Do you know the Institute of Health and Medical Research (INSERM) and School of Montpellier financed experts indicated that regulating ‘good’ and ‘bad’ levels of cholesterol can help prevent mood problems among seniors?

In a newly released issue of the journal Biological Psychiatry (http://www.biologicalpsychiatryjournal.com) written in July 2010, leading researcher Dr. Marie-Laure Ancelin of INSERM (Institut National de la Santé et de la Recherche Médicale http://www.inserm.fr) announced that gender specific regulation of cholesterol levels can help stop depressive disorder in the aging seniors.

French scientists observed a large number of men and women aged sixty five and older for 7 years.

They identified that depressive disorder in women was connected with lower levels of “good” high-density lipoprotein cholesterol (HDL-C), which puts them at higher risk for coronary disease, including stroke.

On the other hand, depression in men was related to low levels of “bad” low-density lipoprotein cholesterol (LDL-C). This association was strongest in men with a genetic vulnerability to depression related to a serotonin transporter gene.

Therefore, proper regulation of HDL-C and LDL-C levels can help reduce depressive disorder in the elderly, the researchers concluded.

The research appeared in the July 15 issue of the journal Biological Psychiatry (Reference:  http://www.biologicalpsychiatryjournal.com/article/S0006-3223(10)00393-8/abstract).

Major nutritional sources of cholesterol include dairy products, egg yolks, meat, pork, chicken, and shrimp. Plant products such as flax seeds and peanuts include cholesterol-like compounds known as phytosterols.

Total cholesterol means the sum of HDL (High-density lipoprotein), LDL (Low-density lipoprotein), and VLDL (Very-low-density lipoprotein). Usually, only the total, HDL, and triglycerides are tested.

Experts recommend to have cholesterol tested more often than five years if a person has total cholesterol of 200 mg/dL or more, or if a man over age 45 or a woman over age fifty has HDL (good) cholesterol less than 40 mg/dL, or exist other risk components for cardiovascular disease and stroke.

So…exactly what can you do to increase your HDL (good) and decrease your LDL (bad) levels?

1. Physical exercise can substantially increase HDL cholesterol while lowering LDL cholesterol.
2. Smoking cigarettes has been shown to lower HDL while raising LDL cholesterol.
3. Highly processed, trans fats at the same time raise LDL cholesterol and lower HDL cholesterol.
4. Monounsaturated fats such as those found in organic olive oil and avocados increase HDL and lower LDL.
5. Fatty fish like sardines and salmon contain omega-3 fats that raise HDL and lower LDL.
6. Whole, intact grains contain dietary fiber and niacin, both of which raise HDL and may lower LDL.

Now it’s all to you…

The author – Betty Doyle shares knowledge for the depression pills .org blog. It’s a nonprofit site specialized in her personal depression journey. The blog focuses on presenting energy and hope to anyone who is suffering from depressive disorder and supports those individuals to find the energy to fight against the effects of depression.
By doing this she would like to support alleviate some of the stigma mental illness depression can cause and help the public perception of mood difficulties.

Hemophilia is manifested by bleeding disorder. But it is more than a bleeding disorder and is complex disorder in terms of diagnosis and management.

Therefore the management of these patients requires a lot more than the treatment and prevention of acute bleeding.

Objectives of Care of Hemophilia are

• Prevention of bleeding
• Long-term management of joint and muscle damage and other sequelae of bleeding
• Management of complications from treatment including inhibitor development and infections transmitted through  blood products.

Comprehensive Care

Core Team

Hemophilia patients should ideally be managed in a comprehensive care centre staffed by the  following core team

• Hematologist
• Nurse coordinator
• Physiotherapist
• Social worker

The members of core team  should have expertise and experience in treating bleeding disorders.

Support Resources

1. Coagulation laboratory capable of

• Clotting factor assays
• Inhibitor detection

2. Appropriate clotting factor concentrates, either plasma derived or recombinant;

If clotting factor concentrates are not available, a blood bank with expertise in preparing fresh frozen plasma (FFP) and cryoprecipitate.

Specialists

Following specialists should be available as consultants, as needed -

• Orthopedic surgeon
• Physiatrist/rheumatologist
• Occupational therapist
• Dentist
• Geneticist
• Hepatologist
• Infectious disease specialist
• Immunologist.

If the center receives patients  with chronic musculoskeletal problems frequently,  an orthopedic surgeon should be a core team member.

The bleeding in hemophilia has been divided into serious and life threatening.

Serious Bleeding

• Joints (hemarthrosis)
• Muscle/soft tissue
• Mouth/gums/nose
• Hematuria

Life-threatening

• Central nervous system
• Gastrointestinal
• Neck/throat

Incidence Of Bleeding In Different Sites

• Hemarthrosis- 70%-80%
• Muscle/soft tissue-10%-20%
• Other major bleeds- 5%-10%
• Central nervous system (CNS) bleeds: < 5%

Incidence of Bleeding In Different Joints

• Knee: 45%
• Elbow: 30%
• Ankle: 15%
• Shoulder: 3%
• Wrist: 3%
• Hip: 2%
• Other: 2%

Hemophilia is an X-linked congenital bleeding disorder  caused by a deficiency of coagulation factor VIII (hemophilia A) or factor IX (hemophilia B).  Hemophilia A is more common (85% of the total) than hemophilia B.
When To Suspect Hemophilia?

• Easy bruising in early childhood
• Spontaneous bleeding particularly into the joints and soft tissue
• Excessive bleeding following trauma or surgery.

Diagnosis

• If there are symptoms suggestive of hemophila, a family history of bleeding is obtained but as many as 1/3 of all patients may not have a family history.
• A prolonged activated partial thromboplastin time (aPTT)
• Deficiency of factor VIII or factor IX.

Severity of manifestation is related to level of  clotting factors

Severe (<.01 IU/ml Factor Level)

Spontaneous bleeding, predominantly in joints and muscles

Moderate (IU/ml Factor Level)

Occasional spontaneous bleeding. Severe bleeding with trauma, surgery

Mild (0.05-0.40IU/ml Factor Level)

Severe bleeding with major trauma or surgery

A study published in Journal of American Academy of Dermatology, August issue, has found no convincing evidence that retinyl palmitate a form of vitamin A is carcinogenic.Retinyl palmitate is an ingredient in many sunscreens,.

The study also noted that human beings already have retinyl palmitate in their skin.

However, there is some controversy about conflict of interests of the authors involved.

A meta-analysis of 15 randomized trials and up to 11 921 participants shows that the use of calcium supplements without coadministered vitamin D is associated with an increased risk of myocardial infarction.

The study also warrants a reassessment of the role of calcium supplements in the management of osteoporosis.

The article has been recently published in BMJ in July edition, online.

Calcium supplements are commonly used in management of  osteoporosis and have been found to reduce the risk of fracture marginally.

In the past, studies have found conflicting evidence with some suggesting high calcium intake as protective against vascular disease, and others showing that calcium supplements speeding vascular calcification and increasing  mortality in patients with kidney failure and increase cardiovascular events in women.

Their current meta-analysis looked at randomized trials of calcium supplements that supplied at least 500 mg/day of elemental calcium vs placebo.

The studies indicate that or most older people, the risks of calcium supplements outweigh the benefits and changing to calcium-rich foods may be a better option.

Waist circumference is a risk factor for mortality in older adults and this risk is not affected by body mass index (BMI). This has been revealed by a large cohort study reported in the August issue of the Archives of Internal Medicine.

The study included 48,500 men and 56,343 women, aged at least 50 years.

Risk for mortality was more than doubled for very high levels of WC after adjustment for BMI and other risk factors.

Among men, relative risk (RR) of mortality was 2.02 circumference 120 cm or larger when compared with less than 90 cm. Among women a waist circumference of 110 cm or larger had a relative risk of 2.36compared with less than 75 cm.

Limitations of this study

• Reliance on self-report and measurement
• Observational design
• Confounding by factors associated with both larger waist circumference higher mortality
• Low generalizability because study participants were 50 years or older, and nearly all were white.

Addisonian crisis is also called adrenal crisis. It  is a constellation of symptoms that indicate severe adrenal insufficiency.

It may occur  in either previously undiagnosed Addison’s disease due to  a disease process suddenly affecting adrenal function. It may  also due to an intercurrent problem like  infection or  trauma in the setting of known Addison’s disease.

The  situation may also develop in those on long-term oral glucocorticoids who have suddenly stopped taking their medication.

Addisonian crisis is also a concern in the setting of myxedema coma. Thyroxine given in that setting without glucocorticoids may precipitate a crisis.

Untreated, an Addisonian crisis can be fatal.

It is a medical emergency, usually requiring hospitalization.

Following symptoms would suggest Addisonian crisis

• Sudden penetrating pain in the legs, lower back or abdomen
• Severe vomiting and diarrhea, resulting in dehydration
• Low blood pressure
• Syncope (loss of consciousness)
• Hypoglycemia
• Confusion, psychosis, slurred speech
• Severe lethargy
• Hyperkalemia
• Hypercalcaemia
• Convulsions
• Fever

Prevention

It is recommended that a person persn with adrenal insufficiency should always carry identification stating their condition in case of an emergency.

The card should alert emergency personnel about the need to inject 100 mg of cortisol if its bearer is found severely injured or unable to answer questions. The card should also include the doctor’s name and telephone number and the name and telephone number of the nearest relative to be notified.

When traveling, a needle, syringe, and an injectable form of cortisol should be carried for emergencies. A person with Addison’s disease also should know how to increase medication during periods of stress or mild upper respiratory infections. Immediate medical attention is needed when severe infections, vomiting, or diarrhea occur, as these conditions can precipitate an Addisonian crisis.

A patient who is vomiting may require injections of hydrocortisone, since oral hydrocortisone supplements cannot be adequately metabolised.

Addison’s disease is also called as chronic adrenal insufficiency, hypocortisolism or hypocorticism. It is a rare disorder where the adrenal glands are not able to produce glucocorticoids and less often mineralocorticoids in sufficient quantity. The condition was first described by Dr Thomas Addison, the British physician who first described the condition.

Causes of Addison disease

Adrenal dysgenesis

This means adrenal glands which produce glucocorticoid are absent.

Impaired Formation of Hormone

To form cortisol, the adrenal gland requires cholesterol, which is then converted biochemically into steroid hormones. Interruptions in the delivery of cholesterol include Smith-Lemli-Opitz syndrome and abetalipoproteinemia.

Congenital adrenal hyperplasia may also cause impaired synthesis

Medications

Medicationslike ketoconazole  interfere with  enzymes that synthesize the hormone, while others like rifampicin, phenytoin increase hormonal breakdown.

Adrenal destruction

• Autoimmune adrenalitis
• Adrenoleukodystrophy (ALD)
• Metastasis (
• Hemorrhage (Waterhouse-Friderichsen syndrome or antiphospholipid syndrome)
• Infection
• Amyloidosis.

What Are Symptoms and signs Of Addison Disease

The disease symptoms are insidious in onset and per se the symptoms are quite non specific. Following symptoms can be noted with this condtion.

• Fatigue
• Lightheadedness upon standing or while upright
• Muscle weakness
• Weight loss
• Anxiety
• Nausea, vomiting, diarrhea
• Headache, sweating
• Changes in mood and personality
• Vague joint and muscle pains.
• Marked cravings for salt or salty foods [Due to loss of salt in urine]
• Darkening of the skin [Due to hypepigmentation]
• Orthostatic hypotension [Low blood pressure that falls further when standing]

Routine Lab Investigations may show

• Hypercalcemia or low calcium level
• Hypoglycemia or low blood sugar level
• Hyponatraemia  or low blood sodium levels
• Hyperkalemia  or raised blood potassium levels
• Eosinophilia and lymphocytosis
• Metabolic acidosis (increased blood acidity), also due to loss of the hormone aldosterone

Special Tests

ACTH stimulation test

Low adrenal hormone levels even after appropriate stimulation with synthetic pituitary ACTH hormone tetracosactide

Renin and adrenocorticotropic hormone levels,  ultrasound, computed tomography or magnetic resonance imaging are other tests used in making a diagnosis.

Treatment

Treatmentaims at replacing the missing cortisol. Hydrocortisone  or prednisone tablets  are commonly used and are continued for life. In addition, many patients require fludrocortisone as replacement for the missing aldosterone.

When the umbilicus is stretched transversely as in ascites, it is called smil9ng umbilicus.

An umbilicus that exudes fluid e.g. ascetic fluid in massive ascites or feculent material in enteric fistulae, or clear fluid in patent urachus is called crying umbilicus.