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eliteayurveda · 3 months ago

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Coping Strategies for Depression and HS

People who have persistent skin disorders such as hidradenitis suppurativa (HS) are more likely to develop depression.

Apathy, sad mood, hopelessness, impatience, and lack of desire are common symptoms of depression in patients with HS.

Coping with depression and HS is a continual journey, but there are measures you can do and people you may call out to for assistance.

Life with hidradenitis suppurativa, often known as acne inversa, is fraught with difficulties. Many persons with HS endure the psychological impacts of having a chronic skin condition that causes misery in their lives, in addition to painful physical symptoms. In fact, those with chronic illnesses are more likely to develop depression.

Depression in HS Patients

“Studies reveal that depression is really common in both pediatric and adult patient populations who have HS because of the effect it has on your mental health well-being,” he said. “In one study, more than 38% of participants with HS had depression, compared to only 2.4 percent of healthy non-HS control groups.” The pain, inflammation, and emotional stress associated with HS appear to play a significant influence in the occurrence of depression in this population, as well as many other chronic and long-term diseases.”

An analysis of ten studies discovered that depression and anxiety are widespread in patients with HS and advocated for greater research to assist identify and treat mental health issues. In another study, researchers in Denmark looked at over 7,000 persons who had been diagnosed with HS. Participants with the skin disease had higher rates of depression and suicide than those who did not.

Note: If you or someone you know needs help, you can contact the National Suicide Prevention Lifeline at 9152987821

Depression Symptoms in People With HS

Several signs may indicate that you are depressed as a result of your HS condition. These are the following list of possible indicators:

Apathy

Depressed state

Embarrassment

The fear of social stigma

Hopelessness

Irritability

Inadequate motivation

Concerns about sexual activity

According to the American Academy of Dermatology Association, feeling unhappy, hopeless, or apathetic for at least two weeks may suggest depression.

“People with HS often feel the need to self-isolate, they have mood disorders and low self-esteem, which correlate with depression, as well as physical limitations in day-to-day activities due to the very painful open sores and lesions on the skin that we know are part of having this condition.” When you have these feelings and symptoms, it is usually a sign that you should get help.”

How Depression Affects Life Quality

Because of feelings of self-consciousness, a negative body image, and low self-esteem, HS can be emotionally draining, especially if you experience chronic pain and flare-ups. It is also difficult to navigate social situations. According to a survey the physical and mental impacts of HS can have a substantial impact on quality of life.

Researchers from the University of Copenhagen interviewed 12 people and held focus groups to learn more about how HS affects quality of life. They discovered that living with HS had a substantial psychological and social impact on over 60% of the participants. Participants discussed emotional issues, self-worth, social stigma, intimacy, general dissatisfaction, and the desire for a community where they can securely communicate their concerns with individuals who understand what it’s like to live with HS. Some also cited difficulties taking time off from work and being worried of losing their employment as a result of having to obtain sick leave on multiple occasions.

“I was doing so well with so many things to help my body and mental health,” one of our patient said. Then I started thinking about all HS has and will continue to take from me. For a few weeks, I lost track of what I was eating, my stress level, and my mental health. So, I’m not going to let my HS continue to take stuff away from me. So I’m back to find my way.”

Obtaining Depression Treatment

If you are experiencing symptoms of depression, it is critical that you speak with someone who can assist you. While your primary care physician and dermatologist can assist in the treatment of physical symptoms of HS, you may also benefit from visiting with a counselor, psychologist, or other mental health specialist. Furthermore, support groups and networks can provide a secure and friendly environment in which you can openly share your experience.

“I’ve had this for 35 years,” one of our patients tells us. To varied degrees, we all experience physical and mental suffering. We understand how it feels to wonder, ‘Why me?’ I’m sure many of us have experienced losing friends and social contacts as a result of HS. You are NOT alone, and it is safe to express yourself here. Nobody will judge you for feeling down. “

In some cases, medicine might help alleviate depression. “This is a genuine question for your doctor.” “If you want to treat your depression with medication, talk to your doctor to see if it’s a viable option,” Yu added. “There are other ways to treat and cope with depression, including therapy, social support groups, exercise, meditation, and other homeopathic routes.”

Depression Coping Strategies

Finding techniques to cope with depression while living with HS is one of the most effective ways to enhance your quality of life. In addition to getting professional assistance as necessary, you could try daily rituals such as:

Contacting a loved one

Exercising

Going for a walk in the fresh air

Meditating

Speaking with family or a support group

Keeping a journal

“Whatever activities you choose, make the commitment and consistency to check in with your own mental health.” But, most importantly, schedule particular times during your workday, school day, and at home when you can prioritize yourself and give yourself the grace and kindness to exist with HS — and everything else going on in your daily life,”

“For the longest time, I felt alone and still do,” our patient says. I hide my low self-esteem and despair from my family. Now that I’m in my 30s, I’m not going to let high school define me. Don’t give up hope. Get out of the house and do something entertaining if you start experiencing bad thoughts.”

We also recommend practicing mindfulness and repeating self-affirmations throughout the day: “You could say something positive to yourself, like ‘I am beautiful,’ ‘I am strong,’ or even ‘I have HS and I am fill-in-the-blank.'” To acknowledge your condition and the fact that you’re owning it, repeat the affirmation to yourself throughout the day and to your friends and family. You’re taking back control. You’re expressing your emotions. You recognize the societal stigma and challenge your negative ideas. ‘Yes, this is difficult,’ remind yourself. Yes, it might be painful at times, but you have control. You’re working your way through it day by day.”

Managing depression and HS is a never-ending process. The good news is that there are steps you can take and individuals you may contact for assistance. “If you have HS and depression, don’t be afraid to seek help. It does not imply that you are inferior or weak. You are not restricted to experiencing life in this manner. There are support groups available. There are family and friends to talk to, as well as customs to experience and try. “There is light at the end of the tunnel,” Yu explained.

Talk to People Who Understand

We also have a strong community of thousands of our ongoing and previous HS patients who ask questions, give advice, and share their stories with others who understand life with HS.

Do you suffer from depression as a result of your HS? Share your thoughts in the comments section below, or start a discussion on our community space.

While HS is still not fully understood, experts believe that emerging research will provide alleviation to those with HS in the future. “While there is still a lot we do not know about HS, there has been a lot of research in the last several years, fortunately, we have made several breakthroughs that have resulted in a wide range of treatment options for this condition.” We hope that more people become aware of this issue so that they can seek treatment sooner and lessen its impact on their quality of life.”

#depression posting #hidradenitis suppurativa #coping mechanism

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arya-namdeo-45 · 3 months ago

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The Importance of Preventive Health: A Comprehensive Guide to Thyrocare Executive Checkup

In today’s fast-paced world, health often takes a backseat to our busy schedules and responsibilities. We often ignore small signs and symptoms, dismissing them as mere inconveniences. However, our health is the foundation upon which everything else is built, and regular checkups are essential to maintaining this foundation. One of the best ways to ensure that your body is functioning optimally is through a comprehensive health checkup, such as the Thyrocare Executive Checkup.

Understanding the Need for Regular Health Checkups

Regular health checkups are vital for early detection of diseases, monitoring of existing health conditions, and overall wellness. Many health issues start with mild symptoms that can go unnoticed. Over time, these can develop into more severe conditions if left unchecked. This is where preventive health checkups come in—they help detect potential health problems before they become serious, allowing for timely intervention and treatment.

Preventive health checkups are particularly important for individuals who have a hectic lifestyle, are over the age of 30, or have a family history of chronic diseases such as diabetes, hypertension, or heart disease. By identifying risk factors early, you can take steps to mitigate them and maintain your health.

What is the Thyrocare Executive Checkup?

The Thyrocare Executive Checkup is a comprehensive health package designed to assess your overall health status. This package includes a wide range of tests that cover various aspects of your health, from vital organ functions to common health indicators. The aim is to provide a holistic view of your health, enabling you to take control of your well-being.

Tests Included in the Thyrocare Executive Checkup

The Thyrocare Executive Checkup typically includes the following tests:

1. Complete Blood Count (CBC): This test provides valuable information about your blood cells, helping detect conditions like anemia, infections, and other disorders.

2. Lipid Profile: This set of tests measures the levels of cholesterol and triglycerides in your blood, providing insights into your risk for heart disease.

3. Liver Function Test (LFT): This test assesses the health of your liver by measuring levels of proteins, liver enzymes, and bilirubin in your blood.

4. Kidney Function Test (KFT): These tests help determine how well your kidneys are functioning by measuring levels of waste products in your blood.

5. Thyroid Profile: This test checks the levels of thyroid hormones (T3, T4, and TSH) to assess your thyroid gland’s functioning, which is crucial for metabolism and energy regulation.

6. Diabetes Screening: The checkup includes tests like fasting blood sugar and HbA1c to screen for diabetes and monitor blood sugar control over time.

7. Electrolyte Panel: This test measures the levels of essential electrolytes in your blood, such as sodium, potassium, and chloride, which are vital for maintaining fluid balance and muscle function.

8. Cardiac Risk Markers: These tests evaluate your risk of developing heart disease by measuring markers like homocysteine and hs-CRP.

9. Vitamin and Mineral Deficiency Tests: These tests check for deficiencies in essential vitamins and minerals, such as Vitamin D, Vitamin B12, and calcium.

10. Urine Analysis: This test examines your urine for signs of kidney disease, diabetes, and other metabolic conditions.

Benefits of the Thyrocare Executive Checkup

1. Early Detection of Health Issues: One of the primary benefits of the Thyrocare Executive Checkup is the early detection of potential health problems. Many conditions, such as diabetes, heart disease, and thyroid disorders, can be managed effectively if caught early.

2. Comprehensive Health Assessment: This checkup provides a thorough assessment of your overall health, covering multiple organ systems and functions. This helps in identifying any underlying issues that may not yet be causing noticeable symptoms.

3. Personalized Health Insights: The results of your Thyrocare Executive Checkup can help you understand your body better. You’ll receive insights into your health that can guide your lifestyle choices, such as diet, exercise, and stress management.

4. Peace of Mind: Knowing that you’ve taken steps to monitor and protect your health can provide peace of mind. Regular checkups can alleviate concerns about potential health problems by confirming that your body is functioning as it should.

5. Cost-Effective: Investing in a comprehensive health checkup like the Thyrocare Executive Checkup can save you money in the long run. Early detection of diseases often leads to less expensive and less invasive treatments compared to treating conditions that have progressed.

Who Should Consider the Thyrocare Executive Checkup?

While everyone can benefit from regular health checkups, certain groups should prioritize the Thyrocare Executive Checkup:

- Individuals Over 30: As we age, our bodies go through changes that can increase the risk of developing chronic diseases. Regular checkups become increasingly important to monitor these changes.

- People with a Family History of Chronic Diseases: If you have a family history of conditions like heart disease, diabetes, or cancer, regular checkups are crucial to catch any early signs.

- Those with a Sedentary Lifestyle: A lack of physical activity can lead to various health issues, including obesity, diabetes, and cardiovascular diseases. Regular health checkups can help monitor the effects of a sedentary lifestyle.

- Individuals Experiencing Symptoms: If you’ve been experiencing unexplained symptoms like fatigue, weight gain or loss, or changes in appetite, a comprehensive checkup can help identify the cause.

Preparing for the Thyrocare Executive Checkup

To get the most accurate results from your Thyrocare Executive Checkup, it’s essential to prepare properly:

1. Fasting: Many of the tests included in the checkup, such as the lipid profile and blood sugar tests, require fasting. You’ll likely need to fast for 10-12 hours before your appointment.

2. Medications: Inform your healthcare provider about any medications you’re taking, as they might affect test results. You may be advised to skip certain medications on the day of the test.

3. Hydration: Drink plenty of water before your checkup, as this can make blood draws easier and provide a clearer urine sample.

4. Rest: Ensure you get a good night’s sleep before your checkup, as stress and lack of sleep can affect some test results.

Conclusion: Take Charge of Your Health Today

Your health is your most valuable asset, and it’s essential to take proactive steps to protect it. Regular health checkups like the Thyrocare Executive Checkup provide a comprehensive overview of your health, enabling you to catch potential problems early and take appropriate action. Don’t wait for symptoms to appear—invest in your health today by scheduling your Thyrocare Executive Checkup and take the first step toward a healthier, happier life.

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prachireport-prime1 · 1 year ago

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C-Reactive Protein Test（CRP）Market Size, Type, segmentation, growth and forecast 2023-2030

C-Reactive Protein Test（CRP）Market

The C-Reactive Protein Test（CRP） Market is expected to grow from USD 660.40 Million in 2022 to USD 993.00 Million by 2030, at a CAGR of 6.00% during the forecast period.

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C-Reactive Protein Test（CRP）Market Size

The C-Reactive Protein Test (CRP) is a diagnostic blood test that measures the level of the protein CRP in the body, which is produced by the liver in response to inflammation and infection. The global market for CRP tests is segmented by type, application, and region, including ELISA, Immunoturbidimetric, CLIA, hospitals, diagnostic laboratories, North America, Asia Pacific, Middle East, Africa, Australia, and Europe. Key market players include Beckman Coulter, Roche, Siemens Healthineers, Boditech, Wondfo, KANTO CHEMICAL, Kehua Group, Beijing Strong Biotechnologies, Getein Biotech, Randox Laboratories, Spinreact, BioSino, and Leadman Biochemistry. Regulatory and legal factors specific to market conditions include the FDA's approval of CRP tests for diagnosis and monitoring of bacterial infections and sepsis, as well as the increasing demand for point-of-care testing and the development of advanced CRP detection technologies.

C-Reactive Protein Test（CRP）Market Key Player

Beckman Coulter

Roche

Siemens Healthineers

Boditech

Wondfo

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C-Reactive Protein Test（CRP）Market Segment Analysis

The C-Reactive Protein Test (CRP) market is a rapidly growing sector as the demand for quick diagnosis and monitoring of infectious and inflammatory diseases has increased. The target market for CRP includes clinical diagnostic laboratories, hospitals, research institutes, and point of care (POC) testing facilities. This is due to the fact that CRP is one of the fastest and most reliable ways to diagnose inflammation within the body.

The COVID-19 pandemic has further contributed to the growth of the CRP market as the test is being used to monitor the severity of infection and predict potential adverse outcomes. Furthermore, the growing prevalence of chronic illnesses such as cardiovascular diseases, diabetes, and cancer is increasing the demand for CRP testing.

The latest trends in the CRP market include the adoption of automated systems for conducting testing and the integration of high sensitivity CRP (hs-CRP) testing in cardiovascular disease risk assessment. Additionally, the availability of CRP testing in POC settings has made it more accessible to patients, resulting in increased market growth.

However, challenges faced by the CRP market include the lack of standardization in testing methods, which can lead to inconsistent results, and the high cost of testing equipment and consumables. Furthermore, the high rate of false positives in CRP testing can lead to overdiagnosis and overtreatment, negatively impacting patient outcomes and increasing healthcare costs.

The main findings of the report indicate that the CRP market is expected to witness significant growth in the coming years, primarily due to the increasing prevalence of chronic diseases and the growing demand for point of care testing. The report recommends that market players focus on developing standardized testing methods and affordable testing equipment to address the challenges faced by the industry.

Overall, the CRP test market is poised for substantial growth, driven by increasing demand for quick diagnosis and monitoring of infectious and inflammatory diseases. While challenges exist in the form of standardization issues and equipment costs, continued research and investment may help overcome these obstacles and solidify the CRP testing industry's role in healthcare.

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Market Segmentation (by Application):

Hospitals

Diagnostic Laboratories

Others

Information is sourced from www.reportprime.com

#business #market growth #market strategy #market analysis #market research

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pulsemedicalcentre22 · 2 years ago

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What is a CRP Test

How is a CRP Test Performed?

Benefits of the CRP Test

A C-reactive protein (CRP) test is a simple blood test used to detect inflammation in the body. High levels of CRP may indicate an increased risk of heart problems and other serious medical conditions. A CRP result of more than 50 mg/dL is considered severe elevation, while results between 0.3–1.0 mg/dL are classified as slight or moderate elevations. Measuring your CRP levels is relatively inexpensive and could be recommended by your healthcare provider if they think you may have an infection or another condition that causes inflammation. Studies have shown that hs-CRP could be an important marker for predicting the risk of death or cardiovascular disease in apparently healthy people as well as those with existing conditions.

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paleorecipecookbook · 6 years ago

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Estrogen in Men: Why You Need to Balance Your Hormones as You Age

Read on to learn about how estrogen relates to men’s health, why estrogen might go out of balance, and what to do if your levels aren’t in line.

Estrogen in Men: You Need Balance

Though estrogen is largely associated with women’s health, this sex hormone regulates many essential aspects of men’s health, too. The importance of maintaining balanced estrogen begins in the womb and extends across a man’s lifetime. (1) Estrogen influences sperm production, male brain development, male libido, and much more. (2)

Estrogen balance is important for women … and men. Find out why you need to make sure you have enough of this hormone, especially as you age. #functionalmedicine #wellness #chriskresser

In a process called “aromatization,” the enzyme aromatase synthesizes estrogens from testosterone and other male sex hormones, known as androgens. Estrogen receptors are present in almost all tissues of the body. (3) In women, estrogens are synthesized mainly in the ovaries and other reproductive tissues. In men, the testes produce 20 percent of total estrogens. (4) Bone, blood vessels, brain tissue, and fatty tissue also produce estrogen.

As men start to age, their testosterone levels steadily decline. By age 35 to 40, they fall, on average, one to two percent per year in a phenomenon often referred to as “andropause,” or so-called male menopause. (Some have even called it “manopause.”) (5)

As testosterone levels drop, estrogen tends to be affected as well. Estrogen levels that are too low—or too high—can become a big problem.

The Risks: Cardiovascular Disease, Cancer, and More

In a study of over 3,000 older men (ranging in age from 69 to 80), low levels of estrogens were associated with increased risk of mortality in a four-and-a-half-year follow-up, compared to men with adequate levels of estrogen. In men with low levels of both estrogen and testosterone, the risk of death nearly doubled. (6)

Imbalanced estrogen levels have also been linked to:

Cardiovascular issues (7, 8, 9, 10)

Prostate cancer (11, 12, 13)

Osteoporosis and bone fractures (14, 15)

Alzheimer’s disease and depression (16, 17)

How Your Estrogen Can Fall out of Balance

Hormone imbalance is one of eight core pathologies that I believe underlie all chronic disease. Here are the most common causes of estrogen imbalance in aging men. In many cases, more than one cause may be present—so it’s important to address all that apply if you want to regain your health.

You Could Have Chronic Inflammation

Estrogens exhibit both pro- and anti-inflammatory properties, depending on what triggers the body’s immune response, the organ or organ systems involved, and other health factors. Estrogens suppress inflammation in many animal models of chronic diseases, but they can also be pro-inflammatory in chronic autoimmune diseases. (18)

Inflammation itself is not a bad thing. As part of the body’s immune response, it initiates healing after a harmful stimulus. Chronic inflammation, on the other hand, causes damage over time. It’s an underlying cause for some of the most prevalent chronic diseases, including:

Obesity

Cancer

Heart disease

Alzheimer’s disease

In a study of men over age 50, researchers tested participants for high-sensitivity C-reactive protein (hs-CRP) in the blood, a reliable marker for inflammation. Serum hs-CRP correlated with estrogen levels, suggesting that inflammation and excess estrogen go hand in hand. (19) Other research has confirmed associations between estrogen and inflammatory pathways. (20, 21)

Your Gut Isn’t Healthy

Scientists have confirmed the gut’s role in hormone metabolism and its influences on the rest of the body. If your gut’s microbiome is unhealthy, it can impact how much estrogen circulates in your body.

The process starts with the liver. Your liver processes estrogen, so it can be excreted in the bile, urine, and feces. Along the way, certain gut bacteria can interrupt that process and allow estrogen and estrogen-like molecules to re-enter circulation. (22)

Gut dysbiosis can affect which estrogen byproducts, or metabolites, are reintroduced to the body. Some bacterial species generate metabolites that are potentially pro-cancerous, while others produce protective metabolites. (23) Estrogen imbalance from gut dysbiosis has been linked with breast cancer development in women and prostate cancer in men. (24, 25, 26, 27)

You’re Experiencing Chronic Stress

The hypothalamic–pituitary–adrenal (HPA) axis controls the body’s response to stress and also helps regulate the immune system, digestion, metabolism, hormone production, and more. High cortisol production from chronic stress can lead to hormone resistance. This resistance in turn depresses pituitary function, and as a result, testosterone and sperm count can decrease. When testosterone levels are low, a man’s estrogen levels can often be low, too.

Chronic stress from sleep restriction is a good example of how stress can influence hormone levels. In an experimental study, restricting sleep to only five hours per night decreased testosterone levels by 10 to 15 percent in young men. (28) Sleep apnea yields similar results. (29)

You Have Insulin Resistance

Estrogen is involved in glucose metabolism, and healthy levels may help protect against excessive fat storage and insulin resistance, both of which can contribute to chronic inflammation. (30, 31)

The relationship between insulin and estrogen is somewhat complex. Insulin helps your body synthesize estrogen from testosterone. (32) Since estrogen plays a role in glucose metabolism, low levels of the hormone can lead to or worsen insulin resistance. Researchers have witnessed this phenomenon in people with a genetic mutation that deactivates the aromatase enzyme, which causes undetectable levels of estrogen. (33, 34, 35) By a similar mechanism in women, insulin resistance and obesity often follow the decline in estrogen that occurs in menopause. On the other hand, high estrogen levels can also cause insulin resistance, again indicating the need for balance. (36)

In both men and women, high levels of insulin can upregulate aromatase, which increases the conversion of testosterone to estrogen. In men, this can cause enlarged breast tissue and abdominal fat accumulation. In women, it can cause or contribute to polycystic ovary syndrome (PCOS).

You’re Dealing with a Toxic Burden

Estrogens are predominantly metabolized in the liver. (37) If your liver’s ability to detox your body is compromised, it may only be able to partially metabolize hormones like estrogen. Certain amino acids like glycine, and antioxidants like glutathione, are required for proper detoxification. If your toxic burden—the amount of environmental toxins your body is trying to process and clear—is already high, you might need help to detox safely. I recommend speaking to a Functional Medicine practitioner to help you with this process.

Seven Ways to Balance Your Estrogen

We have to be cautious when we want to make a connection between disease and serum estrogen levels. One caveat is that serum levels don’t necessarily reflect estrogen concentration in a particular tissue. For example, in estrogen receptor-positive breast cancer, the cancerous tissue itself can have a high concentration of estrogen while serum levels remain low. (38)

However, serum hormone levels still provide a lot of information, especially about what is occurring systemically. Saliva tests are generally much cheaper but can only measure “free” hormones, those which are not yet bound to a specific receptor. Blood tests measure both free (active) and protein-bound (inactive) hormones.

In conventional medicine, a doctor treats a hormonal imbalance using the “replacement model.” For instance, if testosterone is low, then a doctor might prescribe a testosterone cream. I’m extremely cautious about this method. These testosterone creams contain the free form of testosterone, which means that the body has no control over how much testosterone enters tissues as it normally would. Excess testosterone cream could also increase estrogen levels excessively if not properly monitored. Over time, the hormone receptors become somewhat resistant to the constant influx of testosterone, meaning you would eventually need an increased dosage. If you’ve been using the cream for an extended period of time, you need to be slowly weaned off—and that process can be difficult.

A Functional Medicine approach requires a lot of upfront testing to paint the best picture of your overall health. In the case of hormonal imbalance, several underlying issues might be responsible.

Depending on your specific needs, the following strategies can help balance estrogen and other hormone levels.

1. Reduce Your Stress

Chronic stress can disrupt the HPA axis and contribute to chronic inflammation and hormonal imbalances, but managing your stress can help. Meditation and getting enough sleep are good places to start. You can also try some herbal remedies like ginseng, rhodiola, ashwagandha, and eleutherococcus. These botanicals increase cortisol when it’s low and decrease it when it’s too high.

2. Stabilize Your Blood Sugar

Magnesium, green tea extract, and alpha lipoic acid may help fight insulin resistance and level out your blood sugar. Make sure you’re eating quality carbohydrates, not refined carbs. Proper sleep is also important for glucose control.

3. Cut Inflammatory Foods Out of Your Diet

Eliminate inflammatory foods like industrial seed oils and refined sugars. You should also avoid soy, which is a phytoestrogen (a plant-derived estrogen). Make sure your diet includes dietary cholesterol, which is a precursor to all hormones.

4. Detox

To ensure proper hormone metabolism, liver detox support is crucial. One supplement I suggest is Pure Encapsulations DIM Detox. DIM, or diindolylmethane, in particular promotes healthy estrogen metabolism. Milk thistle extract, another ingredient, also helps metabolism estrogen. (39)

5. Heal Your Gut

Maintaining a healthy gut with a rich, biodiverse microbiota will support proper estrogen metabolism. Reducing gut inflammation and fixing a leaky gut are other important steps.

6. Avoid Endocrine Disruptors

Toxins that disrupt your endocrine system should be avoided at all costs. This includes BPA and BPA-free plastics, phthalates, soy, and more.

7. Fix Over-Aromatization

In the case of low testosterone and high estrogen in men, if other sources of phytoestrogen are absent, over-aromatization may be the culprit. That means the enzyme aromatase is synthesizing too much estrogen. The most important way to fix excess aromatization is by first fixing insulin resistance (see the section on insulin resistance above). If that isn’t enough, DIM (see above, under “Detox”) and the herb chrysin, under the supervision of a medical professional, can both sometimes help.

Now I’d like to hear from you. Have you experienced any estrogen imbalance with age? What steps have you taken to get back in balance? Let me know in the comments!

The post Estrogen in Men: Why You Need to Balance Your Hormones as You Age appeared first on Chris Kresser.

Source: http://chriskresser.com December 22, 2018 at 12:58AM

#paleo #recipe #food #delicious #healthy #yum #diet

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ijcmcrjournal · 2 years ago

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B-Type Natriuretic Peptide and High Sensitivity C-Reactive Protein Performances in the Screening for Diabetic Nephropathy in Type 2 Diabetic Patients by Ibtissem O

Abstract

Introduction: The associations between B-type natriuretic peptide (BNP), high sensitivity C-reactive protein (hs-CRP) and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus remain controversial.

Aim: To analyze the performance of BNP and hs-CRP in the screening for DN in type 2 diabetic patients without renal dysfunction.

Methods: In a cross sectional study, we enrolled type 2 diabetic patients aged less than 65 years and having a glomerular filtration rate > 60 ml/minute/1.73 m2. All patients had plasma BNP and hs-CRP measurements.

Statistical analysis used: A receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of plasma BNP and hs-CRP in the screening for DN.

Results: Among 69 participants (mean age: 56.7 ±6.9 years, sex ratio (M/F): 1.46), 26 patients (38%) had diabetic nephropathy (DN). BNP level was higher in patients with DN (42.0 ± 42.2 pg/ml vs 19.2 ± 20.7 pg/ml, p=0.04) and was significantly correlated with albuminuria level (r= 0.295, p=0.017). However, hs-CRP level was not significantly different between the two groups. Using BNP and hs-CRP, the area under the ROC curve was 0.702 (p=0.007) and 0.570 (p=0.316), respectively. A BNP level ≥ 15 pg/ml was significantly associated with DN (Odds Ratio= 3.91, p= 0,008). This cut-off value had a sensitivity of 65 % and a specificity of 67 %.

Conclusion: BNP level was positively associated with diabetic nephropathy. However, prospective controlled studies including a large population are needed to confirm these results.

Keywords: Type 2 Diabetes; Diabetic Nephropathy; Biomarker; B-Type Natriuretic Peptide; High Sensitivity C-Reactive Protein

Introduction

Diabetic nephropathy (DN) is a syndrome characterized by diabetic glomerular lesions, a pathological urinary albumin excretion and a loss of glomerular filtration rate in diabetic patients [1]. It represents the first cause of kidney disease in patients starting renal replacement therapy and affects 40% of type 1 and type 2 diabetic patients (T2D) [2]. Furthermore, DN is a risk factor for cardiovascular diseases. So, the diagnosis and the management of DN are important for the prevention of chronic kidney disease (CKD) and its complications.

Brain natriuretic peptide (BNP) is one of the predictive biomarkers of cardiovascular events. In fact, it is secreted as a prohormone from cardiomyocytes in response to volume expansion and ventricular wall stress, and is then released into the circulation following cleavage into active BNP and N-terminal pro-BNP (NT-pro-BNP) fragment. Although the two latter parameters are released in equimolar amounts, NT-pro-BNP is found in higher concentrations in the circulation and has a longer half-life than active BNP, possibly due to differences in its specific degradation [3]. It is also used for the prediction of cardiovascular events in diabetic patients and in patients undergoing dialysis. Moreover, BNP is considered as a biomarker of renal function and can predict the progression of non-diabetic CKD [4]. In DN, some reports have shown that the plasma BNP level is high in DN and may increase depending on the stage of albuminuria [4-6]. However, the role of BNP as a marker of DN has not yet been established. High sensitivity C-reactive protein (hs-CRP), a marker of inflammation, has been reported to be associated with the development of DN and some authors noted an increase in serum Hs-CRP with the degree of albumin excretion rate (AER) and the severity of DN in T2D [7-9]. Nevertheless, there is not conclusive evidence that the development and the progression of DN were associated with high levels of hs-CRP.

The aim of this study was to analyze the performances of BNP and hs-CRP in the screening for DN in Tunisian T2D patients.

Subjects and Methods

Study Protocol and Subjects

A cross-sectional study was conducted among consecutive T2D patients who attended the Endocrinology outpatient department of the Rabta University Hospital in Tunis from March to September 2017.

Type 2 diabetes was diagnosed according to the American Diabetes Association (ADA) criteria [10]. Inclusion criteria were T2D patients aged between 30 and 65 years and having glomerular filtration rate > 60 ml/mn/1.73 m2. Patients with urinary tract infection, history of treated diabetic nephropathy, severe concomitant diseases, inflammatory and or infectious diseases, heart failure or left ventricular hypertrophy, pregnant or nursing women and patients with hypothyroidism or hyperthyroidism were not included. Patients with BNP level ≥ 300 pg/ml and or hs-CRP > 10 mg/l were excluded.

Sixty nine patients were eligible to participate in this study. They were informed about the aim of the study and were included if they had signed a consent form. All procedures performed in our study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Participants were divided into two groups according to the presence of DN. DN was defined by the presence of a pathological excretion of urinary albumin (with repeated measurements) referred to as microalbuminuria if the level is 30–299 mg/24 hours or macroalbuminuria if the level is ≥ 300 mg/24 hours [1].

Clinical and Biochemical Data

Sociodemographic characteristics (age, gender and smoking habits), diabetes mellitus history (diabetes duration, antidiabetic medication, and diabetic complications), comorbidities and drugs use were determined via a structured interview. Cardiovascular disease (coronary heart disease, peripheral artery disease and or stroke) and microangiopathies (retinopathy and or neuropathy) were assessed based on the medical records and/or the admission data. Cardiovascular disease (CVD) was considered present if any of the following criteria was present: history of stroke, history of myocardial infarction, history of coronary angioplasty or coronary bypass surgery or history of peripheral artery disease.

Patients’ weight and height were recorded. Body mass index (BMI) was calculated as weight (kilograms) divided by height (meters) squared. Overweight and obesity were defined as BMI ≥ 25 and ≥ 30 kg/m2, respectively. Blood pressure was measured after a rest period of approximately 15 minutes in a sitting position. High blood pressure was defined as systolic blood pressure ≥ 140 mmHg and or diastolic blood pressure ≥ 90 mmHg or the use of blood pressure lowering medication during the previous two weeks [11].

Blood samples were drawn after an overnight fast of at least 12 hours. Urine was collected over a full 24-hour period. Fasting blood glucose, HbA1c, total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDLc), serum creatinine, BNP concentration, hs-CRP and albuminuria level were measured. Fasting blood glucose and HbA1c were measured using glucose oxidase method and high performance liquid chromatography (HPLC) method, respectively. TC, TG and HDLc were measured using enzymatic colorimetric methods. The plasma BNP level concentration was measured with specific chemiluminescent enzyme immunoassay using a human BNP kit. Serum hsCRP concentration was determined by a turbidimetric immunoassay method. Urinary albumin rate was assessed by an immuno-nephelometric method. The presence of abnormal albuminuria was confirmed in at least two consecutive samples.

The level of glycemic control was evaluated according to the recommendations of the American Diabetes Association, ADA 2016 [10]. Good glycemic control was defined as HbA1c ≤ 7% for most adult patients or as HbA1c ≤ 8% for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal was difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin. Dyslipidemia was defined according to the guidelines of the European Society of cardiology ESC 2016 [12]. Glomerular filtration rate (eGFR) was estimated using the MDRD (Modification of Diet in Renal Disease Study) equation.

Statistical Analysis

All data were analyzed using the Statistical Program for Social Sciences, SPSS version 22.0 (SPSS Inc., Chicago, IL). Continuous variables were expressed as mean ± SD, and categorical variables were expressed as percentages. For independent groups, we used the parametric Student’s T-test for the comparison of means and the Pearson’s Chi-2 test to compare proportions. Receiver operating characteristics (ROC) analysis was used to identify optimal cut-off values of BNP and hs-CRP for the prediction of DN. The area under the ROC curve (AUC) and the 95% confidence interval (95% CI) were used as measures of the discriminative power of the BNP and the hs-CRP. AUC value above 0.80 was considered as excellent. We calculated quartiles of BNP to analyze the association between BNP serum levels and DN. Relative risk analysis was performed using univariate regression analysis. A nominal p value <0.05 was considered statistically significant.

Results

A total of 69 subjects with T2D were enrolled in this study. Their mean age was 56.7 ± 6.9 years [extremes: 36-65] and the sex ratio (men/women) was 1.46. The mean duration of diabetes was 10.6 ± 7.7 years.

DN was diagnosed in 26 patients (38%). The comparison of clinical and biological parameters between patients with DN and those without DN is shown in table 1.

BNP level was positively correlated with albuminuria level (r= 0.45, p<10-3). However, no correlation was found between hs-CRP and albuminuria levels (r=-0.03, p=0.8).

Discussion

In this cross sectional study, BNP level was significantly associated with the presence of DN in patients with T2D with glomerular filtration rate > 60 ml/mn. A BNP threshold value of 15 pg/ml was associated with a sensitivity of 62 % and a specificity of 67% for the prediction of DN. Moreover, a BNP threshold > 32.2 pg/ml was highly associated to DN with an odds ratio of 4.42.

Several studies have evaluated the relationship between BNP and DN. Hamano et al [6] and Seki et al [4] showed that BNP level was significantly higher in the group of patients with DN compared to patients without DN. In a recent study including 687 patients withT2D, Furukawa el al [13] confirmed the existence of a positive association between elevated BNP levels, microalbuminuria and proteinuria. Besides, Seki et al [4, 5], demonstrated that baseline BNP level was an independent predictor of the annual decline in the glomerular filtration rate in T2D.

Furthermore, our study showed a significant difference in BNP levels according to nephropathy stages (p=0.011). Thus, it is possible that BNP may induce by itself the progression of DN. Seki et al [5] explained that elevated endogenous BNP concentrations cause glomerular hyerfiltration which threatens renal function. Indeed, glomerular hyperfiltration, which is often observed in early diabetes, induces glomerular hypertension and stretches mesangial cells mechanically. These stretched cells secrete cytokines that stimulate production of extracellular matrix proteins, accumulation of which promote the progression of renal injury in DN [4]. Many physiological and biochemical factors can be implicated in this association between elevated BNP levels and DN such as cellular hypoxia, increased oxidative stress, activation of renin angiotensin system, acceleration of the sympathetic nervous system, vascular endothelial growth factors (endhotheline) and tumoral necrosis factor α (TNFα) [5, 14]. Many reports demonstrated that the infusion of natriuretic peptide induced proteinuria in diabetes [15] whereas others showed that renal injury can be prevented by the antagonism of natriuretic peptide receptor [16].

In contrast with other reports [17-20], our study has not found a significant association between hs-CRP levels and the presence of DN in T2D patients. In 2002, Stehouwer et al [21] reported for the first time that CRP levels were associated with an increase of urinary microalbumin levels in patients with diabetes. In a cohort of T2D patients, urinary albumin levels increased by 1.02 mg/24 h (95% CI: 1.01–1.27) for each increase of 1 mg/L of CRP over 10 years of follow-up [21]. As well, Pojskić et al [22] indicated that any increase of CRP by 1 mg/L would increase the risk for microalbuminuria by 11.5%. Navarro et al [23] revealed that CRP levels were higher in T2D patients with microalbuminuria or mild proteinuria compared with those with normoalbuminuria. According to Chuengsamarn et al [20], the cut-off point for hs-CRP level for the prediction of DN was 2.10 mg/L.

The exact mechanisms explaining this association are not yet well understood. Some authors suggest that insulin resistance and hyperglycemia may have a role in the development of DN by promoting inflammation and increasing oxidative stress, leading to elevated hs-CRP [9]. On the same way, other authors suggested that pro-inflammatory cytokines and chemokines such as TNF-α, IL-6, intercellular and vascular cellular adhesion molecules (ICAM-1 and VCAM-1), and monocyte chemo-attractant protein-1 (MCP-1) may play a significant role in the development of microvascular diabetic complications such as DN [7, 24]. Thus, high hs-CRP levels may be a part of this complex mechanism. However, further clinical studies should be conducted in order to assess the place of the hs-CRP in the prevention of DN.

Although our study had demonstrated a significant association between BNP level and DN, some limitations should be acknowledged. In fact, this was a single center cross sectional study including a small number of patients. Furthermore, some confounding factors were not considered such as asymptomatic heart disease and beta-blocker use.

Thus, our results couldn’t be generalized to the whole T2D population. Therefore, prospective controlled studies including a large population are needed to confirm these results.

Conclusion

In contrast to hs-CRP, BNP level was associated with the presence and the severity of DN. However, further prospective controlled studies including a large population are needed to confirm the clinical effectiveness of BNP as a biomarker of DN, especially in its early stages.

For more information about Article : https://ijclinmedcasereports.com/

https://ijclinmedcasereports.com/ijcmcr-ra-id-00123/ https://ijclinmedcasereports.com/pdf/IJCMCR-RA-00123.pdf

#type 2 diabetes #Diabetic Nephropathy #Biomarker #B-Type Natriuretic Peptide #High Sensitivity C-Reactive Protein #Ibtissem O #IJCMCR #clinical studies

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mcatmemoranda · 2 years ago

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Hypertriglyceridemia in adults:

* Addressing modifiable causes includes avoiding medications that cause hypertriglyceridemia and achieving excellent glycemic control for patients with diabetes mellitus. Refer to UpToDate content on causes of hypertriglyceridemia.

¶ Nonpharmacologic measures include regular aerobic exercise, management of ASCVD risk factors including hypertension, and weight loss as indicated. Specific diet and alcohol recommendations vary depending upon the severity of hypertriglyceridemia. For moderate hypertriglyceridemia, targets include <6% calories of added sugar, ≤30 to 35% calories of total dietary fat, and ≤2 drinks per day for males and ≤1 drink per day for females. For moderate to severe hypertriglyceridemia, targets include <5% calories of added sugar, ≤20 to 25% calories of total dietary fat, and alcohol abstinence. Refer to § for targets for severe hypertriglyceridemia.

Δ Refer to UpToDate content on the approach to ASCVD risk assessment and on LDL-C management for primary and secondary prevention of ASCVD.

◊ "High ASCVD risk" is defined here according to the criteria in the REDUCE-IT trial: established ASCVD or diabetes mellitus plus two of the following ASCVD risk factors: age ≥50 years, cigarette smoking, hypertension, HDL-C ≤40 mg/dL for males or ≤50 mg/dL for females, hs-CRP >3 mg/L (0.3 mg/dL), creatinine clearance <60 mL/min, retinopathy, micro- or macroalbuminuria, and ABI <0.9.

§ In the setting of severe hypertriglycedemia, it is crucial to eliminate added sugars, restrict fat to ≤10 to 15% (preferably <5%) of total calories, and abstain from alcohol.

¥ For outpatients with severe hypertriglyceridemia, drug therapy for TG lowering (beyond therapy for LDL-C) is generally deferred. Given the rapid rate of TG lowering achievable with stringent dietary fat restriction, with close monitoring it may be possible to initiate drug therapy for hypertriglyceridemia within days. However, for inpatients with severe hypertriglyceridemia and pancreatitis, immediate treatment with a fibrate is a component of therapy.

‡ The choice of marine omega-3 fatty acid varies depending upon the level of ASCVD risk (as defined above). For patients with high ASCVD risk, we prefer prescription-strength IPE. In patients without high ASCVD risk, any prescription high-dose marine omega-3 fatty acid can be used. Choices include omega-3 fatty acid ethyl esters (EPA+DHA) in generic or brand form or IPE (ethyl ester of EPA). Refer to UpToDate content on administration and side effects.† When choosing fibrate therapy, we generally prefer fenofibrate to gemfibrozil since it has fewer drug interactions, is generally better tolerated, and patient compliance is better due to its once-daily dosage. Refer to UpToDate content on administration and side effects

Treatment goals – The goals of management of patients with hypertriglyceridemia are to lower the risk for pancreatitis and atherosclerotic cardiovascular disease (ASCVD), although evidence on the efficacy of triglyceride (TG) lowering is limited.

●General measures – For all patients with hypertriglyceridemia, first-line management includes:

•Address causes – Factors that may cause or exacerbate hypertriglyceridemia should be addressed.

•Lifestyle modification – Diet and alcohol restrictions depend upon the level of hypertriglyceridemia.

Additional measures include aerobic exercise and management of ASCVD risk factors [2-4].

•Optimize treatment of LDL-C – Assessment of ASCVD risk and management of low-density lipoprotein cholesterol (LDL-C) level is performed according to standard recommendations.

●Additional management – For patients whose TG levels remain >150 mg/dL despite the above general measures, additional management depends on the TG level, ASCVD risk factors, and history of pancreatitis.

In the discussion below, "high ASCVD risk" is defined as established ASCVD or diabetes mellitus plus two additional ASCVD risk factors (age ≥50 years, cigarette smoking, hypertension, high-density lipoprotein cholesterol [HDL-C] ≤40 mg/dL for males or ≤50 mg/dL for females, high sensitivity C-reactive protein [hs-CRP] >3 mg/L [0.3 mg/dL], creatinine clearance <60 mL/min, retinopathy, micro- or macroalbuminuria, and ankle-brachial index [ABI] <0.9).

Our approach is as follows (algorithm 1):

•Moderate hypertriglyceridemia (fasting TG 150 to 499 mg/dL [1.7 to 5.6 mmol/L]) (see 'Moderate hypertriglyceridemia' above):

-Patients with high ASCVD risk – For patients with moderate hypertriglyceridemia who have high ASCVD risk, we suggest adding marine omega-3 fatty acid therapy (Grade 2B). In this setting, we suggest icosapent ethyl rather than other marine omega-3 fatty acid preparations (Grade 2C).

-Patients not at high ASCVD risk – For patients with moderate hypertriglyceridemia who lack the above ASCVD risk factors, management focuses on continuing general measures.

•Moderate to severe hypertriglyceridemia (fasting TG 500 to 999 mg/dL [5.65 to 11.3 mmol/L]):

-Patients with high ASCVD risk – The preferred initial agent to add for patients with moderate to severe hypertriglyceridemia and high ASCVD risk is icosapent ethyl. If TG level remains ≥500 mg/dL despite treatment with icosapent ethyl, we suggest adding fibrate therapy. (Grade 2C).

-Patients not at high ASCVD risk – For patients without the above ASCVD risk factors, we suggest adding fibrate therapy (Grade 2C). If TG level remains ≥500 mg/dL despite treatment with fibrate therapy, we suggest adding a marine omega-3 fatty acid agent (Grade 2C). In this setting, any of the available prescription high-dose marine omega-3 fatty acid preparations may be used.

•Severe hypertriglyceridemia (fasting TG ≥1000 mg/dL [≥11.3 mmol/L]) – Patients with severe hypertriglyceridemia are managed with extreme dietary fat restriction, alcohol abstinence, and LDL-lowering therapy with the goal of reducing the TG level to <1000 mg/dL. For most patients with severe pancreatitis (including all outpatients), addition of TG-lowering agents is deferred until the TG level is ≤1000 mg/dL. For patients with acute pancreatitis, a fibrate is a component of therapy to reduce TG levels along with the above measures.

*Moderate hypertriglyceridemia — For patients with moderate hypertriglyceridemia (150 to 499 mg/dL; 1.7 to 5.6 mmol/L) , the following approach is applied (algorithm 1) in addition to the general measures described above (see 'General measures' above). In patients with moderate hypertriglyceridemia, after 4 to 12 weeks of general measures, we assess the need for further TG-lowering therapy. The key goal of therapy for this TG range is to reduce the risk of ASCVD events as these patients generally do not require treatment to reduce the risk of pancreatitis.

●Lifestyle modification

•Diet – Dietary management should focus on attaining and maintaining a healthy weight and reduction of intake of simple carbohydrates, especially high-glycemic and high-fructose foods and beverages (table 2) with a target of <6 percent calories of added sugar and ≤30 to 35 percent calories of total fat. Dietary fat is not a primary source for liver TG, and higher-fat diets do not raise fasting plasma TG levels in most people. Nevertheless, a change in the types of fat (ie, reducing saturated versus poly- and monounsaturated fats) is recommended [11]. We suggest increased consumption of fish that contain high amounts of omega-3 fatty acids (table 3).

•Alcohol use – For patients with moderate hypertriglyceridemia (without prior pancreatitis), we advise limiting alcohol consumption to no more than two drinks per day in males and to no more than one drink per day for females. The effects of moderate alcohol consumption in patients with moderate hypertriglyceridemia are less clear than with severe hypertriglyceridemia and the effect on TG levels may be limited [12]. However, alcohol consumption is an often underappreciated source of excess calories that may undermine efforts at weight loss.

Alcohol avoidance is advised for patients with prior hypertriglyceridemia-induced pancreatitis.

●Assess and treat LDL-C levels as discussed above.

●Additional therapy based upon ASCVD risk – In this context, "high ASCVD risk" is defined as established ASCVD or diabetes mellitus plus two additional ASCVD risk factors (age ≥50 years, cigarette smoking, hypertension, HDL-C ≤40 mg/dL for males or ≤50 mg/dL for females, high-sensitivity C-reactive protein [hs-CRP] >3 mg/L [0.3 mg/dL], creatinine clearance <60 mL/min, retinopathy, micro- or macroalbuminuria, and ankle-brachial index [ABI] <0.9).

•For patients with high risk of ASCVD – For patients with high ASCVD risk whose TG levels remain >150 mg/dL after lifestyle interventions and optimal therapy to lower LDL-C, we suggest treatment with high-dose marine omega-3 fatty acid. For this indication, we suggest icosapent ethyl rather than other marine omega-3 fatty acids. (See 'Marine omega-3 fatty acids' below.)

•For patients without high risk of ASCVD – For patients without high ASCVD risk, management focuses on continuing the above general measures including lifestyle modification and optimizing treatment of LDL-C. (See 'General measures' above.)

Moderate to severe hypertriglyceridemia — For patients with moderate to severe hypertriglyceridemia (500 to 999 mg/dL; 5.65 to 11.3 mmol/L), the following approach is applied (algorithm 1) in addition to the general measures described above (see 'General measures' above). Goals of therapy for this TG range are to reduce the risks of ASCVD and pancreatitis. However, randomized trials of TG-lowering agents have largely focused on ASCVD outcomes and there is limited available evidence of the effects of TG-lowering drugs on risk of pancreatitis. (See 'Specific agents' below.)

●Lifestyle modification

•Diet – Dietary management should focus on attaining and maintaining a healthy weight, reduction of intake of simple carbohydrates, especially high-glycemic and high-fructose foods and beverages (table 2), with a target of <5 percent calories of added sugar, and limiting dietary total fat intake to ≤20 to 25 percent calories [1]. A change in the types of fat (ie, reducing saturated versus poly- and monounsaturated fats) is recommended [11]. We suggest increased consumption of fish that contain high amounts of omega-3 fatty acids (table 3).

•Alcohol use – For patients with moderate to severe hypertriglyceridemia (with or without prior pancreatitis) we advise abstaining from alcohol consumption [1]. In this setting, alcohol can increase VLDL-TG secretion and further increase TG levels, which might precipitate pancreatitis.

●Assess and treat LDL-C levels as discussed above. (See 'General measures' above.)

●Additional therapy – For patients with moderate to severe hypertriglyceridemia (500 to 999 mg/dL; 5.65 to 11.3 mmol/L) despite the above measures, the following therapy is added.

In this context, "high ASCVD risk" is defined as established ASCVD or diabetes mellitus plus two additional ASCVD risk factors (age ≥50 years, cigarette smoking, hypertension, HDL-C ≤40 mg/dL for males or ≤50 mg/dL for females, hs-CRP >3.00 mg/L [0.3 mg/dL], creatinine clearance <60 mL/min, retinopathy, micro- or macroalbuminuria, and ABI <0.9).

•Patients with high risk of ASCVD – For patients with high ASCVD risk with TG level of 500 to 999 mg/dL despite lifestyle interventions and optimal therapy to lower LDL-C, the suggested initial additional agent is icosapent ethyl. (See 'Marine omega-3 fatty acids' below.)

For patients with persistent TG level of 500 to 999 mg/dL despite treatment with icosapent ethyl, we suggest adding fibrate therapy. (See 'Fibrates' below.)

•For patients without high risk of ASCVD – For patients with moderate to severe hypertriglyceridemia despite lifestyle interventions and optimal LDL-C lowering therapy, the suggested initial additional agent is a fibrate. Fibrate therapy is started after discussing the benefits and risks with the patient. (See 'Fibrates' below.)

If the TG level remains 500 to 999 mg/dL despite fibrate therapy, we suggest addition of marine omega-3 fatty acid therapy. In this setting, any prescription high-dose marine omega fatty acid preparation can be used. (See 'Marine omega-3 fatty acids' below.)

An alternative approach is to begin with marine omega-3 fatty acid therapy and add fibrate therapy as needed.

We do not routinely treat patients with hypertriglyceridemia with niacin (nicotinic acid) given limited benefit and risk of adverse effects (including worsening of insulin resistance). For selected patients with moderate to severe hypertriglyceridemia despite lifestyle interventions, optimal therapy to lower LDL-C, treatment with high-dose marine omega-3 fatty acid and fibrate therapy, and low estimated risk of glucose intolerance (ie, no history of diabetes mellitus or glucose intolerance and normal or low body mass index), some clinicians treat with niacin. (See 'Niacin' below.)

Severe hypertriglyceridemia — The following is our approach for patients with severe hypertriglyceridemia (>1000 mg/dL or 11.3 mmol/L):

●Lifestyle modification – The following lifestyle modifications apply in addition to the general measures above (see 'General measures' above):

•Diet – In this setting (particularly for those with prior acute pancreatitis), it is crucial to restrict dietary fat to ≤10 to 15 percent (preferably <5 percent) of total calories with the goal of reducing the TG level to <1000 mg/dL [1].

Patients should be reminded that even "good fat" such as vegetable oils and nuts, and fat contained in chips and pastries, can raise their TG levels and cause pancreatitis. At fasting TG levels >500 to 1000 mg/dL (5.6 to 11.3 mmol/L), the clearance of chylomicrons from the blood becomes slower, such that chylomicrons from the previous night's meal may still be present in morning fasting blood. This sets the stage for accumulation of chylomicron TG derived from dietary fat, leading to a risk of pancreatitis and other manifestations of fasting chylomicronemia.

•Alcohol use – For patients with severe hypertriglyceridemia (with or without prior pancreatitis), we advise avoiding alcohol, which may further increase the risk of pancreatitis [1].

●Assess and treat LDL-C levels as described above. (See 'General measures' above.)

●Generally defer drug therapy for hypertriglyceridemia – When the TG level is >1000 mg/dL, drugs used to lower TG have limited effectiveness. These agents work primarily by reducing hepatic TG synthesis and secretion as VLDL-TG and thus are relatively ineffective when TG level is severely elevated.

•For most patients – Drug therapy for hypertriglyceridemia (aside from treatment of LDL-C) is deferred for most patients (including all outpatients) until the TG level is lowered to ≤1000 mg/dL. (See 'Moderate to severe hypertriglyceridemia' above and 'Moderate hypertriglyceridemia' above.)

Given the rapid rate of TG level lowering achievable with stringent dietary fat restriction, with close monitoring it may be possible to initiate drug therapy for hypertriglyceridemia within days. (See 'Monitoring therapy' below.)

•For in patients with acute pancreatitis – For inpatients with pancreatitis and severe hypertriglyceridemia, a fibrate is a component of therapy to reduce TG levels along with the above measures. The need for continued fibrate therapy is reassessed during subsequent outpatient management.

#TGs #hypertriglyceridemia

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biomedgrid · 3 years ago

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Biomed Grid | Metabolic Profiling of Borrelia in Ticks and in Whole Blood Samples by Headspace Gas Chromatography - A Case Report

Introduction

Bacteria emit volatile compounds, which are amenable to analysis by static headspace gas chromatography (HS-GC) if cultured in nutrient medium in the septum vials used for HS-GC. The technique of HS-GC has been applied since 1965 in examining the growth of bacteria in milk [1] . The class of compounds that receiving the most study was volatile organic compounds (VOCs), and the unique volatile mixture emitted may be used to identify infectious microbes to the species, and possibly the strain level [2, 3, 4] . Moreover, the impact of antibiotics on the emission of VOCs, if added to the microbial cultures, enables to test their antibacterial activity. N.J. Hayward investigated bacterial resistance of Clostridia from urinary tract infections against antibiotics by monitoring ethanol formation [5]. Antimicrobial resistance is a serious and current issue in medicine and novel antibiotics are needed to treat such multi-resistant microbes. HS-GC may be of interest to identify and characterize antimicrobial properties by chemical antibiotics as well as by phytochemicals and other natural compounds.

Such phytochemicals often contain several different classes of substances to combat multiple resistances of pathogens [6]. This approach requires many measurements and needs automation to improve efficacy. Gas chromatography is a well-established technique for automated qualitative and quantitative analysis of volatiles. In addition to the analysis of VOCs released from bacteria, both hydrogen (H2) and carbon dioxide (CO2) are highly informative metabolites. Obligate aerobes produce CO2 water, while facultative anaerobes and microaerophilic anaerobes emit H 2 and CO2 together with some other organic compounds, for example ethanol. Obligate anaerobes emit many VOCs and H2 and CO2 but need an oxygen-free atmosphere in the culture vial, because they would not survive atmospheric oxygen concentrations, but when air is replaced by nitrogen gas these bacteria can thrive.

By monitoring both, H2 and CO2 the class of bacteria can be identified [7]: peaks of H2 and CO2 in the chromatogram are produced by facultative anaerobes and by obligate anaerobes too, but the latter only in an oxygen-free atmosphere in the closed headspace vials, while obligate aerobes generate CO2but no hydrogen peak. Our method is focused on hydrogen emitting facultative anaerobic and microaerophile bacteria only. We previously applied the analysis of H2 and CO2emission profiles to study tick-borne disease related pathogens and tested the efficacy of antibiotics such as doxycycline and amoxicillin [8] against Lyme-disease. Tick-borne diseases are difficult to recognize since they often arise late after Borreliella infection and comprise a wide range of various Lyme disease symptoms, such as Lyme arthritis, myalgias, heart abnormalities, chronic fatigue, neuropsychiatric depression and several more. In some areas up to 25% of ticks contain Borreliella bacteria and from these only few percent are also supposed to cause infection. Borreliella are microaerophile and can thrive in an atmosphere with a reduced oxygen concentration compared to air. When the concentration of oxygen in the gas-tight culture vials declines by oxygen consumption they change from oxidative metabolism generating carbon dioxide and water, to fermentation with hydrogen emission. The closed headspace vials thus act just as a micro anaerobic incubator.

The objective of the current study compares the activity of chemical and natural antibiotics on contaminated ticks and on blood samples of infected patients. The HS-GC-analytic method can monitor both, disease progress as well as regression. Lyme disease is a potentially fatal illness transmitted through the bite of infected ticks. Most infected humans are cured by standard chemical antibiotics, such as doxycycline, if treated in due time following the bite by an infected tick [9]. However, recommendations for this antibiotic treatment depend on the documentation of a reactive skin lesion, namely Erythema migrans (EM). Lesions are the most common signs of infection, but in many cases these lesions do not occur, and a potential infection would not be recognized and therefore not be treated. About 10-20 % of patients suffer from chronic pain caused by persistent borreliosis and tick-transmitted pathogens. All diagnostic devices available bear major drawbacks in terms of sensitivity and specificity [10]. Serological tests (Western Blot and ELISA) are invalid to determine the duration of antibiotic therapy necessary for treatment (two weeks up to several months). A simple and easy to handle technique is therefore highly desirable for monitoring the presence of bacteria in the blood of an infected patient and to control the efficacy of an antibiotic therapy. The method of HS-GC proposed in this study may meet this requirement in an excellent way. Lyme-disease, however, may not always be caused by Borreliella burgdorferi alone, but often by co-infection with subspecies of Borreliella (B. afzellii, B. garinii, B. spielmanii) or by other accompanying facultative bacteria such as Mycoplasma and Yersinia and some more [11]. Our GC-technique can only prove the presence of hydrogen-emitting facultative anaerobic bacteria and not a single species such as Borreliella burgdorferi and for this reason we prefer the term Borreliella as common genus, suggested by S.J. Cutler et al. [12]. This is reasonable because the proof of hydrogen comprises senso latu all those members of this species complex, which all together may be responsible for Lyme-disease.

Materials and MethodsMaterials and instrumentation

Gas chromatograph GC-AK 11, Aug. Hedinger GmbH & Co KG, Germany; GC-column: 0.8 m x 6 mm polyamide tube, Silica gel 60/80 mesh; headspace vials: 6 ml from Perkin Elmer crimp-capped with PTFE-laminated butyl rubber septa. Nutrient medium: heipha, Dr. Müller GmbH, Germany, tryptic soy broth acc EP+ USP 3080r-20p; composition: pancreatic digest of casein, 17g; papaic digest of soya bean meal, 3g; sodium chloride, 5g; dipotassium hydrogen phosphate, 2.5g; glucose monohydrate. Sugar coated tablets with pulverized garlic Kwai©forte 300mg: Cassella-med GmbH & Co.KG, Germany.

Interpretation of the chromatograms

The gas chromatograph is operated with ambient air as carrier gas and using a heat conductivity detector. Depending on the differences in heat conductivity both positive and negative peaks are generated. Hydrogen, due to its high heat conductivity produces a positive peak with good sensitivity while carbon dioxide due to its lower heat conductivity a negative one. Two negative peaks are shown in the gas chromatograms, one close to the rear of the positive hydrogen peak and later a negative peak from carbon dioxide. Blood in the headspace vials is still active and converts the oxygen of the air in the vials to carbon dioxide, thus producing this negative peak at the end of the chromatogram. The small negative peak at the rear of the hydrogen peak is thus caused by a deficit of oxygen in the air in the vials, not only due to the oxygen consumption of blood in case of blood samples, but also to a smaller extent by some oxidation of the nutrient medium. The air sample withdrawn from the vial is thus enriched with nitrogen and produces this small negative peak at the rear of the hydrogen peak according to the retention time of nitrogen. Presentation of the chromatograms: x-axis time in seconds [s]; y-axis gas phase concentration in arbitrary units.

Method and sample preparation

Volunteer donors with and w/o clinical signs of borreliosis provided blood samples by piercing a fingertip with a needle, except the example given in (Figure 1), where the blood sample was withdrawn from the vain by a physician. The resulting droplet of blood (~50 μl) from the fingertip was sucked into a sterile cotton ball from a cotton bud in such a way that the cotton ball came not in contact with the skin and the blood-soaked cotton ball was then inserted into the sterile nutrient broth in the vial which was closed immediately by a crimp closure. Not infected blood samples produced no hydrogen peak because healthy blood contains no hydrogen emitting bacteria. Ticks were sampled from humans and house cats and are simply thrown into the nutrient broth. The charged vials are incubated in general for 3 days at 35°C. Only if the GC analysis after 3 days incubation is negative is the time prolonged for another day, either to confirm the negative result or to allow more time for the slow reproduction of spirochetes in the case of a low concentration in blood to meet the GC detector sensitivity. The samples under investigation, either solid ticks or liquid samples and the cotton ball from a cotton bud as used for a smear, are cultured in 6ml septum vials containing 2.5ml sterilized nutrient medium. After the necessary time of incubation an aliquot of 0.3 ml is withdrawn from the gas phase by a gas tight syringe and the volatile compounds are analysed by HS-GC. Antibiotics added to the bacterial cultures in the vials are effective if any gas emission is suppressed. If not, they are either ineffective or the related bacteria are resistant.

Figure 2: GC analysis of Borreliella in tick samples. A) (a) Borreliella in ticks. 1: contaminated; 2: non-contaminated. (b) Antibiotic resistance of contaminated ticks. 1: contaminated ticks, 2: contaminated ticks + Penicillin, 3: contaminated ticks + Doxycycline, 4: blank from sample-free bacterial broth. B) (a) Borreliella in blood and in the tick; 1: H2 from infected blood sample, 2: H2 from the responsible tick. (b) Borreliella in blood; 1: infected blood with Borreliella 2: normal healthy blood without Borreliella, 3: blank from cotton ball in nutrient medium.

Electron microscopy

Bacterial cultures tested by HS-GC were fixed in 2.5% of glutardialdehyde (Sigma.com) followed by osmium tetroxide staining (0.1%) and stepwise embedding of the samples in Epon (Fluka.com, USA) (polymerization at 333K within 72h). Ultrathin sections were cut using a microtome (Leica Ultracut CT ultramicrotome) with a diamond knife (Diatome, Switzerland). Specimen were counterstained with lead citrate and examined using a JEOL (JEOL.com, Germany) 1400 at 120 keV.

ResultsBorreliosis therapy with Doxycycline

Ticks cultured in the nutrient medium emit hydrogen if they are contaminated by facultative or microaerophilic anaerobes.We have examined many ticks with the following result: about 20 % emitted hydrogen and were apparently charged by such bacteria, while the rest (about 80%) failed to generate hydrogen. This result agrees with the official statement that in our area about 20-30% are contaminated. The chromatograms from not contaminated ticks were in every case identical with the blank sample of a pure sterilized cotton ball in the nutrient broth. However, there might still be the possibility of contamination by other microbes such as aerobes or obligately anaerobes, but our method is specific for hydrogen emitting facultative anaerobes such as Borreliella and ignores such microbes. (Figure 1) presents such an example taken from many others: two ticks were inserted separately into two vials already containing the nutrient medium and were incubated for 3 days. One of the two ticks was contaminated as indicated by the emitted hydrogen while the other was found to be free of bacteria. Proof of bacterial load in ticks by HS-GC was already described [8]. The intention of this work was the extension of the GC-analysis technique for

i) evaluation of the effectiveness of antibiotic treatment and

ii) supporting the search for effective antimicrobial compounds.

Figure 1-Ab shows the comparison of two common antibiotics regarding their antimicrobial activity. Penicillin was found to be ineffective, while doxycycline, the standard antibiotic for Lyme borreliosis worked sufficiently well by complete disappearance of the characteristic hydrogen emission peak (Figure 1). In further experiments, three ticks were crushed and incubated in 100 μl of the sample-free nutrient medium, thereby assuming that at least one of them was contaminated. Aliquots of such a homogenous suspension were transferred into the nutrient medium in the vials containing the antibiotics to be examined.

Figure 3: Trans electron microscopy of cultured Borreliella species. (a) Bacterial cultures tested by HS-GC were fixed in 2.5% of glutardialdehyde (Sigma.com) followed by osmium tetra-oxide staining (0.1%) and stepwise embedding of the samples in Epon (Fluka.com, USA) (polymerization at 333 K within 72h). Ultrathin sections were cut using a microtome (Leica Ultracut UCT ultramicrotome) with a diamond knife (Diatome, Switzerland). Specimen were counterstained with lead citrate and examined using a JEOL (JEOL.com, Germany) 1400 at 120 keV.

Only few percent of contaminated ticks are known to infect the human target, due to inefficient transmission of the pathogen and only the analysis of a blood sample can unambiguously confirm a suspected borreliosis infection. (Figure 1) gives such an example of bacterial transfer to human blood after tick bite of a contaminated insect, shown by the hydrogen peak from the contaminated tick and in the blood sample. Blood normally contains no bacteria, and blood from healthy donors therefore was always found negative of hydrogen emitting bacteria. This is representatively shown in (Figure 1) and compared with a contaminated blood sample from a patient who was bitten by a tick followed few weeks later by an erythema migrants which is the most common sign of an infection after a bite by a tick and shown by an expanding area of redness on the skin. This blood sample was withdrawn from the vein by a physician and then forwarded to a microbial lab for the usual serological tests. The evidence of antibodies by IgG tests indicated a recent infection by Borreliella burgdorferi sensu lato (B. burgdorferi s. s, B. garnii, B. afzelii, B. spielmanii). This result agreed well with that of the gas chromatographic analysis as shown by the emitted hydrogen peak in the chromatogram in (Figure 2). Electron micrographs performed with the cultured specimen prepared 48h later, are shown in Figure (Figure 2) using trans electron microscopy (TEM). We here identified the successful enrichment of spirochaetes resembling Borreliella l-forms after 7 days of cultivation and 48h of shipment ((Figure 1), sample1).

As soon as bacterial infection by Borreliella species are detected by HS-GC-analysis of blood a suitable antibiotic therapy should commence. In accordance to the current guidelines tetracyclines are recommended as first-line treatment. However, opinions on the necessary dosage and the adequate length of therapy varies widely between many experts. This is due to the missing control about the effect of such a therapy. Borreliella bacteria in blood are in general identified indirectly by serological tests by determining antibodies. However even after completion of the infection the antibodies persist in blood. Moreover, these serological tests are notoriously unreliable. The following example represents such a typical case. Some weeks after having been bitten by the tick, the patient complained about typical symptoms of a tick-borne infection including myalgia. A blood sample was then analysed by the GCmethod and the hydrogen peak indicated a possible infection by Borreliella (Figure 3).

The result from a simultaneously performed serological test, however, was unclear because antibodies by ELISA test were not found, which may be due to a short persistence of the clinical symptoms. But due to the hydrogen peak in the resulting chromatogram from HS-GC-analysis, a therapy with doxycycline started with a daily dosage of 200mg doxycycline. After nine days of treatment, a hydrogen peak in the chromatogram still implicated the therapy as insufficient. Seven days later after administration of a total doxycycline dosage of 3200mg, the hydrogen peak was eliminated (Figure 3). An additional control analysis performed a few days later, implicated the successful end of the therapy as the missing hydrogen peak of the blood sample was identical to the blank of a sterilized cotton ball in the nutrient broth. Since the emission of hydrogen is a direct proof for infected blood, the progress of a therapy can be monitored, and the successful therapeutic outcome might thus be determined.

Borreliosis therapy with the natural antibiotic in garlic tablets.

The first line treatment of borreliosis is based on antibiotics such as doxycycline used for adults and amoxicillin or cefuroxime acetyl for adults and children. These antibiotics work sufficiently well when administrated at the early stages of borrelia infection but not at its late stages [13-18] However, some patients experience adverse effects with chemical antibiotics which may range from undesired to life threatening. Furthermore, in course of the treatment regimen resistances may rise. Some natural products, particularly essential oils, are known for their antibiotic effect [7, 19] and Cardea, cress seed, propolis and several more have been examined in this work (data not shown). From these, two natural products have emerged as most effective: oil of cloves and garlic. The application of oil of cloves, however, poses difficulties unless the active agent is isolated and identified. Garlic on the other hand is available as various preparations for ingestion, such as pills, tablets, draggees or extracts. In this work tablets with pulverized garlic were examined for their suitability in replacing rough garlic.

The antibiotic property of garlic had already been described by Louis Pasteur and was investigated for its suitability against Borreliella bacteria in vitro [20]. Particularly allicin and related sulphur compounds are known for their anti-microbial activity [21]. Garlic therefore may be considered a natural antibiotic that furthermore has also been demonstrated as effective against some antimicrobial-resistant bacteria. For these reasons, garlic was selected in this work to investigate whether it can be applied against Lyme borreliosis in vivo. Figure 3-B displays the results of the therapy applied to an infected patient with garlic tablets. After a 7day therapy regimen with a daily dosage of 900mg the hydrogen peak has disappeared and apparently the Borreliella bacteria in blood have been eliminated. The therapy was continued with a daily dosage of 300mg and even 30 days later was the result of GCanalysis the same as given by chromatogram 2 in (Figure 3) and thus identical with that of a healthy person.

These results demonstrate that garlic, even applied as tablets, can be an effective drug against borreliosis, comparable to the standard antibiotic treatment. However, it should be mentioned that the short therapy span in the above-mentioned example doesn’t apply to every case. We have found for other patients longer therapeutic regimens between one to three weeks to be necessary. The difference might be caused by a different bacterial load in blood or inter-individual differences such as immune status or pre-existing conditions. Each therapy should therefore be controlled regularly until its successful end is confirmed. The method described allows complete control of a Borreliella-infection starting with the proof a contaminated tick up to the successful end of a suitable therapy.

The actual absence of Borreliella in blood does not necessarily indicate complete bacteria eradication because they may change into inactive round bodies (stationary phase, cysts, L-forms (Figure 2) and enter other parts of the human body such as skin or cartilage, where up to now they cannot be detected neither by the described GC-method nor with the standard serological tests, but may be treated by the garlic therapy [18]. From these hidden places the bacteria may change back to the motile helical form and can migrate into blood where they can be recognized and combated again. Such regularly repeated attacks are well known and described as persistent Lyme disease and are often enhanced if the immune system is weakened by a new infection or by a new disease as shown by the following example. The patient suffering from hidden persistent Lyme disease experienced an infection by Noro virus. Figure 3Ca is the result of blood analysis before this viral infection, apparently with no bacteria in blood. One week after Noro virus infection the hydrogen peak (peak 1, (Figure 3)) from blood analysis indicated the repeated emergence of Borreliella bacteria, apparently due to the weakened immune system. A 12- day garlic therapy with a daily dosage of 1800mg pulverized garlic the bacterial load in the blood (peak 2, (Figure 3)) was still not enough to eliminate all bacteria. Only after an extended additional 9-day therapy with 900mg/day the bacteria were eradicated in blood and the GC-test was identical with that shown in (Figure 3), as was a control test two weeks later.

Figure 4: GC analysis of blood samples under different conditions A) GC analysis of blood samples pre and post doxycycline treatment. (a) Analysis of blood after tick infection. (b) Analysis of blood after doxycycline therapy with 200 mg of doxycycline daily; 1: after 9 days; 2: after 16 days. B) GC analysis of blood samples pre and post therapy with garlic tablets. Efficacy of therapy with garlic tablets. 1: infected blood before therapy; 2: blood after 7 days therapy; 3: blank from cotton ball in medium. C) GC analysis of blood samples pre and post Noro virus infection. (a) GC analysis of blood nutrient before infection with Noro virus; 1: blood before Noro virus infection; 2: blank from cotton ball in nutrient medium. (b) Influence of Noro virus infection; 1: blood 8 days from beginning of Noro-disease, 2: blood 12 days later after application of garlic tablets.

Discussion

Static HS-GC successfully detects hydrogen emitted from bacterial cultures. We here applied a small, and low-cost device, GCAK- 11 to detect the bacterial contamination and infection in ticks and patients derived blood samples, respectively. Moreover, this device has been successfully applied to test and evaluate the effect and treatment by standard antibiotics as well as phytochemicals such as clove oil and ingredients from whole garlic extracts. As a conclusion, this GC-method appears to be valid for both: diagnosis and therapy to control facultative anaerobe spirochaetes including Borreliella. In contrast to acute Borreliella infection, chronic borreliosis has been found to be resistant to even extended antibiotic treatment, but promising effects have already been attributed to treatment regimen using phytochemicals. Using in vitro culture of Borreliella, the group headed by Eva Sapi summarized effects on different forms of pathogenic Borreliella [22], (another comprehensive report has been published by Goc and colleagues [23].

The here described GC-method can be used to test more natural substances as well as combinations for their biocide properties against facultative anaerobes, e.g. Borreliella bacteria. Knowledge of the actual bacterium or the composition of such a bacteria mix in case of Lyme disease is of less interest, if an effective therapy would eradicate all of them. The patient is interested only to get the most effective therapy and to know how long it takes. It is the advantage of our method that all those hydrogen emitting pathogens, such as Borreliella are comprised in our test and that it is not confined to B. burgdorferi. The HS-GC technique has the unique advantage that the whole procedure is carried out in hermetically closed vials, already beginning with sample preparation. When the samples are inserted into the nutrient medium the headspace vials are capped with PTFE-lined septa and sealed with a crimped closure and any contamination by invasion of external microbes is thus excluded. The septum is then pierced with the needle of a gas tight syringe and an aliquot of the headspace gas is withdrawn and injected into the gas chromatograph.

The septum remains tight and several gas samples can be analysed at given time intervals thus enabling kinetic measurements to be carried out. After analysis, the closed vials with their contents can be sterilized at the necessary high temperature and then safely discarded. Thus, the personnel in a laboratory never meet pathogens. The described method can be carried out with all commercially available gas chromatographs, even including simple low-cost instruments up to expensive and fully automated instruments. The results presented here were obtained with a very cheap gas chromatograph for students equipped with a standard packed column, a thermal conductivity detector and can be operated at room temperature with ambient air as carrier gas fed onto the column by an aquarium pump. With commercially available instruments on the other hand, up to 100 samples can be processed automatically. This automated technique is thus particularly suited for screening purposes to analyse a large number of samples, for example to search for alternative antibiotics in the event of antibiotic resistance, and even for adaptation to an individual patient. The electrical signal generated by an automated headspace instrument lends itself to automated computer evaluation and documentation.

A systematic diagnosis and therapy may proceed according to the following scheme:

1. A tick after having been removed from the body is analysed immediately as to whether it is contaminated by Borreliella or by other pathogens.

2. If the tick has been found contaminated, analysis of the blood shows whether the infection was transmitted to the blood, since not in all cases are the bacteria transferred.

3. If bacteria are found in the blood, a suitable therapy should be started immediately.

4. The progress of the applied therapy is permanently controlled until it is successfully finished.

5. Even after the therapy is finalized, it is recommended to repeat this test regularly, particularly in the case of persistent borreliosis or newly emerging health complaints.

In case this test confirms borreliosis the physician will in any case initiate the common and well accepted antibiotic treatment such as doxycycline. In case of serious side effects, alternative natural antibiotic may help. Herbs are commonly safe, while chemical antibiotics may damage the microbiome. Particularly chronic use of antibiotics may disrupt the immune system and the protective biofilm in the colon. The possibility of using a natural product as an alternative antibiotic was examined on the example of garlic in this study, but other natural antibiotics may work as well [8, 19]. The garlic tablet preparations were found to be advantageous since no prescription is required and bacterial testing could be performed independently of a caring physician. Further biotechnological developments of the HS-GC-method may be addressed in the future.

Read More About this Article: https://biomedgrid.com/fulltext/volume6/metabolic-profiling-of-borrelia-in-ticks-and-in-whole-blood-samples-by-headspace-gas-chromatography.001057.php

For more about: Journals on Biomedical Science :Biomed Grid | Current Issue

#biomedgrid #american journal of biomedical science & research #journals on biomedical imaging #top medical open access journal

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physiotherapyathomeinkolkata · 3 years ago

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9 Ways to Thrive and Remain Active with Knee Arthritis

Arthritis is that the leading reason behind disability in India and its impact on society is increasing though there is an opportunity for Physiotherapy at Home in Kolkata. So in this article, there are 9 ways to remain active with knee arthritis.

1. Change the narrative:

You’re not wearing your knee joint out by exercising. Walking or playing tennis, as long as the pain is mild, is not going to shorten the lifespan of your knee. Quite the opposite! The stronger your legs are, the more flexible you are, the more active you are; the longer you will before need to consider surgery. We have some excellent reading for you to support this.

Why exercise improves arthritic knee pain?

Muscle mass, strength, and longevity?

Why we should focus on leg strengthening?

Does leg strengthening help prevent knee arthritis?

Common analogies like cheese being grated or sandpaper on the wood just aren’t accurate. You are not wearing away your knee by walking, stretching, weight training, or exercising. If your pain level is a 3-4 or lower, you should probably keep going. Pain does not often imply that you are causing harm.

2. Treat the patient — not the X-ray:

This is so critical. X-rays do not tell us the whole picture. I know people with horrible-looking X-rays who are running marathons? I know people with severe pain and very mild changes on an x-ray. We do not treat X-rays; we treat people.

Do not consider surgery on your knee based solely on the way your X-ray looks.

The treatment should be geared towards your symptoms, your complaints, your exam, and your X-rays combined. Your X-rays alone are only a small part of what will contribute to my recommendations if I see you in the office.

3. Exercise:

It bears repeating; exercise is not going to cause your arthritis to worsen. It may cause discomfort, especially for the first few weeks of a new exercise program– but that does not mean you are causing harm to your knee. The more flexible your knee joint is, the stronger the muscles are that support the knee joint, the better your quality of life will be. There are four pillars to an appropriate exercise program. Walking alone is not enough.

4. Aerobic exercise:

Aerobic exercise implies that you are getting your heart rate up. The best aerobic exercise is the one that you enjoy doing. Some great examples of aerobic exercises are walking, jogging, and riding a bicycle, using a rowing machine, treadmill, elliptical trainer, and so on.

Aerobic exercise improves your cardiovascular system, improves your metabolic health, and decreases your risk of stroke, heart attacks, dementia, and other chronic diseases. Walking often helps the s arthritic knee feel better because it stimulates the production of your natural anti-inflammatories like IL-10. This article on my site discusses these changes in more detail.

Examples of Leg Exercises: Learn them from the best physiotherapy center in Kolkata, so your form is proper.

5. Resistance exercise:

Resistance exercise implies that you are pushing or pulling something heavy. You can complete an exercise program with only your body weight as there are many options for physiotherapy for arthritis in Kolkata. You do not have to spend money on a gym membership.

You will not make your arthritis worse by exercising. Of course, resistance exercise involves a small risk of injury, but that risk is lower than the risks to your overall health and well-being caused by not exercising.

We covered how resistance exercise improves our health in this post, and why those exercises should be focused on your legs in this post.

6. Balance:

You are catching your toes on the carpet more often, you are stumbling a bit more, and occasionally when you get up from a chair, you feel a little more wobbly. As with our muscle mass, our balancing abilities start to diminish as we age.

Our ability to balance will contribute significantly to our chance of living a longer, healthier life– free from injuries sustained as a result of falling.

Balance training also improves the sense of joint stability. Our walking becomes more confident, our fear of falling diminishes, and our risk of falling diminishes. This article that I wrote went into a lot more detail about the importance of balance training, and it provided some videos to consider doing as part of a balanced training program.

7. Your diet and your metabolism:

Our diet contributes significantly to the overall disease burden that many of us suffer from. Our standard American diet has led to an increase in heart disease, diabetes, fatty liver disease, dementia, and so on. Our diet and its downstream effects on our body can also cause osteoarthritis and other causes of joint pain. We covered how our diet and metabolism affect our joints in this article.

One key issue is to eliminate as much added sugar as you can tolerate. Start easily. Remove all sweetened beverages. Water should be your primary drink.

Sports drinks are NOT your friend. Those added calories add up very quickly. The fructose in those drinks is a cause of liver issues such as NAFLD. Fructose will also increase your Uric Acid level.

Next, we start to eliminate other sweets such as donuts, cookies, and so on. We start eating nuts and berries instead of packaged sweets.

Removing added sugar and processed carbohydrates (bread, rice, cereal, cookies, etc.) will also decrease the glucose burden our body needs to deal with. This can help control diabetes, reduce your risk of fatty liver, and it could decrease the level of inflammation within your body, which will increase the rate of arthritis progression and the pain you experience.

8. Inflammation:

Talk about a complex topic! Inflammation is a critical variable in the causation of heart disease, liver disease, dementia, diabetes, pain, and so many other chronic disease states. Our diet and our activity levels can directly affect the levels of inflammation in our bodies. We measure the level of your inflammation with tests like:

ESR

hs-CRP

Fibrinogen

and other less well-known inflammatory biomarkers or mediators. Your ability to metabolize and dispose of glucose via your insulin will affect your level of inflammation. So if you are pre-diabetic, or diabetic, the level of inflammation in your body is often very high. For those of you with Type 2 diabetes, you can improve your glucose metabolism and disposal. And you should not be looking for a better pill.

If possible, choose to be active.

9. Medications/Supplements/Injections:

Heat or cold? I am asked this constantly. Ice will not control chronic inflammation. If ice makes your knee feel better, then use it. If it doesn’t make your knee feel better, then do not use it. I have seen people respond very well to moist heat more than I have seen people react well to ice. This is a modality used only for pain relief, so if it helps your knee feel better, then please use it.

Conclusion:

If you are doing ought to see a doctor for joint replacement, physiotherapists will be concerned about your care before and once your surgery is involved that you regain your strength and maximize the use of your new joint as there are options for Physiotherapy at Home in Kolkata.

#Physiotherapy at Home in Kolkata #Physiotherapy at Home #best physiotherapist in kolkata #Best physiotherapy centre in kolkata #Best Physiotherapy Services in Kolkata #top certified physiotherapists of kolkata

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denebola42-blog · 4 years ago

Photo

After using the inhaler my body isn't under a ton of stress. #welltoryapp #welltory #healthylifestyle #inhaler #asthmaproblems i had the same problem in Mexico City as a child. I can't believe i ran track. My lungs burned though and in all sports. But i was at sea level. Check out "Welltory: EKG Heart Rate Monitor & HRV Stress Test" https://play.google.com/store/apps/details?id=com.welltory.client.android https://app.welltory.com/share-measurement-p/?token=daf1249b0e What a relief! I'm in a better mood as well. I'll Google that. How Allergic Asthma Can Affect Your Mood | Everyday Health https://www.everydayhealth.com/hs/breathing-easier-with-allergic-asthma/allergic-asthma-mood/ Asthma and Mood Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631932/ Asthma and Mental Health | Severe Asthma Toolkit https://toolkit.severeasthma.org.au/living-severe-asthma/mental-emotional-health/ That explains it. Chaos theory. Mere luck i figured this out plus faith in God. Trust. It opens your ears so to speak. Emotions Can Trigger Asthma Symptoms | AAFA.org https://www.aafa.org/asthma/asthma-triggers/emotions.aspx No wonder I've been taken in an ambulance and had problems working and then with school and sleep apnea. Asthma and obstructive sleep apnea: More than an association! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946549/ Asthma - Symptoms and causes - Mayo Clinic https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653 Shit. i should have called 911 many times then. It lists when to call 911. Yeah, someone up there is watching out for me. Thanks. 🙏🏼 #googlepixel4a5g #TeamPixel #googlefi #googlepixel4a5gphotography #pixel4a5gphotography #pixel4a5g #americanphotographer #californiatransplant #californiaphotographer #mexicanphotographer #utahphotographer #godmatters #familymatters #godisfamily #weareallfamily #digitalnomadpotatoe (at North Ogden, Utah) https://www.instagram.com/p/CM5xdXvBc3D/?igshid=hpcx8q89pltk

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juniperpublishers-crdoj · 4 years ago

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Psychological Predictors of Weight Loss Success Following Roux-en-Y Gastric Bypass

Authored by Hazem N Shamseddeen

Abstract

Background: Weight loss is a primary outcome measure for the success of Roux-En-Y gastric bypass (RYGB). Much attention has been paid to the negative effects of psychology on postoperative weight loss. We sought to identify personality traits and eating habits that predict weight loss success following RYGB.

Methods: A single psychologist prospectively evaluated 346 patients, who subsequently underwent laparoscopic RYGB. Psychological evaluation included Minnesota Multiphasic Personality Inventory Short Form (MMPI-2 SF) and long form subscales (MMPI-2 RC) as well as Overeating Questionnaire (OQ). Demographic, anthropomorphic, and clinical data were collected before and after surgery.

Results: The overall mean percent excess weight loss (%EWL) was 71.34+/-24.35%. Of the ten MMPI-2 SF scales, Masculine-Feminine (MF), Hypochondriasis (HS), Schizophrenia (SZ), and Mania (MA) correlated to %EWL, but only MA reached statistical significance (r=-0.24, p<0.005). Of the nine MMPI-2 RC scales, Somatic Complaints (SC), Cynicism (CY), Aberrant Experiences (AE), and Hypomanic Activation (HA) correlated to %EWL, with AE (r=-0.17, p<0.05) and HA (r=-0.15, p<0.005) reaching statistical significance. Of the ten OQ scales, Health Habits (HH), Rationalizations (RA), and Motivation to Lose Weight (MLW) correlated to EWL, with MLW reaching statistical significance (r=-0.59, p<0.005).

Conclusion: This study corroborates the effectiveness of RYGB in achieving weight loss and shows that psychological factors can impact weight loss success. While several personality traits and eating habits correlate with improved weight loss, MA, AE, HA, and MLW seemed to have particularly strong correlations with weight loss success.

Keywords: Morbid obesity; Roux-en-Y gastric bypass; Psychological evaluation; MMPI-2; Overeating questionnaire; Weight loss; Bariatric surgery

Introduction

Obesity has been increasing globally over the last three decades, and its national and global burden has been projected to grow in the future [1,2]. Bariatric surgery is an effective tool for the management of morbid obesity, and several studies have reported decreased mortality and morbidity after bariatric surgery compared to conventional therapy [3,4]. Preoperative psychological screening of bariatric patients is performed at many centers specializing in weight loss surgery, following the consensus statement on bariatric surgery from the National Institutes of Health [5,6]. This statement, however, did not specify the nature of the evaluation, characterize how to utilize the information to determine surgical candidacy, or identify the role such data may play in the postoperative management of patients.

The determinants of obesity are complex and might involve several environmental and psychosocial factors that interact together. Several studies have correlated the psychosocial factors related to obesity and eating habits with surgical outcomes specific to weight loss and weight loss maintenance [7-13]. Other studies focused on the relationships between behavioral traits and postoperative patient compliance and weight regain [14,15]. Preoperative psychological screening is a prominent component of our bariatric surgery program. This screening focuses on identifying psychiatric disorders, characterizing personality traits, and assessing attitudes toward eating. We sought to determine the effects of personality traits and eating habits on weight loss after Roux-en-Y gastric bypass (RYGB).

Materials and Methods

Over five years, a single psychologist prospectively evaluated 605 patients in preparation for bariatric surgery at our institution. Comorbidity and anthropomorphic data were also collected prospectively for clinical purposes. Patient records were then reviewed under approval from the Institutional Review Board for the purposes of this study. The single inclusion criterion for this study was completion of a minimum of10 months of postoperative follow-up.

Psychological evaluation primarily included Minnesota Multiphasic Personality Inventory (MMPI-2) and the Overeating Questionnaire (OQ). Initially, we relied on the long form (MMPI- 2), which consists of 567 questions, and evaluated patients based on the MMPI-2 Restructured Clinical (RC) scales. Over the study period, the algorithm for psychological testing evolved with experience. The MMPI-2 Short Form (MMPI-2 SF) (which consists of the first 370 questions on the MMPI-2) was substituted for MMPI-2 RC to minimize the discomfort expressed by morbidly obese patients during the long period of testing. Additionally, the OQ was not yet available at the beginning of the study period. Once available, we chose to include this questionnaire in an attempt to more fully evaluate bariatric surgery candidates. Thus, the study population contains patients who completed the MMPI- 2 SF only (Group 1, n=114), the entire MMPI-2 only (Group 2, n=44) or the OQ only (Group 3, n=23). The majority of patients completed the entire MMPI-2 and the OQ (Group 4, n=165). Thus, 209 patients completed the entire MMPI-2. Since the MMPI-2 SF simply consists of the first 370 questions of the MMPI-2, MMPI- 2 SF subscales were available for these 209 patients in addition to the 114 patients who completed MMPI-2 SF only, for a total of 323 patients. OQ data were available for the 23 patients who only completed this form and the 165 patients who completed OQ in addition to MMPI-2. Ultimately, MMPI-2 RC data were available for 209 patients, MMPI-2 SF data were available for 323 patients, and OQ data were available for 188 patients.

Weight loss data were collected during clinical encounters with the bariatric surgery program preoperatively and at each postoperative appointment. All patients in this study underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). No other primary bariatric procedures were performed at our program during the study period. All data are presented as mean+/- standard deviation. Data were analyzed using ANOVA for multiple comparisons of means of continuous variables and Fisher's exact test for comparisons of discrete variables. Pearson and Spearman coefficients were calculated to examine correlations between questionnaire variables and postoperative excess weight loss. Statistical significance was set at alpha=0.05 for all analyses.

Results

Over a five-year period, 605 candidates for bariatric surgery underwent pre-surgical psychological testing by a single psychologist. At the time of data analysis, 346 patients had undergone RYGB and achieved postoperative follow-up between 10 to 24 months. The remaining patients had not undergone surgery (n=114) or had not reached the minimum follow-up of 10 months (n=145). Of the patients who had not reached 10 months of follow-up, 57 patients did not return to clinic and, thus, werelost to follow-up. The study population consisted of 346 patients with a mean age of 43.5+/-9.4 years (Table 1). The patients were primarily females (85.6%). Mean preoperative weight was 125.9+/-21.2 kg, and mean preoperative excess weight was 56.3+18.2 kg. On average, patients were able to achieve 71.3+/-24.4% excess weight loss. Preoperative psychological evaluation was accomplished via MMPI-2 SF (n=323), MMPI-2 RC (n=209), and OQ (n=188), with 165 patients completing all three instruments. There were no significant differences in demographic data among the patient groups (1-4 as described in methods section) in terms of age, gender proportions, preoperative excess weight, or postoperative excess weight loss.

Correlation analyses between MMPI-2 SF, MMPI-2 RC, and OQ subscales and the percentage of excess weight loss (%EWL) following RYGB are summarized in Table 2. Only four of the ten subscales of the MMPI-2 SF correlated with greater postoperative %EWL. The masculine-feminine (r=-0.10, p=0.07) and schizophrenia (r=-0.10, p=0.07) subscales showed a correlation with %EWL but did not reach statistical significance. Hypochondriasis (r=-0.12, p=0.03) and mania (r=-0.25, p<0.0001), on the other hand, significantly correlated with greater %EWL following LRYGB. The remaining subscales (depression, hysteria, psychopathic deviation, paranoia, psychasthenia, and social introversion) did not correlate with %EWL. Similarly, four of the nine MMPI-2 RC subscales exhibited a correlation with %EWL. Somatic complaints (r=-0.13, p=0.06) and cynicism (r=- 0.12, p=0.08) demonstrated correlations with %EWL that were not significant. Statistically significant correlations with %EWL were identified for hypomanic activation (r=-0.16, p=0.02) and aberrant experiences (r=-0.21, p=0.002). The remaining subscales (demoralization, low positive emotions, antisocial behavior, ideas of persecution, and dysfunctional negative emotions) did not correlate with %EWL. As for OQ, the rationalizations (r=- 0.12, p=1.0) and health habits (r=-0.14, p=0.06) exhibited nonsignificant correlations. The motivation to lose weight subscale, however, correlated strongly with %EWL, as evidenced by r=- 0.59. This correlation was statistically significant (p<0.0001). The remaining OQ subscales (overeating, undereating, craving, expectations about eating, body image, social isolation, and affective disturbance) did not demonstrate a relationship with %EWL.

Discussion

Morbid obesity is a multifactorial disease which has been growing at an alarming rate [16]. The current epidemic nature of morbid obesity has motivated a great deal of research aimed at elucidating its causes. It has become clear that the predisposition to obesity begins with genetic tendencies [17]. The resulting metabolic dysregulation disrupts energy homeostasis and leads to the accumulation of adipose tissue [18]. The adipose tissue, in turn, perpetuates the metabolic abnormalities through significant endocrine activity which affects many organ systems [19,20].

Yet, there are documented psychosocial and environmental facets to this disease [21]. It is unclear whether this is simply the result of individual and societal behaviors or the result of interaction of the brain within the disordered metabolic milieu. Regardless of the cause, the impact of behavior and personality on the development of obesity are undeniable. Psychological screening is considered an important component ofcomprehensive care of the bariatric surgery patient [5,6]. While several studies have discussed the psychological profiles of bariatric surgery patients, there is little consensus as to the elements that should be considered when evaluating patients [22,23]. While no current instrument can reliably predict patient weight loss outcomes, there is evidence that eating behaviors and personality traits can be useful in assessing bariatric surgery candidates [22,24].

The MMPI-2 questionnaire is widely-used to evaluate psychosomatic conditions and to identify personality traits [25,26]. This instrument is valid for assessing obese patients [27]. Some investigations have demonstrated that obese patients have an increased prevalence of psychopathology on MMPI-2 [27], while other work did not find a correlation between psychopathology level and obesity [28]. The OQ is an 80-item instrument that measures attitudes toward obesity and eating. The OQ provides scores in ten areas. Six areas reflect general health habits and assess psychosocial functioning. The other four areas target psychosocial issues that coexist with obesity. The OQ is reputed to assist in planing effective weight loss efforts for patients. In our study, personality characteristics and attitudes toward eating correlated with %EWL at 12 to 24 months following LRYGB. Between the RC subscales and the SF subscales, eight elements of MMPI-2 correlated with better %EWL, as indicated by r <-0.1, with four of these elements (hypochondriasis, mania, aberrant experiences, and hypomanic activation) reaching statistical significance (Table 2). Three subscales of the OQ correlated with improved %EWL, but only one (motivation to lose weight) was statistically significant (Table 2).

Other investigators have used MMPI-2 to evaluate patients in preparation for RYGB [13,29]. One such study identified that some scales were associated with better weight loss outcomes at six months post surgery [13]. Furthermore, some scales were associated with weight loss at various postoperative intervals, such that the investigators suggested a potential role for time- dependent postoperative patient management strategies [13]. Another study identified an "emotionally disturbed" patient group, based on the MMPI-2, and found that these patients were less compliant and had decreased weight loss [29].

In terms of evaluating attitudes toward eating, Powers et al studied eating pathology in bariatric surgery patients preoperatively and found no relationship between presurgical eating pathology and weight loss [30]. Yet, in a review of the literature, Niego et al found that patients with preoperative binge eating behavior were more likely to continue the eating pathology following surgery and achieve less weight loss [31]. These assertions are supported by Kalarchian et al, who found that the recurrence of binge eating after surgery was associated with weight regain [9]. Finally, it has been reported that risk for weight regain following bariatric surgery can be predicted during preoperative screening, as primarily indicated by increased food urges, decrease well-being, and concerns over addictive behaviors [14].

Our study differs from a large portion of the available literature in that we focused on identifying predictors of weight loss success rather than weight loss failure. We were able to identify correlations between improved weight loss and certain psychological traits and eating habits. In our practice, we plan to combine our findings with the available literature to preoperatively identify traits that may motivate a patient to succeed as well as those that may predispose to failure. The ultimate goal is to address the predictors of failure while promoting the predictors of success in an attempt to maximize the benefits of bariatric surgery to the patient. Psychological screening will continue to be part of preoperative screening for bariatric surgery in many programs. We were able to identify personality and eating-associated traits that correlated to weight loss success followingLRYGB. Further investigation is warranted in this field to more fully understand how to support patients along the weight loss journey and maximize postoperative weight loss and weight loss maintenance.

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meetpositivesblog · 6 years ago

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Did You Know? Hepatitis and HPV are Vaccine-Preventable by STDs/STIs was first published to: https://www.blog.meetpositives.com/ Hepatitis A, hepatitis B and HPV are the only vaccine-preventable STDs/STIs. (Not all HPV types are covered by the vaccine, so women who receive it still need Pap tests.) This is the perfect time to think about protecting yourself from sexually transmitted viruses. These bacteria or infections can be passed from person to person primarily through a variety of sexual activities and they can only be diagnosed through testing since most of them shows no symptoms at all. The recent data shows that Hepatitis A, Hepatitis B and HPV are the only vaccine-preventable STDs/STIs. First seen on: (http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/infections.html) Sexually transmitted infections (STIs) have historically been referred to as venereal disease, named for Venus, the goddess of love. Medical providers and public health practitioners today have replaced this term with more accurate and neutral terminology: sexually transmitted disease (STD) or sexually transmitted infection (STI). The term reproductive tract infection (RTI) is often used to describe infections that are sexually transmitted, as well as other common infections that may or may not be sexually transmitted (i.e. candidiasis, bacterial vaginosis). Epidemiology of STIs Sexually transmitted infections (STI's) are transmitted from person to person through vaginal, oral, or anal sex with an infected partner; and/or from a pregnant woman (if infected) to her fetus or baby during pregnancy and labor and delivery. In 2008, the CDC reported that a nationally representative study estimated that 1 in 4 teenage girls in the U.S. has an STD. The study included the most common STDs: HPV, chlamydia, herpes simplex virus, and trichomoniasis. There are approximately 15 million new cases of sexually transmitted infection each year in the United States, and 340 million worldwide.30 The majority of STI's are asymptomatic (no symptoms). Asymptomatic infections can be transmitted to sexual partners. Having certain sexually transmitted infections increases the risk of acquiring or transmitting HIV. Gender Disparities Although the health risks associated with STIs affect both women and men, women are disproportionately affected. Women are more likely than are men to have asymptomatic infections, and also have greater biological susceptibility to acquire infections if exposed. Untreated STIs in women can lead to pelvic inflammatory disease (PID), infertility, ectopic pregnancy, cancers of the reproductive tract, pregnancy loss, neonatal morbidity and mortality, and an increased risk of HIV transmission. Untreated STIs in men can lead to an increased risk of HIV transmission, prostatitis, epididymitis, infertility, and reactive arthritis (formerly known as Reiter’s syndrome). Common Sexually Transmitted Infections There are over 20 different sexually transmitted infections, and other infections that are considered “sexually associated”. Viruses, and bacteria cause the majority of STIs. Bacterial STIs, which include infections such as chlamydia, gonorrhea, and syphilis, can be cured with antibiotics. Viral STIs, including HPV, herpes, hepatitis, and HIV, cannot be cured, though they can often be treated. The most common STIs are discussed below. You've probably received the advice previously to use protection and make sure that you get tested if you are sexually active. This is very important since most of the times a person infected with STI/STD viruses doesn't have any idea that they already have the virus. If you feel like you need a test, talk to your doctor about your concerns. First seen on: (http://www.cdc.gov/std/treatment/2010/vaccine.htm) Several STDs can be effectively prevented through pre-exposure vaccination with widely available vaccines, including HAV, HBV, and HPV. Vaccines for other STDs (e.g., HIV and HSV) are under development or are undergoing clinical trials. This guidance focuses largely on integrating the use of available vaccines into STD prevention and treatment activities. Every person being evaluated or treated for an STD should receive hepatitis B vaccination unless already vaccinated. In addition, some persons (e.g., MSM and IDUs) should receive hepatitis A vaccination. Hepatitis A Hepatitis A, caused by infection with HAV, has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease (CLD). However, 10%–15% of patients experience a relapse of symptoms during the 6 months after acute illness. Acute liver failure from hepatitis A is rare (overall case-fatality rate: 0.5%). The risk for symptomatic infection is directly related to age, with >80% of adults having symptoms compatible with acute viral hepatitis and most children having either asymptomatic or unrecognized infection. Antibody produced in response to HAV infection persists for life and confers protection against reinfection. Video Credit HAV infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or through consumption of contaminated food or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of HAV is uncommon. HAV occasionally is detected in saliva in experimentally infected animals, but transmission by saliva has not been demonstrated. In the United States, almost half of all persons with hepatitis A report having no risk factor for the disease. Among adults with identified risk factors, most cases occur among international travelers, household or sexual contacts, nonhousehold contacts (e.g., those encountered through play and daycare), and IDUs (437). Because transmission of HAV during sexual activity probably results from fecal-oral contact, measures typically used to prevent the transmission of other STDs (e.g., use of condoms) do not prevent HAV transmission. In addition, efforts to promote good personal hygiene have not been successful in interrupting outbreaks of hepatitis A. Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection (e.g., MSM, illegal drug users, and persons with CLD), many of whom might seek services in STD clinics. Treatment Patients with acute hepatitis A usually require only supportive care, with no restrictions in diet or activity. Hospitalization might be necessary for patients who become dehydrated because of nausea and vomiting and is critical for patients with signs or symptoms of acute liver failure. Medications that might cause liver damage or are metabolized by the liver should be used with caution among persons with hepatitis A. Prevention Two products are available for the prevention of HAV infection: hepatitis A vaccine (Table 2) and immune globulin (IG) for IM administration. Hepatitis A vaccines are prepared from formalin-inactivated, cell-culture–derived HAV and have been available in the United States since 1995, initially for persons aged ≥2 years. In 2005, the vaccines were approved by FDA for persons aged ≥12 months, and the vaccine is available for eligible children and adolescents aged 70 years. Screening for HAV infection might be cost-effective in populations where the prevalence of infection is likely to be high (e.g., persons aged >40 years and persons born in areas of high HAV endemicity). The potential cost-savings of testing should be weighed against the cost and the likelihood that testing will interfere with initiating vaccination. Vaccination of a person who is already immune is not harmful. Postvaccination Serologic Testing Postvaccination serologic testing is not indicated because most persons respond to the vaccine. In addition, the commercially available serologic test is not sensitive enough to detect the low, but protective, levels of antibody produced by vaccination. Hepatitis B Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. The highest concentrations of HBV are found in blood, with lower concentrations found in other body fluids including wound exudates, semen, vaginal secretions, and saliva (439,440). HBV is more infectious and relatively more stable in the environment than other bloodborne pathogens like HCV and HIV. HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at acquisition; approximately 90% of infected infants and 30% of infected children aged

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greenkeepery · 4 years ago

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Feeling Sore After a Workout? Don’t Do These Things if You Have Muscle Pain or Joint Pain

Working out in the gym, beginning a new workout routine, or taking up a novel sport can both challenge and support the body. While exercise is regarded as one of the best ways to maintain your physical and psychological wellbeing, sore muscles and aching joints are an inevitable result of new and strenuous exercise.

You might find yourself in dire need of muscle pain relief after a workout.

Sore muscles may make you want to throw in the towel on your exercise routine, but rest assured, there are ways you can reduce, even avoid, post-workout tenderness. And we assure you that if you stick with your new routine, post-workout muscle pain will more than likely dissipate as your body adjusts and you will see the effects of your hard work in no time.

There are actions you should avoid to reduce exercise-induced muscle pain. Before we get started on the actions to avoid, we’ll start with identifying the cause of post-workout muscle and joint pain. In addition, we’ll provide easy lifestyle choices to avoid and take to support your sore muscles.

What is the Exact Cause of Post-Workout Muscle and Joint Pain?

Sore muscles after a workout can set in after beginning a new exercise routine or raising the bar on a current regimen. The medical term for this is delayed onset muscle soreness or DOMS. When you put in a hard workout, very small, microscopic tears in your muscle fibers can occur (this is the pain you feel when your muscles are sore), which cues your body that there is damage that needs to be repaired.

Then, as with any injury to the body, the inflammatory process kicks in. Healing cells and chemicals rush in to aid repair. This triggers swelling and tenderness typically within 24 hours, which can last for several days.

Because this type of muscle soreness is related to the inflammatory process, you can take anti-inflammatory steps to encourage muscle pain relief.

Read on to learn simple lifestyle choices to avoid as well as their alternatives, when possible.

Don’t Make Your DOMS Worse With Inflammatory Foods and Dehydration

Generally speaking, the foods we eat can both heal or harm the body. An overall healthy diet can benefit us in a multitude of ways, but an anti-inflammatory diet specifically can help reduce inflammation and aid muscle pain relief.

Inflammatory foods can exasperate post-workout muscle soreness. Additionally, common foods that may increase discomfort due to their inflammatory effects include sugar, omega-6:omega-3 fatty acid imbalance, trans fats, gluten, and excessive alcohol.

Reducing inflammation in the body is an easy, holistic approach to reducing DOMS and utilizing food to speed up your post-workout recovery.

1. Don’t eat too much sugar (or complex carbohydrates)

Most of us know that a high sugar diet can lead to extra body weight and obesity, but too many teaspoons can also elevate inflammation. A 2014 study showed that drinking a beverage sweetened with 50 grams of fructose elevates hs-CRP, an inflammatory marker identified in a blood test.

Many packaged and processed foods and beverages contain high amounts of sugar, especially in the form of high fructose corn syrup (HFCS).

Common high fructose corn syrup foods include:

Bakery goods like bread, doughnuts, cookies, and cakes

Pre-made foods like pizza and TV dinners

Salad dressings

Soda

And even some nutrition bars and cereals

Instead, stick to natural, whole food sources for your carbohydrate intake, like fresh fruits, vegetables, and whole grains. If you’re looking for an alternative sweetener that can actually aid your workout recovery, try mānuka honey.

This type of honey is an ideal post-workout superfood, due to its ability to support healthy inflammation and its lower glycemic index compared to pure glucose or sugar. It is ideal for restoring glycogen levels lost from a workout as well as supporting recovery from exercise-induced inflammation—not to mention, it is chock full of vitamins and minerals, such as essential B-vitamins, magnesium, calcium, copper, zinc, and potassium, all of which strongly affect athletic performance and help speed up recovery.

Additionally, research published in Pharmacognosy Research showed that mānuka honey contains 22 amino acids, including all 9 that must be consumed through food.

You can also sweeten your foods and drinks with stevia, a plant extract that scores a 0 on the glycemic index and has a low-calorie count. Just remember that a little goes a long way.

2. Don’t consume too much omega-6 fatty acids from processed foods

While it may seem odd, not all fats are created equal. Many scientists and health professionals believe the skewed omega-6:omega-3 fatty acid ratio consumed by most people in the Western world is harmful and inflammatory.

When we were cave people, we ate roughly equal amounts of each fat type. Now, we consume around 15 times more omega-6 than omega-3. This matters because when out of balance, omega-6 encourages inflammation, which can trigger physical discomfort.

While both fats are essential to a healthy diet, it all depends on the source.

Processed foods like cured meats, cakes, fast foods, and snacks like potato chips and power bars might contain excessively high amounts of omega-6 fats. If you feel sore after workout, avoiding processed foods with omega-6 fats may facilitate a faster recovery.

If you insist on a fatty snack, try these low to moderate omega-6 healthy snacks instead:

a handful of almonds, sunflower seeds, or cashews

avocado on spelt or buckwheat toast or crackers

edamame beans

3. Don’t overly indulge in saturated fats

Diets high in saturated fats from meats, dairy, and trans fats have also been shown to cause low-grade inflammation in the body, which can exaggerate post-workout muscle soreness. Processed foods, particularly those that are fried, tend to be high in trans fats and should be avoided.

To keep inflammation at bay, eat anti-inflammatory foods containing healthy fats, such as nuts, seeds, olive oil, and avocado.

4. Don’t overdo it on the bread

A gluten-free diet is followed by many, including those without Celiac disease. But have you ever wondered if this style of eating might aid muscle recovery?

Gluten includes the proteins found in a range of grains including barley, rye, wheat, and triticale (a hybrid of wheat and rye). Research shows that opting for a gluten-free diet can reduce inflammation, muscle pain, and back pain. As an added advantage, it may reduce fatigue, too.

But it doesn’t mean you have to give up your favorite meals and snacks altogether. Simply try changing your diet up a bit with gluten-free replacements, just be wary about sugars and excessive carbs.

Photo courtesy of Ted Eyton/ Kaiser Permanente

Gluten-free or low-gluten snacks and meals to try instead:

Collard green wraps

Corn tortilla shells

Quinoa with steamed veggies

Spelt (While low on gluten, it’s not suitable for those with celiac disease and gluten sensitivities)

Lentil or vegetable chips

Seaweed chips

Mixed nuts (preferably unsalted)

5. Don’t forget to hydrate

You probably learned elsewhere that water makes up for more than half of the human body and that you cannot live without it. But did you know that dehydration can lead to subtle problems that can affect your muscles, including producing inflammatory responses in the body?

That’s why it’s important to remain hydrated and replenish your body with liquids after a workout. Since you also lose salt as you sweat, a sports drink containing electrolytes is recommended. However, watch the sugar content.

Don’t Forget These 5 Essentials to Support Your Sore Muscles

If you feel sore for several days after a workout, you might consider quitting. Don’t! As you maintain consistency, your muscles will adapt and thrive. This is simply par for the course.

If you experience pain that prevents you from carrying out daily activities, you likely pushed yourself too far, too soon. Back off and build up gradually. The discomfort shouldn’t last beyond 72 hours.

Besides avoiding certain foods, don’t forget these things before you begin strenuous exercise.

Make sure you warm-up and cool down sufficiently. This includes stretching for a minimum of 5 minutes before and after your workout. It is also imperative to warm your body up with some low-intensity cardio activity, such as walking on a treadmill or using the elliptical.

Take cold baths or showers. This can help numb the pain temporarily and give you some much-needed relief.

Use a topical pain reliever. Naturally derived topicals like CBD MEDIC

Active Sport Ointment or Active Sport Stick provide pain relief quickly by directly targeting the source of discomfort with cooling and heating sensations of menthol and camphor.

Take supplements that support muscle and joint health. Turmeric and ginger are both known to support healthy inflammatory processes and joint health. You can include them in your diet or use Charlotte’s Web

CBD RECOVERY GUMMIES to support recovery from exercise-induced inflammation.

Use a foam roller. If you feel sore muscles kicking in a day or two after your workout, the continued pressure and rolling motion over sore muscles can help diminish built-up lactic acid and speed up your recovery time. You can also do this immediately following your workout as a preventative measure.

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*Remember: If your muscle soreness begins during or immediately after exercise, it is not delayed onset muscle soreness. It takes time for the inflammation related to this to settle in. That’s why the word “delayed” is in the name. Pain that occurs during an exercise can be a sign there is a problem. Stop the activity and seek professional advice before serious joint or muscle damage occurs.

Don’t Let Muscle Soreness Keep You Down

Working out in the gym brings a raft of health benefits. Finding ways to continue exercising, safely and comfortably, are crucial for both your physical and psychological wellbeing. The steps discussed in this article will enable you to settle sore muscles and harness your fitness.

<<Ease Your Pain and Get Better Workouts>>

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This information is for educational purposes only and is not intended to replace medical diagnosis or treatment. Seek medical assistance for any injuries. These statements have not been evaluated by the FDA. The products mentioned in this blog are not intended to diagnose, treat, cure, or prevent any disease.

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