The first successful pregnancy after a transplantation of a uterus will give hope to those who can afford such a procedure if they lack a functioning uterus. Of course, the cost of that procedure would be quite excessive!
Mats Brännström, MD, at the University of Gothenburg, Sweden, documented their successful transplant the subsequent childbirth of a 36 year old female with Rokitansky syndrome, an affliction in which the woman is born without a uterus. The transplant was from a 61 year old woman who donated her uterus!
The woman became pregnant through in-vitro fertilization within a year of the transplant. She was taking triple immunosuppression medications (tacrolimus, azathioprine, and corticosteroids) to protect against rejection. She had one minor rejection episode during the pregnancy.
The baby was born at 31 weeks via c-section due to preeclampsia in the mother, a condition of high blood pressure and protein in the urine that affects some mothers. It can harm the fetus and mother. The baby was completely normal!!
Do you think that a man could receive that transplant and have a baby?
Osteoporosis is diagnosed by bone density tests or fragility fractures. Bone densitometry is reported in the form of a T-score. A normal value is a value that is within a standard deviation (S.D) of a young adult mean bone density value. Anything that is 2.5 S.D. or more below the mean is osteoporosis.
Target serum 25-OH-D (25-hydroxy-vitamin D) level is 30-60 ng/ml. This is a measurement of how much vitamin D is in your system.
We obtain vitamin D from food sources (see link above) such as salmon, tuna, milk, and many other sources. Calcium is obtained in milk products and vegetables. See the link above for sources.
Calcium supplementation: There is no evidence that calcium supplements increase your heart attack risk up to 1000 mg a day when taken with 400IU of vitamin D, based on the women’s health initiative. The choice of calcium supplement would include Calcium citrate if you take anti-acid medications such as proton pump inhibitors or proton pump inhibitors. If your take calcium carbonate, it should be taken with food to increase absorption.
treat osteoporosis if you (1) get a hip or spine fractue (2) you have a T score of less than -2.5 at the spine, femoral neck, or total hip area, or (3) if your FRAX risk is > or = 3% for hip fracture and your T score is between -1.0 and -2.5.
Options for treatment include Biphosphonates, which are non-hormonal agents that inhibit osteoclasts, which break down bone. Examples are Alendronate (Fosomax), Risendronate, Ibandronate (Boniva), and Zoledronic acid (Reclast). each has various routes of administartion and frequency of administration. You have a choice of once a day, weekly, monthly, or even annual intake of some medications.
Side effects that are common with bisphosphonates include heartburn and esophagitis if you don’t drink enough water and stay upright for 30 minutes after taking the pill. Osteonecrosis of the jaw is rare, but more common in immunocompromised patients. If use occurs for longer than 5 years, there is an increased risk of atypical hip fractures.
Duration of treatment is not clear, but continuing bisphosphonates beyond 5 years does decrease the number of vertebral fractures, but not non vertebral fractures. Some doctors recommend stopping treatment for a while after 5 years of medication with Bisphosphonates.
Denosumab (Prolia) is a monoclonal antibody that inhibits osteoclasts and decreases bone breakdown. It is injected every 6 months and decreases vertebral, hip, and nonvertebral fractures as well as increasing bone density.
Estrogen antagonists such as Raloxifine is useful to prevent and treat postmenopausal osteoporosis. It reduces only vertebral fracture incidence, not non vertebral fracture rate. It can reduce the risk of invasive breast cancer.
Duavee, a combination of estrogen and Bazedoxifene ( a selective estrogen receptor modulator like Raloxifene), is useful in postmenopausal women with an intact uterus. It increased bone density. There was no increase in endometrial, ovarian, or breast cancer.
Contact your doctor to discuss the options right for you.
Exercising lowers ones risk of heart disease, stroke, hypertension, depression, diabetes, and premature death risks.
The CDC recommends 5 hours of moderate or 2 1/2 hours of vigorous aerobic activity a week. This decreases the risk of heart disease and diabetes, as well as breast and colon cancer risks! Strength training should be performed at least two or more days a week including all major muscle groups. Videos by the cdc are provided in the link below:
Moderate intensity exercise raises your heart rate and makes you break a sweat, such as walking fast (3 mph) or riding a bike on level ground. Vigorous activity means you are breathing hard and your heart is beating rapidly, such as jogging or riding a bicycle fast or on hills.
Alzheimer’s disease presents with plaques and tangles in the brain, the plaques being clumps of a protein fragment, beta-amyloid, and the tangles being misshaped ‘tau’ proteins. These can be present in people and yet the individual does not show signs of dementia. Thirty percent of people over age 70 have elevated beta-amyloid but are cognitively normal.
Neurofibrillary tangles damage neurons and synapses, disrupting the architecture of the brain. It may take more than 10 years before amyloid deposition begins and symptoms of dementia start.
Damaged blood vessels in the form of small strokes add on to the problem of dementia. Some 20 percent of the elderly have had ‘silent’ strokes and do not have any knowledge of it. These small strokes further the destruction of the brain’s architecture, leading to vascular dementia.
Risk factors for vascular damage include smoking, high blood pressure, and diabetes.
Watch your blood pressure!
High blood pressure is a huge risk factor for later cognitive impairment. Why? Small strokes cut off blood flow to brain tissue due to uncontrolled blood pressure and diabetes, destroying brain architecture and function. On an MRI, bright white matter areas of hyper-intensities represent areas of damage, in which neurons cannot connect well with one another. Patients with uncontrolled blood pressure tend to have more hyper-intensities, representing compromised brain functioning.
Control your diabetes and sugar intake.
Type 2 diabetes in a strong risk factor for dementia. People with this problem are insulin resistant, mostly due to obesity. High levels of insulin in the blood correlate with more rapid cognitive decline, possibly due to less brain insulin as a result of decreased receptors for insulin in the blood-brain barrier. This results in less insulin entry into the brain. Insulin may help clear the toxic beta-amyloid from the brain.
Insulin receptors in the brain seem to localize in areas that are important for the formation of new memories. When the receptors decrease, memory seems to get impaired. Intranasal insulin may have a positive effect on cognitive abilities in patients with memory impairment, but studies are ongoing.
What to do: Lose weight and exercise more. Evidence from studies show that patients who had a diet low in saturated fats and carbohydrates with a low glycemic index had lower beta-amyloid levels in the brain CSF, which surrounds and bathes the brain) So eat less saturated fats and sugars!
Exercise! Executive functioning (the ability to plan and make decisions, correct errors, and respond to new information) is improved by exercise. Executive functioning is lost in cognitive impairment and Alzheimer’s disease. People who move and exercise, especially over their lifetime, have a lower risk of dementia. Sedentary people have less blood flow to the distant blood vessels in their brain and that makes them vulnerable. Exercise may expand brain volume and protect blood vessels in the brain. It helps with stress, insulin levels, and many other parameters in good ways.
Keep your brain active! People who are involved with mentally stimulating activities, like reading, going to classes, playing games) have a lower risk of dementia. This cognitive reserve may protect against the onset of symptoms.
Caffeine may protect your brain! There is evidence that up to 500 mg of caffeine a day was helpful in preservation of memory. Caffeine may reduce amyloid burden.
Blueberries and strawberries may reduce memory decline. Aim for at least one serving of blueberries a week and two of strawberries.
Increase the amount of fish in your diet! Dark-meat fish, such as swordfish, salmon, mackerel, sardines,) are excellent in certain measures of cognition. Omega-3 fats alone (which are present in high amounts in fish) have not been shown to help dementia.
Avoid sleep restriction! Get plenty of sleep! Sleep seems to expand the area between brain cells making it easier to clear beta-amyloid and toxins from the brain, sleep disruption impairs this capability.
DASH diet: A healthy diet that includes fruit, vegetables, fiber, low sugar content, and low saturated fat, helps with blood pressure and overall health. The American Heart Association recognizes this diet as being effective in a number of health scores.
Consider the Mediterranean Diet. More on this diet later.
Antioxidant vitamins, such as vitamin E/C/beta-carotene, B vitamins, phosphatidyl serine, ginkgo, huperzin-A, and other supplements have been found to be ineffective in preventing memory decline and dementia.
Chikungunya Virus was first found inTanzania in 1952. It is an RNA virus of the alphavirus genus and the Togaviridae family.
It is primarily found in Western Africa, similiar to where ebola is currently found this year. It is endemic in West Africa, but in 2103, it was found in the Caribbean, including St. Martin and Puerto Rico. Two mosquitos, Aedes aegypti and Aedes albopictus (African tiger mosquito) are the mosquito vectors for the disease. The Aedes albopictus mosquito can carry Yellow fever and Dengue fever as well as Chikungya.
The virus causes crippling arthralgias and fever. The illness can result in a rash. It lasts for several months, with the arthritis pain being prolonged and severe. Hence, the name Chikungunya, which in Tanzania means ”stooped over.’
The initial fever lasts 7-10 days and there may be swelling if the fingers and toes. In severe cases, a person can get an inflamed heart muscle, known as myocarditis and kidney failure.
Similar viruses include O’nyong-Onong (Central Africa), Baima-Ross River virus, Semili Virus, Mayaro virus (South America), and the Sindbis group virus. All of them cause severe arthritis.
Treatment – supportive care only, Fluids and pain management are cornerstone to treatment. There is no vaccine currently available. The best treatment is prevention – prevent mosquito bites by wearing long clothes and lots of bug spray! If you are traveling to the Carribbean, be certain to wear bug spray to prevent infection.
Irritable Bowel Syndrome (IBS) affects a lot of people with low abdominal discomfort and bloating, diarrhea, and/or constipation.The disease is chronic and relapsing. It is, in part, a result of malabsorbed carbohydrates that are fermented by gut bacteria to produce gas.
FODMAPS (fermentable oligo-saccharides/disaccharides/monosaccharides/and polyols) are believed to be a major cause of bloating and abdominal cramping symptoms in IBS patients. FODMAPS are carbohydrates found in our diets.Many people who perceive that they have Gluten intolerance (celiac disease) in fact have FODMAP intolerance.
FODMAPS include fructose, lactose, fructans (in wheat), galactans, and polyolo sweeteners.
FODMAPS are not absorbed in the small intestine and pass to the large intestine where they get broken down by bacteria in the gut, forming gas.
Galactose (Galactans) are a oligosaccharides that are found in beans
Fructans (Fructose) are present in wheat, rye, barley, onions, and many other vegetables.
A recent study in the journal, Gastroenterology, demonstrated that FODMAPS are the primary cause of abdominal cramping and IBS symptoms, not gluten intolerance. Changing ones diet to avoid FODMAPS helped many patients with IBS symptoms.
How does one change to a diet that is low in FODMAPS? There are apps that have dietary recommendations as well as the following site: www.med.monarch.edu/cecs/gastro/fodmap/
General information: Animal protein is low in FODMAPS
Fats and oils are low in FODMAPS, but remeber that butter, palm and coconut oil are high in saturated fat, so avoid too much of them
Cheeses have lactose, a FODMAP, but hard cheeses, such as brie and camembert or feta cheese are lower in lactose than cream cheese or ricotta cheeses.
Garlic and onions are high in fructans ( a FODMAP), so avoid too much of them. These are frequently added to oil-based sauces and condiments and increase the FODMAP levels.
Some flours have lower amounts of FODMAPS, such as spel or oats, whereas wheat and rye are high.
Fruits have variable amounts of FODMAPS, but drying may concentrate them even more.
A recent study demonstrated the use of Ondansetron, a 5- hydroxytryptamine-3 receptor antagonist, as being effective for irritable bowel symptoms if the person has diarrhea-type symptoms primarily. Ondansetron is an anti-emetic agent and was found to increase stool consistency, decrease urgency and bloating, and decrease the number of bowel movements in patient with diarrhea caused by IBS.
If you are concerned over the glycemic index of the foods that are low in FODMAPS, consult www.glycemicindex.com
So, if you suffer from irritable bowel syndrome, consider consulting a dietician and trying a low FODMAP diet, as opposed to a gluten-free, celiac-type diet. You might not have gluten-intolerance!!
There is more evidence that Green Tea improves your working memory. It improves the short term plasticity of the brain and reduces oxidative stress.
Green tea has a polyphenol compound (Epigallocatechin-3-gallate) that works against Alzheimer’s plaques and helps improve memory. We will see , over time, if the use of green tea has any positive effect in Alzheimer’s.
If you have been taking niacin to help your HDL, there is more and more evidence that it may be hurting you! Besides the red flushing it can cause if taken in large amounts that is needed to help increase HDL levels, it also can cause liver damage.
In the AIM-HIGH study in 2011, no benefits were found from Niacin supplementation, and in fact there were increased side effects, including bleeding risks.
In the HSP2-Thrive study, Niacin supplementation had no effect on major vascular events. There were bad side effects including a 32% increase in new-onset diabetes, and a 55% worsened glucose control in diabetics taking the supplement. In fact, mortality risk increased by 9%
I think it’s time to throw out the Niacin supplements and not worry so much about an isolated HDL problem. Low HDL is probably a symptom of another lipid and metabolic problem.
Onychomycosis – refers to nail infections by fungus, including yeasts and molds. Toenail onychomycosis is most commonly due to dermatophytes, a type of fungus (i.e. Trichophyton rubrum and T. mentagrophytes)
Risk factors for the problem include swimming, athlete’s foot, diabetes, genetics, and living with family members who have the disease.
Besides being unsightly, the nails can be difficult to cut and also can increase the risk of bacterial infection. Pain can be an issue as well, as nails can become sensitive to pressure.
Yeasts, like Candida Albicans, can also cause some cases of nail fungus, especially on the hands. People who immerse their hands in water a lot are at risk.
Some fungal infections can discolor the nail black – (dematiaceous fungi – pigment-producing molds)
As a result of these infections, the nails get thickened, discolored, with crazy shapes and debris under the nail.
Two recent approved topical therapies that appear to have excellent effectiveness have come to the market.
Kerydin (Tavaborole) topical solution can be applied to the nail daily for 48 weeks. No nail removal is required and the solution is not absorbed to any degree by the body. About a third had significant improvement without adverse reactions to any large degree. It is expensive (~400$)
Efinaconazole (Jublia) topical solution is another new arrival to treat the standard nail infections caused by T. Rubrum/T. Mentagrophytes. It is a topical triazole that blocks the fungus from producing it’s cell membrane. Applied at a drop a day to the affected nail for 52 weeks, 40% had mycological cure with minimal side effects, but at a cost of $450 a month.
Oral treatments that are mainstay include Terbinafine (Lamisil) daily for 12 weeks and itraconazole daily for three months. Their effectiveness is about 30%-40% with more side effects.
Alternative therapies with some possible efficacy include applying Vicks Vapor rub (a mixture of menthol, eucalyptus oil, camphor, and thymol) to the nails every day for up to a year. This has worked well for quite a few people.
Tea tree oil is another alternative topical therapy with unproven results.
Still, oral therapies are still the best options as of yet. Oral Lamisil (terbinafine) cures 40% to 60% of patients…compared to less than 9% for Penlac (ciclopirox) and 11% for clotrimazole 1% topical solutions (less effective topical agents also on the market).
Key preventative measures include wearing flip-flops around a shared shower or pool, wash and dry feet thoroughly every day , do not clip your nails too low to the base, and avoid nail polish.
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