009 Feb .
Autochthonous liver tumors induce systemic T cell tolerance associated with T cell receptor down-modulation.
Ney JT, Schmidt T, Kurts C, Zhou Q, Eckert D, Felsher DW, Schorle H, Knolle P, Tüting T, Barchet W, Büttner R, Limmer A, Gütgemann I
The reason the adaptive immune system fails in advanced liver tumors is largely unclear. To address this question, we have developed a novel murine model that combines c-myc-induced autochthonous tumorigenesis with expression of a cognate antigen, ovalbumin (OVA). When c-myc/OVA transgenic mice were crossed with liver-specific inducer mice, multifocal hepatocellular carcinomas co-expressing OVA developed in a tetracycline-dependent manner with a short latency and 100% penetrance. Transferred OVA-specific T cells, although infiltrating the tumor at high numbers, were hyporesponsive, as evidenced by a lack of in vivo cytotoxicity and interferon gamma production. This allowed the tumor to progress even in the presence of large numbers of antigen-specific T cells and even after vaccination (OVA+CpG-DNA). Interestingly, T cell receptor down-modulation was observed, which may explain antigen-specific hyporesponsiveness. This model is helpful in understanding liver cancer-specific mechanisms of T cell tolerance and dissection of antigen-specific and nonspecific mechanisms of immunotherapies in the preclinical phase.
PMID: 19105207 [PubMed - in process]
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-5,030,540,434,713,464,000 | Cardiovascular Diseases
Cardiovascular disease (CVD) refers to any disease condition affecting the vascular system (blood vessels) and the heart. Cardiovascular diseases can be broadly classified into various types depending on the cause and specific location of the disease, such as coronary heart disease, cardiomyopathy, atherosclerosis, congestive heart failure, hypertensive heart disease, inflammatory heart disease, and valvular heart disease.
Cardiovascular diseases are life threatening and require intervention. CVDs are a leading cause of death worldwide, affecting both men and women. Over six million deaths were reported in the US in 2006 and statistics show that someone has a heart attack every 34 seconds.
Symptoms
Symptoms of Cardiovascular diseases are marked and numerous. Primary symptoms include chest pain, cyanosis, dyspnea, edema, fatigue, palpitations, and syncope. Chest pain is the most common symptom. The term Cyanosis indicates a bluish discoloration of the skin and mucous membranes caused by inadequate oxygen supply during an adverse cardiovascular event. Dyspnea involves the shortness of breath or difficulty breathing. Edema denotes swelling around the ankles, legs, eyes, chest wall, or abdominal wall. Palpitations are abnormally fast and irregular heartbeats. Fatigue describes an abnormal weakness. Syncope is fainting and loss of consciousness.
Risk Factors
According to the American Heart Association, 1 in every 9 deaths reported in the United States is due to heart failure. This statistic shows that traditional risk factors like smoking, alcohol, hypertension, cholesterol, and diabetes remains an issue for many Americans. The 2012 statistics clearly points out the relationship between the obesity epidemic and CVD prevalence.
The risk factors for cardiovascular diseases can be classified as:
Behavioral risk factors include tobacco and alcohol abuse, sedentary life style, and high cholesterol and high calorie diet. Metabolic risk factors include persistent high blood pressure, diabetes, high LDL cholesterol, obesity, and excess homocysteine in blood. General risk factors include poverty, illiteracy, aging, family or genetic disposition, stress and other psycho-sociological factors.
These risk factors are related and one can lead to the other. For example, alcohol and high fat diet coupled with sedentary life style causes hypertension, high cholesterol, and diabetes. These risk factors are further aggravated by poverty, illiteracy, aging, stress, and anxiety. These risk factors contribute to CVDs not only as a single entity but also in synergy. Thus, cardiovascular diseases have multiple risk factors, especially in older adults.
Common Cardiovascular diseases (CVDs)
1. Coronary Heart Disease
Coronary heart disease (CHD) is the most common cardiovascular disease that occurs due to blocked or congested coronary arteries. Reduced blood supply to the heart muscles distresses the heart, leading to various heart diseases.
Symptoms. Chest pain and the sensation of pressure or squeezing in the chest, extending to shoulders, arms, neck, jaw and back, shortness of breath with gasping and difficulties breathing are all symptomatic of coronary heart disease.
Treatment. Treatment options for CHD include drug and surgical interventions. Drug intervention includes statins that reduce LDLcholesterol, nitroglycerin, ACE inhibitors, calcium channel blockers, and aspirin. Surgical interventions include angioplasty, stent placement, coronary artery bypass, and heart transplant.
2. Cardiomyopathy
Heart muscles are referred to as the myocardium. Cardiomyopathy is the disease of the heart muscles. It is most often caused by external factors, rather than problems related to the structure and function of the heart muscle. These factors include alcohol addiction, hypertension, and fat deposits.
Symptoms. Breathlessness during normal activity, abnormal non-injury related swelling in the legs, ankles and feet, abdominal bloating with fluid, abnormal fatigue, irregular heart rhythms, and sudden fainting are marked symptoms of cardiomyopathy.
Treatment. Common medications include ACE inhibitors, beta-blockers, digoxin, and diuretics. Surgical interventions include septal myectomy, septal ablation, pacemaker implantation, and implantable cardioverter-defibrillator.
3. Atherosclerosis
Atherosclerosis is a type of arteriosclerosis that causes the formation of plaques due to fat or lipid deposits in the inner walls of blood vessels. These atherosclerotic plaques in the blood vessels rupture, forming blood clots that block the blood vessels supplying blood to the heart muscles.
Symptoms. Atherosclerosis of the major arteries that supply blood to heart shows symptoms such as chest pain and pressure in the chest region. Breathlessness during normal activity, abnormal non-injury swelling in the legs, ankles and feet, abdominal bloating with fluid, abnormal fatigue, irregular heart rhythms, and sudden fainting are also common symptoms.
Treatment. Drugs for the treatment of atherosclerosis include statins or fibrates that lower LDL cholesterol, anti-platelet drugs like aspirin, beta-blockers, ACE inhibitors, calcium channel blockers, and diuretics. Surgical interventions include angioplasty, stent placement, endarterectomy, thrombolytic intervention, and bypass surgery.
4. Congestive Heart Failure
Any structural or functional disability of the heart to pump adequate blood throughout the body leads to congestive heart failure.
Symptoms. Acute symptoms include chest pain, shortness of breath, pink foamy mucus from coughing, and palpitations. Chronic symptoms include shortness of breath from normal activity, abnormal fatigue, edema in legs, palpitations, abdominal swelling, weight gain, and pinkish blood stained phlegm from coughing.
Treatment. Treatment includes ACE inhibitors, angiotensin II receptor blockers, digoxin, beta blockers, aldosterone antagonists, and diuretics. Coronary bypass surgery, heart valve repair or replacement, implantable cardioverter-defibrillators, cardiac resynchronization therapy or biventricular pacing, heart pumps including left ventricular assist devices or LVADs, and heart transplant are the recent surgical interventions available for congestive heart failure.
5. Valvular Heart Disease
There are four valves in the human heart that regulate the flow of blood into and out of the heart chambers, these include the aortic and mitral valves on the left side of the heart and the pulmonary and tricuspid valves on the right. These valves open and close during normal pumping cycles of the heart. Any dysfunction in one of these valves leads to heart valve diseases.
Symptoms. Heart valve disease symptoms include shortness of breath during normal daily activity, abnormal fatigue or weakness with or without dizziness; chest discomfort, pressure in the chest region, irregular heartbeats, edema or swelling in the lower limbs and abdomen, and sudden weight gain.
Treatment. Treatment for heart valve diseases includes medications that regulate heart rhythms and heart load. Balloon Valvotomy is a common medical procedure used to treat valve stenosis. Surgical heart valve repair procedures include ring annuloplasty and valve repair by surgical trimming. Valve replacement surgery is performed when the heart valve is damaged beyond repair.
Other Cardiovascular diseases (CVDs)
The Cor pulmonale is a condition in which complications in the lungs like COPD cause failure of the right side of the heart.
Hypertensive heart disease is caused by chronic high blood pressure. Hypertensive heart disease often leads to other cardiovascular complications, such as left ventricular hypertrophy, cardiomyopathy, and arrhythmias.
Inflammatory heart disease refers to the inflammation of the heart muscles and tissues. Endocarditis refers to the inflammation of the endocardium, especially the heart valves. Myocarditis denotes the inflammation of heart muscles.
Maintaining a Healthy Heart
Life style changes, stress management strategies, and adherence to medical guidance can all help to prevent cardiovascular diseases. A low-fat, fiber-rich diet with green vegetables and fruits can help maintain a healthy heart. Dietary fiber is effective in flushing unwanted cholesterol deposits in the colon and blood vessels. Daily intake of dietary vitamins like folate helps in the regulation of homocysteine levels in blood, thereby promoting cardiovascular health. Moderate physical exertion and exercise helps support preventive heart care.
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The Risks and Benefits of Calcium Supplements
There has been an assumption for decades that as a natural element, calcium supplements must intrinsically be safe. But, as I explore in my video Are Calcium Supplements Effective?, calcium supplementation is neither natural nor risk-free. The same could be said, however, for all medications, yet doctors continue to write billions of drug prescriptions every year hoping the benefits outweigh the risks.
So, what about the benefits of calcium supplements versus the risks they pose for heart attacks and strokes? Having a heart attack or stroke can be devastating, but so can a hip fracture. In the months after a hip fracture, risk of dying shoots up, with about one in five women passing away within a year. The odds are even worse for men, with hip fractures having the potential to shorten lifespan by an average of four or five years. Unfortunately, these dismal statistics haven’t been getting much better.
Even if calcium supplements caused a few heart attacks and strokes, it could be argued that if they prevented many more hip fractures, then the risk-benefit ratio might be favorable. But how effective are calcium supplements in preventing hip fractures? We’ve known that milk intake doesn’t appear to help, but maybe that’s because any potential benefit of the calcium in milk may be overshadowed by the increased risk of fracture and death associated with the galactose sugar in milk. (See Is Milk Good for Our Bones? for more on this.) Then what about the calcium in a calcium supplement alone? Calcium intake in general does not seem to be related to hip fracture risk at all. When people have been given calcium supplements, they saw no reduction in hip fracture risk but rather an increased risk was possible. In fact, the randomized controlled trials suggested a 64 percent greater risk of hip fractures with calcium supplementation, compared to a placebo sugar pill.
So where did we get the idea that taking calcium supplements might help our bones? An influential 1992 study found that a combination of vitamin D and calcium supplements could reduce hip fracture rates by 43 percent. However, the subjects in the study were institutionalized women, living in places like nursing homes, who were vitamin D deficient. They weren’t getting sufficient sun exposure. So, if you’re vitamin D deficient and then you take vitamin D and calcium, it’s no surprise your bones get better.
For postmenopausal women living independently in the community, the latest official recommendation for calcium and vitamin D supplementation to prevent osteoporosis is unambiguous: We should not supplement. Why? Because “[i]n the absence of compelling evidence of benefit, taking supplements is not worth any risk, however small.” This is not to say that these supplements don’t play a role in treating osteoporosis or that vitamin D supplements might not be good for other things. But, if you’re just trying to prevent fractures, women living outside of institutions should not take them—and this might even apply to those who live within them.
In a 2012 study, instead of giving nursing home residents vitamin D and calcium supplements, researchers randomized them so one group received sunlight exposure and the other took calcium supplements. Those in the calcium pill group had significantly increased mortality, living shorter lives than those in the sunshine group.
Although calcium supplements don’t appear to prevent hip fractures, they may reduce overall fracture risk by approximately 10 percent. If you’re wondering whether this means it could be worth taking them, here’s how the risk-benefit shakes out: If 1,000 people took calcium supplements for five years, we would expect 14 excess heart attacks—that is, 14 people having heart attacks who would not have had heart attacks if they hadn’t started taking the calcium supplements. They were effectively going to the store and buying something that gave them a heart attack. We also would expect 10 strokes and 13 deaths that otherwise would not have happened. An expected 14 heart attacks, 10 strokes, and 13 deaths compared with preventing only 26 fractures. Of course, it’s no fun falling down and breaking your wrist, but most people would probably look at the risk-benefit analysis and conclude that calcium supplements are doing more harm than good.
Dietary calcium, on the other hand, has not been associated with an elevated risk of heart attacks. Given these findings, individuals should be discouraged from taking calcium supplements and advised to obtain calcium from their diet instead. How much dietary calcium should we shoot for then?
Interestingly, unlike most other nutrients, there’s not an international consensus on how much to take. For example, in the United Kingdom, the recommendation for adults is 700 mg per day. Across the pond in the United States, it’s up to 1,200 mg per day. Whenever I see that kind of huge discrepancy between government panels, I immediately think scientific uncertainty, political maneuverings, or both.
Newer data based on calcium balance studies where researchers made detailed measurements of the calcium going in and out of people suggest that the calcium requirements for men and women are lower than previously estimated. They found that calcium balance was highly resistant to change across a broad range of intakes, meaning our body is not stupid. If we eat less calcium, our body absorbs more and excretes less. And if we eat more calcium, we absorb less and excrete more to stay in balance.
Therefore, current evidence suggests that dietary calcium intake is not something most people need to worry about. This may explain why in most studies, no relationship has been found between calcium intake and bone loss anywhere in the skeleton because the body just seems to take care of it.
Don’t push it too far, though. Once you get down to just a few hundred mg per day, you may get significantly more bone loss. Though there may not be great evidence to support the U.S. recommendations, the United Kingdom may have the right idea shooting for 500 to 1,000 mg per day from dietary sources. This applies unless you’ve had gastric bypass surgery or have another reason for needing supplementation. For most people, though, calcium supplements cannot be considered comparatively safe or effective for preventing bone fractures.
What’s this about calcium supplements and heart attacks and strokes? You can learn more about it in my Are Calcium Supplements Safe? video. And be sure to watch Should Pregnant Women Take Calcium Supplements to Lower Lead Levels? and Lead in Calcium Supplements
As mentioned above, for a more in-depth discussion on the milk-fracture relationship see my Is Milk Good for Our Bones? video.
All of this is not to say that these supplements cannot play any role in treating osteoporosis or that vitamin D supplements might not be good for other things. I do advise vitamin D supplementation for those not getting enough sun. (See my recommendations here.) For background on how I arrived at my recommended dose and more information on vitamin D, check out:
In health,
Michael Greger, M.D.
PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:
Discuss
Michael Greger M.D., FACLM
Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.
105 responses to “The Risks and Benefits of Calcium Supplements
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1. There seem to be so few cases where people have managed to ‘outsmart’ or optimize ourselves more effectively than our bodies and millions of years of evolution have already managed to. It seems like the recipe really is as simple as unprocessed plant foods and regular/consistent movement.
Can anyone think of any solidly evidence-based examples other than b12 and algae delivered omega 3s?
2. Thank you for this post. Good info.
Since this is a nutrition blog, would it make sense to provide the dietary homework for the topic at the end, e.g., “To get 500-1,000 mg of dietary calcium per day, eat x cups of collard greens and x cups of almonds”?
1. Chessie
I found out the hard way that Collard Greens have oxalic acid which does cause kidney stones. But Collard Greens are okay to eat as long as not too much.
1. Sydney, I thought collards were okay on that score, but I see that you’re right. I’ve been using them for smoothies and avoiding spinach and beet greens and such due to the issue with oxalic acid. Apparently collards have lower levels of oxalates than other greens, but not none. Argh. I guess raw is not always best.
3. Good point about not being in a calcium deficit. I think I’ve read that when that happens the body (trying to maintain stasis) steals from the stored calcium in the body (bones for instance.)
A healthy body is constantly remodeling bone through osteoclast/osteoblast activity but when that destruction/construction of bone gets out of balance, skeleton weakens.
1. Follow up to the above. I read long ago that astronauts in space would stand on a vibrating pad of some sort to create the effect of “pounding the pavement.”
That caused me to purchase a foot vibrator that I’ve recently taken out of storage, to use while I’m sitting at my desk writing.
I have no idea if it keeps my bones remodeling (and thus growing stronger as the micro fractures are healed) or not, but it does make my feet feel good. ‘-)
1. Lonie, Vibration is one of the things the astronauts did use, and they did have studies, The studies revealed that astronauts who spent months in space stations lost 1
to 2% of bone each month. Standing on a vibrating plate for 10 to 20 minutes per day helped them is what their studies said, but Toronto did a study with women who used a vibrating pad for a year and it didn’t help them.
Vibrating pads are one of the things they tried for brain plasticity and some people get relief from them, but long use and long term use might have contraindications.
What I noticed is that places like Harvard who studied vibrating insoles aren’t doing that research anymore. You can still buy the insoles on-line, but I have pondered a few of the studies and wonder about it.
1. Some of the people on-line who I looked at their sites swear by it. There is a man who had a serious brain injury who has a web-site Adventures in Brain Injury and it is one of his “favorite” things.
I chose the MicroPulse ICES instead, because he had before and after photos of animals whose bone grew back. That was another originally for NASA device.
I also bought a cold laser, based on studies like this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599844/ but cold laser is more “site specific” and I felt like I could “wear” the MicroPulse ICES device, but had to hold the cold laser for a long time, trying to hit every site, but chiropractors would do that for you.
I also bought infrared bulbs and vie light, because they increase circulation and there is a link between circulation and bone health and there is a link between heart health and bone health:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781192/
It makes it that going Vegan SUPERWFPB to unblock the arteries ASAP seems the way to go,
1. There is a $25 intranasal light on Amazon for sinuses and you can get an infrared heat lamp bulb for $7 or the self-hackers get a Infrared LED security camera light and use that.
Because it is related to circulation, I think cold laser would do excellent. I say that, because there is a Dr. Burke from Harvard (I think. It was a year or two ago, when I did the gadget studies) he showed before and after photos of Cold Laser and one of the photos was feet with gangrene, where the foot was black as black could be and after months of cold laser therapy, the skin color started coming back. He showed people who had previously had amputations and they were scheduled for more amputations of things like fingers, but after a few months, the fingers were healed instead of being amputated.
That makes it excellent for circulation in my mind.
Chiropractors and Laser Centers have them. I just don’t know how many hours you would have to spend there. That is why I bought my own, but I bought a flash light kind and I would rather have what Dr. Burke was using on the horses.
1. But the NASA researcher who sells the MicroPulse ICES says that his device is more efficient than any electrical gadget, because it has to pass through the skin.
What I liked about him is that he answers his emails and gives very long detail-oriented explanations of things.
He has the absolute worst web-site for believing in his product, but I looked him up and he really was a fireman and really works where he says and the NASA studies really did happen. What I liked most about how his mind thinks is that he trying to figure out how to make medical devices as inexpensive and efficient as possible.
I laugh though, because I watched his interviews and immediately liked him, and was seriously drawn to his product and to the price, but his page is more like: I am not recommending you using this product on human beings oriented.
I can only tell you that it healed my ankle after something like 7 years of continuous pain and I like gadgets enough to want to try to pre-re-grow my knee cartilage before I lose it all the way. Not sure how that will work, but it is a two year concept and I have already had it heal so many things that I am not afraid of using it for two years.
But if the researcher is not pushing it on people, I really can’t.
I just like it.
1. TG
I once had a friend who had a job making up titles to books,
and then someone else would write the book. I have no knowledge
of electric currents and bones, but “The Body Electric” sounds like such a book.
1. Yes, I think the famous science fiction writer Ray Bradbury wrote an anthology of stiries, which was also called the Body Electric.
I read Becker;s book years ago though – a fascinating read.
2. Thanks Tom. I will look into it.
My ankle was in pain for something like 7 years and I used the Micropulse ICES on it one time. Just once on my ankle and it is like it is still healing. No pain at all. Much sounder. No limp anymore.
It didn’t work as quickly on my back, so I am guessing it must have been inflammation that went down.
I used it to stimulate my vagus nerve while watching videos here to try to change my emotional relationship with food, based on studies and it worked beyond my wildest dreams.
It is a research gadget and the inventor isn’t into money and I alreadu know that I am lucky he sold them at all.
I say it, because I could use TMS to accomplish some of what I used it for, but that would have cost ten thousand dollars and I couldn’t just ask a doctor to give me a prescription.
I am so grateful that vegan gets rid of pain and inflammation, too, so I can stay away from doctors as much as possible.
2. I think that you have to stand on them to get a whole body effect. Otherwise, with just sitting and restng your feet on them, I suspect that your feet and lower legs only will benefit.
Some people use the time on these vibration plates to do some other exercises (eg dumbells, stretching etc) to get the maximum benefit from the time spent.
However, I gather that the evidence doesn’t support claims that these machines are effective in stopping bone loss. According to Harvard
“Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.
The results are a disappointment for older women and men looking to strengthen their bones without exercising, not to mention to the companies that have sprung up to sell whole-body vibration platforms as an easy way to halt osteoporosis, the age-related loss of bone.”
https://www.health.harvard.edu/blog/whole-body-vibration-doesnt-slow-bone-loss-201111173820
1. Yeah Tom, I’m actually doing it now more for the muscle tone in my lower legs as I don’t do as much outside now as I normally do.
Not too worried about my bone density as I eat dried plums (prunes) on a daily basis.
I’ve read research that suggested that eating 6 prunes a day maintains bone health. Reasonably sure it wasn’t the Plum people funding it, but even if it were, eating plums whether fresh or dried is not a bad thing.
My favorite way of eating them is with a mouth full of unadulterated peanut butter.
4. The studies quoted apparently did not look at Magnesium. Manganese, K1 and K2. I believe it is silly and irresponsible to do studies on Calcium and bones with out looking also at Mg, Mn, K1 and K2.
Having survived six weeks in a nursing home, I can attest to the deficient diets people are fed. The 1st few days there I was COLD. I realized I was not getting enough iodine so I had my friend smuggle in extra eggs which did warm me up. (but what about everybody else?) I convinced staff I needed extra K and they did cook me spinach and Broccoli with did help, but again what about everybody else? Only when I left the nursing home did I put on muscle mass and regain weight.
The point is: How can studies in a nursing home be valid with such poor diets.
BTW: I haven’t eaten dairy since 1980.
1. Hi I’m an RN health support volunteer with Dr. Greger. Thanks for your great question. Calcium is found in all sorts of healthy plant based foods, especially dark leafy greans. You really don’t need to add any fortified foods to get adequate calcium intake if you are eating everything on Dr. Greger’s daily dozen:
https://nutritionfacts.org/video/dr-gregers-daily-dozen-checklist-2/
There is more information in this link-
https://nutritionfacts.org/topics/calcium/
All the best.
NurseKelly
1. Leafy greens are a very good source as are beans IIRC. Almost all whole plant foods have it. Go to cronometer.com and log your diet to see your nutrition. Except for B12 and D, it would be almost impossible to eat a WFPB diet and be deficient in anything.
1. Hi P H! I think this article will help to answer your questions. Dark green leafy vegetables are a good source of calcium, and if you meet the Daily Dozen recommendations of 2 servings of greens, 1 serving of cruciferous vegetables, and 2 servings of other vegetables, you should easily meet the recommended 600mg/day!
1. It may look good on cronometer, but bioavailability is key. You’d have to eat 25 pounds of spinach to get enough calcium because the bioavailability rate is only at around 5%.
A lot of people make light of this subject and make it sound easy to get enough calcium, getting even 600 mg a day is quite a task (if you don’t drink or eat fortified food).
I inserted into cronometer a Gregers Daily Dozen and ended up with 902 mg/calcium, but after taking into consideration bioavailability it is likely around 300-400. And that included Chia and Sesame seeds, which are very high in calcium.
Black/Red/White Beans, Chia/Sesame, Bok Choy/Kale/Chinese Cabbage. These are some of the best sources. But you will have to eat a lot of it. To put it into perspective, if you were to get it from Bok Choy, which is the best source when taking into account bioavailability (53.8% absorption) and calories. You’d have to eat 7 cups of it to reach 600 mg/day.
So please research it on your own to learn more as this is more complicated than it may seem.
5. Great article very helpful. I’ve recently been diagnosed with osteoporosis followed suit with the prescription of Teva Alendronate 70g weekly combined with recommendation of Calcium and Vit D. I live in a location which sun is limited for pretty much 7-8 months of the year, so taking Vit D is required however my intake of Calcium from food non dairy nut milks in addition to nuts and veggies etc should cover my Calcium intake after reading through your blog.
However, I do have some reservations about taking Alendronate; would you have any feedback in regards to prescribed medications for osteoporosis?
1. wendy, there is a discussion of the benefits and side-effects of Fosmax, (alendronate), on the Harvard Health site.
Can find by putting “What’s the Story with Fosamx” in your search engine.
Read the whole article for the pros and cons.
Ignore the advice to take all that calcium, wouldn’t be absorbed anyway, and you need more than 800iu vit D.
1. Thank-you very much TG, I will take a read. This is fantastic, all you folks taking the time to provide resources. Very much appreciated.
1. Thank-you so much for info Marilyn. I’ll take a look. I’m taking 2000iu Vit D3 daily as was prescribed. Hopefully it isn’t too much vit D. I really do need to find out more about the Vit D3 vegan, didn’t know it was available.
2. Hi I’m a RN health support volunteer with NutritionFacts. Sorry to hear about your osteoporosis. Dr. Greger has several videos /posts about this you might like:
https://nutritionfacts.org/topics/osteoporosis/
https://nutritionfacts.org/video/prunes-for-osteoporosis/
https://nutritionfacts.org/video/almonds-for-osteoporosis/
He hasn’t done much on osteoporosis medications. This is something Dr. McDougall (another fighter in the plant based nutrition battle and mentor of Dr. Greger’s) has spoken a lot on. I would look into some of his information:
https://www.youtube.com/results?search_query=dr+mcdougall+osteoporosis+
https://www.drmcdougall.com/health/education/health-science/hot-topics/medical-topics/osteoporosis/
Hope that helps.
NurseKelly
1. Hi Robert. Thanks for your comment!
As Dr. Greger said, “calcium supplementation is neither natural nor risk-free”, I think those disadvantages mention above also applied for children. However, I could found an interesting methanalysis addressing this issue:
Calcium supplementation for improving bone mineral density in children.
AUTHORS’ CONCLUSIONS: (…) The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.
Here’s another one very useful: Optimizing bone health in children and adolescents.
You can also watch Dr. Greger video and more info about suplements here: https://nutritionfacts.org/video/are-calcium-supplements-safe/
6. Susan, the algae-cal has too much lead for me, check it out first.
I had a parathyroid tumor that was removed in 2016 that had been disrupting my calcium metabolism for about 10 years. It caused osteoporosis in my arms and was heading that way for my hips. Fortunately for me, I started with strong bones, so the damage was not what it could be. Hyperparathyroidism pulls calcium out of your bones to keep levels too high in your blood. It’s bad news for both your bones and your cardiovascular health. Pay attention to your calcium level in annual blood tests – high calcium is not a good thing, and this is not a rare condition.
This has left me with instructions from the endocrinologists to take a calcium supplement to get my bones back to normal. I use cronometer and take only enough to bump me up to 1000mg/day, plus K2 (both mk-4 and mk7 forms) and vitamin D3. My hope is that I am directing a reasonable dose of calcium to my rebuilding bones and keeping it away from my cardiovascular system.
It’s important to note that K2 is not the same as the vitamin K in greens, and that we are extremely poor converters of K to K2 as we age. I would like to hear Dr. Greger discuss K2 and calcium metabolism in the future. I have tentatively concluded that K2, like B12, is a vitamin that vegans should supplement.
7. Another thing to throw in there: vegans and others often prefer the K2 mk-7 form because it persists in the body longer and can be sourced from natto (fermented soy beans). However, the mk-7 form of K2 is rare in the natural diet, and can cause heart palpitations in some people who are genetically programmed to clear it from their body more slowly. The mk-4 form of K2 was a natural part of our diet when people ate small quantities of wild, grass-fed meat or grass-fed dairy. Modern meat and dairy is not a good source. We are probably all deficient. K2 mk-4 is the form that our body synthesizes from K1 in greens (if only it could do enough of that long enough). K2 mk-4 is the form that the research in Japan has shown to reverse osteoporosis.
So I am updating my statement: I have tentatively concluded that K2 mk-4 is a vitamin like B-12 that vegans should supplement. And I would really like to hear Dr. Greger talk about all of this.
1. Annie
Do I understand you correctly?:
However we get K2 mk-4, it will reverse osteoporosis.
K2 mk-4 is made in our bodies from K1 if there is enough K1 available.
K2 mk-4 is also available from 100% grass fed beef and lamb
QUESTION: Is the 100% grass fed beef and lamb that is currently available close enough to wild pre-agricultural revolution beef and lamb to give us similar amounts of K2 mk-4?
QUESTION: Is K2 mk-4 also available from egg yolks?
Can you supply a link for the Japanese research you mentioned?
Anecdotally speaking: My osteoporosis has improved to osteopenia by eating foods rich in both K1 and K2 and taking supplements of Calcium Carbonate, Magnesium Gluconate, Manganese Gluconate and D.
8. I take a mere 200 to 400 mg a day of cal citrate always with mag citrate, both in powdered form. I drink some plant milks as well. I take K2 a few times a week. I don’t want to stop supplementing. I have Celiac Disease and struggle with safe eating factors and malabsorption problems. And yes, I have mild osteoporosis.
1. Bebe:
An endocrinologist told me to not take Calcium and Magnesiun at the same time
as they interfere with each other’s absorption.
1. Yes, they compete for uptake by the body. I recall reading somewhere that high magnesium consumption can lead to calcium deficiency.
It is probably worth consulting a pharmacist on dosing and timing if Bebe wishes to continue with these supplements.
9. Look to Japan, where they use 45mg vitamin K2, MK-4 form, to treat osteoporosis regularly. K2 is chronically deficient in the USA, and many in the nutrition-health field are pointing out the way it works, but few in the medical literature are paying any attention. It seems to take 50 or more years for anyone to read anything outside a narrow band of research, even if the results are so good they are standard practice elsewhere. I get the orthodoxy view but when a country is practicing medicine mainline using something, it would make sense to at least investigate it.
1. It is my understanding that the Japanese derive K2 as MK-4 directly from natto consumption. It is found in grass-fed meats and dairy and does not remain in the body for very long. It therefore requires copious amounts of the supplement throughout the day which can be very expensive. The supplement is also not as bioavailable as the MK-7 version.
1. MK7, not MK4, is found in natto. Why the japanese doctors are using MK4 is not clear to me, but that’s what they use. It is produced synthetically. MK7 has longer half life, quite a bit, so has a big effect at a miniscule dose compared with MK4, and many are using MK7. When tested, a dose of 360mcg (not mg) of MK7 fully carboxylated (activated) MGP, and was used in a test to see if this dose of mk7 could reverse coronary calcium buildup. The results are not yet out. The debate about MK7 vs MK4 goes on and on, but it may not matter which form. Those selling each claim theirs is best, of course.
10. I am strict vegan who is very close if not at osteoporosis. Should I supplement with k2. Is it available without calcium? I am very confused and concerned. Please help!!
1. U Bridges:
If I understand correctly a post by Anne, your body will make all the K2 mk-4 you need IF you have plenty of K1 from ORGANIC: Parsley flakes, kale, broccoli, etc.
2. Some of these articles may help
http://www.theveganrd.com/vegan-nutrition-101/vegan-nutrition-primers/protecting-bone-health-on-a-vegan-diet/
http://www.todaysdietitian.com/newarchives/0216p24.shtml
Note that none of them mention vitamin K. The evidence for K2 supplemetation on bone (and cardiovascular) health appears mixed, All the studies showing K2 benefits on bone health appear to come from one country only (Japan) so the jury is still out on this one I think.
In the interest of full disclosure, though, I should say that I personally take a D3/K2 supplement. Dr Greger recommends vitamin d supplements and I figure, correctly or incorrectly, that adding K2 may help. I get 120 vegetarian capsules for less than US $8 so it’s financially easy decision.
3. U – There are so many factors with osteoporosis. There should be a check list way beyond Calcium. I honestly got overwhelmed two nights ago, by how much information there is.
Beyond Animal Products:
Osteoporosis is linked to:
Cancers and Cancer treatments, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783531/
Heart Problems https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781192/
High Blood Pressure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258724/
Diabetes, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094869/
Thyroid problems, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314789/
Heavy Metal Toxicity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153379/
Cell Phone and WIFI exposure https://saveourbones.com/3-secrets-improve-bone-density/
Air Pollution Exposure http://www.techtimes.com/articles/215588/20171113/air-pollution-linked-to-increased-risk-for-osteoporosis-and-bone-fractures-study.htm
Crohn’s and Celiac https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/celiac
Mitochondrial Problems (Low Co-Enzyme Q10) https://www.sciencedirect.com/science/article/pii/S0005272815001085
Sedentary lifestyle
Lack of deep enough sleep in a dark enough room / Lack of Melatonin https://www.ncbi.nlm.nih.gov/pubmed/27823720
https://clinicaltrials.gov/ct2/show/NCT01152580
Low levels Glutathione https://glutathioneforhealth.wordpress.com/2011/12/24/low-glutathione-levels/
High levels of Cortisol from stress https://www.ncbi.nlm.nih.gov/pubmed/18710063
Lack of sun exposure / Vitamin D3 deficiency https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520343/
Inflammation https://www.ncbi.nlm.nih.gov/pubmed/18240539
Alcohol https://www.webmd.com/osteoporosis/features/alcohol#1
Sugar and fat and white flour intake https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452236/
Smoking https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/bone-smoking
I ran out of time doing this part, I will try to do more later, but I wanted to make the point that your bones are about way more than Calcium.
1. My second list had everything from
Sodium Intake,
to Drinking demineralized waters
to RoundUp,
to Gut Microbiome,
to Saturated Fats
to high cholesterol
to high blood pressure
to Lactose Intolerance
to anorexia
to kidney problems
to soda for some abstract reasons
to asthma (corticosteroid use)
to other drugs like SSRI/s
to living in a high altitude
to fluoride in water
to eating the wrong proteins and wrong amount of proteins
to acrylamide from burning food
to having low levels of choline (get your choline from plant sources, don’t fuel Cancer)
to low carnitine
I hate that I lost my whole list with all of the links, but I just wanted people to know if they have osteoporosis, they have to look for the cause and not just supplement.
That being said, there are some excellent ways to help, things like broccoli sprouts and amla and turmeric etc.
https://saveourbones.com/ has a nutrition section to look at.
1. Genuinely, the list of things, which cause it and which help it BOTH are so much longer than what I am able to reproduce again.
Look at https://saveourbones.com/ for a lot of information. There is even more out there than this, but it is almost two in the morning and I am going to try to get some sleep. Doesn’t usually happen, but losing my whole list makes me want to.
4. Hi I’m a RN health support volunteer with NutritionFacts. Sorry to hear about your situation. You can get Vitamin K supplements without calcium if you are so inclined, but from what I have seen, the evidence of Vitamin K for osteoporosis in is not real strong-
https://www.ncbi.nlm.nih.gov/pubmed/15320745
https://www.ncbi.nlm.nih.gov/pubmed/24090644
A great source of both vitamin K and calcium is your leafy green vegetables.
Here is some more information that Dr. Greger has which may help guide the difficult decision you are facing:
https://nutritionfacts.org/video/are-calcium-supplements-effective/
https://nutritionfacts.org/video/prunes-for-osteoporosis/
https://nutritionfacts.org/video/almonds-for-osteoporosis/
https://nutritionfacts.org/video/is-milk-good-for-our-bones/
Dr. McDougall, another fighter in the plant based nutrition battle and mentor of Dr. Greger’s, has spoken a lot about osteoporosis. You might like to check out some of that information:
https://www.drmcdougall.com/health/education/health-science/hot-topics/medical-topics/osteoporosis/
https://www.youtube.com/results?search_query=dr+mcdougall+osteoporosis+
All the best to you.
NurseKelly
11. There’s solid evidence-based example of algae delivered omega 3’s doing good? Would really like to read that study.
Thanks, Mark
1. A Harvard team conducted a systematic review and meta analyisis of trials and studies of algal oil, that was published back in 2011 in The Journal of Nutrition. The link won’t post here but you can Google the title:
A Meta-Analysis Shows That Docosahexaenoic Acid from Algal Oil Reduces Serum Triglycerides and Increases HDL-Cholesterol and LDL-Cholesterol in Persons without Coronary Heart Disease
12. “All of this is not to say that these supplements cannot play any role in treating osteoporosis”. Could you elaborate on that for those of us who are concerned with all the facts?
1. Hi I’m a RN health support volunteer with NutritionFacts. Thanks for your questions. Here are several videos Dr. Greger did specifically on calcium supplements. If you click on “sources cited” at the bottom, you can find all the references where the information came from.
https://nutritionfacts.org/video/are-calcium-supplements-effective/
https://nutritionfacts.org/video/are-calcium-supplements-safe/
NurseKelly
13. When I worked for a vitamin supplier I read research on the various forms of calcium supplements and their uptake into the body. Calcium carbonate – chalk – was at the bottom of the list although it was the one most recommended by doctors. I never found any noticeable improvement in takers of Caltrate. I was well aware of the negative side effects of taking Caltrate and such products and advised against them in the years of Osteoporosis fever and bone density measuring fads in pharmacies etcetera. I did however find much evidence of bone density improvement in taking the herb Horsetail Grass – Equisetum. Its high silica content appeared to assist the thyroid and para thyroid glands to regulate calcium more efficiently in the body and stimulate bone repair.
14. I’d like to hear what level of calcium supplementation was associated with the various outcomes in this article. I’m a vegan with osteopenia and I choose to supplement just 100-200 mg calcium (plus other minerals, K2, D3) daily as a little ‘insurance’. Have low levels of calcium supplementation or mixed supplementation been studied?
1. Hi VegeMarian,
I am a volunteer for Dr. Greger. Thank you so much for your question.
The calcium supplements in the studies listed are often between 500-1000 mg. So taking 100-200 mg calcium will likely not increase your risk of cardiovascular disease very much. However, assuming you are getting a sufficient dietary intake of calcium (regular consumption of green leafy vegetables should do the trick), as well as getting adequate vitamin D, you shouldn’t need to worry about any “insurance” intakes of calcium. I don’t believe we have data on very low-level calcium supplements and cardiovascular risk. In a meta-analysis looking at all the studies in subjects taking less than 500 mg of calcium supplementation, the study found that they may be 18% more likely to suffer from a cardiovascular event, but the sample size was so small, that this was NOT statistically significant.
Overall, you shouldn’t need to take a calcium supplement given that your diet is adequate. However, taking such a small amount of calcium in the form of supplement will either have no effect or such a small effect that it would be nearly impossible to determine the risk.
I hope this helps!
15. https://www.ncbi.nlm.nih.gov/pubmed/25063690
This pubmed abstract says that boron is essential in bone health. I noticed that there are a number of doctors on the internet who say that boron should be included with the K-2, and vitamin D3 for improved bone health. They say that boron acts in a similar way to K-2 in that it helps to make sure that calcium is not collected in soft tissues such as the arteries. I am sure that the gate keeper of this forum will disagree with this.
16. https://youtu.be/Z8EMfIe5pfU
This is an interesting 3 minute video on YouTube that shows the recovery of a young man who was paralyzed from the chest down from an accident. Because you can only have clinical trials in the U.S. with stem cells, he was forced to travel to India. In India he made dramatic improvement with stem cell therapy. However, I am sure that there are some people on this forum who will disagree with this young man’s recovery because he went to India. God forbid….he went to a foreign country like India or maybe even Panama. https://youtu.be/Z8EMfIe5pfU
17. https://youtu.be/NM_YOiJ0Mks
Dr. Sarrah Stancic is a new and upcoming medical doctor who is shouting the whole plant food diet from the roof tops. She overcame M.S. by eating a whole plant food diet. Check out her testimony. Ooops….I forgot there are people on this forum who say that she is just anecdotal evidence and we should not pay any attention to her. What they want is a million dollar triple blind study before they are going to believe this woman was really cured of M.S.
https://youtu.be/NM_YOiJ0Mks
1. Sorry Bill but you should try doing some research before making such absolute statements about other other people’s views. On the other hand, yes, persnaol statements and testimonies are meaningless – not least because you can often contradictory testimonials from other people.
If you had done some reserach on ms and diet though, you might for example have read this on the PCRM website
http://www.pcrm.org/health/health-topics/treating-multiple-sclerosis-with-diet-fact-or
2. From an article by Dr. McDougall, there have been doctors treating MS and low fat vegan diets since the 1950’s.
Roy Swank, M.D., former head of University of Oregon’s neurology department and now a practicing physician at Oregon Health Sciences University, observed that MS patients improved on this forced low-fat diet. In the 1950s, Swank began treating his own patients with such a diet. He got excellent results, so for the next 35 years he treated thousands of MS patients in this way. By any medical standard, his results have been remarkable: patients’ conditions improved by as much as 95 percent.6 Patients fared better if they had detected the disease early and had had few attacks, but even long-time MS sufferers experienced a slowdown of the disease’s progression. Originally Swank was most concerned with limiting saturated fat, but over the years he has become more attuned to the dangers of all kinds of fat. His MS diet is now about 20 percent fat by calories.
18. So, Tom Goff, maybe we should discount any personal testimonies that you have to offer. Dr. Sarrah Stancic, is a medical doctor. She is a vegan. She claims that a whole food plant diet cured her of M.S. and you say that her testimony does not count. You are more narrow minded than can be imagined. I don’t think you even listened to her testimony.
https://youtu.be/NM_YOiJ0Mks
Just to bring you up to logical thinking, testimonies and anecdotal experiences are the first step in doing scientific research. If you only believe what is written down on a piece of paper that has the label science stamped over it, then you need to do more research. Most scientific papers have some kind of bias to them. Research is driven by money, or haven’t you noticed that. Now, if you were open minded you would listen to this vegan doctor’s testimony. If you were living at the time of Galileo you would be the first one to accuse him of being wrong….or Copernicus.
1. Bill, I watched the video and paid attention. That’s how I know that here first name is “Saray” – you on the other hand keep referring to her as “Sarrah”. Did you really watch that video?
What do you do when you have various people offering personal testimonials and anecdotal reports that are all different and even contradictory?
In any case, it was Dr Mirkin who noted that celebrity endorsements, testimonies etc are meaningless. I agree with him. What about all those cigarette adverts from years ago with doctors endorsing cigarettes and offering personal testimonies of benefits?
And if you think testimonials are so wonderful, perhaps you ought to be drinking your own urine
https://www.youtube.com/watch?v=V8Tv5LDEqvY
19. Tom Goff — lots of people are giving anecdotal experiences with vibrating plates, taking supplements, doing different exercises and you never chastise them for giving anecdotal evidence. All of Dr. Greger’s videos have readers and viewers giving different anecdotal stories of how different things have helped them. But, NO….a vegan doctor gives her anectodal story on how a whole plant food diet has cured her of MS and you put on your white jacket and say NO no no we can’t have her testimoney because we can only accept science. Who’s science are you talking about, FDA science, Big Pharma Science, Big Agriculture science, Aryan race nazi science, global warming science, Chinese herbal science, Indian Aryvedic science. You rant and rave about people believing in God and ask which God should I believe, the pagan god? The hindu god? the Apache God? Maybe you should have a near death experience and see if their is an after life, but then, it would only be your testimony wouldn’t it?
1. Hi Bill
Don’t be shy and don’t beat about the bush. Tell us what yiu really think and don’t hold back. Please.
Venting is reputed to be very good for you. I hope that you feel better now.
20. Read your article with interest – thank you for all you do. I take 4 capsules of a natures garden bone supplement that contains calcium from certified organic algaeCal.
Also contains lots of various mushroom, vit d , k and c, magnesium and alma berry but its the calcium that I’m concerned about as I have osteoporosis. Eat almonds but also have hashi so mindful of the goitregenic nature of those.
Again thank you – from grateful reader in UK.
21. Has Dr. Greger ever discussed how to take vitamins and supplements? I am thoroughly confused about which ones to take when and which ones need to be taken separately from others. It would be such a valuable tool to have such an index. Does anyone know of a truly reliable source that addresses this issue? Since I take a good many vitamins and supplements I worry that I may not be taking them properly for greatest efficacy.
1. Steven, Thank you for your input. I think I may have worded my request poorly. I am aware of Dr. Greger’s recommendations (although on the site you suggested he doesn’t mention vitamin K2). I am fairly confident in the choices of vitamins and supplements that I have made. What I need to know is when it is best to take some of these and which should be taken together or separately for greater efficacy. The reason for my confusion, for instance, is that some sources indicate that D3 and K2 should be taken together while other sources say to separate them because when taken together one will diminish the effects of the other. Confusion reigns.
2. Steven, As an afterthought, what I am hoping for is some sort of a chart similar to those that show how much fiber in different foods for instance. This one, however, would list the vitamins, herbs, supplements that are most commonplace and then indicate how much to take, when to take them, etc. It would also indicate which vitamins/supplements must be separated by time so that one doesn;t diminish the effect of the other.Pipedream?
22. My doctor recommended calcium supplements because of my slight post-menopausal bone density decrease. I knew from my holistic background that this was problematic, but when I wanted to discuss, he was adamant that more calcium meant stronger bones. While I enjoyed your article and references to studies, I believe doctor would take it to hear without study citations.
23. What if you take calcium with magnesium? You should never take single minerals unless you have a specific deficiency because they work in proportions. They compete with one another for absorption. Too much of one interferes with the absorption of others.
1. This is exactly why I need a reliable and authoritative source regarding vitamin and mineral supplements. Is anyone on the forum able to recommend? How I wish Dr. Greger would be interested in writing on this subject.
24. Does anyone know if red marine algae calcium supplements carry the same risk? I am hoping Dr. Greger will address this in the future.
25. I like that natural sources of vitamins are advocated but why not just add where the plant based sources of vitamins found.
26. Not sure if this correction has already been made or not. But this statement is NOT true: “For postmenopausal women living independently in the community, the latest official recommendation for calcium and vitamin D supplementation to prevent osteoporosis is unambiguous: We should not supplement.”
The current official recommendation (USPSTF) is for all community-dwelling adults at increased risk for falls SHOULD BE taking a Vit D supplement, which has been shown to reduce falls: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/vitamin-d-and-calcium-to-prevent-fractures-preventive-medication
In addition, the current guideline is in the process of being updated: https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/vitamin-d-calcium-or-combined-supplementation-for-the-primary-prevention-of-fractures-in-adults-preventive-medication
One can quibble about whether the Vit D supplement is to prevent osteoporosis (not evidence-based) or prevent falls (evidence-based), but I believe the statement by Dr. Greger is misleading as it suggests older folks shouldn’t be taking Vit D. This research is not (yet) “unambiguous”.
1. So – watching the video referenced suggests you agree. Will you update/correct the “Risks and Benefits of Calcium Supplements” video?
27. Just curious what your takes are on this? It does not seem feasible to reach 600 or 1000 mg/day without supplementation due to the low absorption rate, unless there is some way to tweak it that I’m unaware of. I just find it odd that everyone says we don’t need to supplement when in theory it will be extremely very difficult to get enough.
For example, broccoli is considered a good source of calcium with great absorption rate 61.3%, and you’d have to eat 16 cups (2.5 kg) to reach 600 mg/day.
It just doesn’t seem to make sense.
28. Hi, shollins! I know that websites can be very convincing, but keep in mind that they are trying to sell you something, so being convincing is the point. You should be able to meet your calcium needs with a whole food, plant-based diet, if you follow the Daily Dozen. https://nutritionfacts.org/app/themes/sage/dist/images/book/daily-dozen_6c40d3eb.jpg
You can find everything on this site related to calcium here: https://nutritionfacts.org/topics/calcium/
You might also be interested in these resources regarding ulcerative colitis:
https://nutritionfacts.org/topics/ulcerative-colitis/
Everything on this site related to osteoporosis may be found here:
https://nutritionfacts.org/topics/osteoporosis/
I hope that helps!
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650,207,959,170,103,400 | Homeopathy
Homeopathy is practiced around the world by dentists, homeopaths, medical doctors, naturopathic doctors, and veterinarians. Our naturopathic doctors take a mind-body approach to health care and may choose to combine homeopathy with Naturopathic Medicine to address the underlying cause(s) of illness. Our homeopathic approach can treat diverse conditions ranging from children’s earaches and colic to women’s health concerns such as bladder infections, PMS, menopause, and pregnancy associated problems. Deep rooted conditions such as anxiety and depression often respond positively to homeopathy. All of our homeopathic remedies are prescribed based on the uniqueness of the patient’s physical, mental and emotional symptoms.
What is homeopathy?
Homeopathy is a holistic approach that uses natural substances to gently stimulate the body’s self-healing abilities. If a herb or natural substance is consumed in large amounts and causes a specific set of symptoms to occur, then the same ingredient in the herb or substance in small amounts can stimulate the body to fight against the same symptoms.
Homeopathic medicine is used to treat illnesses and address physical and emotional symptoms. An example of how homeopathic medications work can be seen in the simple example of the red onion.People often experience watery eyes, runny nose, sneezing, and itchy throat after chopping up some red onions. In homeopathic medicine, the red onion is actually used in certain potencies to treat watery eyes, runny nose, sneezing, and itchy throat that stems from mild allergies or the common cold. The great thing about homeopathic medicine is that it stimulates the body’s own healing powers to overcome symptoms naturally thereby strengthening the body’s own defenses at the same time.
Are homeopathic remedies safe?
Yes. Homeopathy is gentle and suitable for use on all ages including pregnant women and babies. Additionally, each remedy is in specialized potencies that, in most cases, can be safely combined with prescription medications under the supervision of a naturopathic doctor. They are not only safe to use on humans, but also animals. Many Veterinarians regularly use homeopathy in treating animals.
How long does it take for the remedies to work?
Everyone responds to homeopathic medications differently therefore, the time it takes for the medications to work is based on each individuals emotional and physical state. Some patients show immediate results that continue to increase as time goes by while others see results over a few weeks of regular usage.
Homeopathic remedies work from the source of the issue and often lead to more energy and positivity. It also works externally on skin conditions which often times clear up after a few treatments. Sometimes patience is needed due to the fact that internal balance is slowly being restored especially in cases where conditions have been harbored for many years.
Call us at 778-218-3111 to schedule in an appointment. Our naturopathic doctors will work together with you to create a tailored treatment plan that will help heal your issues at its source.
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Mark A Silverberg, MD, MMB, FACEP Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center
Hypertension is a common medical condition that often has severe consequences over the long-term. You generally would not know that you have hypertension unless you have your blood pressure checked. If you have mildly elevated levels, lifestyle adjustments may be enough to lower your blood pressure within ideal ranges. If you need medication, you may need to have some adjustments to get your dose just right, especially early on. Blood pressure management is generally effective, and most people are able to avoid the complications of hypertension with lifestyle modifications and medical management.
However, medication is needed to sufficiently reduce blood pressure for most stage 1 and almost all stage 2 hypertension cases. There are a vast number of prescription medications that have been approved for the treatment of hypertension, and guidelines have been developed to help doctors quickly find an effective and well-tolerated treatment regimen for almost anyone with this concern. https://www.healthshare.com.au/storage/avatars/True_Local_Shot.jpg.60x60_q85_box-0,140,558,697.jpg
Triglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.
People who have metabolic syndrome typically have apple-shaped bodies, meaning they have larger waists and carry a lot of weight around their abdomens. It's thought that having a pear-shaped body — that is, carrying more of your weight around your hips and having a narrower waist — doesn't increase your risk of diabetes, heart disease and other complications of metabolic syndrome.
Lipase inhibitors can play a role. These are foods that have action in decreasing the digestion of fats so they move out of the body instead of getting absorbed. Since the digestive tract is the major place where POPs are both removed from the body and taken into the body, doing what is possible to NOT allow fat soluble compounds reentry is important. Some common lipase inhibitors include green tea, oolong tea, mate tea, and ginger root.
Most conventional practitioners recommend that patients follow a healthy eating plan like the American Dietary Association (ADA) diet, the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean Diet. All of these emphasize fruits, vegetables, and whole grains, while limiting unhealthy fats and promoting leaner protein foods like low-fat dairy and lean meats like chicken and fish.
Although many processes are involved in this, your thyroid is one of them. The thyroid is a small gland at the front of the neck that releases hormones that control your metabolic rate and the functions of nearly every cell in the body. Going low calorie is a great way to make you feel cold, tired, constipated and frumpy because your brain uses your thyroid to slow everything down!
Researchers assigned overweight subjects to three groups: diet-only, diet plus aerobics, diet plus aerobics plus weights. The diet group lost 14.6 pounds of fat in 12 weeks. The aerobic group lost only one more pound than the diet group. Their training was three times a week starting at 30 minutes and progressing to 50 minutes over the 12 weeks. Nothing special. But the weight training group lost over 21 pounds of fat. That's 44% and 35% more than diet and cardio-only groups respectively. The addition of aerobic training didn't result in significant fat loss over dieting alone. Thirty-six sessions of up to 50 minutes is a lot of work for one additional pound of fat loss. But the addition of resistance training greatly accelerated fat loss results.
The most common side effects of anti-hypertensive medications include hypotension (low blood pressure) and dizziness. These effects are the result of the excessive lowering of blood pressure, and they can be alleviated if your doctor adjusts your medication dose. Each drug and medication category also has its own unique side effects, which you should familiarize yourself with when you begin taking the medication (check patient information provided by your pharmacy, or ask the pharmacist herself).
Hypertension is defined as elevated blood pressure and is the leading cause globally of death and disability. It is the major risk factor for heart attack and stroke, and is also a significant risk factor for for chronic kidney disease and chronic heart failure. Because individuals with hypertension usually don’t have any symptoms, it is a disease that is often under-diagnosed. Diagnosis relies upon routine blood pressure screening to monitor and detect affected individuals.
Your current healthcare provider may not end up being your future provider, but your current body is yours forever. If you undergo any blood tests or exams, ask for copies of the results so that you can keep them filed away at home. It’s essential that you know your baseline numbers and keep track of the evolution of your health throughout the course of your life.
Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine level in the blood will rise. Normal levels of creatinine in the blood vary from gender and age of the individual.
If the amount of insulin available is insufficient, or if cells respond poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by the body cells that require it, and it will not be stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.[60]
^ Jump up to: a b c Members, Authors/Task Force; Mancia, Giuseppe; Fagard, Robert; Narkiewicz, Krzysztof; Redon, Josep; Zanchetti, Alberto; Böhm, Michael; Christiaens, Thierry; Cifkova, Renata (13 June 2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension". European Heart Journal. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. hdl:1854/LU-4127523. ISSN 0195-668X. PMID 23771844. Archived from the original on 27 January 2015.
The metabolic syndrome quintuples the risk of type 2 diabetes mellitus. Type 2 diabetes is considered a complication of metabolic syndrome. In people with impaired glucose tolerance or impaired fasting glucose, presence of metabolic syndrome doubles the risk of developing type 2 diabetes.[28] It is likely that prediabetes and metabolic syndrome denote the same disorder, defining it by the different sets of biological markers.
The term "diabetes" or "to pass through" was first used in 230 BCE by the Greek Apollonius of Memphis.[108] The disease was considered rare during the time of the Roman empire, with Galen commenting he had only seen two cases during his career.[108] This is possibly due to the diet and lifestyle of the ancients, or because the clinical symptoms were observed during the advanced stage of the disease. Galen named the disease "diarrhea of the urine" (diarrhea urinosa).[110]
Set up agonist/antagonist stations so you are able to move quickly between exercises. Perform a set of the first exercise and then go directly to the second movement. Rest for approximately 30 seconds, and then perform two additional supersets. Once you finish, quickly proceed to the next agonist/antagonist pairing (and so on) until all muscle groups have been worked.
Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population. (See Treatment.)
Diabetic ketoacidosis can be caused by infections, stress, or trauma, all of which may increase insulin requirements. In addition, missing doses of insulin is also an obvious risk factor for developing diabetic ketoacidosis. Urgent treatment of diabetic ketoacidosis involves the intravenous administration of fluid, electrolytes, and insulin, usually in a hospital intensive care unit. Dehydration can be very severe, and it is not unusual to need to replace 6-7 liters of fluid when a person presents in diabetic ketoacidosis. Antibiotics are given for infections. With treatment, abnormal blood sugar levels, ketone production, acidosis, and dehydration can be reversed rapidly, and patients can recover remarkably well.
Insulin is vital to patients with type 1 diabetes - they cannot live without a source of exogenous insulin. Without insulin, patients with type 1 diabetes develop severely elevated blood sugar levels. This leads to increased urine glucose, which in turn leads to excessive loss of fluid and electrolytes in the urine. Lack of insulin also causes the inability to store fat and protein along with breakdown of existing fat and protein stores. This dysregulation, results in the process of ketosis and the release of ketones into the blood. Ketones turn the blood acidic, a condition called diabetic ketoacidosis (DKA). Symptoms of diabetic ketoacidosis include nausea, vomiting, and abdominal pain. Without prompt medical treatment, patients with diabetic ketoacidosis can rapidly go into shock, coma, and even death may result.
Although the first formal definition of metabolic syndrome entered medical textbooks not so long ago (1998), it is as widespread as pimples and the common cold . According to the American Heart Association, 47 million Americans have it. That's almost a staggering one out of every six people. The syndrome runs in families and is more common among African-Americans, Hispanics, Asians, and Native Americans. The risks of developing metabolic syndrome increases as you age. https://www.healthshare.com.au/storage/avatars/34553.png.60x60_q85_box-0,0,256,256.png
But, the metabolism compensates. This person starts feeling hungry all the time. Their energy begins to suffer, and they feel cravings for sweet, salty, and fatty foods. This makes it harder for them to comply. But worse than that, depending on their individual response to the law of metabolic compensation, their metabolism has now put on the brakes, slowing their daily calorie burn rate by between 200 and 800 calories per day.
Treatment of hypertension is important, despite the fact that it rarely causes noticeable symptoms at the early stages. Hypertension accelerates atherosclerosis, which leads to coronary artery disease, heart attacks, heart failure, strokes, kidney failure, peripheral artery disease, and aortic aneurysms. Treating hypertension in the early stages has been shown to prevent these complications.
Once the diagnosis of hypertension has been made, healthcare providers should attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension.[83] Laboratory tests can also be performed to identify possible causes of secondary hypertension, and to determine whether hypertension has caused damage to the heart, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and may require treatment.[6]
In the United States, metabolic syndrome has a high prevalence in African Americans, particularly African American women, and this has been attributed to the higher prevalence of obesity, hypertension, and diabetes in this population. [40] However, the highest age-adjusted prevalence of metabolic syndrome in the United States is found in Mexican Americans, approximately 31.9% of whom had the condition (compared with 27% of the general population) in a 1988-1994 survey. [41]
As waistlines expand, so does the epidemic of metabolic syndrome. It’s estimated that nearly one of every four American adults has this condition(1). If you’re one of them, it puts you on the track to developing type 2 diabetes and triples your risk for heart disease down the road. The identification of metabolic syndrome two decades ago(2) is now recognized as a turning point in our understanding of how metabolism can go awry, resulting in obesity, diabetes and cardiovascular disease.
If you're short on time but still want to fit in an effective training session—especially if your goal is fat burn—metabolic resistance training (MRT) is tough to beat. With this training style, the goal is to maximize caloric expenditure while also increasing your metabolic rate. There are many different ways to structure an MRT session, but generally speaking, circuit training lends itself well to this approach.
^ Emadian A, Andrews RC, England CY, Wallace V, Thompson JL (November 2015). "The effect of macronutrients on glycaemic control: a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups". The British Journal of Nutrition. 114 (10): 1656–66. doi:10.1017/S0007114515003475. PMC 4657029. PMID 26411958.
Diabetes mellitus occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low- and middle-income countries,[101] where more than 80% of diabetic deaths occur.[105] The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.[106] The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the "Western-style" diet).[101][106] The global prevalence of diabetes might increase by 55% between 2013 and 2035.[101] https://www.pickthebrain.com/blog/wp-content/uploads/2013/03/meditation.png
When it comes to laboratory values, numbers like blood glucose and A1C levels are commonly checked. Less often, doctors order a test for your fasting insulin level; yet this test can help predict your risk of developing prediabetes and metabolic syndrome. Insulin plays a key role in metabolism, and high insulin levels can promote obesity, stimulate hunger, and increase the storage of fat.
However, medication is needed to sufficiently reduce blood pressure for most stage 1 and almost all stage 2 hypertension cases. There are a vast number of prescription medications that have been approved for the treatment of hypertension, and guidelines have been developed to help doctors quickly find an effective and well-tolerated treatment regimen for almost anyone with this concern. https://www.healthshare.com.au/storage/avatars/True_Local_Shot.jpg.60x60_q85_box-0,140,558,697.jpg
^ Jump up to: a b Petzold A, Solimena M, Knoch KP (October 2015). "Mechanisms of Beta Cell Dysfunction Associated With Viral Infection". Current Diabetes Reports (Review). 15 (10): 73. doi:10.1007/s11892-015-0654-x. PMC 4539350. PMID 26280364. So far, none of the hypotheses accounting for virus-induced beta cell autoimmunity has been supported by stringent evidence in humans, and the involvement of several mechanisms rather than just one is also plausible. http://www.sandysidhumedia.com/wp-content/uploads/2012/12/bennyquote.png
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.
Hypertension is rarely accompanied by symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.[20] These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself.[21]
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-5,248,724,238,819,316,000 | Research Activities
Last updated 06/2019
Antibodies
Antibodies have emerged as a major class of biopharmaceuticals, with indications ranging from autoimmune diseases to cancer. A majority of antibody-related research is currently based on sequence information or stationary structures alone. Here in Innsbruck, we apply a wide range of simulation-based techniques to link structural and dynamic information to pharmaceutically relevant properties such as specificity, stability, hydrophobicity and developability. A key topic of our research is the accurate representation of antibodies as conformational ensembles. Our scope is to provide state-of-the-art tools to develop and optimize novel antibody therapeutics.
Allergens
It is still entirely unclear what makes a protein an allergen. However, what we do know so far is, that a key step in allergic sensitization is the cleavage of allergen proteins into small peptides. Yet, most protease cleavage sites are found within secondary structure elements, which are not accessible to proteases. The allergen thus has to undergo major conformational rearrangements and local unfolding to become susceptible to proteolysis. This process is strongly linked to a decreasing pH value in the endosome. Using classical and enhanced MD simulations, we study these partial unfolding and refolding events and profile their relation to proteolytic susceptibility. Furthermore, we apply constant pH MD simulations coupled with dynamic NMR experiments to capture shifts in unfolding probability upon changes in pH. Embedded in a strong network of experimental collaborators, we work on elucidating the molecular origins of protein stability, allergenic potency and allergen cross-reactivity.
Proteases
The human genome comprises more than 560 different proteases, suggesting that nearly 3% of all human genes code for proteases. Their vast variety of biological functions stretch from the degradation of proteins in the digestive tract, over key aspects in the immune system, to involvement in blood coagulation. Depending on its task, substrate recognition of a protease thus needs to range from highly specific to widely promiscuous. We investigate the underlying physical mechanisms on the protein-protein interface, which influence the binding process and determine substrate recognition. We employ and develop MD-based tools to quantify and localize the individual terms contributing to specificity or promiscuity in biomolecular recognition. | {
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2,377,399,463,740,155,000 | Molecular Vision 2005; 11:1071-1082 <http://www.molvis.org/molvis/v11/a126/>
Received 12 May 2005 | Accepted 5 December 2005 | Published 9 December 2005
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Reprint
Use of transduction proteins to target trabecular meshwork cells: outflow modulation by profilin I
Azucena Gómez-Cabrero,1 Nuria Comes,1 Javier González-Linares,2 Joaquín de Lapuente,2 Miquel Borras,2 Jordi Pales,1 Arcadi Gual,1 Xavier Gasull,1 Miguel Morales1
(The first two authors contributed equally to this publication)
1Laboratory of Neurophysiology, Department of Physiological Sciences I-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine, and 2Experimental Toxicology and Ecotoxicology Unit, Parc Científic de Barcelona, University of Barcelona, Barcelona, Spain
Correspondence to: Miguel Morales, PhD, Laboratori de Neurofisiologia, Facultat de Medicina, UB-IDIBAPS, Casanova 143, E-08036 Barcelona, Spain; Phone: (34) 93 4024519; FAX: (34) 93 4035295; email: miguelmorales@ub.edu
Abstract
Purpose: Fusion proteins containing a protein transduction domain (PTD4) are able to cross biological membranes. We tested the applicability of the protein transduction method for study of the aqueous humor trabecular outflow pathway by targeting the actin cytoskeleton, which is known to be involved in outflow facility regulation.
Methods: Expression vectors useful for generating fusion proteins with the PTD4 domain and the actin-binding protein Profilin I were constructed. The transductional and functional properties of these proteins were tested in bovine trabecular meshwork cells in culture. The effects of PTD4-Profilin I on outflow facility were evaluated in perfused bovine anterior segments. PTD4-β-galactosidase was used to visually check correct delivery of fusion proteins to trabecular meshwork cells.
Results: The fusion proteins generated were characterized by western blot. Immunocytochemistry experiments showed intracellular staining for PTD4-Profilin I in trabecular meshwork cells in culture. The fusion protein was found in the cytoplasm associated with actin filaments and in the leading edge of the cellular membrane. In contrast, control Profilin I, without the PTD4 domain, was unable to cross the cell membrane. In perfused anterior segments, 2 μM PTD4-Profilin I increased trabecular outflow facility in a reversible manner, while Profilin I had no significant effect. Anterior segments perfused with PTD4-β-galactosidase showed positive staining in the trabecular meshwork tissue.
Conclusions: Protein transduction technology is a valuable tool for targeting trabecular meshwork tissue, not only for performing physiological studies, but also as a potential drug-delivery method. Profilin I action on the actin cytoskeleton further reinforces the importance of this structure in outflow facility regulation.
Introduction
In the eye, most of the aqueous humor exits the anterior chamber through the trabecular meshwork (TM) and Schlemm's canal. For many years, the TM was believed to be merely a passive filter. Today this tissue, located in the iridocorneal angle, is considered an active network of cells able to modulate its permeability and, therefore, the aqueous humor outflow rate [1-3]. Nevertheless, TM physiology is still largely unknown, probably due to the location, structure, and heterogeneity of the tissue [4].
It has been reported that various mechanisms contribute to aqueous humor (AH) outflow regulation, including contraction/relaxation of both TM and ciliary muscle [1,5], cell volume regulation [6-9], membrane stretch [10], changes in cell shape [11-13], extracellular matrix composition and remodeling [13-15], pore formation in Schlemm's canal endothelium [16,17], and gene expression changes [18-20]. Several authors have demonstrated the involvement of the actin cytoskeleton in AH outflow modulation [13] upon observing that latrunculins and other actin-depolymerizing drugs increased outflow facility [21-23]. In fact, the Rho/Rho-kinase pathway [24,25] appears to regulate actin polymerization, and reorganizes the actomyosin cytoskeleton which finally modulates TM contractility and aqueous outflow facility [20,24,26].
Actin filaments are in a dynamic equilibrium between the filamentous and monomeric forms. The elongating filaments consist of ATP-actin. Along the filament, due to actin's intrinsic ATPase activity, the ATP is slowly hydrolyzed to ADP-actin in the older part of the filament, from where it can be released. Profilin I (Pfn I) is a ubiquitous actin-binding protein with ATP nucleotide exchange properties [27]. In vitro studies have identified three major functions for profilins. First, Pfn I binds and sequesters actin monomers in a 1:1 ratio, thereby decreasing the concentration of free actin. Second, due to its ATP nucleotide exchange function, Pfn I can restore monomeric ADP-actin with ATP, thereby replenishing the pool of actin-ATP in the cell. And third, the profilin-ATP-actin complex can interact with the growing end of the actin filament and release the ATP-actin monomer which is then added to the filament, promoting filament elongation (for a review see [27,28]).
In the present report we evaluate an in vivo protein transduction technique in combination with perfusion of ocular anterior segments to deliver Pfn I to trabecular meshwork cells. We also study the ability of Pfn I to modulate the actin cytoskeleton and its involvement in AH outflow regulation.
Most of the information used to assess TM cell function has been obtained from cell cultures. It is still difficult to understand how the TM works in vivo, and the mechanisms by which different cellular processes modify the tissue's permeability. To evaluate TM function in situ in response to different experimental treatments, several techniques have been used, including in vivo measurements of trabecular outflow facility [29,30], perfusion of anterior segments [31-33], or gene delivery to TM cells using adenovirus [34-37]. Transduction of active proteins into cells in vivo is another powerful experimental approach for the study of cell physiology. Protein transduction was first demonstrated with the transactivating transcriptional activator (TAT) protein from HIV [38]. The sequence responsible for the transduction properties consists of a highly basic region of only 11 amino acid residues from the HIV-TAT protein (YGRKKRRQRRR). The methodology to generate transducible fusion proteins was greatly improved by Dowdy and coworkers and has been used in a wide variety of mammalian cells to deliver different proteins or peptides [39,40]. We generated a series of fusion proteins containing a modified version of the TAT transduction domain; the PTD4 (protein transduction domain 4; YARAAARQARA) allows them to cross biological membranes [41]. Using this novel approach, we now describe the effects of PTD4-Profilin I (PTD4-Pfn I) on trabecular outflow regulation.
The present report shows that protein transduction technology is a valuable tool for studying aqueous humor outflow physiology, and an interesting delivery method to target TM cells. Our data indicate that the PTD4-Pfn I fusion protein effectively penetrates TM cells, increasing outflow facility in perfused anterior segments.
Methods
Expression vector generation and cloning
Oligonucleotides containing the transduction sequence PTD4 (YARAAARQARA) and several glycine residues in each side for a free rotation between domains, (pre-PTD4-MCS-F and pre-PTD4-MCS-R; Table 1, Figure 1), were hybridized by heating to 95 °C and slowly cooling down to room temperature for at least 2 h. The resulting pre-PTD4-MCS adaptor was cloned into the expression vector pRSET-A (Novagen, Madison, WI) between NheI and XhoI restriction sites to generate the pRSETA-PTD4-MCS vector, keeping both NheI and XhoI restriction sites (Figure 1). In order to keep fusion proteins free from unnecessary domains, the restriction procedure eliminated the tag-T7pol, the Tag XpressTM and the EK proteolysis site. In the new expression vector (pRSETA-PTD4-MCS), only the tag T7pol was rebuilt by the pre-PTD4-MCS-F and pre-PTD4-MCS-R oligonucleotides, while the multiple cloning site (MCS) was left intact (Figure 1). The pRSETA-mod vector, used to generate control proteins, was created missing the Tag XpressTM fragment, the EK proteolysis site, and the PTD4 sequence. For this purpose, pre-MCSnoPTD4-F and pre-MCSnoPTD4-R oligonucleotides were used following the procedure described (Table 1, Figure 1). The resulting pre-MCSnoPTD4 adaptor was cloned using the same strategy. Both vectors retained pRSET-A's resistance to ampicillin (Figure 1).
For β-galactosidase (β-Gal) cloning, two oligonucleotides, β-GalXC-F and β-GalSE-R (Table 1, Figure 1) were used to amplify the β-galactosidase encoding sequence from pCMV-β-Gal (GenBank U02451; Clontech, Mountain View, CA) kindly provided by Miguel Chillón (UAB, Spain). PCR reactions (50 μl volume in 0.2 ml PCR tube) were performed with 1 μM of each oligonucleotide, 1 mM MgCl2, 2 mM each of dATP, dCTP, dGTP, and dTTP (dNTP mix), 0.2 μg pCMV-β-Gal vector, 2.5 U Accuzyme polymerase in 1X Accuzyme Reaction Buffer with 2% DMSO (Bioline, Teknovas, Spain). Reactions were carried out with an initial 5 min long denaturing step at 96 °C, 30 cycles at 96 °C for 1 min, 60 °C for 1 min and 72 °C for 7 min, and a final elongation step of 15 min at 72 °C. Amplification products were separated by electrophoresis on 0.8% agarose in 1X TAE buffer and then visualized by ethidium bromide staining. A fragment of 3,072 bp corresponding to the β-Gal coding sequence was cut and isolated (Perfect Prep Gel Cleanup kit; Eppendorf, Madrid, Spain). Cohesive ends were added to the purified fragment using the fragment as a template in a PCR reaction (50 μl) performed only with the dNTP mix and 2.5 U Taq polymerase in 1X Taq Reaction Buffer. The resulting fragment was isolated and cloned into the pGEM-T vector (Stratagene, La Jolla, CA). After sequence confirmation, β-Gal cDNA was subcloned into pRSETA-mod and pRSETA-PTD4-MCS vectors between XhoI and EcoRI sites, generating the expression vectors pRSETA-mod-β-Gal and pRSETA-PTD4-β-Gal (Figure 1).
Two oligonucleotides (XhoI-Profilin and Profilin-HindIII; Table 1) were used to amplify human PfnI cDNA (GenBank NM_005022) using the CMV-C1-PfnI-GFP vector as a template (kindly provided by Dr. Hitomi Mimuro, University of Tokyo, Japan) [42]. PCR reactions (50 μl) were performed with 1 μM of each oligonucleotide, 1 mM MgCl2, 2 mM dNTP mix, 0.5 μg CMV-C1-PfnI-GFP vector, and 2.5 U Accuzyme polymerase in 1X Accuzyme Reaction Buffer. Reactions were carried out with an initial 5 min long denaturing step at 96 °C, 25 cycles at 96 °C for 3 min, 68 °C for 1 min with a temperature ramp of -0.2 °C each cycle and 72 °C for 1.5 min, and a final elongation step of 7 min at 72 °C. A fragment of 449 bp was isolated and cloned into the EcoRV restriction site of pBluescript SK- (Stratagene, La Jolla, CA). After sequence confirmation, Pfn I cDNA was subcloned between XhoI and HindIII sites, generating the vectors pRSETA-mod-Pfn I and pRSETA-PTD4-Pfn I (Figure 1).
The oligonucleotides used were purchased from Sigma-Genosys (Haverhill, UK). All constructions were transformed into competent Escherichia coli DH5α bacteria growing in LB medium. Prior to protein expression, positive clones were isolated and in-frame cloning was confirmed by sequencing.
Expression and purification of proteins
Chemically competent Escherichia coli BL21-PLys bacteria were transformed with pRSETA-PTD4-β-Gal, pRSETA-mod-β-Gal, pRSETA-PTD4-Pfn I, and pRSETA-mod-Pfn I. Protein expression was induced by adding 1 mM IPTG (Sigma, Madrid, Spain) at 37 °C for 6 h with continuous agitation. Bacterial pellets were isolated by centrifugation, resuspended in phosphate-buffered saline (PBS), and lysated by a freezing and unfreezing protocol in liquid N2 followed by sonication on ice in the presence of DNase and a protein inhibitor cocktail (Sigma). Cellular lysates were resolved by centrifugation. The soluble fraction was loaded onto a 25 ml column packed with Ni-NTA resin (Quiagen, Hilden, GmgH) in purification buffer (0.5 M NaCl, 20 mM Na2HPO4, pH 7.4). The column was washed with 20 and 50 mM and eluted with 250 mM imidazole in purification buffer up to 20-25 ml. Purification efficiency was assessed by acrylamide gel electrophoresis and Coomassie staining. Buffer exchange and concentration of eluted proteins was performed by centrifugation in Amicon Ultra-15 10000 MWCO centrifugal filters (Millipore Iberica, Madrid, Spain) with PBS. Proteins were frozen in liquid N2 and stored at -80 °C in 10-15% glycerol-PBS. After being defrosted, proteins were kept at 4 °C for up to one week.
Bacteria and proteins were handled following the Safety Guidance for Laboratory Personnel Working with TAT transduction domains [43].
Western blot analysis
Samples were electrophoresed in 8% sodium dodecyl sulfate-polyacrylamide gel and transferred to nitrocellulose membrane (Bio-Rad Laboratories, Hercules, CA) following the Laemmli method. Nonspecific protein binding sites were blocked with a solution containing 3% BSA and 0.1% Tween-20 in Tris-buffered saline (TBS; 20 mM Tris-HCl [pH 7.4] and 137 mM NaCl; TBT-BSA) for 30 min. Membranes were then incubated with rabbit anti-Profilin IgG (1:1000; Cytoskeleton, Denver, CO) and mouse anti-T7-tag IgG antibodies (1:10000; Novagen) in TBT-BSA for 1 h. Membranes were washed 6 times with TBT-BSA and incubated with horseradish peroxidase-conjugated anti-mouse IgG (1:5000) or horseradish peroxidase-conjugated anti-rabbit IgG antibodies (1:5000; Jackson ImmunoResearch Laboratories, Westgrove, PA) in TBS-T (0.1% Tween-20 in TBS) for 1 h. Finally, the membranes were washed 5 times in TBS-T and twice in TBS. Detection was performed by a chemiluminescence method with Immuno-HRPTM Star Substrate (Bio-Rad).
Bovine trabecular meshwork cell culture
Bovine TM cells (BTM) were cultured using a modification of the technique described by Stamer et al. [44]. As previously described [5], bovine TM strips were digested with 2 mg/ml collagenase (Sigma) and 0.5 mg/ml bovine serum albumin (BSA; Sigma) at 37 °C for 2 h. After mechanical disruption, the supernatant was collected, centrifuged, resuspended, and seeded in culture flasks containing Dulbecco's Modified Eagle's Medium (DMEM; Bio-Whitaker, Barcelona, Spain) plus 10% fetal bovine serum, 100 mg/ml L-glutamine (Sigma), 100 IU/ml penicillin, 100 μg/ml streptomycin, and 2.5 μg/ml amphotericin-B (Bio-Whitaker). Cell growth was observed 2-4 days after seeding, and culture medium was changeed three times a week. Confluence was reached after 12-15 days in culture. After confluence, cells were passaged using Trypsin-EDTA (Bio-Whitaker). Cells from this first passage to the third one were used.
Anterior segment perfusion
Eyes from 3- to 6-month-old cows were obtained at the local abattoir 0.5 to 2 h after killing, and kept in PBS at 4 °C for no more than 1.5 h. Isolation and perfusion of bovine anterior segments were performed as previously described [5,8,32]. Bovine anterior segments, located in their respective chambers together with force transducers (Letica, Barcelona, Spain) and the tubing system, were placed in an incubator (Selecta, Barcelona, Spain) at 37 °C and 5% CO2. Perfusion was carried out with DMEM. The pressure of the artificial anterior chamber was monitored and recorded throughout the experiment with a pressure transducer (9162-0; Mallinckrodt, Northampton, UK) and was maintained with a suspended reservoir at a constant pressure of 10 mm Hg. Outflow facility (C), calculated as the ratio between flow and perfusion pressure (μl/min/mm Hg) was averaged in 15 min periods (mean of 450 data points for each period; sampling rate 0.5 Hz). A total of 20 periods of 15 min each were obtained for the whole protocol. Baseline facility (C0) was calculated during the first 90 min period of stable C. Only anterior segments with baseline outflow facility values between 0.3-1.3 μl/min/mm Hg were used. Moreover, anterior segments that during the baseline period presented more than a 10% variability in outflow facility values were rejected as well [32]. Whenever a different experimental condition was implemented or drug added to the perfusion medium, the tubes and anterior chamber were flushed and refilled with the new medium. This change was made by rapidly replacing the contents of the artificial anterior chamber by opening the exit needle until 200% of the volume had been exchanged; this exchange was always made at a pressure below 10 mm Hg. Recording of C measurements started after flow stabilization. The perfusion procedure was carried out using a protocol with three different periods: perfusion with control DMEM for 90 min to establish C0; perfusion with 2 μM Pfn I or 2 μM PTD4-Pfn I for 120 min to determine outflow facility changes produced by these proteins, and finally a 90 min period with DMEM to return to baseline conditions. After the last period, 2 μM latrunculin A (Lat A; Molecular Probes, Eugene, OR) was added to the perfusion medium as a positive control. Perfusions (60 or 90 min) with PTD4-β-Gal or β-Gal were done using the same experimental setup.
Immunocytochemistry
BTM cells were cultured on 12 mm diameter glass coverslips to a subconfluent monolayer. The recombinant purified proteins (PTD4-Pfn I and Pfn I) were added to the culture medium containing serum. After treatment for different time periods, cells were washed twice with PBS, fixed with 4% paraformaldehyde in PBS for 30 min, and then further washed (4 times). After blocking and permeabilization with a PBS solution containing 0.2% Triton X-100, 2% BSA, and 2% goat serum for 30 min, cells were incubated at room temperature with a mouse anti-T7-tag IgG antibody (1:1000; Novagen) in blocking solution for 1 h. Cells were next washed 4 times with PBS, followed by a second incubation with a goat Cy3 conjugated anti-mouse IgG antibody (1:5000; Jackson ImmunoResearch) and Oregon-green phalloidin (1:100; Molecular Probes). Finally, cells were washed 5 times with PBS and preserved with Mowiol mounting solution for fluorescence microscopy and confocal imaging. The secondary antibody was tested for cross-reactivity in BTM cells, incubating them in the absence of primary antibody. Confocal images were acquired using a Leica TCS NT laser scanning confocal microscope (Leica Microsystems Heidelberg GmbH, Mannheim, Germany) with Krypton-Argon laser attached to a Leica DMIRB upright microscope. All images were obtained using 63x oil immersion objective lens (NA 1.4) and the confocal pinhole set at 1 Airy unit. All optical sections were of 0.2 μm. Photographs were taken from representative fields. Pictures were analyzed using Leica software and Adobe Photoshop (Adobe Software, Mountain View, CA).
X-gal staining
After perfusion with PTD4-β-Gal or β-Gal proteins, bovine ocular anterior segments were washed with PBS and fixed with glutaraldehyde 2.5% for 1 h. Anterior segments were cut in quarters (about 2 cm wide), and each quadrant incubated with X-gal staining solution containing 1 mg/ml X-gal, 5 mM K3Fe(CN)6, 5 mM K4Fe(CN)6, 2 mM MgCl2, 0.01% sodium deoxycholate, and 0.02% Nonidet-P40 (Sigma) [45] in PBS at 37 °C until development of blue staining (about 1 h). After X-gal staining, selected quadrants were immersed overnight in 4% paraformaldehyde in PBS, then embedded in paraffin, and sagittally oriented 5 μm sections of the chamber angle region were cut and counterstained with hematoxylin and eosin stain.
Data analysis
One-way ANOVA with Bonferroni post hoc tests were used to evaluate statistical differences between control perfusion with Pfn I and PTD4-Pfn I. An α level of 0.05 was selected for statistical significance.
Results
Construction of expression vectors, cloning, and protein preparation
To assess the efficiency of protein transduction as a tool to introduce active fusion proteins in TM cells, we constructed two bacterial expression vectors, pRSETA-mod and pRSETA-PTD4-MCS, which facilitate the production of fusion proteins. The expression vector omitting the PTD4 domain (pRSETA-mod) was used to express a control protein without the transduction domain. β-Gal and human Pfn I cDNAs were amplified and cloned in both expression vectors. Induction for 6 h of BL21-PLys bacteria transformed with the expression vectors resulted in overexpression of the corresponding recombinant proteins. The T7pol Tag antibody was used to recognize recombinant β-Gal and PTD4-β-Gal (Figure 1B). Fusion proteins Pfn I and PTD4-Pfn I were recognized as expected by antibodies against profilin and T7pol tag, as shown in Figure 1C,D.
Transduction into trabecular meshwork cells
To determine the fusion protein's ability to transduce into BTM cells, 2 μM PTD4-Pfn I or Pfn I were added directly to the culture medium containing 10% FBS. Cells were fixed at different time intervals (10, 30, and 60 min) and processed for immunocytochemistry. Single confocal microscopy images show intracellular localization at the same focal plane as actin stress fibers (Figure 2). A weak but consistent staining was clearly visible after only 10 min (Figure 2A). Longer incubations markedly increase the amount of intracellular protein (Figure 2B,C). After 60 min, a large amount of protein was present around the cellular edge or accumulated in a perinuclear position in most cells. Although not quantified, fluorescence intensity suggests that the amount of internalized protein is time-dependent. Pfn I was never found inside the cells in any of the intervals studied (Figure 2D). In both groups and after 1 h treatment, protein was also clearly present at the top focal plane, probably corresponding to the cell membrane. Confocal microscopy optical slices from the top and bottom of the cell confirmed that both proteins were present at the membrane level, but only PTD4-Pfn I was located intracellularly (Figure 3A). We noted that after long incubation times (over 30 min), a large amount of PTD4-Pfn I sticks to the coverslip. Nevertheless, the ratio of intracellular to background signal was relatively high. In contrast, Pfn I was easily washed out during the fixation process.
Endogenous Pfn I appears concentrated in regions with high actin dynamics, such as the leading lamellae and ruffles [28]. After 60 min incubation, PTD4-Pfn I immunolabeling appears to be more concentrated at the leading edge of the membrane lamellae where it colocalized with the actin cytoskeleton (Figure 3B).
PTD4-Pfn I increased outflow facility in perfused anterior segments
The trabecular meshwork is thought to regulate aqueous humor outflow resistance by cytoskeletal rearrangement of its cells. In order to study the ability of PTD4-Pfn I to transduce into the whole tissue and to modulate actin dynamics, we used a constant pressure perfusion system as a functional test. This system allowed us to measure trabecular outflow facility while perfusing control protein (Pfn I) or PTD4-Pfn I. The baseline outflow facility was 0.66±0.1 μl/min/mm Hg. Perfusion with 2 μM Pfn I (n=6) for 120 min did not significantly modify outflow facility (Figure 4A,B), which remained stable after returning to baseline conditions. To validate tissue functionality, 2 μM Lat A was used as a positive control at the end of the perfusion protocol (Figure 4B, bottom). In all eyes tested, Lat A significantly increased outflow facility, as previously reported [21]. In contrast, when 2 μM PTD4-Pfn I was added to the perfusion medium (n=5; Figure 4A), outflow facility significantly increased after 30 min (compared to control perfusion; p<0.05), reaching a maximum at 45 min (19%; p<0.001). Outflow facility remained high in the presence of PTD4-Pfn I, and returned to baseline values once the protein was removed from the perfusion medium. Again, to validate outflow facility modulation by PTD4-Pfn I, 2 μM Lat A was applied at the end of the experiment. A significant outflow facility increase was observed in all cases in the presence of this drug (Figure 4B, top).
Fusion protein localization in perfused anterior segments
To evaluate protein delivery to the trabecular meshwork tissue, PTD4-β-Gal or β-Gal at 2 μM concentration was tested in the perfusion system under the same experimental conditions as previously described. In Figure 5A, an anterior segment perfused with PTD4-β-Gal during 60 min was fixed and stained for β-Gal activity. Prominent staining was seen in the TM area as well as parts of the sclera and corneal endothelium. In a second set of experiments, after 90 min perfusion with PTD4-β-Gal or β-Gal, anterior segments were perfused for 90 min with control media to wash extracellular protein (Figure 5B,C). Then, anterior segments were removed and stained for β-Gal activity. Paraffin sections of the angle tissues showed a prominent blue staining at the trabecular meshwork area (Figure 5B) compared with the control (Figure 5C). The most intense staining was present in external cellular layers of the trabecular meshwork (Figure 5A,B), confirming positive delivery of the transduction proteins into this tissue. As a control for possible effects due to the transduction technique, outflow facility was monitored; neither PTD4-β-Gal nor β-Gal modified outflow facility significantly (Figure 5D).
Discussion
This study shows that protein transduction techniques are useful for the study of TM cell physiology and the evaluation of outflow pathway mechanisms. Manipulation of cells has previously been achieved by several techniques such as expression vectors, microinjection, gene deletion, and viral infection. A different kind of approach has taken advantage of the transduction properties of HIV TAT transcription factor [38]. Since 1988, several transduction domains have been identified and fused to different proteins, allowing them to cross biological membranes in a time- and concentration-dependent manner. The process is based on a receptor-independent mechanism whose limits in terms of protein size and function are not known [43]. Transduction of fusion proteins can be used to introduce inhibitory peptides or mutated exogenous proteins that may compete with the cell's endogenous proteins, allowing study of their cellular functions in vivo, while circumventing the problems derived from deleting a gene in the whole animal [46].
To generate transduction fusion proteins, we modified a commercial expression vector with the addition of a transduction domain (PTD4). The PTD4 is an optimized and more efficient version of the wild type TAT domain, where the putative α-helix structure of the TAT domain has been strengthened by substituting several residues with alanines [41]. The exact mechanism of protein transduction across cellular membranes remains unclear. Some authors have suggested that they cross the membrane directly by an unknown receptor-independent mechanism [47]. Recently, it has been proposed that TAT fusion proteins require binding or interaction with membrane lipid rafts (directly with cholesterol or proteoglycans) followed by rapid internalization by macropinocytosis [48]. Following internalization, most of the protein is thought to be released into the cytosol after a fall in pH inside the macropinosome, which destabilizes its membrane integrity [48]. The PTD4 domain presumably has the same transduction mechanism.
In agreement with the afore described model, the intracellular location of the recombinant protein indicates that the protein has been released into the cytoplasm. The early effect on outflow facility described in this report (15-30 min) suggests that the PTD4-PfnI must be released rapidly from the macropinosomes, although we cannot rule out the possibility that some of the protein may transduce directly by crossing the membrane. Confocal microscopy fluorescence images show that both control and transduced proteins are located on the cellular membrane, but only the PTD4-Pfn I has a clear intracellular localization in the same focal plane as actin stress fibers. It is possible that trabecular meshwork cells internalize some of the protein due to their phagocytic activity [49,50], which would explain the presence of both proteins (Pfn I and PTD4-Pfn I) in submembranous compartments. This pattern was commonly found at longer incubation times (Figure 3B), while fluorescence close to the membrane was absent at shorter time periods (data not shown). We also noticed that the PTD4-Pfn I construct is stickier than the control, and protein fluorescence is sometimes present as background in immunocytochemistry images (Figure 2). Histological sections of the chamber angle tissues from anterior segments perfused with PTD4-β-Gal show β-Gal activity concentrated in the cellular layers of the TM, as was expected due to the AH flow through this tissue. PTD4-Pfn I is likely to follow the same pathway. Some β-Gal activity is also present in scleral tissues surrounding the artificial anterior chamber, but not in deep tissue layers, supporting the view that AH flow predominantly delivers the fusion protein to the outflow pathway.
After internalization, protein staining overlaps with actin polymerization areas close to the leading edge of the lamellae. It has been reported that endogenous profilin is highly concentrated in these cellular areas [51]. Since the expected localization of the fusion protein is a good criterion for its functionality, we can hypothesize that PTD4-Pfn I is a functional protein and may be involved in actin dynamics. The effects on trabecular outflow, similar to those induced by actin-depolymerizing drugs, support this argument [21,22]. In fact, the control protein, which was unable to transduce the cells, had no effect on outflow facility. This indicates that the effect of PTD4-Pfn I on outflow facility is not an extracellular function of Pfn I and is not an effect of the PTD4 peptide either, since perfusion of PTD4-β-Gal did not induce any outflow facility changes.
Studies in cell lines have shown that microinjection of high concentrations of Pfn I (50 μM to 1 mM) produces depolymerization of actin stress fibers [52,53] and increases the off rate of actin monomers in vitro [54]. These results are in agreement with the avidity of Pfn I for actin monomers. In addition, cells injected with lower concentrations of profilin/actin complexes displayed alterations in actin filament formation, as seen by a change in the morphology of membrane lamellae [55]. In contrast, in the presence of preformed actin filaments, lower concentrations (5 to 10 μM) of Pfn I increase the rate of actin polymerization in vitro [54].
An extensive depolymerization of the actin cytoskeleton was found after treatment of TM cells with Lat A or other depolymerizing agents (unpublished and [56]). In spite of the fact that Pfn I sequesters actin monomers, we did not detect substantial changes in actin stress fiber morphology in cultured cells after PTD4-Pfn I addition at any time interval analyzed. Because Pfn I affinity for actin monomers is much lower than Lat A (Kd of 40 nM and 0.6 μM, respectively), it is possible that no evident structural changes can be detected at the concentration tested. Experiments using higher concentrations and longer incubation times are required to clarify this point.
It has been proposed that a population of TM cells have smooth-muscle contractile properties, and that modulation of their contractile state may influence outflow facility [1]. Agonists known to decrease trabecular outflow facility and contract TM tissue (e.g., endothelin-1, carbachol) [1,57] activate the Rho/Rho-kinase pathway through Gα12/13 proteins [58]. In addition, inhibition of cellular contractility by Rho kinase (ROCK) inhibitors increases outflow facility [59]. Moreover, drugs that directly affect the cytoskeleton network, such as cytochalasin B or latrunculin A or B, have also been shown to increase outflow facility by direct disassembly of the actin cytoskeleton and associated cellular adhesions in the trabecular meshwork [13,56]. In nonmuscle cells, the intracellular concentration of actin/profilin has been estimated to be around 3-20 μM [55]. Assuming a free equilibrium for PTD4-Pfn I, a maximum internal PTD4-PfnI concentration of 2 μM could be achieved, although this concentration may actually be reduced by a limited diffusion through the TM tissue. Since in culture PTD4-Pfn I appears to be mainly concentrated in the cellular edges, it is possible that a similar intracellular distribution may occur in the tissue.
At this point, we can only speculate about the precise mechanism by which Pfn I increases outflow facility. The functional properties of Pfn I and the effects of actin-depolymerizing drugs on outflow facility suggest that Pfn I may exert its effects through a similar mechanism. It might be hypothesized that an increase in the intracellular concentration of Pfn I would modify the actin polymerization/depolymerization equilibrium and interfere in the normal function of the actomyosin network. This may induce a relaxation of the tissue and therefore, an increase in outflow facility.
Further experiments are required to achieve a better understanding of Pfn I effects on TM cell actin dynamics and outflow facility. Beside highlighting the interesting effects of Pfn I on outflow facility, the present report demonstrates that protein transduction is a useful technique for inserting functional proteins into TM cells and for the study of AH outflow regulation.
Acknowledgements
We thank Dr. Imanol Martinez-Padrón for his critical review of the manuscript. We also thank Dr. J. Freeman for English grammar revisions. Work supported by SAF V2002-PN03517-O, BFI2002-01190, FIS 031495, Spain.
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-3,258,054,293,222,218,000 | What Is Protein? Everything You Need To Know
protein water
protein water
Protein is the most essential macro-nutrient for bodybuilders, athletes, and anyone else involved in regular exercise. Although it can be very difficult to make sure that you are eating protein consistently throughout the day, protein supplements are in easy, tasty, and relatively inexpensive way to make sure you reach all of your nutritional demands. NOT getting enough protein is a sure way to destroy muscle and promote catabolism, which is obviously detrimental to any type of fitness program or goal. The most popular and useful types of protein supplements are:
Whey Protein (Concentrate/Isolate)
This supplement is a must have for pretty much everyone. With proper utilization of this protein supplement I have seen many “hardgainers” gain 10 pounds of muscle and increase their overall strength drastically in about a month’s time. Now I’m not saying that everyone will have this type of reaction to taking a protein supplement, but I truly believe that you cannot have a balanced nutrition program without incorporating a high quality protein source into your daily regimen.
Whey isolate is an easily digestible supplement and has a better amino acid profile than even egg whites, meaning it has the highest biological value that you can get from any food or supplement. This makes whey protein the best supplement for your post workout meal because of how easily it is for your body to process and use this type of protein.
Water Based Proteins (Casein)
protein water
Casein protein supplements are similar to whey supplements in the sense that they both come from Water. The difference between the two is that casein protein is extracted in a process called ultrafiltration which enables it to be completely separated and used. These types of proteins are great because of their ability to slowly release amino acids over an extended period of time, creating a muscle sparing effect.
Many people consider casein one of the best supplements for protecting muscle and creating a positive nitrogen balance (anabolic). This is a great protein supplement for a mid-day snack or before bed time.* Because of the low biological value(BV) and the time it takes your body to actually digest this type of protein, your body is far less likely to store it as fat while you sleep.
Weight Gainers
These protein water supplements/Meal Replacements are meant for people with high metabolisms looking to either gain weight (duh…), or looking to help with recovery. Weight gainers usually have a combination of essential, on-essential amino acids, protein isolates, and sometimes even glutamine and creatine in them to provide maximum absorption and stimulate muscle growth. This is one of the simplest ways to add calories to your regular meals or add extra calories between your larger meals.
With all of the effective exercise techniques available today it is more important than ever to make sure that you are meeting all of your nutritional demands for recovery and proper muscle growth. These protein water supplements are a great base for building lean muscle, shedding fat, and increasing athletic performance. | {
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2,780,936,538,702,457,000 | Psychosomatic illness
Psychological imbalances manifest themselves in the form of a physical illness or discomfort. Known as a psychosomatic disorder, your regular physician normally will not find any organic causes. Back pain, stomach pain, cardiovascular problems, tinnitus are just a few examples. Mental stress either due to professional or private circumstances can load the body so much that the reaction is physical pain. Psychotherapy can help reduce or eliminate these symptoms. | {
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-1,691,649,578,375,658,000 | Preparing your future career......
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Do you want to be Big or Strong?
Training Room Weights
Muscular hypertrophy is defined as the increase in size of a skeletal muscle. Hypertrophy training is common within the free weight and resistance section of the gym where guys and girls aim to improve the size of their muscles. The common consensus to novice gym goers is that the biggest guy in the free weight section is the strongest, this is not necessarily true and the reasons will be explained here.
There are two types of hypertrophy, sarcoplasmic hypertrophy and sarcomere hypertrophy, which is also referred to as myofibril hypertrophy.
• Sarcoplasmic hypertrophy involves an increase in the amount of the sarcoplasmic fluid that surrounds the muscle. The increase in fluid leads to the size of the muscle being increased and appearing bigger. There is no increase in strength as the amount of contractile proteins (actin and myosin) stays the same.
• Sarcomere hypertrophy training will generate an increase in actin and myosin but no increase in sarcoplamic fluids, what this means is that strength will be increased but there will significant improvement in size.
Actin and myosin are the two protein filaments that exist within muscles and work together to produce muscular contraction. Whether you want to move a weight, object or to run, contractions need to occur for movement to happen. The more actin and myosin that exist within a muscle, the stronger they will become and the more force you can generate.
If wondering how you can focus on one type of hypertrophy and not the other, it all reverts back to the rep ranges used in training.
• For sarcoplasmic hypertrophy, working at rep ranges of 6 – 12 at 70% 1 Rep Max (1RM) will give the muscles the 'pumped' look and increase the size of the muscle. A good training system to use for this type of hypertrophy would be German Volume Training (GVT); this involves 10 sets of 10 reps with 60 second recovery in between sets. The high amount of reps and sets at a moderate intensity would trigger the release of sarcoplasmic fluid.
• Rep ranges below 6 working at 80%+ 1RM will mainly focus on the Sarcomere hypertrophy so strength will be increased but there may not be a dramatic change in size. A common training system for this type of hypertrophy would be basic multiple sets, working at 5 sets of 5 reps with a 2min rest in between sets. This will help with strength improvements
To summarise the physical size of an individual is not enough to determine the amount of strength that they possess. Firstly it is important to find out what the individual wants to improve on in the gym, and then work on a plan to achieve it. If looking to improve size, rep ranges of 6 – 12 working at 70% 1RM will be the best method to use to get bigger. Rep ranges of 1 – 6 at 80%+will be best suited for individuals whose primary goal is to get stronger.
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7,617,993,440,556,140,000 | The Finest Diet To Lose Weight Very Shortly
A breastfeeding diet is the suitable routine of meals and nutritional vitamins that a nursing mother needs to take in, for sustaining her health and the nutritive content of her milk; in this way also maintaining the well being of her child. The thought behind this diet is that by ditching the carbs, your physique will switch into fat-burning mode. A low-carb diet typically excludes or limits most grains, legumes, fruits, breads, sweets, pastas and starchy greens, and generally nuts and seeds. Some diets advocate reducing out certain foods, such as meat, fish, wheat or dairy merchandise. Under are some of the problems with fad diets, plus recommendation on healthy eating and how to shed weight healthily.
Scientists have intensely studied the eating patterns attribute of the Mediterranean Diet for greater than half a century. Nevertheless they could additionally see fats diverted from their stiffer, more rigid tissue into and around the arteries, which may predispose individuals to high blood pressure, coronary heart illness and strokes. Because it emphasizes nutrient-rich foods and eliminates a number of food groups that might not be so stellar for digestion, many have seen success with the plan in each bettering intestine health and treating numerous ailments.
Some individuals might eat plenty of meals on the non-quick days, which is not going to end in long-term weight reduction. WEIGHT REDUCTION might be on many individuals’s minds as the festive season attracts to an in depth, and in case you’re seeking to lose these additional pounds in time to your New Years celebration chances are you’ll want to do that really helpful diet plan. Day two, you eat vegetables, beginning your day with a large baked potato.
The wholesome eating ideas at the core of this diet – corresponding to reducing sugar, alcohol and processed meals and increasing vegetables – could lead to weight reduction. Researching this story one evening, I read concerning the alkaline diet (invented by a convicted fraud, espoused by actress Kate Hudson) which stipulates that, because our blood’s pH level is slightly alkaline, we should always eat foods that are alkaline, or threat making our bodies too acidic.
The academics have found a molecule which causes the scarring, and the knock-on effect thought to drive fats into individuals’s organs and arteries, placing them susceptible to high blood pressure, coronary heart illness and stroke. Study rapid weight loss claims, forms of diets, and the dangers and benefits of fast weight reduction. Really feel even fuller: Do what celeb chef Ellie Krieger does: Toss wheat berries with apples, nuts and different diet-friendly meals to make an excellent tasty salad. | {
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-5,068,735,313,151,349,000 | Follow us on :
Spotty Skin
Acne vulgaris has always been a common skin condition in teenagers. In most cases it used to cease by 20 years old, bug as you are experiencing, the age range can be much broader these days. Children as young as eight are getting spots and the problem may continue until the age of 40 or later.
There are two types of gland in the skin: sweat and sebaceous. The latter are the oil- or fat-producing glands that lubricate the hair on our heads and bodies to make it waterproof. Acne is an inflammation of the skin caused by a disruption in the sebaceous glands. Spots usually appear on the face, and to a lesser degree on the chest, back and shoulders. They are usually raised (medically called papules) and often hard (nodules). Sebaceous glands are directly controlled by male hormones (androgens)W. omen produce androgens too – though a lesser amount – through the ovaries and the adrenal glands. In both sexes, an excess of these male hormones leads to the overproduction of sebum and then acne.
Sebum is a waxy mixture, which is normally sterile. In the case of acne, it is infected by a certain type of bacterium, which seems to convert the sebum into fatty acids. This causes inflammation of live cells in the inner layer of the skin, resulting in sore, red, swollen spots containing fatty pus. which is released when the spots burst. Some people squeeze them, but if you do this prematurely it causes further hardness and scarring, which can be pigmented.
Whiteheads and blackheads( comedones) are sterile papules that have not become inflamed. Whiteheads remain closed but blackheads are open, the sebum turning black as it oxidises in the air.
The medical approach to treating acne is varied. Topical creams are prescribed for mild cases. The contraceptive pill is given to women to balance the ratio of androgen production with the female hormones oestrogen and progesterone. Long-term antibiotics are also used to suppress bacteria growth. Other drugs based on retinol are used to control cystic acne, where the follicle is really swollen with sebum, but these have serious potential side effects. In general, conventional doctors believe that diet has no effect on acne and the other problems you mention, but I find that good nutrition helps to regulate the body’s functions, so that there is no excess production of androgens and thus of sebum. Building up the body’s immunity helps prevent the bacteria infecting the sebum.
Here is my advice:
• Eat lots of fresh vegetables and non-citrus fruits for their vitamins – at least five portions daily. (Eat fruit as snacks, rather than at the end of meals, if you have any digestive problems.)
• Avoid all fatty, oily fried and rich foods.
• Eat fish, chicken breasts, turkey and game.
• Avoid yeast products and citrus fruits, which both tend to make the skin sensitive.
• Do not drink prepared juice drink of any kind (however pure the label says they are): they tend to be very acidic.
• Avoid sugar and sugary foods.
• Drink freshly juiced carrot with mint every other day, to help skin condition and to control stomach acid.
• Soak three twigs of kadu and ½ teaspoon kariatu in a cup of hot boiled water overnight in the morning, strain and add a little freshly boiled water, then drink on an empty stomach. Take these cleansing herbs for two months.
• Take shatavari : one daily for three months to regulate hormonal functions.
• Mix one tablespoonful of chickpea powder (or besan, available from Indian grocers), a pinch of sandalwood powder and a pinch of turmeric into a paste with warm skimmed milk or water. Gently massage the spots so that they burst and some of the contents are released. Wash your face with warm water. Do this last thing at night then apply Dr. Ali’s Skin Oil on a fresh cotton bud to each visible spot. Also squeeze a fresh aloe vera leaf and smooth the raw pulp on the affected area.
• Consult a qualified and experienced homoeopath.
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2,764,772,905,193,959,000 | Mivacurium chloride
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Mivacurium chloride
Mivacurium.svg
Systematic (IUPAC) name
(1R,1'R)-2,2'-[[(4E)-1,8-dioxooct-4-ene-1,8-diyl]bis(oxypropane-3,1-diyl)]bis[6,7-dimethoxy-2-methyl-1-(3,4,5-trimethoxybenzyl)-1,2,3,4-tetrahydroisoquinolinium]
Clinical data
AHFS/Drugs.com International Drug Names
• Worldwide: prescription only medicine
IV
Pharmacokinetic data
Bioavailability 100% (IV)
Metabolism ester hydrolysis by plasma cholinesterases
Identifiers
106791-40-6
M03AC10
PubChem CID 71316
DrugBank DB01226
UNII 600ZG213C3 YesY
ChEMBL CHEMBL984 YesY
Synonyms bis[3-[6,7-dimethoxy-2-methyl-1-[(3,4,5-trimethoxyphenyl)methyl]-3,4-dihydro-1H-isoquinolin-2-yl]propyl] oct-4-enedioate
Chemical data
Formula C58H80N2O14+2
1029.26 g/mol
Mivacurium chloride (formerly recognized as BW1090U81, BW B1090U or BW1090U) is a short-duration non-depolarizing neuromuscular-blocking drug[1] or skeletal muscle relaxant in the category of non-depolarizing neuromuscular-blocking drugs,[2] used adjunctively in anesthesia to facilitate endotracheal intubation[3] and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Structure[edit]
Mivacurium is a symmetrical molecule although it is a mixture of three of the twenty possible isomers: the isomerism stems from chirality at the C-1 carbon position of both the tetrahydroisoquinolinium rings, as well as both the positively charged nitrogen (onium) heads, and the E/Z diastereomerism at the C=C double bond of the oct-4-ene diester bridge. Thus, owing to the symmetry and chirality, the three isomers of mivacurium are (E)-1R,1'R,2R,2'R, (identified as BW1217U84), (E)-1R,1'R,2R,2'S, (BW1333U83) and (E)-1R,1'R,1'S,2'S, (BW1309U83). These are also known as cis-cis, cis-trans and trans-trans Mivacurium. The proportions are; (E)-cis-cis 6% of the mixture, (E)-cis-trans 36% of the mixture and (E)-trans-trans 56% of the mixture. Unlike the potency of the cis-cis isomer of Atracurium (also known as 51W89 and eventually marketed as the drug cisatracurium), the cis-cis isomer of mivacurium has by far the lowest potency as a muscle relaxant when compared with its other two stereoisomers. It has approximately 10% of the activity of each of the other two structures.
Mivacurium belongs to a class of compounds that is commonly and most erroneously referred to as "benzylisoquinolines" when, in fact, it is a bisbenzyltetrahydroisoquinolinium agent, often abbreviated to bbTHIQ.
The orientation of the two O atoms in the bridge is to the THIQ side of the carbonyl C=O group, whereas in Atracurium the O atom is on the bridge side. Atracurium's groups are "reversed ester" linkages. This makes ester hydrolysis degradation by plasma cholinesterase more favourable.
Pharmacology[edit]
Having ten methoxy -OCH3 groups, mivacurium is a more potent neuromuscular blocking drug than Atracurium, which has eight, but is less potent than Doxacurium, which has twelve.
Like other non-depolarizing neuromuscular blockers, the pharmacological action of mivacurium antagonism to nicotinic acetylcholine receptors. However, unlike other non-depolarizing neuromuscular blockers, it is metabolized by plasma cholinesterase. Metabolism can therefore be very slow in people with pseudocholinesterase deficiency, resulting in prolonged paralysis. The same problem exists with the depolarizing NMB succinylcholine.
Availability[edit]
Mivacurium is available worldwide although, in recent years, its use in the United States has declined rapidly in favor of alternative agents perceived to offer a more rapid onset of action and a safer cardiovascular profile when administered in a rapid bolus dose. It is far more commonly used in Europe and the United Kingdom. The drug is marketed worldwide under the tradename of Mivacron.
History[edit]
Mivacurium represents the second generation of tetrahydroisoquinolinium neuromuscular blocking drugs in a long lineage of nicotinic acetylcholine receptor anatagonists synthesized by Mary M. Jackson and James C. Wisowaty, PhD (both chemists within the Chemical Development Laboratories at Burroughs Wellcome Co., Research Triangle Park, NC) in collaboration with John J. Savarese MD (who at the time was an anesthesiologist in the Dept. of Anesthesia, Harvard Medical School at the Massachusetts General Hospital, Boston, MA). Specifically, mivacurium was first synthesized in 1981. Early structure-activity studies had confirmed that the bulky nature of the "benzylisoquinolinium" entity provided a non-depolarizing mechanism of action. Partial saturation of the benzylisoquinoline ring to the tetrahydroisoquinoline ring provided an even further increase in potency of the molecules without detrimental effects to other pharmacological properties: this key finding led to the rapid adoption of the tetrahydroisoquinolinium structures as a standard building block (along with a 1-benzyl attachment), and it is the primary reason why the continued unwarranted reference to "benzylisoquinolinium" is a complete misnomer for all clinically introduced and currently used neuromuscular blocking agents in this class because they are all, in fact, tetrahydroisoquinoline derivatives. By definition, therefore, there has never been, in the history of clinical anesthetic practice, the use of a benzylisoquinoline neuromuscular blocking agent.
The heritage of mivacurium and indeed its very closely related cousin, doxacurium chloride, harks back to the synthesis of numerous compounds following structure-activity relationships that drove researchers to find the ideal replacement for succinylcholine (suxamethonium). Both mivacurium and doxacurium are descendants of early vigorous attempts to synthesize potent non-depolarizing agents with pharmacophores derived from cross-combinations of the non-depolarizing agent, laudexium, and the well-known depolarizing agent, succinylcholine (suxamethonium chloride). Ironically, laudexium itself was invented by a cross-combination between the prototypical non-depolarizing agent, d-tubocurarine and the depolarizing agent, decamethonium. From the 1950s through to the 1970s, the present-day concept of a neuromuscular blocking agent with a rapid onset and an ultra-short duration of action had not taken root: researchers and clinicians were still on the quest for potent but non-depolarizing replacements devoid of the histamine release and the dreaded "recurarizing" effects seen with tubocurarine and, more importantly, the absence of a depolarizing mechanism of action as seen with succinylcholine and decamethonium.
Clinical pharmacology and pharmacokinetics[edit]
The first clinical trial of mivacurium (BW1090U), in 1984, was conducted in a cohort of 63 US patients undergoing surgical anesthesia.[4] at the Harvard Medical School at Massachusetts General Hospital, Boston, MA. Preliminary data from the study confirmed a promise for this agent to elicit considerably lesser severity of histamine release than that observed with its immediate predecessor clinically tested agents, BW785U77[5][6] and BWA444U,[7] which were discontinued from further clinical development. Mivacurium did not exhibit the ultra-short duration of action seen with BW785U; whereas, BW A444U produced an intermediate duration of action.
Mivacurium is a biodegradable neuromuscular blocking agent owing to its degradation by plasma cholinesterases - the esterases rapidly hydrolyze one ester moiety initially resulting in a two mono-quaternary metabolites of which one still has an intact ester moiety. The second ester is metabolized much more slowly, although the lack of a bis-quaternary structure effectively terminates the neuromusuclar blocking action.
References[edit]
1. ^ Ihmsen H, Schmidt J, Schwilden H, Schmitt HJ, Muenster T (May 2009). "Influence of disease progression on the neuromuscular blocking effect of mivacurium in children and adolescents with Duchenne muscular dystrophy". Anesthesiology 110 (5): 1016–9. doi:10.1097/ALN.0b013e31819daf31. PMID 19352159.
2. ^ Stout RG, Shine TS, Silverman DG, Brull SJ (September 2004). "Recovery of neuromuscular function after a combination of mivacurium and rocuronium". Yale J Biol Med 77 (5–6): 149–54. PMC 2259125. PMID 15989744.
3. ^ Dempsey EM, Al Hazzani F, Faucher D, Barrington KJ (July 2006). "Facilitation of neonatal endotracheal intubation with mivacurium and fentanyl in the neonatal intensive care unit". Arch. Dis. Child. Fetal Neonatal Ed. 91 (4): F279–82. doi:10.1136/adc.2005.087213. PMC 2672731. PMID 16464937.
4. ^ Basta SJ, Savarese JJ, Ali HH, Scott RPF, Gargarian M, Embree PB, Murphy B, Weakly JN, Batson AG (1985). "The neuromuscular pharmacology of BW B1090u in anesthetized patients". Anesthesiol 63 (3): A318. doi:10.1097/00000542-198509001-00318.
5. ^ Savarese JJ, Ali HH, Basta SJ, Ramsey FM, Rosow CE, Lebowitz PW, Lineberry CG, Cloutier G (1980). "Clinical neuromuscular pharmacology of Bw785u, an ultra-short-acting nondepolarizing ester neuromuscular blocking agent". Anesthesiol 53 (3): S274. doi:10.1097/00000542-198009001-00274.
6. ^ Ali HH, Savarese JJ, Basta SJ, Ramsey F, Rosow CE, Lebowitz PW (1980). "Prediction of clinical neuromuscular Ed95 of Bw785u from low dose studies in awake volunteers". Anesthesiol 53 (3): S275. doi:10.1097/00000542-198009001-00275.
7. ^ Savarese JJ, Ali HH, Basta SJ, Sunder N, Moss J, Gionfriddo MA, Lineberry CG, Wastila WB, El-Sayad HA, Montague D, Braswell L (1983). "The clinical pharmacology of BW A444U. A nondepolarizing ester relaxant of intermediate duration". Anesthesiol 58 (4): 333–341. doi:10.1097/00000542-198304000-00006. PMID 6220623. | {
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6,121,296,115,133,391,000 | The Not-So-Sweet Truth about Sugar
themojocoach
The Truth about SugarI’m not going to “sugarcoat” this for you so here it is: sugar makes you fat. As a nation, we’re eating about 150 pounds of sugar per year, per person in the form of soda, bread, pasta, cereal, cake, cookies and more. We’re bigger and unhealthier than ever before. The calories from sugar do little to nourish and fuel us while steadily chipping away at our health as well as our waistlines. As a mom, you need to know the facts so you and your kids can stay healthy.
Why is Sugar so Bad For Me (and My Kids)?
Not only does sugar cause weight gain but it’s also the root cause of many illnesses and conditions we face today; these are just a few:
• obesity
• diabetes
• heart disease
• liver and pancreatic disease
• premature aging
• skin problems
• arthritis
• weakened immune system
• tooth decay
• digestive disorders
• mood swings
• infertility
• osteoporosis
Sugar also causes inflammation. Think about what happens when you have a cut on your finger: your immune response signals the body that it’s in a state of crisis and as a result, the body responds to heal the wound. But, when your body is in a state of constant internal inflammation because it’s constantly dealing with sugar, your body reacts as if it’s always in crisis. Your body responds by flooding you with stress hormones in an effort to “save” you. This eventually exhausts your adrenal glands (which is where the stress hormone cortisol is released from). When this happens, it drives fat storage, particularly around your middle while also suppressing your thyroid, impacting your immune system, affecting your sleep, mood, libido and more.
If Sugar is So Bad, Why Do I Crave It?
Sugar Tastes Good
This one is pretty obvious…it tastes good. We’re hard wired to enjoy sweet tastes. It’s easy to crave a piece of chocolate cake, but how often is it that you crave steamed broccoli? The food industry is well aware of our love for sweets and has taken full advantage of this knowledge to create millions of high sugar, calorie dense yet nutrient poor “sub foods” we consume on a daily basis.
Sugar Makes Us Feel Good
When you eat something sweet, the reward centers of our brain are triggered which releases the neurotransmitter dopamine. Dopamine helps control the brain’s reward and pleasure centers so a hit of sugar simply makes us feel good.
Serotonin is another neurotransmitter released when we eat something sweet. A boost of serotonin enhances our mood so it’s easy to see why we’d look for foods which will trigger serotonin, especially when we’re tired or feeling any negative emotions.
Sugar is Addictive
Sugar is highly addictive. The same receptors that are engaged with recreational drugs are engaged when we consume sugar. Just as a drug addict “needs” a hit of a certain drug and will feel a withdrawal without it, when we’re used to consuming high concentrations of refined sugar, we can feel the same way.
Can your break your sugar addiction? Absolutely, but give yourself some leeway to not be at your “sweetest” for a day or two.
Sugar is Easy to Digest
Sugar is also easy to consume and digest. Foods high in sugar barely need to be chewed so they go down easily and the calories add up quickly. Manufacturers know this and use this knowledge to their advantage as well so you can consume way more than you intended before you even realize what hit you.
Am I Destined to be Overweight and Unhealthy?
Of course not! The first step is determining where you’re sugar sources are coming from and finding healthy substitutions to replace these items with. Are your sugar calories coming in in the form of liquids (soda, juice, some type of calorie-bomb coffee concoction)? Are your sugar calories coming in the form of high fructose corn syrup, desserts or carbohydrate-loaded meals?
Determine which meal or snack has been keeping you from living with the health and body you deserve and commit to making some different choices…starting today.
More articles on healthy living:
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