April 15th, 2011
The DCCT has yielded important longitudinal information about the natural history of microvascular and macrovascular complications in people with type 1 diabetes. Long-term information is provided by the ongoing study of DCCT patients in the Epidemiology of Diabetes Interventions and Complications Trial (EDIC). The study also afforded the best information available about the effect of intensive glycemic management on the natural history of type 1 diabetes and its complications. Because the DCCT led to a major change in guidelines for diabetic care, with a focus on obtaining HbA1c values as close to normal as safely possible, a discussion of the natural history of type 1 diabetes must incorporate major DCCT findings.
At the inception of the DCCT in 1983, the natural history of diabetic retinopathy had been carefully defined from cross-sectional analyses of large numbers of type 1 diabetic patients with varying duration of diabetes. It was clear that retinopathy was a function of duration of the disease and that virtually 100% of people with type 1 diabetes of over 15 years’ duration would have some degree of retinopathy. It was also recognized that the disorder can progress in stages: from microaneurysms alone to the addition of hemorrhages, exudates, and microinfarcts6 to a proliferative process in which friable new vessels may bleed into the retina, macula, and/or vitreous. Laser therapy successfully avoids serious vision loss, if administered properly at the preproliferative or proliferative stage of retinopathy or when vision is threatened by maculopa-thy. It was recognized that the process proceeded at variable rates and extents in people with type 1 diabetes and that it can be accelerated by hypertension, cigarette smoking, genetic factors, and metabolic control. Some of the evidence related to the effect of glycemic regulation on retinopathy progression was conflicting. Although short-term studies suggested that intensive glycemic management can accelerate preproliferative or proliferative retinopathy, many correlative analyses and animal studies indicated that intensive glycemic management was associated with slower progression.
*24\357\8*
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September 22nd, 2010
This allows for the compulsory admission to hospital of people who, because of their mental illness, are either a danger to themselves or others or who will get much worse unless treated. Sufferers from dementia rarely fall into these categories, though occasionally the behaviour disorder is severe enough to warrant it. The elderly suffering from severe depression or paranoia may need compulsory admission and these will recover.
If an admission of an elderly mentally ill person is to occur there is a set format depending on the section of the Act used. The request can come from the nearest relative but is usually from a social worker specializing in the field. Two doctors have to recommend the admission, usually the patient’s GP and either a psychiatrist or psychogeriatrician. Often the GP has been alerted to a serious problem by a family member and consults the social worker who assesses the situation and in turn alerts the psychiatrist, who must examine the person. The whole procedure can be organized and carried out within a few hours.
One section lasts 28 days, though if the person is still in need of treatment they can be kept in for up to six months (though many remain in longer as voluntary patients after 28 days). As stated before, though, it is commonly thought that most cases of dementia do not fit under the umbrella of the Mental Health Act.
*80/128/5*
Buy generics without a prescription
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September 22nd, 2010
Much has been written about love, sex and marriage; but intercourse requires little more than the insertion of the penis into the vagina with a modicum of rhythmic pelvic thrusting. This essentially pleasurable procedure continues until such time as orgasm or ejaculation occurs. The ways and means these simple manoeuvres can be accomplished are legion and fill the pages of many a novel and text book.
Intercourse poses many problems for the sick and the handicapped who have the same drive to complete the act of sexual intercourse as the walking well. Special attention is drawn to the plight of patients in hospital. If anything, this group of people has their sexual appetites increased because of the special need for reassurance and support. These people have less chance of gaining sexual satisfaction in their hospital beds than do inmates of maximum security prisons who at least manage to avail themselves of the homosexual option.
Home Remedies
When sexual intercourse results in back pain in the male and Urinary Tract Infection in the female, a change of position is the desiderata. The male is advised to adopt the reverse “missionary position” with the female on top. Conversely he may lower his sights by avoiding the urethral and lumbar trauma consequent to the aggressive habit of “riding high”.
*79/131/5*
Generics online – no prescription
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June 2nd, 2010
For many years we have heard the unequivocal advice that all Westerners should significantly reduce their salt consumption. This was based on the fact that a percentage develop a type of high blood pressure that is aggravated by a salty diet. For some patients, the need to cut back on salt is very real, and most of us could be more moderate with the salt shaker.
But the total picture on salt and sodium consumption is not so clear. Not everyone needs to greatly restrict salt intake. On the other hand, most Westerners consume far too much. View this entire discussion as a call for moderation.
The International Intersalt study is the most comprehensive population study yet undertaken to get some answers. Researchers looked at blood pressures and sodium intake in people in 32 countries. The results revealed little link between sodium intake and blood pressure in people around the world.
Yes, in populations where sodium intake is extremely low—at a level at which most of us would find the diet virtually inedible— blood pressure is low. That was true in 4 out of 52 centres studied. But in the other 48 centres where there was wide variation in sodium intake there was little if any difference in blood pressure. These findings suggest that unless sodium intake is very severely limited, most people will not see any improvement. Any drop in blood pressure will be clinically insignificant.
A study published in the Archives of Internal Medicine (January 1990) also failed to show a strong sodium-hypertension link. For three years, 841 men and women were observed for the blood pressure-lowering effects of diet. Some restricted sodium alone, a second group cut back on kilojoules, a third group reduced both sodium and kilojoules, while a fourth group was put on a low-sodium, high-potassium diet. The group with the greatest drop in blood pressure was that which reduced kilojoules. Those cutting back on sodium showed little benefit.
It may even be possible that a low-salt diet may hurt more than help. Dr Brent Egan reported his findings at the American Heart Association meeting in New Orleans in 1989. He and other researchers at the Medical College of Wisconsin in Milwaukee found that a low-salt diet will not reduce blood pressure in 50 per cent of people with higher-than-normal blood pressure and in 80 per cent of those with normal blood pressure. In fact, for some people, salt restriction actually may result in higher blood pressure.
Dr Egan takes a very practical approach with his own patients. He has them monitor their blood pressure for a week before starting a low-salt diet in order to establish a baseline. Then they keep track of their pressure after cutting down on salt. If there is no reduction in blood pressure after one to two months, he tells them to discontinue salt restriction.
Dr Carter Newton, a cardiologist at the University of California at Los Angeles who practises in Santa Monica, believes this is the best approach, but points out that it takes co-operation and time. He suggests that patients might have to “push” their MDs to do this with them.
Certainly some people are salt-sensitive. It is estimated that 25 to 60 per cent of people with high blood pressure, or about 10 to 15 per cent of the general population, is sodium sensitive. Only those individuals are likely to benefit from stringent sodium restriction. Eventually we’ll have a test for such sensitivity, but right now the only way to tell is by trial and error.
Moreover, it appears now that not all sodium can be clumped in the same “villain” category as salt. While you may be sensitive to salt and may need to cut back on intake, you may not respond at all to other sodium compounds in the diet such as MSG (monosodium glutamate). Again, trial and error is the only completely effective way to tell just what you can and cannot consume without adversely affecting your pressure.
Advocates of salt and sodium restriction for everybody across the board say that such an approach will mean that some individuals will benefit, and no one will be harmed since no one needs the salt or sodium in the diet anyway. At first glance this makes sense, but upon closer examination, there are two major flaws in such thinking.
First, why give something up when you don’t have to? Second, salt makes food taste better. For those of us trying to keep the fat content of our diets down, overly restricted salt intake might torpedo our efforts.
As in most things, moderation should be the watchword in salt and sodium intake. The National Health and Medical Research Council indicates that a “safe and adequate” daily sodium intake is about 100 mmol daily for adults. This is equivalent to 2.3 grams of sodium or 6 grams of salt. To put that into perspective, one teaspoon of salt contains about 2000 milligrams of sodium. That’s how much we need to maintain good health under normal circumstances. Australians consume from 8 to 12 grams daily. Many people consume much more than that. There’s a big difference between salting all food until it’s virtually white and sprinkling on a few grains here and there.
Actually, researchers have demonstrated that the best way to cut back on salt is to reduce or eliminate it in cooking. That way you can enjoy a sprinkle at the table. When they measured the amount consumed in that way, the total intake was way down.
Actually, most of the salt and sodium in the Western diet gets there by way of processed foods and foods in fast-food restaurants. Those are the same foods which are highest in saturated fats and cholesterol. So if you cut down on them in your efforts to lower your cholesterol level, you’ll automatically reduce your salt and sodium intake.
*129\85\2*
Cardio & Blood/ Cholesterol
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June 2nd, 2010
Exercise is so important an element in a heart-healthy lifestyle that you’ll see it come up again and again in this book. We discuss regular physical activity in chapter 11. One of the dramatic benefits of exercise is blood pressure control. Numerous studies have shown that patients can often control mild hypertension with exercise and diet alone, with no need for drugs. This remains a bit controversial for some doctors, who feel more comfortable when prescribing drugs that they can adjust and control. The fact remains, however, that drugs can often be avoided. If you’re like most patients, you will want to keep the number of medications you take to a minimum.
What to do if your doctor is adamant about your taking drugs to control mild hypertension? You may decide to go along with him for the time being, while actively pursuing your own program of diet and exercise as spelled out in this book. Assuming that these non-drug approaches are effective for you, your doctor will soon see that there is no need for the drugs.
If you have a moderate or severe form of hypertension, the diet and exercise regimen may not completely replace the need for medications, but certainly the amount of drugs will be lessened. Perhaps instead of needing two pills three times a day, you’ll only need to take one.
By all means it’s necessary to have a good relationship with your doctor so you can work out the formula that’s best for you. If you don’t think such a relationship is possible with your current doctor, you might think about a change.
*128\85\2*
Cardio & Blood/ Cholesterol
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April 27th, 2010
Studies with sibutramine and orlistat in a clinical setting have been designed to show what happens in ‘real life’. Results from both are favourable, and indeed broadly comparable. On average, one can expect weight loss of around 9% maintained over 12 months, among those who respond to, and continue treatment. However, while every physician involved in weight management will be able to tell you of the marvelously successful patient who lost 40% body weight, they will equally be able to tell you of their abject failures.
Sibutramine
When used in conjunction with a low-calorie diet, data show that 77% of sibutramine-administered patients achieve a medically beneficial weight loss of at least 5%. Importantly, continuation of therapy can sustain these weight losses for at least 2 years. Further, a recent meta-analysis has shown that, in sibutramine-administered obese patients, subjects who achieved weight losses of over 4 kg in the first 3 months of treatment were more likely to achieve long-term weight loss maintenance if therapy was continued. This in turn, led to marked improvements in metabolic factors such as lipid profile, insulin sensitivity and hypertension.
Orlistat
A placebo-controlled study involving obese patients found that orlistat can promote and maintain weight loss (when administered in conjunction with a hypocaloric and a eucaloric diet, respectively). During the weight-loss phase (year 1), orlistat patients lost 10.2% body weight, compared with 6.1% in the placebo group. Results from the weight-maintenance phase of the trial (year 2) showed that patients who continued on orlistat regained half as much weight as patients switched to placebo. Weight-loss-associated improvements in cardiovascular risk factors, including lipid profile, blood pressure and fasting glucose, have also been demonstrated.
*49/312/5*
WEIGHT LOSS/BODY-BUILDING
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May 21st, 2009
Epiglottitis is less common than croup but more serious. It occurs most commonly in the toddler and preschool age group.
Cause
Epiglottitis is caused by a germ (Haemophilus influenzae) which causes inflammation and swelling of the epiglottis. The epiglottis normally sits at the top of the windpipe and prevents food and liquid entering the windpipe during swallowing. When it is inflamed and swollen, the epiglottis blocks air flow, causing breathing difficulty and marked distress.
Clinical features
The onset of epiglottitis is very rapid. Unlike croup, where the child has symptoms of a cold before he develops a barking cough and stridor, epiglottitis develops rapidly in a child who has previously been perfectly well. Within a few hours the child is often desperately sick. He looks toxic and unwell, pale, with saliva drooling from his open mouth. He will often have a soft snoring noise when he breathes, and will sit well forward, refusing to lie down because it causes him further respiratory distress. He is irritable and restless, feels hot, and it is difficult to console him.
No investigations are indicated. The diagnosis of epiglottitis is made on the basis of a very rapid onset of symptoms in a previously well child, and characteristic clinical signs. In fact, no investigations or procedures (such as taking blood, measuring temperature) etc. should be performed if epiglottitis is suspected because they may distress the child and precipitate obstruction of the windpipe.
Treatment
If epiglottitis is suspected, the child must be transferred immediately to a hospital which has an intensive care unit. There a breathing tube is usually inserted to help the child breathe, and antibiotics given intravenously.
When to see your doctor
Epiglottitis is a medical emergency, and if it is suspected then medical assessment must be obtained immediately. Do not delay — it is literally a matter of life and death.
Prevention
Epiglottitis is preventable by having your child vaccinated against Haemophilus influenzae. This is commonly called the Hib vaccine, and is now available in Australia. Make sure your child is fully immunised. This will prevent him from contracting this and other potentially fatal diseases.
*223\90\8*
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May 19th, 2009
Losing a baby, at any stage of pregnancy, can be a devastating experience for parents. No matter how much we try to rationalise this experience or to be philosophical about it, we cannot negate the fact that emotionally we have experienced a loss. The conspiracy of silence that has surrounded miscarriage for so long only serves to reinforce the sense of isolation that parents may feel regarding their loss.
Miscarriage is common. One in five pregnancies ends in miscarriage, and 75% of these occur within the first 10 weeks. Most miscarriages that occur in the early stages of pregnancy are a result of an abnormality in the foetus. Sometimes the miscarriage is due to a blighted ovum, that is, an egg that was not fertilised but caused a ‘phantom pregnancy’. Some fertilised eggs simply do not develop properly, and are rejected by the mother’s body.
Miscarriages during the later stages of pregnancy can be due to numerous factors, cental insufficiency (a placenta which stops functioning properly).
Having a miscarriage is not an experience that you need to go through alone, and talking over your feelings with others who have had similar experiences may help to ease the burden of guilt (unfounded) that you may be carrying. It may also give you the opportunity to air the sadness that you are bound to feel. This will help to rebuild your confidence, and make you feel more positive about trying again. Talk to your partner, who will also be feeling down. Share your concerns, feelings of guilt, fantasies with each other. Couples who have gone through repeated miscarriages, or who have had difficulty conceiving, may experience a sense of grief with the onset of each period, as if they have lost another ‘potential child’. This is a perfectly normal reaction, and you both need to mourn for this too, in order to achieve acceptance of the loss and to heal the ‘wounds’. Not discussing these feelings openly with each other can lead to a sense of resentment and anger which may interfere with sexuality too. This can lead to a vicious cycle of anxiety about sex, which is exactly what you don’t need if you are trying to conceive again.
*56\90\8*
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May 18th, 2009
“He wants to put it up my butt. I hate it. It hurts. Why would anybody want to do that?”
ANSWER: Even though the rectum has connotations in our culture that make it seem dirty and corrupt, it is actually a very sensitive area. You know that, because you know how much it hurts you when he tries to enter you there. There is nothing unnatural about anal penetration. It is purely a matter of two things, preference and knowledge. The issue of preference can be addressed only by open communication. The issue of knowledge may help in this situation, because the facts may help you both to come up with a solution to your differences. The tissue in that area of the body is not only sensitive but can be damaged easily. Lubrication is important, so if you ever decide to do it, use a well-lubricated condom. Infection can be a problem, too, so make sure there is no cross-stimulation from the rectum to other areas of the body. Finally, it takes practice and cooperation to accomplish penetration of the anus. Practicing with slight insertion of the little finger and moving on to more and more penetration can help, and learning to relax the muscles in that area facilitates entry. Super marital sex rules indicate that the small-step approach can help here, with approximations of penetration aided by verbal fantasy of penetration. Surrendering or forcing only causes you both to relate such activity to the cultural orientation of “a pain in the ass.” An important super marital sex rule is that there should never be intentional mental or physical pain or coercion during any sexual interaction.
*247\97\8*
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May 18th, 2009
Why is the size an important guide as to whether or not a cancer is likely to be cured? One reason is that, because bigger cancers contain more cells, the chance that they will contain some cells which have a natural resistance to radiation is higher than for small cancers. Another reason is that tumours generally do not develop an efficient blood supply. This means that big tumours contain a high proportion of cells which are getting very little oxygen. This is important because cells which are getting very little oxygen are not as sensitive to radiation as cells which are getting plenty of oxygen. It takes two to three times the dose of radiation to kill the poorly oxygenated cells. A third reason is that big growths contain a higher proportion of cells which are not actively dividing than small growths. As we have seen, cells which are not dividing are less sensitive to radiation.
The bigger the tumour, the more of these relatively resistant cells it will contain. However, some of them are present even in tumours that are only a few millimetres across. The chances of curing growths which contain some poorly oxygenated cells and some cells which are not dividing can be improved by giving the radiation treatment in small doses spread over some weeks rather than giving the whole dose in one treatment session. As the cancer shrinks, cells which were not dividing start to divide and cells which were poorly oxygenated get more oxygen. Thus, as the weeks go by, these cells become much more sensitive to radiation treatment than they were to start with. Although the results are better when the treatment is spread out like this, bigger cancers still need a much higher total dose. Even with a higher dose, there is still a much smaller chance of curing the bigger cancers. Very big cancers simply cannot be cured with doses that are safe.
*262/40/1*
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