Antibiotic Prophylaxis

Dental patients should not take prophylactic antibiotics simply because they have pacemakers or implanted defibrillators, according to a new statement from the American Heart Association (AHA).
Although 2007 guidelines already exclude these patients from the list of those who need prophylactic antibiotics to prevent endocarditis, the AHA wanted to emphasize this point because many physicians are ignoring these guidelines, and because an increasing rate of infections related to the devices has raised concerns, said coauthor Peter Lockhart, DDS.
A summary of the dental aspects of the new guidelines is published in the February issue of the Journal of the American Dental Association. The full statement, which offers guidance on managing these infections, was previously published in Circulation.
Dr. Lockhart, chair of the Department of Oral Medicine at Carolinas Medical Center in Charlotte, North Carolina, estimates that dentists are unnecessarily prescribing antibiotics to millions of patients with implanted devices and many other conditions. "It's quite a big problem," he said.
There is no evidence that antibiotics can prevent infections of implanted devices caused by dental procedures, he said, but the antibiotics may cause allergic reactions and create resistant strains of bacteria. "There are deaths due to use of antibiotics," said Dr. Lockhart.
According to the statement, prescription antibiotics would cost more than $80 million in the United States each year if given for all the cardiovascular conditions that might lead to infection.
Implanted heart devices are becoming more common, according to the statement. From 1997 to 2004, the rate of implantation increased 19% for permanent pacemakers and 60% for implantable cardioverter-defibrillators; despite improved methods for device implantation, the prevalence of infection has increased faster than the rate of implantation.
The notion of prescribing antibiotics to prevent infections from dental procedures dates back to a 1955 AHA statement, said Dr. Lockhart, but that recommendation was based on speculation at a time when antibiotics were seen as miracle drugs that could do no harm. Recommendations for prophylaxis for various conditions such as orthopedic implants proliferated after that, all without evidence to support them.
Since then, several studies, including some by Dr. Lockhart, have failed to show an advantage to the prophylaxis.
Bacteria do enter the bloodstream from dental procedures, and oral bacteria can cause endocarditis, explained Dr. Lockhart, but most endocarditits is not caused by these strains of bacteria. He has not been able to find an actual case in which a dental procedure led to a bloodborne infection, and daily tooth brushing and food chewing release far more bacteria into the bloodstream than procedures that take place in a dental office.
Michael A. Siegel, DDS, chair of oral medicine at Nova Southeastern University in Fort Lauderdale-Davie, Florida, said that the new guidelines increase the legal risks for dentists who prescribe antibiotics as prophylaxis in most heart patients. "These dentists who give it to everyone just in case are going to be hung out to dry," he said.
If physicians recommend antibiotics contrary to the guidelines, dentists should insist that the physicians write the prescriptions, he said.
So who should get antibiotics to prevent endocarditis during dental procedures? The 2007 guidelines list the following conditions:
prosthetic cardiac valve or prosthetic material used for cardiac valve repair,
previous infective endocarditis,
specific types of congenital heart disease, and
cardiac transplantation in patients who develop cardiac valvulopathy.
Patients with implanted devices probably do not run the risk of infection once their incisions are healed, said Dr. Siegel. "The long and the short of it is that once it's put in, give them 30 days to heal, and then there's no problem," said Dr. Siegel.

Vitamin D

Is the Institute of Medicine (IOM), which bills itself as the “advisor to the nation on health,” trying to make you sick?
I wouldn’t blame you if you thought so… The U.S. and Canadian governments asked the IOM to look at its inadequate recommendation for vitamin D at 400 IU per day. So the IOM has just come out with its new recommendations. It says that “all North Americans are receiving enough vitamin D” from their diets and exposure to the sun. It also says there is “inconsistent and conflicting results” on whether or not vitamin D protects you from cancer and other diseases.
Let’s set the record straight. There’s overwhelming evidence that increased vitamin D levels lower the risk of diabetes, cancer and heart disease.
A four-year study conducted by researchers at Creighton University found that vitamin D and calcium supplementation can help prevent 17 types of cancer and lower your overall cancer risk by 77 percent.1
Another extensive study conducted on more than 27,000 patients at the Intermountain Medical Center in Salt Lake City found that those with the lowest vitamin D levels were 43 percent more likely to develop coronary artery disease than those with normal levels.2
In addition, vitamin D is known to help lower the risk of Type-1 and Type-2 diabetes, and helps prevent auto-immune disorders like multiple sclerosis and rheumatoid arthritis.
Best of all, it does all this naturally and with no side effects. But vitamin D doesn’t do all of this at the 400-600 IU level that they just recommended. It only does this at much higher levels. I recommend from 2,000-5,000 IUs.
As for the IOM’s other claims, that people already get enough vitamin D, what about the study from earlier this year, published in the Archives of Internal Medicine, which found that 75 percent of Americans don’t get enough vitamin D?3
It’s also irresponsible to recommend eating fortified foods to bolster your vitamin D intake. Real dietary sources of vitamin D come from animal fats. Fortified milk gives you the synthetic, chemical form of vitamin D2, not the vitamin D3 you need to boost your energy level and maintain a strong immune system.4
The same is true of other fortified foods like breakfast cereals, yogurt, margarine and soy beverages. These often contain additives such as inulin, maltodextrose, and polydextrose that don’t provide the same health benefits as foods with natural fibers.5
You may already know the benefits of vitamin D and calcium in building strong bones and avoiding skeletal diseases such as rickets, osteomalacia and osteoporosis.
The IOM report represents a missed opportunity to spread the good news about vitamin D to more Americans, and that’s a shame.
Here’s what I recommend you do to increase your daily intake of vitamin D and improve your overall health:
• Catch some rays. Get out in the sunlight for 10 to15 minutes a couple of times per week. This is the best way for your body to obtain vitamin D. In fact, just 20 minutes of sunshine can provide you with as much as 10,000 IUs.
• Eat foods rich in vitamin D. These include small fish like herring, sardines and anchovies. Organic milk from grass-fed cows is also an excellent source, as are egg yolks, cooked salmon and mackerel, tuna fish and orange juice.
• Try some cod liver oil. Next to sunlight, this is the best source of vitamin D, providing 1,360 IUs in just a single teaspoon.
• Take a good-quality vitamin D supplement. I recommend 2,000 IUs via supplement daily, especially during winter months or if you’re located in a colder, damp climate with less sunlight.
1 Lappe, J.M., et al, “Vitamin D and calcium supplementation reduces cancer risk,” Am. J. Clin. Nutr. June 2007; 85(6):1586-91
2 “Vitamin D Shows Heart Benefits in Study,” NYTimes.com, 11/16/2009
3 Ginde, A. “Demographic Differences and Trends of Vitamin D Insufficiency in the US Population, 1988-2004,”Archives of Internal Medicine, March 23, 2009; vol 169: 626-63
4 “Vitamin D2 vs. vitamin D3,” The Heart Scan Blog (http://heartscanblog.blogsport.com), April 26, 2007
5 “The Pros and Cons of Fiber-Fortified Foods,” Healthy Living

Stroke Mortality

Reperfusion in acute ischemic stroke is often not happening quickly enough, a new study confirms. Even in "Get With the Guidelines" stroke hospitals, investigators report that less than a third of patients treated with intravenous tissue plasminogen activator (tPA) had door-to-needle times within the hour recommended by current guidelines.
"It's alarming," Gregg Fonarow, MD, from the University of California at Los Angeles told reporters here yesterday at the International Stroke Conference. "It's time for a targeted national initiative to treat patients more quickly."
During his presentation, Dr. Fonarow pointed out, "When we looked at door-to-needle time modeled as a continuous variable and after adjustment for patient and practice characteristics, we see that for every 15-minute reduction in door-to-needle time, it was associated with a 5% lower odds of in-hospital mortality, and this was highly statistically significant."
Symptomatic intracranial hemorrhage was also less frequent in patients treated within the hour vs those treated later (4.7% vs 5.6%; P < .0017).
The findings were also published online February 10 in Circulation. Investigators studied more than 25,500 patients with ischemic stroke treated within 3 hours of symptom onset. Patients were from the more than 1000 hospitals participating in the guidelines stroke program. The goal of the plan is to help hospitals improve outcomes in stroke. The program's slogan is "time lost is brain lost."
Time lost is brain lost.
Dr. Fonarow reports that door-to-needle time was within the recommended hour in only 27% of patients. The fact that even these hospitals are having trouble meeting the recommendations is calling attention to the problem.
Asked by Medscape Medical News to comment, Robert Adams, MD, director of the Medical University of South Carolina Stroke Center in Charleston, said the difficulty is real. "There can be lots of time losers in the process and we have to start looking at these in a systematic way."
Mark Alberts, MD, from the Northwestern Stroke Center in Chicago, Illinois, agreed the finding is important. However, he cautioned, it may oversimplify a complex issue. "In some cases, a delay may be justified," he pointed out. "The alternative would be no treatment, so a more detailed analysis of appropriate delays versus unjustified or process delays would be important."
The recommendations to date have been consistent. A National Institute of Neurological Disorders and Stroke symposium recommends a door-to-needle target time of 60 minutes. Current American Heart Association and American Stroke Association guidelines also recommend that evaluation and treatment be within the hour of the patient's arrival in the emergency department, and the Brain Attack Coalition's target for primary stroke centers is a door-to-needle time within 60 minutes in 80% or more of patients.
Despite growing evidence, the investigators showed the rate of successful treatment within this time frame only modestly improved over the past 6.5 years — from 19% in 2003 to 29% in 2009. Patients who were younger, male, and white and had no prior stroke were most likely to receive treatment within the hour window.
"It is a concern that older patients, women, and black patients were less likely to receive timely tPA," Dr. Fonarow acknowledged. "It's also notable that the symptom onset-to-arrival times were shorter in patients with door-to-needle times of greater than 60 minutes, suggesting that hospitals were taking a more relaxed approach to the administration of tPA in earlier-arriving patients."
The investigators found hospitals that had greater annual volumes of patients with stroke treated with tPA were more likely to administer therapy quickly. "This suggests that greater hospital team experience translates into improved performance," Dr. Fonarow said.
He says he hopes national programs such as the American Stroke Association Target Initiative will help.
Dr. Adams told I'd like national programs to educate everyone in emergency medical services from dispatch right through. "Any delays right there can ripple through the whole system," he pointed out.
Dr. Adams would also like to see more attention paid to stroke in hospital triage. "We can lose a lot of time with a misdiagnosis like seizure."
Dr. Adams added, "I’d like the American Stroke Association to tell everyone who is 50 or older and anyone else who will listen what the symptoms of stroke are, that there are places that exist for specialized care, and there's a treatment that in many cases is better, faster."
The Get With the Guidelines Stroke program is provided by the American Heart Association and American Stroke Association. It is currently supported in part by a charitable contribution from Bristol-Myers Squibb and Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. The program has been funded in the past by Boehringer-Ingelheim and Merck. Dr. Gregg Fonarow receives research support from the National Institutes of Health. He has received funding from Pfizer, Merck, Schering Plough, Bristol-Myers Squibb, and Sanofi-Aventis. Dr. Fonarow is an employee of the University of California, which holds a patent on retriever devices for stroke.

Η Βιταμίνη C προστατεύει το DNA

συγγραφέας Δαλαμάγκα Μαρία

Το 1976 ένας γιατρός σε ένα μικρό ερευνητικό Ινστιτούτο στο Menlo Park της Καλιφόρνια , μια κωμόπολη έξω από το Σαν Φρανσίσκο έκανε κάτι , που κανείς δεν είχε κάνει ποτέ πριν.
Πήρε 100 ασθενείς , με επίσημη διάγνωση καρκίνου τελικού σταδίου και πρόσθεσε στη διατροφή τους 10 γραμμάρια μιας συστατικής ουσίας κάθε μέρα.
Και έζησαν .
Όχι μόνο για λίγες μέρες , ούτε για λίγους μήνες…
Ο μέσος όρος ζωής τους ήταν περίπου ένα χρόνο. Ο γιατρός σύγκρινε αυτούς τους 100 ασθενείς με άλλους 1000 επίσης τελικού σταδίου καρκίνου . Ο μέσος όρος ζωής τους ήταν μόνο 38 ημέρες.
Το όνομα του γιατρού ήταν Linus Pauling και η συστατική ουσία ήταν η βιταμίνη C .
Ο Pauling και ο συνάδελφος του Dr. Ewan Cameron δημοσίευσαν τα αποτελέσματα τους στην Εθνική Ακαδημία των Επιστημών.
Η βιταμίνη C είναι ένα αντιοξειδωτικό. Αφοπλίζει μόρια τα οποία ονομάζονται ελεύθερες ρίζες , οι οποίες επιτίθενται στα υγιή κύτταρα. Η βιταμίνη C απενεργοποιεί τις ελεύθερες ρίζες, πριν αυτές προκαλέσουν οξείδωση των κυττάρων , η οποία ενεργοποιεί την ανάπτυξη του καρκίνου.
Οι επιστήμονες το γνωρίζουν αυτό από το 1980 , αλλά σήμερα γνωρίζουμε περισσότερα για την οξειδωτική βλάβη.
Αυτό που ξέρουμε σήμερα είναι ότι τα τελομερή , που είναι τα προστατευτικά καλύμματα στις άκρες του DNA είναι πολύ ευαίσθητα στη οξείδωση. Η βράχυνση των τελομερών , επιταχύνει τη γήρανση των κυττάρων και τα ευαισθητοποιεί στο καρκίνο.
Σε μια Ιαπωνική μελέτη εξέτασαν τη δράση της βιταμίνης C στα τελομερή .Διαπιστώθηκε ότι η αύξηση των επιπέδων της βιταμίνης C , επιβράδυνε τη μείωση των τελομερών έως και 62%.
Η βιταμίνη C επιβραδύνει τη διαδικασία της γήρανσης. Προστατεύει το DNA.
Πλούσια σε βιταμίνη C είναι : το θυμάρι και το μαϊντανό , φυλλώδη λαχανικά , πιπεριές , μαύρες σταφίδες , παπάγια , πορτοκάλια , φράουλες και κεράσια .
1 Cameron, E. and Pauling, L. “Supplemental ascorbate in the supportive treatment of cancer.” Proc. Natl. Acad. Sci. USA. 1976. 73:3685-3689.
2 E. Cameron and A. Campbella. “An ‘unpublishable’ clinical trial of supplemental ascorbate in incurable cancer.” Medical Hypotheses, November 1991; Volume 36, Issue 3, Pages 185-189
3 Sebastian J. Padayatty, Hugh D. Riordan, Stephen M. Hewitt, Arie Katz, L. John Hoffer and Mark Levin. “Intravenously administered vitamin C as cancer therapy: three cases.” CMAJ,March 28, 2006; 174 (7).
4 Maramag C, Menon M, Balaji KC, Reddy PG, Laxmanan S. “Effect of vitamin C on prostate cancer cells in vitro: effect on cell number, viability, and DNA synthesis.” Prostate. 1997 Aug 1;32(3):188-95.
5 Furumoto K. et al. “Age-dependent telomere shortening is slowed down by enrichment of intracellular vitamin C via suppression of oxidative stress.” Life Science 1998, vol. 63, no. 11 pp. 935-48
6 Yokoo S, Furumoto K, Hiyama E, Miwa N. “Slow-down of age-dependent telomere shortening is executed … by anti-oxidative effects of pro-vitamin C.” J Cell Biochem. 2004 Oct 15;93(3):588-97.
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Mind

When you’re young, your mind is sharp, you’re quick-thinking, you’ve got clarity and focus … you feel like you’re “on top” of every situation. When you get a little older, your mental functions decline … your thinking and reaction time slow. It’s probably natural. But is it unavoidable?
As it turns out, you don’t have to become one of those slow-lane drivers just because you’re “getting older.” In fact, despite what you may have heard, cognitive decline is not inevitable.
You can improve your memory, mental focus and clarity starting today, and I’m going to show you how.
The good news is, it has little to do with genetics, and even less to do with drugs.
You can boost your mental performance and have a sharper, more agile mind by doing two simple things:
Exercising your brain and feeding your brain.
Let me explain …
When you were very small, you couldn’t do a whole lot of things. You couldn’t add numbers together, tie your shoes or even walk. But you had the ability to learn those things.

That’s because your brain has millions of cells called neurons. And they all have tiny branches coming off of them just waiting to connect to other neurons.
When you’re born, most of them are not connected to each other. But when you learn things, the messages travel from one neuron to another, creating connective pathways called synapses. The more of these connections, or synapses, you can develop between brain cells, the better your brain will perform.
And, if you can keep the connections you have, and constantly create new pathways, you’ll activate you mind and boost your brain performance no matter your age.
So, how do you it?
One way is to keep your mind challenged – keep it guessing – and create your own mental exercise program.
The Seattle Longitudinal Study of Adult Intelligence has followed more than 5,000 people since 1956, reporting on their cognitive abilities every seven years. The findings are remarkable.
Two-thirds of the people following any kind of mental exercise program showed significant improvement in brain performance. And 40 percent returned to pre-decline cognitive performance levels. What’s more, they maintained these benefits indefinitely.
Improving your brain’s abilities can be as simple as playing games. It’s true. Games aren’t just fun… many are just the kind of mental exercises that keep your brain young.
Take crossword puzzles, which are a favorite of mine. Even the simple ones get you thinking about people, places and things you may not ever think of, or even try to remember.
Other good mental exercises include word and math games.
The Internet and your local library are filled with articles, books and exercises that can help you use numbers, math, logic and puzzles so you can constantly create new synapses and keep your brain performance humming along.
One fun book you can buy at your local bookstore is called “Arithmetricks: 50 Easy Ways to Add, Subtract, Multiply, and Divide Without a Calculator” by Edward Julius. Another is “21 Games for The Mind that Won’t Shut Up!” by AT Lynne. There’s also “Mind Hacks: Tips & Tricks for Using Your Brain” by Tom Stafford and Matt Webb.
A couple of good places to start on the Web are:
SharpBrains
Brainist.com
NeuroMod online memory improvement test
MindTools
brain rules by John Medina
Mempowered
The Original Memory Gym
Boost Your Brain to a New Level
Your brain wants to be fed all the time. It has a huge appetite for energy so it can keep going even while you sleep. And if you don’t feed it the right way, you’re not going to keep creating new pathways in your brain so it can work faster and give you better focus.
You probably already know all about “brain food” like eggs, fish and blueberries. But we’re talking about improving your sharpness and clarity, not just maintaining it. And to use nutrition to take your brain’s performance to another level means you should do two things:
Boost your neurotransmitters – These are the chemicals your brain cells use to send and receive signals between neurons.
Fight free radicals with antioxidants – Free radicals are a product of oxidation. Oxidation is what I like to call “slow burn” of living. All the work your cells do and all the energy you produce throws off unstable molecules called free radicals that attack your healthy cells and drain them of energy and strength. In your brain, they cause many of the symptoms associated with aging, and even tissue damage.
Your body’s way of neutralizing free radicals is with antioxidants. The more antioxidants you give your brain, the better it will perform.
Fortunately, there are plenty of nutrients that can give your neurotransmitters a boost, and help you fight free-radical damage in your brain. And you can use them right now to feed your mind so it can stay focused, clear and perform better.
1. Acetyl L-carnitine (ALC) – ALC provides a range of brain protection, improving mood and memory. It protects the brain from damage due to poor circulation. ALC helps injured nerve cells to repair and function normally again. ALC also increases the release of the memory neurotransmitter, acetylcholine.
Researchers have found that ALC is so powerful that it protects brain cells from damage even when blood flow is temporarily blocked.2 ALC keeps the cell energy going even when there is little or no blood flow for short amounts of time.
I recommend 250 mg a day.
2. Choline – This is the major building block for acetylcholine, which lets your nerve cells fire along all those new pathways and through the synapses you’ve created in your brain.
You need it for all the basics like thought, memory and sleep. It even controls how you move. Your muscles receive commands from your brain via acetylcholine. That means your sense of balance and stability is controlled by this key transmitter.
You need at least 425 mg a day as a woman, 550 mg if you’re a man. The best sources from food are eggs, chicken and turkey liver and pork.
If you would like to supplement, there are several forms available. For a brain performance boost, you would have to take a high dose of the bitartrate or chloride forms, which can give you diarrhea. And the phosphatidyl form doesn’t give you much active choline.
That’s why my favorite form is choline citrate. You get a lot of active choline, and the only side effect is is a clean rush of energy for your brain.
3. DMAE – This is the natural, brain-stimulating nutrient found in some fish. Studies show it increases levels of acetylcholine. Degenerative brain conditions like Alzheimer’s and Parkinson’s are connected to the loss of brain cells that produce acetylcholine. DMAE replaces this chemical naturally and can ease symptoms.
DMAE can also temper mood and ease behavioral and learning problems. In one study, 50 hyperactive kids showed improvement in just 10 weeks.3 In another study, children with learning disabilities did better in concentration and skill tests with this nutrient.4 And there were no side effects like jumpiness, or an increase in heart rate and blood pressure like with drugs.
You need at least 35 mg per day. The best sources are wild-caught fish like salmon and small, oily fish like pilchards.
4. Vitamin B12 – This vitamin is crucial to brain function and the overall health of your nervous system because it’s the engine behind your body’s ability to make blood. That’s because B12 forms a protective layer around the nerve cells in your brain. Without that protective layer your brain can’t function properly.
In fact, a study, published in the prestigious journal Neurology, used M.R.I. scans to measure brain volume, and blood tests to record vitamin B12 levels. They divided the subjects into three groups, based on their level of the vitamin, and followed them for five years with annual scans and physical and mental examinations.
The group with the lowest levels of vitamin B12 lost twice as much brain volume as those with the highest levels.5 You should try to get at least 500 mcg per day.
5. Phosphatidylserine (PS) – This is vital to accurate brain functioning. It is highly concentrated in brain cells. Its job is to house neurotransmitters and regulate their release. As we age, we need more help from PS.
Neurology published a well-done study, which proves that PS supplementation can restore cognitive function. Researchers gave the subjects either a regimen of PS or a placebo for 12 weeks. Volunteers were between the ages of 50 and 75 with memory impairment due to age.
The PS subjects had an improvement in learning and recalling names. They were better at face recognition, remembering telephone numbers, remembering misplaced objects, and concentrating. Subjects began to improve in as little as 3 weeks.6
I recommend taking 100-200 mg of PS a day.
6. SAM-e – This nutrient is what’s called a “co-enzyme,” which means that it enables other chemical compounds to perform a number of essential functions. SAM-e is one of the main building blocks your brain needs to produce neurotransmitters.
SAM-e raises levels of another neurotransmitter called dopamine. Dopamine enhances learning, memory, motivation, and even helps with attention and sleep. It’s also the key to experiencing pleasure and maintaining an overall sense of well being and a good mood.
For over 20 years, SAM-e has been widely used in Europe to treat depression. And in 2002, The American Journal of Clinical Nutrition published a study that confirmed its efficacy. The study gave one group of people SAM-e and the other the antidepressant imipramine for 6 weeks. Both groups reported the same amount of improvement in mood. Better yet, the SAM-e group also reported significantly fewer side effects.7
You can get SAM-e at your local health-food store. I recommend you take 200 mg a day to start. If after two weeks you’re not seeing considerable improvement, increase to 400 mg.
7. Coenzyme Q10 (CoQ10). You may know that CoQ10 is your heart’s best friend because it gives the heart so much energy. But did you know that CoQ10 protects your brain at the same time? That’s because CoQ10 blocks the loss of dopamine, and is a powerful antioxidant for your brain.
Brain levels of CoQ10 start to decline in your 20s and are lowest in stroke victims and those with brain and nerve cell diseases, such as Parkinson’s and Huntington’s. So it makes sense that getting more CoQ10 could help increase your brain performance.
The best food source is red meat – but make sure that it’s grass-fed. Grass-fed beef contains more CoQ10 than any other meat on the planet. But it is still hard to get enough CoQ10 from your diet alone.
I recommend taking 50 mg of ubiquinol CoQ10 daily. The ubiquinol form is 8 times more powerful and stays in your bloodstream longer than conventional CoQ10.
8. Creatine – You may have heard that weightlifters use creatine because it builds muscle. But what we know now is that using creatine along with CoQ10 can give you a real brain boost.
An animal study published in the Journal of Neurochemistry shows that taking CoQ10 and creatine blocks the loss of dopamine in the brain (a hallmark of Parkinson’s disease), protects cell membranes (they leak with age), and reduces oxidative damage.8
Your body – primarily the liver – makes creatine naturally. You can also get it from foods like grass-fed beef, fish and apples. For every 2 lbs. of beef you eat, you will gain 5 grams of creatine.
The amount you should take is related to body weight and gender.
Source: The Colgan Institute, San Diego.

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1 Schaie, K. “The Seattle Longitudinal Studies of adult intelligence,” In M. Powell Lawton & Timothy A. Salthouse (eds) essential papers on the psychology of aging, Warner 1998; 263-271
2 Calvani, M. et al, “Attenuation by acetyl-l-carnitine of neurological damage and biochemical derangement following brain ischemia and reperfusion,” Int. J. Tissue React. 1992; 21(1): 1-6
3 Coleman, N., Dexheimer, P., Dintascio, A., et al, “Deanol in the treatment of hyperkinetic children,” Psychosomatics 1976; 17:68-72
4 Geller, S. J., “Comparison of a tranquilizer and a psychic energizer,” JAMA 1960; 174:89-92
5 Vogiatzoglou, et al, “Vitamin B12 status and rate of brain volume loss in community-dwelling elderly,” Neurology 2008; 71:826-832
6 Crook, T. et al, “Effects of phosphatidylserine in age-associated memory impairment,” Neurology May 1991; 41(5): 644-649
7 Delle, C, et al, “Efficacy and tolerability of oral and intrramuscular S-adenosyl-l-methionine …” Am. J. Clin. Nutr. Nov. 2002; 76(5): 1172S-1176S
8 Yang, L., et al, “Combination therapy with coenzyme Q10 and creatine produces additive neuroprotective effects in models of Parkinson’s and Huntington’s diseases,” J. Neurochem. June 2009;109(5):1427-39

Exercise

Whether you’re 9 or 90, abundant evidence shows exercise can enhance your health and well-being. But for many people, sedentary pastimes, such as watching TV, surfing the Internet, or playing computer and video games, have replaced more active pursuits.
Millions of Americans simply aren’t moving enough to meet the minimum threshold for good health — that is, burning at least 700 to 1,000 calories a week through physical pursuits. The benefits of exercise may sound too good to be true, but decades of solid science confirm that exercise improves health and can extend your life. Adding as little as half an hour of moderately intense physical activity to your day can help you avoid a host of serious ailments, including heart disease, diabetes, depression, and several types of cancer, particularly breast and colon cancers. Regular exercise can also help you sleep better, reduce stress, control your weight, brighten your mood, sharpen your mental functioning, and improve your sex life.
A well-rounded exercise program has four components: aerobic activity, strength training, flexibility training, and balance exercises. Each benefits your body in a different way.
Aerobic exercise is the centerpiece of any fitness program. Nearly all of the research regarding the disease-fighting benefits of exercise revolves around cardiovascular activity, which includes walking, jogging, swimming, and cycling. Experts recommend working out at moderate intensity when you perform aerobic exercise — brisk walking that quickens your breathing is one example. This level of activity is safe for almost everyone and provides the desired health benefits. Additional health benefits may flow from increased intensity.
Strength or resistance training, such as elastic-band workouts and the use of weight machines or free weights, is important for building muscle and protecting bone.
Bones lose calcium and weaken with age, but strength training can help slow or sometimes even reverse this trend. Not only can strength training make you look and feel better, but it can also result in better performance of everyday activities, such as climbing stairs and carrying bundles. Stronger muscles also mean better mobility and balance, and thus a lower risk of falling and injuring yourself. In addition, more lean body mass aids in weight control because each pound of muscle burns more calories than its equivalent in fat.
Stretching or flexibility training is the third prong of a balanced exercise program. Muscles tend to shorten and weaken with age. Shorter, stiffer muscle fibers make you vulnerable to injuries, back pain, and stress. But regularly performing exercises that isolate and stretch the elastic fibers surrounding your muscles and tendons can counteract this process. And stretching improves your posture and balance.
Balance tends to erode over time, and regularly performing balance exercises is one of the best ways to protect against falls that lead to temporary or permanent disability. Balance exercises take only a few minutes and often fit easily into the warm-up portion of a workout. Many strength-training exercises also serve as balance exercises. Or balance-enhancing movements may simply be woven into other forms of exercise, such as tai chi, yoga, and Pilates.
In a nutshell, exercise can:
reduce your chances of getting heart disease. For those who already have heart disease, exercise reduces the chances of dying from it.
lower your risk of developing hypertension and diabetes.
reduce your risk for colon cancer and some other forms of cancer.
improve your mood and mental functioning.
keep your bones strong and joints healthy.
help you maintain a healthy weight.
help you maintain your independence well into your later years.

Childhood obesity

Early introduction of solid foods is linked to a risk for early childhood obesity, according to the results of a prospective prebirth cohort study reported online February 7 in Pediatrics.
"Parental feeding practices during early infancy, such as the timing of solid food introduction, may be 1 key modifiable determinant of childhood obesity," write Susanna Y. Huh, MD, MPH, from the Division of Gastroenterology and Nutrition, Children's Hospital Boston in Boston, Massachusetts, and colleagues. "Data suggest that the introduction of solid foods earlier than 4 months of age is associated with increased body fat or weight in childhood or with greater weight gain during infancy, which itself predicts later adiposity. Other studies have found no association between the timing of solid food introduction and body fat or an association between delayed introduction of solid foods after 6 months and greater adiposity."

The goal of the study was to evaluate the association between timing of introduction of solid foods during infancy and obesity at age 3 years, defined as a body mass index for age and sex at the 95th percentile or above, using a cohort of 847 children enrolled in Project Viva. Timing of introduction of solid foods was categorized as younger than 4 months, ages 4 to 5 months, and 6 months or older. Logistic regression models were applied separately for infants who were breast-fed for at least 4 months ("breast-fed"; n = 568; 67%) and for infants who were never breast-fed or in whom breast-feeding was stopped before age 4 months ("formula-fed"; n = 279; 32%). These models were adjusted for child and maternal factors, including change in weight-for-age z score from 0 to 4 months as a marker of early infant growth.
Obesity was present in 75 children (9%) at age 3 years. The timing of solid food introduction was not associated with odds of obesity in breast-fed infants, (odds ratio, 1.1; 95% confidence interval [CI], 0.3 - 4.4). However, introducing formula-fed infants to solid foods before age 4 months was associated with a 6-fold increase in odds of obesity at age 3 years, which was not explained by rapid early growth (odds ratio after adjustment, 6.3; 95% CI, 2.3 - 6.9).
"Among infants who were never breastfed or those who stopped breastfeeding before the age of 4 months, the introduction of solids before the age of 4 months was associated with a sixfold increase in the odds of obesity at the age of 3 years," the study authors write.
Limitations of this study include possible residual confounding; some loss of the cohort to follow-up; limited generalizability to more socioeconomically disadvantaged populations; and small numbers in some cells, leading to possible chance results.
"Among infants breastfed for 4 months or longer, the timing of the introduction of solid foods was not associated with the odds of obesity," the study authors conclude. "Increased adherence to guidelines regarding the timing of solid food introduction may reduce the risk of obesity in childhood."

Cerebral Venous Thrombosis

The American Heart Association/American Stroke Association has unveiled its first scientific statement on cerebral venous thrombosis. The recommendations will help clinicians identify this uncommon cause of stroke that mostly affects young people.
"The diagnosis and management of cerebral venous thrombosis requires a high level of suspicion," told committee chair Gustavo Saposnik, MD, from the University of Toronto in Ontario, Canada. "The guidelines are intended to improve awareness and recognition."
The committee includes a multidisciplinary group of experts from the United States, Canada, Mexico, Portugal, and Argentina. The guidelines were published online February 3 in the journal Stroke. They have been endorsed by
• The American Academy of Neurology;
• The American Association of Neurological Surgeons;
• The Congress of Neurological Surgeons;
• The Ibero-American Stroke Society; and
• The Society of NeuroInterventional Surgery.
Cerebral venous thrombosis is caused by clots in the dural venous sinuses and accounts for 0.5% to 1% of all strokes. It disproportionally affects women who are pregnant or taking oral contraceptives and people 45 years and younger.
The incidence of cerebral venous thrombosis during pregnancy and post partum ranges from 1 in 2500 deliveries to 1 in 10,000 deliveries in Western countries, according to the guidelines. The greatest risk periods are during the third trimester and in the first 4 postpartum weeks. Up to 73% of cerebral venous thrombosis in women occurs during the time immediately after childbirth. However, the risk for complications during future pregnancies is low, report the guideline authors.
They recommend patients with suspected cerebral venous thrombosis undergo blood studies to see whether they have a prothrombotic factor, such as protein C or S, antithrombin deficiency, antiphospholipid syndrome, prothrombin G20210A mutation, and factor V Leiden.
"A predisposing condition to form clots or a direct cause is identified in about two-thirds of patients with cerebral venous thrombosis,” Dr. Saposnik said.
An estimated 30% to 40% of patients with cerebral venous thrombosis may develop an intracranial hemorrhage. "It’s important to distinguish a hemorrhage caused by rupture of a brain artery from those associated with cerebral venous thrombosis," he said. "The mechanisms — and treatment — of the bleeding are quite different."
The guidelines suggest that patients having a brain hemorrhage with an unclear cause undergo imaging of their cerebral veins.
Headache Most Common Symptom
According to the International Study on Cerebral Venous and Dural Sinuses Thrombosis, headache is the most common symptom and was recorded in about 90% of patients (Stroke. 2005;36:1720–1725).
"The usual appropriate acute treatment includes prevention of complications and anticoagulation therapy," Dr. Saposnik said. The guidelines emphasize that magnetic resonance imaging and magnetic resonance venography are the most sensitive and therefore recommended tests.
In the emergency department, computed tomography may be useful when magnetic resonance imaging is not readily available, Dr. Saposnik added.
For patients who develop a stroke, he emphasized the importance of care in an appropriate setting, such as a stroke unit, for the prevention and management of complications.
"Testing for prothrombotic conditions in the acute phase has limited value," he noted. "Thorough blood work should be completed later. And the duration of anticoagulation therapy should ultimately depend on the underlying etiology."
Dr. Saposnik said , there is limited evidence regarding endovascular treatment or thrombolysis in patients with cerebral venous thrombosis. "Based on that, the current guidelines recommend this approach only in patients with progressive neurological deterioration despite the best medical treatment."
"As with any guideline," Dr. Saposnik said, "the current one provides a general approach analyzing the available evidence. It doesn't address individual situations."

Headaches

Headaches are familiar to nearly everyone: in any given year, almost 90% of men and 95% of women have at least one. In the vast majority of cases, however, the pain isn’t an omen of some terrible disease.
About 95% of headaches are caused by such common conditions as stress, fatigue, lack of sleep, hunger, changes in estrogen level, weather changes, or caffeine withdrawal. The three most common types of headache are tension, sinus, and migraine (see table below).
Mixed headaches
As understanding of the different types of headaches has evolved, researchers have altered some of their beliefs about tension and migraine headaches and the relationship between the two. This is largely because of the realization that some headaches don’t neatly fit either category. “Mixed” headaches have characteristics of both types, and because they’re hard to classify, treatment can be challenging.
For instance, the more intense a tension headache gets, the more it resembles the sharp, throbbing pain of a migraine headache. Likewise, when a migraine headache becomes more frequent, its pain begins to feel like that of a tension headache. Thus, experts now believe that headaches fall along a continuum ordered by their characteristics: the occasional tension headache is at one end and the migraine headache is at the other. In between are chronic tension headache and chronic migraine, which are often lumped together as chronic daily headache.
This doesn’t mean that all headaches share the same mechanisms. Experts still generally believe that tension headaches are stimulated by muscle tightness, while migraine headaches are caused by the dilation and inflammation of blood vessels. However, if you have migraine headaches frequently, you may develop muscle tightness, which can trigger more headaches, creating a vicious cycle.
Headache caused by a medication or illness
Some headaches are actually symptoms of another health problem. Many non-life-threatening medical conditions, such as a head cold, the flu, or a sinus infection, can cause headache. Some less common but serious causes include bleeding, infection, or a tumor. A headache can also be the only warning signal of high blood pressure (hypertension). In addition, certain medications — such as nitroglycerin, prescribed for a heart condition, and estrogen, prescribed for menopausal symptoms — are notorious causes of headache.
Because the following symptoms could indicate a significant medical problem, seek medical care promptly if you experience:
• a sudden headache that feels like a blow to the head (with or without a stiff neck)
• headache with fever
• convulsions
• persistent headache following a blow to the head
• confusion or loss of consciousness
• headache along with pain in the eye or ear
• relentless headache when you were previously headache-free
• headache that interferes with routine activities.
Always take children who have recurring headaches to the doctor, especially when the pain occurs at night or is present when the child wakes in the morning.
Common types of headaches
Type What it feels like Who gets it How often and for how long
Tension Mild to moderate steady pain throughout the head, but commonly felt across the forehead or in the back of the head. Generally not accompanied by other symptoms. Can affect children, but is most common in adults. Frequency varies. Generally hours in length.
Sinus Mild to moderate steady pain that typically occurs in the face, at the bridge of the nose, or in the cheeks. May be accompanied by nasal congestion and postnasal drip. Affects people of all ages. People with allergies seem most vulnerable. Frequency varies. Generally hours in length. Often seasonal.
Migraine Moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. The pain may be localized to the temple, eye, or back of the head, often on one side only. In migraine with aura, visual disturbance precedes the pain. Typically occurs from childhood to middle age. In children, migraine is slightly more common among males, but after puberty, it’s much more common in females. Attacks last a day or longer. They tend to occur less often

Νευροπαθητικός πόνος

συγγραφέας Δαλαμάγκα Μαρία

Ο νευροπαθητικός πόνος προκύπτει σαν αποτέλεσμα βλάβης ή νόσου στο σωματοαισθητικό σύστημα , επηρεάζει το 1.5 % του πληθυσμού και η διάγνωση και θεραπεία του είναι αρκετά δύσκολη.
Ο νευροπαθητικός πόνος μπορεί να ταξινομηθεί σύμφωνα με :
• Την υποκείμενη νόσο ( διαβητική νευροπάθεια , σκλήρυνση κατά πλάκας )
• Τη θέση της βλάβης ( περιφερική νευρική βλάβη , νωτιαίος μυελός )
• Και τον υποκείμενο μηχανισμό
Ο νευροπαθητικός πόνος μπορεί να σχετίζεται με :
Διαβητική νευροπάθεια
Μετεγχειρητικό χρόνιο πόνο
Κάκωση νωτιαίου μυελού
Νευραλγία τριδύμου
Σκλήρυνση κατά πλάκας
Πολυνευροπάθεια
Ακρωτηριασμό
Μεθερπητική νευραλγία
Μέλος φάντασμα
Αλκοολισμό
Χημειοθεραπεία του καρκίνου
Αγγειακό εγκεφαλικό επεισόδιο
Ισχιαλγία
Σημαντικός και επίμονος χρόνιος πόνος απαιτεί περαιτέρω έλεγχο. Κοινωνικοί και ψυχολογικοί παράγοντες θα πρέπει να αξιολογηθούν από τα πρώιμα στάδια. Η διάγνωση του νευροπαθητικού πόνου βασίζεται σε ακριβή ιστορικό και εξέταση . Τα διαγνωστικά εργαλεία βαθμολόγησης όπως το DN4 ή το LANSS μπορεί να φανούν χρήσιμα.
Χαρακτηριστικά του νευροπαθητικού πόνου :
• Αυτόματη έναρξη, ανεξάρτητη ερεθίσματος
• Συνεχής αίσθηση καύσου
• Διαπεραστικός πόνος
• Δυσαισθησία (παθολογική και δυσάρεστη αίσθηση)
• Παραισθησία
• Υπεραλγησία (αυξημένη απάντηση σε φυσιολογικά επώδυνα ερεθίσματα)
• Αλλοδυνία (πόνος από μη επώδυνα ερεθίσματα )
Κλινική αξιολόγηση του πόνου:
• Ιστορικό και έναρξη των συμπτωμάτων
• Εντόπιση , ποιότητα , ένταση και διάρκεια του πόνου
• Αξιολόγηση της επίδρασης του πόνου στις συνήθεις δραστηριότητες καθώς και τυχόν διαταραχές ύπνου
• Επίδραση του πόνου στη ψυχολογική σφαίρα του ασθενή
• Απάντηση ή μη σε προηγούμενες θεραπείες
Αρχικές επιλογές θεραπείας για το νευροπαθητικό πόνο:
Μη φαρμακολογικές θεραπείες:
• Διατήρηση της δραστηριότητας και της εργασιακής απασχόλησης
• Κινητοποίηση , άσκηση , TENS , Βελονισμός
Φαρμακολογικές θεραπείες
• Οπιοειδή , Αντικαταθλιπτικά , αντιεπιλεπτικά
Διάφορες θεραπείες
• Τοπικοί παράγοντες όπως Lidocaine 5%
• Οπιοειδή όταν οι άλλες θεραπείες αποτύχουν
Αναλγητικά όπως:
• Παρακεταμόλη , ήπια οπιοειδή (τραμαδόλη , κωδεϊνη) και Μη Στεροειδή Αντιφλεγμονώδη φάρμακα.
Επεμβατικές τεχνικές – Neuromodulation - Νευροδιαμόρφωση : Μια σειρά από θεραπείες που στόχο έχουν να αλλάξουν την αντίληψη του πόνου μετά από διέγερση ή αναστολή των νευρικών οδών.
Διέγερση νωτιαίου μυελού: σε ανθεκτικό νευροπαθητικό πόνο γίνεται εισαγωγή ενός ή δύο επισκληρίδιων ηλεκτροδίων , τα οποία στη συνέχεια συνδέονται σε ηλεκτρική πηγή , όπως για παράδειγμα αυτή του βηματοδότη.
Παλμική ραδιοσυχνότητα :Μια μεμονωμένη βελόνα εισάγεται στη περιοχή της νευρικής βλάβης. Η παραγόμενη θερμότητα δημιουργεί μια προσωρινή βλάβη του νευρικού ιστού.


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