#so due to a combination of anatomically relating to plants more than animals + not being raised in space + being unisex

[argonphoenix]

looks at new alien character. i would like to award you the highest honor i can bestow. it/its pronouns

[scienceblogtumbler]

Understanding why trees are dying may be key to locking up carbon

by Gareth Willmer

Rising tree deaths may be reducing the ability of many forests worldwide to lock up carbon by pulling in greenhouse gases from the air. To properly grasp what this means for carbon budgets, scientists need to solve the puzzle of why trees are dying – and how they respond to change.

‘There are widespread observations of increasing tree mortality due to changing climate and land use,’ according to new research. This appears to be transforming woodland habitats, with trees getting younger and shorter in many forests, the authors add.

Estimates suggest that forests have absorbed up to 30% of anthropogenic carbon emissions in the past few decades. Though the overall effects of tree loss on the carbon cycle are complex because old trees and the young ones that replace them take up carbon at different rates, rising mortality appears to be affecting forests’ ability to lock up carbon.

The researchers in the new study think that higher mortality rates may begin to outweigh the capacity of remaining and new trees to maintain that uptake at the same level – and potentially lead to an overall reduction of canopy cover and biomass.

‘It’s quite concerning, because at the moment, two to three of every 10 molecules of carbon dioxide in the atmosphere come back into the forests, but we don’t know how it’s going to continue into the future,’ said Dr Thomas Pugh, an environmental scientist at the University of Birmingham, UK.

Although the trend towards rising mortality and the changing make-up of trees in forests has been evident in more localised studies, the team’s literature review and data analysis of land-use change have indicated this is happening on a broad basis, he says.

Dr Pugh points out, however, that it’s not possible to say yet whether this is occurring everywhere because many locations still have not been studied. ‘What we’re showing is that if you look across all the forests, these trends are widespread, though different places are moving at different rates.’

Tree death

Further research is needed to understand how forest changes relate to future carbon storage prospects. Many studies have looked at photosynthesis-related effects on storage, but another critical piece of the puzzle is understanding the rates and causes of tree death at a wide scale.

Until now, getting a global picture of this has been surprisingly difficult, says Dr Pugh.

This is partly because trees can live hundreds of years – and even if you manage to observe death, the cause is often unclear, he says. If you can get that information for one tree, you need to make thousands of observations to understand trends.

‘Likewise, we know how long certain tree species can live, but we don’t know how long they typically live,’ Dr Pugh added.

A project he leads called TreeMort, which was involved in the new research, is trying to improve understanding of lifespans by combining measurements made over the past four decades from a wide range of sources, including local studies, forest inventories, plant trait data and satellite observations. Only recently has enough information been amassed to really do this, he says.

So far, the team has gained insight on the more visible causes of death, finding that about 12% of tree mortality in terms of biomass loss across the world is caused by large disturbances, such as fires, wide-scale uprooting of trees by wind, harvesting and pest outbreaks.

‘I’d expected larger-scale events to account for a larger fraction overall,’ said Dr Pugh. ‘They have such a large impact on the landscape, but it turns out that in many forests, most of the action is happening at smaller scales.’

Pests such as bark beetles, along with fires, wind and harvesting, are responsible for large-scale destruction events in forests, but these only account for around 12% of tree deaths. Image credit – Thomas Pugh

At the same time, he was surprised in a separate study at the extent to which trees in Europe seemed to ‘overwhelmingly’ die from harvesting.

The next step, he says, is to get a better understanding of the causes and timing of the remaining 88% from less visible events, such as smaller-scale harvesting and uprooting by wind, competition with neighbouring trees, disease, drought and longer-term climatic effects such as warmer temperatures.

Over the past couple of years, Dr Pugh’s team has been assembling and standardising data from a large variety of studies, and is now ready to take a closer look.

He believes getting this tree death information – and adding it to research into photosynthesis effects and tree numbers – can be a ‘game changer’ in forecasting carbon budgets more precisely. ‘We’re not going to remove uncertainty by any means… but we think we can put much tighter bounds on this carbon sink.’

Not only that, but understanding tree mortality has much wider implications for changes to forest ecosystems with respect to the mix and diversity of trees and animals they contain. ‘It opens up a lot of possibilities to build work on top of this, because the rate at which trees die has so many implications for ecosystems,’ said Dr Pugh.

‘In the light of climate change, it means that even boreal forests in a relatively wet climate might encounter drought stress.’

Daniele Castagneri, Swiss Federal Institute for Forest, Snow and Landscape Research

Smaller scale

But we still have much to learn about trees at a far smaller scale to help improve global predictions for carbon storage over time. Trees lock up carbon in their wood and roots as they grow, so analysing growth of woody tissue and how this is affected by climate variations can shed light on storage prospects.

The INTREE project is seeking to do this in temperate forests in the Alps and Canada through a new approach it has developed for analysing the formation of xylem – woody tissue that conducts water and nutrients.

The method, called ‘intra-ring qualitative wood anatomy’, involves new anatomical studies combined with previous findings from two traditional approaches – long-term analysis of annual tree rings over decades, and shorter-term seasonal monitoring of weekly wood cuttings under a microscope.

Observing processes at both scales is key for getting a more comprehensive overview, according to Dr Daniele Castagneri, a researcher for INTREE at the Swiss Federal Institute for Forest, Snow and Landscape Research (WSL).

Some of the team’s studies have already hinted at the importance of their approach. When the researchers investigated how budmoth outbreaks affected the European larch (Larix decidua) through defoliation – which can suppress growth by hindering photosynthesis – they found that previous studies may have underestimated resulting biomass loss by about 25%.

Cores from living trees are extracted for study using an increment borer. Image credit – Daniele Castagneri

They have also found evidence that a warmer climate might in the long-term have an overall impact on reducing tree growth rates in boreal forests in some of the northernmost latitudes they examined in Canada. This contradicted their expectations that evidence would point to trees in that region actually growing faster in the future due to a corresponding longer growing season. The researchers suggest this could also lead to tree dieback, where trees die starting from their tips.

‘In the light of climate change, it means that even boreal forests in a relatively wet climate might encounter drought stress,’ said Dr Castagneri.

While such studies suggest that some climate effects may be larger than previously thought, he cautions that it is currently difficult to generalise because of the need for information on many more tree species and habitats.

Dr Patrick Fonti, another researcher at WSL who supervises INTREE, says this is being helped by a growing body of research. ‘We’re getting closer to that because there are several groups working in the same direction, so there’s more and more data coming together,’ he said.

In the next year or two, INTREE hopes to link its findings at an anatomical scale more directly to the carbon cycle, but Dr Castagneri says it will be some time before this can be done on a global basis.

‘Connections with the global carbon cycle are very complex, and scaling from the cell level to the forest cannot be easily done,’ he said.

He hopes the team will eventually be able to get a good quantitative grasp on carbon fluxes and combine this with other groups to boost understanding. Maybe then, he said, we can ‘have more precise models that predict what will happen to forests’.

The research in this article was funded by the EU. If you liked this article, please consider sharing it on social media.

Published by Horizon

source https://horizon.scienceblog.com/1364/understanding-why-trees-are-dying-may-be-key-to-locking-up-carbon/

[jakehglover]

Saw Palmetto for Thinning Hair?

By Dr. Mercola

There's a plethora of research on the effectiveness of certain plant-based supplements, and saw palmetto is one of them. Fanlike fronds identify this palm tree (Serenoa repens) that grows from sandy coastal areas to pine forests in the Southeastern U.S. Extracts of saw palmetto have been used by Native Americans as a traditional medicine for centuries.

As a supplement, saw palmetto has myriad uses, but some are controversial due to the (alleged) absence of scientific evidence. One of them is how it may be able to impact testosterone; another is its effect, for men, on reproductive health, including the prostate, a small gland located just below the bladder that's part of the male reproductive system; most studies on saw palmetto come from studies on men.1

Saw palmetto inhibits an enzyme called 5-alpha reductase, which converts testosterone to a powerful androgen hormone known as dihydrotestosterone, or DHT. As such, it may reduce the effects of DHT as men age. A hormone that regulates the development of primary sex organs, particularly for male development in puberty, DHT production takes place in both ovaries and testes, as well as the adrenal glands.

However, some scientists don't recognize studies on saw palmetto in regard to its ability to regulate testosterone levels, refuting a review of studies published in the Journal of the International Society of Sports Nutrition, during which men taking the supplement for two weeks had higher testosterone levels than those given a placebo.2 Naysayers say the evidence comes from outdated studies.

There does seem to be an association between saw palmetto in regard to its influence on testosterone, as there are many more studies indicating there's much more to this plant than previously known. One benefit that's been getting much more attention lately has to do with hair loss. (Anagen, incidentally, refers to the state of active hair growth, versus telogen, which is the "resting" phase during which your hair falls out.)

Saw Palmetto for Alopecia

Although it's common in both men and women, androgenetic alopecia (aka hair loss) can cause balding more so in men than women, because men have more testosterone than women. Usually androgenetic alopecia begins with a receding hairline in men, eventually forming the classic male pattern baldness "M" shape. Women's hair, on the other hand, generally presents as an all-over thinning on the scalp; it's rare for women to lose their hair completely.3

While it's normal for healthy people to lose hair and have it grow back, one interesting study shows that high DHT levels can prevent regrowth, due to the way DHT binds to the androgen receptors and increases their expression, encouraging the "miniaturization" of the hair follicles and preventing new growth from occurring.4

A different type of hair loss, alopecia areata, produces balding in circular patches.5 Alopecia areata affects around 6.8 million people in the U.S., and refers to a common autoimmune disorder that often results in unpredictable hair loss, with no known cure.6 It affects both sexes, usually before age 30.

A more serious form is known as alopecia totalis, where all the hair on the head goes. Alopecia universalis is the most serious case, when the hair loss involves the entire body. Medical News Today also reported the results of an animal study in China7 that investigated the effects of saw palmetto:

"The research on saw palmetto and hair growth is varied and somewhat limited, but there are studies indicating that the plant extract might show some promise as a treatment. One study in mouse models found that saw palmetto promotes hair regeneration and repairs hair loss by activating the signaling pathways responsible for hair growth."8

More specifically, the study demonstrated that transforming growth factor β2 (or TGF-β2) signaling and mitochondrial signaling pathway was how hair growth was regenerated. According to the study, saw palmetto significantly increased human keratinocyte cells incubated with DHT, which resulted in increased hair density, weight and thickness.

It significantly triggered follicle growth and decreased inflammatory response even better than finasteride (Propecia),9 a drug used to treat an enlarged prostate and/or scalp hair loss in men. A clinical trial in 201610 noted that when saw palmetto was applied topically, men with male androgenetic alopecia (AGA) had increased hair count at weeks 12 and 24 compared to baseline. However, study authors added that "concentrated S. repens [saw palmetto] product beyond four weeks may be necessary for sustained efficacy."

A study11 conducted in 2014 also yielded positive results. Twenty-five male participants experienced an 11.9 percent increase of their hair count after using saw palmetto along with a treatment of 10 percent trichogen veg complex12 (an herbal agent said to stimulate the scalp and subsequent hair growth, according to one site) topically for four months.

Saw Palmetto May Also Help Enlarged Prostate and Prevent Prostate Cancer

According to another study conducted in 2002,13 AGA is the "structural miniaturization of androgen-sensitive hair follicles in susceptible individuals, and is anatomically defined within a given pattern of the scalp."

Again, biochemically, one of the contributing factors of AGA is the conversion of testosterone to DHT via the enzyme 5-alpha reductase. This conversion or metabolism is also key to the onset and progression of benign prostatic hyperplasia (BPH), aka prostate gland enlargement, which can block urine flow from the bladder and cause other symptoms.

Randomized, controlled and double-blind studies in 201114 and 201215 show that when given increased dosages of saw palmetto for BPH, its effectiveness was quite lackluster. However, another study in 201416 combining it with lycopene, selenium and tamsulosin proved more effective.

Getting back to the 2002 study that looked at saw palmetto for AGA, 10 men between the ages of 23 and 64 years of age and in good health, with "mild to moderate" AGA, joined the study, which involved testing saw palmetto extracts and beta-Sitosterol (another plant-based extract linked to relieving BPH symptoms) to treat it.

The authors noted "highly positive" responses to treatment, as after the final visit, six out of the 10 participants were rated as improved, a conclusion the authors said established the treatment and justified larger trials. However, in addition, researchers found another benefit for saw palmetto in relation to its ability to slow testosterone conversion: the prevention of prostate cancer, which strikes 1 in 9 men in the U.S. alone.17

"Research has suggested that DHT may contribute to the development of prostate cancer. Therefore, it is possible that saw palmetto might help to prevent this disease by slowing down the conversion of DHT. Prescription medications can also slow down this conversion, but they often have severe side effects. Saw palmetto may inhibit DHT without serious side effects."18

What You Didn't Know Might Help You: Saw Palmetto Can 'Up' Your Sex Drive

It's a fact: Saw palmetto really can improve the libido of men with low testosterone. In one study, improvement for men was fivefold, the journal Urologia Internationalis asserted after the 120 men with prostate problems reported better working order in the areas of:

Enlarged prostate symptoms

Erectile function

Urine flow

Blood prostate-specific antigen (PSA)

Quality of life

The study involved men suffering from lower urinary tract symptoms (LUTS) brought on by BPH, which the study authors say affects around 60 percent of males by the time they reach 60 years of age. The comprehensive study19 revealed "statistically significant improvements" in the men who took saw palmetto over a two-year period.

All five of the above improvements were noted during the study period, during which time the participants were treated with 320 milligrams (mg) of saw palmetto extract. In terms of erectile dysfunction, the men who filled out the 15-question International Index of Erectile Function (IIEF) Questionnaire20 at the end of the study related "improved sexual function" as well. But what does saw palmetto do for women?

Saw Palmetto and PCOS — Polycystic Ovary Syndrome

While low testosterone can also lower women's sex drive, there's evidence that supplements or extracts of the palm plant may have some very valuable benefits in this regard. According to Medical News Today, saw palmetto may help regulate certain female hormones; it may have an estrogen-like effect and balance out the effects of excess testosterone in women, which is often seen in a condition known as polycystic ovary syndrome (PCOS):

"Women with PCOS have elevated levels of male hormones. This causes a specific set of symptoms, including irregular and heavy menstrual periods, excess body and facial hair, and acne."21

In fact, women who have PCOS may find that it can also make the arrival of menstrual periods hard to predict or even bring them to a stop. It may also alter women's ability to have a child. (It should be noted that one thing saw palmetto does not do is improve fertility, something that's been claimed in some cultures for many years.) WebMD22 lists symptoms of PCOS, which often takes years to diagnose:

Weight gain

Hair loss

Oily skin/acne

Infertility

Insomnia

Sleep apnea

Headaches

Difficult menstrual periods

Some scientists say a substantive link between saw palmetto and PCOS in women is hard to pin down because most of the studies have been on animals. However, one study shows that saw palmetto can block prolactin receptors on ovarian cells that are overexpressing them and reduce high levels of androgens and prolactin in women with PCOS.23

Adverse Reactions and Possible Side Effects

In the clinical trial on the 120 men with enlarged prostates, scientists concluded there were no adverse effects from taking saw palmetto. That's not to say there are none, however, even though it's plant based. Possible side effects include:

Stomach pain

Headache

Nausea

Heartburn

Diarrhea

Constipation

Bad breath

Vomiting

Additionally, experts warn it may cause reactions in people taking certain medications, including oral contraceptives, aspirin, anticoagulants, blood thinners or prescriptions such as warfarin, and iron supplements. Saw palmetto generally comes in four basic forms: tablets, powdered capsules, liquid extracts and whole dried berries. People have tried making tea from the berries, but since the compounds aren't water soluble, it's not a good way to "get the goods."

Tablets and capsules are the easiest to find and the easiest to ingest, and it's interesting to note that they're also what some researchers have used in their studies. In regard to how much to take, you should consult your doctor (or integrative doctor) first about safe dosages, but for prostate problems or PCOS, a journal article on the topic recommends 160 mg twice a day.24

from HealthyLife via Jake Glover on Inoreader http://articles.mercola.com/sites/articles/archive/2018/07/30/saw-palmetto-for-alopecia.aspx

[sherristockman]

Saw Palmetto for Thinning Hair? Dr. Mercola By Dr. Mercola There's a plethora of research on the effectiveness of certain plant-based supplements, and saw palmetto is one of them. Fanlike fronds identify this palm tree (Serenoa repens) that grows from sandy coastal areas to pine forests in the Southeastern U.S. Extracts of saw palmetto have been used by Native Americans as a traditional medicine for centuries. As a supplement, saw palmetto has myriad uses, but some are controversial due to the (alleged) absence of scientific evidence. One of them is how it may be able to impact testosterone; another is its effect, for men, on reproductive health, including the prostate, a small gland located just below the bladder that's part of the male reproductive system; most studies on saw palmetto come from studies on men.1 Saw palmetto inhibits an enzyme called 5-alpha reductase, which converts testosterone to a powerful androgen hormone known as dihydrotestosterone, or DHT. As such, it may reduce the effects of DHT as men age. A hormone that regulates the development of primary sex organs, particularly for male development in puberty, DHT production takes place in both ovaries and testes, as well as the adrenal glands. However, some scientists don't recognize studies on saw palmetto in regard to its ability to regulate testosterone levels, refuting a review of studies published in the Journal of the International Society of Sports Nutrition, during which men taking the supplement for two weeks had higher testosterone levels than those given a placebo.2 Naysayers say the evidence comes from outdated studies. There does seem to be an association between saw palmetto in regard to its influence on testosterone, as there are many more studies indicating there's much more to this plant than previously known. One benefit that's been getting much more attention lately has to do with hair loss. (Anagen, incidentally, refers to the state of active hair growth, versus telogen, which is the "resting" phase during which your hair falls out.) Saw Palmetto for Alopecia Although it's common in both men and women, androgenetic alopecia (aka hair loss) can cause balding more so in men than women, because men have more testosterone than women. Usually androgenetic alopecia begins with a receding hairline in men, eventually forming the classic male pattern baldness "M" shape. Women's hair, on the other hand, generally presents as an all-over thinning on the scalp; it's rare for women to lose their hair completely.3 While it's normal for healthy people to lose hair and have it grow back, one interesting study shows that high DHT levels can prevent regrowth, due to the way DHT binds to the androgen receptors and increases their expression, encouraging the "miniaturization" of the hair follicles and preventing new growth from occurring.4 A different type of hair loss, alopecia areata, produces balding in circular patches.5 Alopecia areata affects around 6.8 million people in the U.S., and refers to a common autoimmune disorder that often results in unpredictable hair loss, with no known cure.6 It affects both sexes, usually before age 30. A more serious form is known as alopecia totalis, where all the hair on the head goes. Alopecia universalis is the most serious case, when the hair loss involves the entire body. Medical News Today also reported the results of an animal study in China7 that investigated the effects of saw palmetto: "The research on saw palmetto and hair growth is varied and somewhat limited, but there are studies indicating that the plant extract might show some promise as a treatment. One study in mouse models found that saw palmetto promotes hair regeneration and repairs hair loss by activating the signaling pathways responsible for hair growth."8 More specifically, the study demonstrated that transforming growth factor β2 (or TGF-β2) signaling and mitochondrial signaling pathway was how hair growth was regenerated. According to the study, saw palmetto significantly increased human keratinocyte cells incubated with DHT, which resulted in increased hair density, weight and thickness. It significantly triggered follicle growth and decreased inflammatory response even better than finasteride (Propecia),9 a drug used to treat an enlarged prostate and/or scalp hair loss in men. A clinical trial in 201610 noted that when saw palmetto was applied topically, men with male androgenetic alopecia (AGA) had increased hair count at weeks 12 and 24 compared to baseline. However, study authors added that "concentrated S. repens [saw palmetto] product beyond four weeks may be necessary for sustained efficacy." A study11 conducted in 2014 also yielded positive results. Twenty-five male participants experienced an 11.9 percent increase of their hair count after using saw palmetto along with a treatment of 10 percent trichogen veg complex12 (an herbal agent said to stimulate the scalp and subsequent hair growth, according to one site) topically for four months. Saw Palmetto May Also Help Enlarged Prostate and Prevent Prostate Cancer According to another study conducted in 2002,13 AGA is the "structural miniaturization of androgen-sensitive hair follicles in susceptible individuals, and is anatomically defined within a given pattern of the scalp." Again, biochemically, one of the contributing factors of AGA is the conversion of testosterone to DHT via the enzyme 5-alpha reductase. This conversion or metabolism is also key to the onset and progression of benign prostatic hyperplasia (BPH), aka prostate gland enlargement, which can block urine flow from the bladder and cause other symptoms. Randomized, controlled and double-blind studies in 201114 and 201215 show that when given increased dosages of saw palmetto for BPH, its effectiveness was quite lackluster. However, another study in 201416 combining it with lycopene, selenium and tamsulosin proved more effective. Getting back to the 2002 study that looked at saw palmetto for AGA, 10 men between the ages of 23 and 64 years of age and in good health, with "mild to moderate" AGA, joined the study, which involved testing saw palmetto extracts and beta-Sitosterol (another plant-based extract linked to relieving BPH symptoms) to treat it. The authors noted "highly positive" responses to treatment, as after the final visit, six out of the 10 participants were rated as improved, a conclusion the authors said established the treatment and justified larger trials. However, in addition, researchers found another benefit for saw palmetto in relation to its ability to slow testosterone conversion: the prevention of prostate cancer, which strikes 1 in 9 men in the U.S. alone.17 "Research has suggested that DHT may contribute to the development of prostate cancer. Therefore, it is possible that saw palmetto might help to prevent this disease by slowing down the conversion of DHT. Prescription medications can also slow down this conversion, but they often have severe side effects. Saw palmetto may inhibit DHT without serious side effects."18 What You Didn't Know Might Help You: Saw Palmetto Can 'Up' Your Sex Drive It's a fact: Saw palmetto really can improve the libido of men with low testosterone. In one study, improvement for men was fivefold, the journal Urologia Internationalis asserted after the 120 men with prostate problems reported better working order in the areas of: Enlarged prostate symptoms Erectile function Urine flow Blood prostate-specific antigen (PSA) Quality of life The study involved men suffering from lower urinary tract symptoms (LUTS) brought on by BPH, which the study authors say affects around 60 percent of males by the time they reach 60 years of age. The comprehensive study19 revealed "statistically significant improvements" in the men who took saw palmetto over a two-year period. All five of the above improvements were noted during the study period, during which time the participants were treated with 320 milligrams (mg) of saw palmetto extract. In terms of erectile dysfunction, the men who filled out the 15-question International Index of Erectile Function (IIEF) Questionnaire20 at the end of the study related "improved sexual function" as well. But what does saw palmetto do for women? Saw Palmetto and PCOS — Polycystic Ovary Syndrome While low testosterone can also lower women's sex drive, there's evidence that supplements or extracts of the palm plant may have some very valuable benefits in this regard. According to Medical News Today, saw palmetto may help regulate certain female hormones; it may have an estrogen-like effect and balance out the effects of excess testosterone in women, which is often seen in a condition known as polycystic ovary syndrome (PCOS): "Women with PCOS have elevated levels of male hormones. This causes a specific set of symptoms, including irregular and heavy menstrual periods, excess body and facial hair, and acne."21 In fact, women who have PCOS may find that it can also make the arrival of menstrual periods hard to predict or even bring them to a stop. It may also alter women's ability to have a child. (It should be noted that one thing saw palmetto does not do is improve fertility, something that's been claimed in some cultures for many years.) WebMD22 lists symptoms of PCOS, which often takes years to diagnose: Weight gain Hair loss Oily skin/acne Infertility Insomnia Sleep apnea Headaches Difficult menstrual periods Some scientists say a substantive link between saw palmetto and PCOS in women is hard to pin down because most of the studies have been on animals. However, one study shows that saw palmetto can block prolactin receptors on ovarian cells that are overexpressing them and reduce high levels of androgens and prolactin in women with PCOS.23 Adverse Reactions and Possible Side Effects In the clinical trial on the 120 men with enlarged prostates, scientists concluded there were no adverse effects from taking saw palmetto. That's not to say there are none, however, even though it's plant based. Possible side effects include: Stomach pain Headache Nausea Heartburn Diarrhea Constipation Bad breath Vomiting Additionally, experts warn it may cause reactions in people taking certain medications, including oral contraceptives, aspirin, anticoagulants, blood thinners or prescriptions such as warfarin, and iron supplements. Saw palmetto generally comes in four basic forms: tablets, powdered capsules, liquid extracts and whole dried berries. People have tried making tea from the berries, but since the compounds aren't water soluble, it's not a good way to "get the goods." Tablets and capsules are the easiest to find and the easiest to ingest, and it's interesting to note that they're also what some researchers have used in their studies. In regard to how much to take, you should consult your doctor (or integrative doctor) first about safe dosages, but for prostate problems or PCOS, a journal article on the topic recommends 160 mg twice a day.24

[pharmapedia2]

New Post has been published on Pharmapedia

New Post has been published on http://pharmapedia.pw/2017/01/26/b12-inject-kit-indications-and-side-effects/

B12 Inject Kit indications and side effects

B12 Inject Kit indications and side effects

DESCRIPTION:

Cyanocobalamin Injection, USP is a sterile solution of cyanocobalamin for intramuscular or subcutaneous injection. Each mL contains 1000 mcg cyanocobalamin.

Each vial also contains Sodium Chloride, 0.9%. Benzyl Alcohol, 1.5%, is present as a preservative. Hydrochloric acid and/or sodium hydroxide may have been added during manufacture to adjust the pH (range 4.5-7.0).

Cyanocobalamin appears as dark red crystals or as an amorphous or crystalline red powder. It is very hygroscopic in the anhydrous form, and sparingly soluble in water (1:80). It is stable to autoclaving for short periods at 121°C. The vitamin B12 coenzymes are very unstable in light.

The chemical name is 5,6-dimethyl-benzimidazolyl cyanocobamide; the molecular formula is C 63H 88CoN 14O 14P. The cobalt content is 4.34%. The molecular weight is 1355.39.

The structural formula is represented below.

B12 Inject Kit indications and side effects

CLINICAL PHARMACOLOGY:

Vitamin B 12 is essential to growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis.

Cyanocobalamin is quantitatively and rapidly absorbed from intramuscular and subcutaneous sites of injection; the plasma level of the compound reaches its peak within 1 hour after intramuscular injection. Absorbed vitamin B 12 is transported via specific B 12 binding proteins, transcobalamin I and II to the various tissues. The liver is the main organ for vitamin B 12storage.

Within 48 hours after injection of 100 or 1000 mcg of vitamin B12, 50 to 98% of the injected dose may appear in the urine. The major portion is excreted within the first eight hours. Intravenous administration results in even more rapid excretion with little opportunity for liver storage.

Gastrointestinal absorption of vitamin B 12 depends on the presence of sufficient intrinsic factor and calcium ions. Intrinsic factor deficiency causes pernicious anemia, which may be associated with subacute combined degeneration of the spinal cord. Prompt parenteral administration of vitamin B 12 prevents progression of neurologic damage.

The average diet supplies about 5 to 15 mcg/day of vitamin B 12 in a protein-bound form that is available for absorption after normal digestion. Vitamin B 12 is not present in foods of plant origin, but is abundant in foods of animal origin. In people with normal absorption, deficiencies have been reported only in strict vegetarians who consume no products of animal origin (including no milk products or eggs).

Vitamin B 12 is bound to intrinsic factor during transit through the stomach; separation occurs in the terminal ileum in the presence of calcium, and vitamin B 12 enters the mucosal cell for absorption. It is then transported by the transcobalamin binding proteins. A small amount (approximately 1% of the total amount ingested) is absorbed by simple diffusion, but this mechanism is adequate only with very large doses. Oral absorption is considered too undependable to rely on in patients with pernicious anemia or other conditions resulting in malabsorption of vitamin B 12.

Cyanocobalamin is the most widely used form of vitamin B 12, and has hematopoietic activity apparently identical to that of the antianemia factor in purified liver extract. Hydroxycobalamin is equally as effective as cyanocobalamin, and they share the cobalamin molecular structure.

INDICATIONS AND USAGE:

Cyanocobalamin is indicated for vitamin B 12 deficiencies due to malabsorption which may be associated with the following conditions:

Addisonian (pernicious) anemia

Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacteria overgrowth, total or partial gastrectomy

Fish tapeworm infestation

Malignancy of pancreas or bowel

Folic acid deficiency

It may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption (see Drug Interactions), use of a gluten-free diet in nontropical sprue, or administration of antibiotics in tropical sprue. Such measures remove the need for long-term administration of cyanocobalamin.

Requirements of vitamin B 12 in excess of normal (due to pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be met with oral supplementation.

Cyanocobalamin Injection, USP is also suitable for the vitamin B 12 absorption test ( Schilling test).

CONTRAINDICATIONS:

Sensitivity to cobalt and/or vitamin B 12 is a contraindication.

WARNINGS:

Patients with early Leber’s disease (hereditary optic nerve atrophy) who were treated with cyanocobalamin suffered severe and swift optic atrophy.

Hypokalemia and sudden death may occur in severe megaloblastic anemia which is treated intensely.

Anaphylactic shock and death have been reported after parenteral vitamin B 12 administration. An intradermal test dose is recommended before Cyanocobalamin Injection, USP is administered to patients suspected of being sensitive to this drug.

This product contains Benzyl Alcohol. Benzyl Alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants.

This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.

Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

PRECAUTIONS:

General Precautions: Vitamin B 12 deficiency that is allowed to progress for longer than 3 months may produce permanent degenerative lesions of the spinal cord. Doses of folic acid greater than 0.1 mg per day may result in hematologic remission in patients with vitamin B 12 deficiency. Neurologic manifestations will not be prevented with folic acid, and if not treated with vitamin B 12, irreversible damage will result.

Doses of cyanocobalamin exceeding 10 mcg daily may produce hematologic response in patients with folate deficiency. Indiscriminate administration may mask the true diagnosis.

Information for Patients: Patients with pernicious anemia should be informed that they will require monthly injections of vitamin B 12 for the remainder of their lives. Failure to do so will result in return of the anemia and in development of incapacitating and irreversible damage to the nerves of the spinal cord. Also, patients should be warned about the danger of taking folic acid in place of vitamin B 12, because the former may prevent anemia but allow progression of subacute combined degeneration.

A vegetarian diet which contains no animal products (including milk products or eggs) does not supply any vitamin B 12. Patients following such a diet, should be advised to take oral vitamin B 12 regularly. The need for vitamin B 12 is increased by pregnancy and lactation. Deficiency has been recognized in infants of vegetarian mothers who were breast fed, even though the mothers had no symptoms of deficiency at the time.

Laboratory Tests: During the initial treatment of patients with pernicious anemia, serum potassium must be observed closely the first 48 hours and potassium replaced if necessary.

Hematocrit, reticulocyte count, vitamin B 12, folate and iron levels should be obtained prior to treatment. Hematocrit and reticulocyte counts should be repeated daily from the fifth to seventh days of therapy and then frequently until the hematocrit is normal. If folate levels are low, folic acid should also be administered. If reticulocytes have not increased after treatment or if reticulocyte counts do not continue at least twice normal as long as the hematocrit is less than 35%, diagnosis or treatment should be reevaluated. Repeat determinations of iron and folic acid may reveal a complicating illness that might inhibit the response of the marrow.

Patients with pernicious anemia have about 3 times the incidence of carcinoma of the stomach as the general population, so appropriate tests for this condition should be carried out when indicated.

Drug/Laboratory Test Interactions: Persons taking most antibiotics, methotrexate and pyrimethamine invalidate folic acid and vitamin B 12 diagnostic blood assays.

Colchicine para-aminosalicylic acid and heavy alcohol intake for longer than 2 weeks may produce malabsorption of vitamin B 12.

Carcinogenesis, Mutagenesis, Impairment of Fertility: Long term studies in animals to evaluate carcinogenic potential have not been done. There is no evidence from long-term use in patients with pernicious anemia that cyanocobalamin is carcinogenic. Pernicious anemia is associated with an increased incidence of carcinoma of the stomach, but this is believed to be related to the underlying pathology and not to treatment with cyanocobalamin.

Pregnancy: Teratogenic Effects. Pregnancy Category C: Adequate and well-controlled studies have not been done in pregnant women. However, vitamin B 12 is an essential vitamin and requirements are increased during pregnancy. Amounts of vitamin B 12 that are recommended by the Food and Nutrition Board, National Academy of Science-National Research Council for pregnant women (4 mcg daily) should be consumed during pregnancy.

Nursing Mothers: Vitamin B 12 is known to be excreted in human milk. Amounts of vitamin B 12 that are recommended by the Food and Nutrition Board, National Academy of Science-National Research Council for lactating women (4 mcg daily) should be consumed during lactation.

Pediatric Use: Intake in children should be in the amount (0.5 to 3 mcg daily) recommended by the Food and Nutrition Board, National Academy of Science-National Research Council.

ADVERSE REACTIONS:

Generalized: Anaphylactic shock and death have been reported with administration of parenteral vitamin B 12(see WARNINGS).

Cardiovascular: Pulmonary edema and congestive heart failure early in treatment; peripheral vascular thrombosis.

Hematological: Polycythemia vera

Gastrointestinal: Mild transient diarrhea

Dermatological: Itching; transitory exanthema

Miscellaneous: Feeling of swelling of entire body

OVERDOSAGE:

No overdosage has been reported with this drug.

DOSAGE AND ADMINISTRATION:

Avoid using the intravenous route. Use of this product intravenously will result in almost all of the vitamin being lost in the urine.

Pernicious Anemia: Parenteral vitamin B 12 is the recommended treatment and will be required for the remainder of the patient’s life. The oral form is not dependable. A dose of 100 mcg daily for 6 or 7 days should be administered by intramuscular or deep subcutaneous injection. If there is clinical improvement and if a reticulocyte response is observed, the same amount may be given on alternate days for seven doses, then every 3 to 4 days for another 2 to 3 weeks. By this time hematologic values should have become normal. This regimen should be followed by 100 mcg monthly for life. Folic acid should be administered concomitantly if needed.

Patients with Normal Intestinal Absorption: Where the oral route is not deemed adequate, initial treatment similar to that for patients with pernicious anemia may be indicated depending on the severity of the deficiency. Chronic treatment should be with an oral B 12 preparation. If other vitamin deficiencies are present, they should be treated.

Schilling Test: The flushing dose is 1000 mcg.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.